PM constituents associated with mortality and kidney failure in childhood-onset lupus nephritis: A 19-year cohort study.

BACKGROUND

Childhood-onset lupus nephritis (cLN) is a severe form of systemic lupus erythematosus (SLE) with high morbidity and mortality. The impact of long-term exposure to fine particulate matter (PM) on adverse outcomes in cLN remains unclear.

METHODS

We combined a 19-years cLN cohort from seven provinces in China with high-resolution PM dataset from 2001 to 2020, investigating the association between long-term exposure to PM and its constituents (sulfate, nitrate, organic matter, black carbon, ammonium) with the risk of death and kidney failure, analyzed with multiple variables Cox models. We also evaluated the association between 3-year average PM exposure before study entry and baseline SLE disease activity index (SLEDAI) scores using linear regression models.

RESULTS

Each 10 μg/m increase in annual average PM exposure was associated with an increased risk of death and kidney failure (HR = 1.58, 95 % CI: 1.24-2.02). Black carbon showed the strongest association (HR = 2.14, 95 % CI: 1.47-3.12). Higher 3-year average exposures to PM and its constituents were significantly associated with higher baseline SLEDAI scores.

CONCLUSIONS

These findings highlight the significant role of environmental pollutants in cLN progression and emphasize the need for strategies to mitigate exposure to harmful PM2.5 constituents, particularly in vulnerable pediatric populations.