Service de Santé Publique, Epidémiologie, Economie de la Santé et Prévention, CHU de Lille, Lille, France.
UMR1167 RID-AGE, Institut Pasteur de Lille, INSERM, Université de Lille, CHU Lille, Lille, France.
Front Public Health. 2024 Jul 30;12:1390999. doi: 10.3389/fpubh.2024.1390999. eCollection 2024.
Little is known about the effect of combined exposure to different air pollutants on mortality in dialysis patients. This study aimed to investigate the association of multiple exposures to air pollutants with all-cause and cause-specific death in dialysis patients.
This registry-based nationwide cohort study included 90,373 adult kidney failure patients initiating maintenance dialysis between 2012 and 2020 identified from the French REIN registry. Estimated mean annual municipality levels of PM, PM, and NO between 2009 and 2020 were combined in different composite air pollution scores to estimate each participant's exposure at the residential place one to 3 years before dialysis initiation. Adjusted cause-specific Cox proportional hazard models were used to estimate hazard ratios (HRs) per interquartile range (IQR) greater air pollution score. Effect measure modification was assessed for age, sex, dialysis care model, and baseline comorbidities.
Higher levels of the main air pollution score were associated with a greater rate of all-cause deaths (HR, 1.082 [95% confidence interval (CI), 1.057-1.104] per IQR increase), regardless of the exposure lag. This association was also confirmed in cause-specific analyses, most markedly for infectious mortality (HR, 1.686 [95% CI, 1.470-1.933]). Sensitivity analyses with alternative composite air pollution scores showed consistent findings. Subgroup analyses revealed a significantly stronger association among women and fewer comorbid patients.
Long-term multiple air pollutant exposure is associated with all-cause and cause-specific mortality among patients receiving maintenance dialysis, suggesting that air pollution may be a significant contributor to the increasing trend of CKD-attributable mortality worldwide.
对于不同空气污染物联合暴露对透析患者死亡率的影响知之甚少。本研究旨在探讨多种空气污染物暴露与透析患者全因和死因特异性死亡的关系。
本基于登记的全国性队列研究纳入了 2012 年至 2020 年间从法国 REIN 登记处确定的 90373 名开始维持性透析的成年肾衰竭患者。在 2009 年至 2020 年期间，将 PM2.5、PM10 和 NO 的估计年均市县级水平组合到不同的综合空气污染评分中，以估计每个参与者在开始透析前 1 至 3 年的居住地暴露情况。使用调整后的死因特异性 Cox 比例风险模型估计每个四分位距（IQR）空气污染评分增加的危害比（HR）。评估了年龄、性别、透析护理模式和基线合并症的效应修正。
较高水平的主要空气污染评分与全因死亡率的增加率相关（HR，每 IQR 增加 1.082[95%置信区间（CI），1.057-1.104]），无论暴露滞后如何。这种关联在死因特异性分析中也得到了证实，尤其是在传染性死亡率方面（HR，1.686[95%CI，1.470-1.933]）。使用替代综合空气污染评分的敏感性分析显示出一致的结果。亚组分析显示，女性和合并症较少的患者之间的相关性更强。
长期暴露于多种空气污染物与接受维持性透析的患者的全因和死因特异性死亡率相关，这表明空气污染可能是全球慢性肾脏病相关死亡率上升的一个重要因素。
