School of Nursing, College of Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan.
Department of Environmental and Occupational Medicine, National Taiwan University (NTU) College of medicine and NTU Hospital, Taipei, Taiwan; National Institute of Environmental Health Science, National Health Research Institutes, Miaoli County, Taiwan; Institute of Environmental and Occupational Health Sciences, NTU College of Public Health, Taipei, Taiwan.
Ecotoxicol Environ Saf. 2024 Oct 1;284:116940. doi: 10.1016/j.ecoenv.2024.116940. Epub 2024 Sep 3.
Individuals diagnosed with type 2 diabetes (T2D) frequently exhibit chronic kidney disease (CKD) which may be caused by environmental hazards such as exposure to air pollutants. However, limited research has explored the effects of prolonged exposure to air pollutants on CKD development in this population. This study examines the relationship between long-term exposure to air pollutants and CKD incidence in a longitudinal cohort of individuals with type 2 diabetes in Taiwan METHODS: Between 2003 and 2005, we recruited 1316 T2D patients (693 females [52.66 %]; mean age 56.16 ± 8.97 years). Patients were followed until December 31, 2012, with at least two clinical visits. Baseline demographics, medical history, and biomarker levels were collected. The development of CKD was determined by eGFR level < 60 mL/min/1.73 m. Monthly averages of nitrogen dioxide (NO) and fine particulate matter [PM ≤ 2.5 μm in aerodynamic diameter (PM)] were acquired from 72 ambient air monitoring stations. The kriging method was employed to estimate the exposure levels to PM NO temperature, and relative humidity in the participants' residential areas. Cox regression with time-dependent covariates regression was applied to assess the impact of long-term exposure to air pollutants and CKD risk.
Of 992 patients with normal renal function at baseline, 411 (41.43 %) experienced CKD occurrence over a median follow-up period of 5.45 years. The incidence of CKD was 93.96 cases per 1000 person-years. In multivariable adjusted models, patients exposed to PM levels above the third quartile of (>33.44 μg/m) and NO levels above the fourth quartile (>22.55 ppb) were found to have an increased risk of CKD occurrence compared to lower exposure levels.
This longitudinal study highlights the increased risk of CKD in individuals with type 2 diabetes due to prolonged exposure to NO and PM, emphasizing the need for tailored air quality management strategies for this high-risk population.
患有 2 型糖尿病（T2D）的个体经常患有慢性肾脏病（CKD），这可能是由于暴露于环境危害物如空气污染物等引起的。然而，有限的研究探索了长期暴露于空气污染物对该人群 CKD 发展的影响。本研究在台湾的一个 2 型糖尿病纵向队列中检查了长期暴露于空气污染物与 CKD 发病率之间的关系。
在 2003 年至 2005 年期间，我们招募了 1316 名 T2D 患者（693 名女性[52.66%]；平均年龄 56.16±8.97 岁）。患者随访至 2012 年 12 月 31 日，至少有两次临床就诊。收集基线人口统计学、病史和生物标志物水平。通过 eGFR 水平<60 mL/min/1.73 m 确定 CKD 的发展。从 72 个环境空气监测站获得每月平均二氧化氮（NO）和细颗粒物[空气动力学直径≤2.5μm 的 PM（PM）]。使用克里金法估计参与者居住地区的 PM、NO、温度和相对湿度的暴露水平。应用具有时间依赖性协变量回归的 Cox 回归评估长期暴露于空气污染物与 CKD 风险的关系。
在基线肾功能正常的 992 名患者中，411 名（41.43%）在中位随访 5.45 年后发生 CKD。CKD 的发病率为每 1000 人年 93.96 例。在多变量调整模型中，与较低暴露水平相比，暴露于 PM 水平高于第三四分位数（>33.44μg/m）和 NO 水平高于第四四分位数（>22.55 ppb）的患者发生 CKD 的风险增加。
这项纵向研究强调了由于长期暴露于 NO 和 PM，2 型糖尿病患者发生 CKD 的风险增加，这强调了为这一高危人群制定有针对性的空气质量管理策略的必要性。
