Kwon Soie, Sim Hyunman, Ko Ara, Lee Whanhee, Kim Ho, Han Seung Hyun, Hwang Hyeon Seok, Kim Dong Ki, Lim Chun Soo, Kim Yon Su, Lee Jung Pyo, Lee Woojoo
Department of Internal Medicine, Chung-Ang University Seoul Hospital, Seoul, Republic of Korea.
Department of Internal Medicine, Chung-Ang University, Seoul, Republic of Korea.
Clin Kidney J. 2025 Jul 9;18(7):sfaf216. doi: 10.1093/ckj/sfaf216. eCollection 2025 Jul.
Ambient air pollutants adversely affect renal function and increase type 2 diabetes incidence. However, the impact of air pollution on diabetic kidney disease (DKD) patients remains underexplored, with limited consideration of medication-related effects. We assessed the influence of air pollutants on DKD patients while meticulously adjusting for medication use.
We retrospectively enrolled DKD patients. Primary and secondary outcomes included end-stage kidney disease (ESKD) and a composite (ESKD and mortality). Nationwide forecasted ultra-high-resolution air pollutant data [2.5-μm particulate matter (PM), 10-μm particulate matter (PM), nitrogen dioxide (NO), carbon monoxide (CO)] were obtained from the Ai-Machine learning Statistics Collaborative Research Ensemble for Air pollution, Temperature, and all types of Environmental exposures (AiMS-CREATE). Monthly updated ambient air pollutants and medication prescription information were considered time-varying variables in multivariable time-dependent Cox analyses.
Patients ( = 9482) were followed for a median of 9 (ESKD) and 11 (composite outcome) years; 20.6% progressed to ESKD and 46.7% experienced composite outcomes. The DKD-stage patient distribution was 12.5% (stage 1-2), 35.8% (stage 3) and 51.6% (stage 4-5). Initial renin-angiotensin system blocker use increased from 37.4% to 58.5% during year 1 then gradually decreased. During follow-up, all four air pollutant concentrations significantly decreased, with CO exhibiting the most pronounced decline. The 1-month lagged PM exposure (Lag1_PM) was significantly associated with higher ESKD progression risk {adjusted hazard ratio [aHR] 1.28 [95% confidence interval (CI) 1.085-1.508]}, whereas PM itself showed no significance [aHR 1.05 (95% CI 0.872-1.260)]. Both exposures increased the composite outcome risk (PM aHR 1.16 Lag1_PM aHR 1.15). PM and Lag1_PM showed no significant associations with either ESKD progression or composite outcomes. NO exposure increased ESKD progression risk but was not associated with composite outcomes.
Even after comprehensive medication use adjustment, higher PM exposure was independently associated with an increased risk of ESKD progression and composite outcome in DKD patients.
环境空气污染物会对肾功能产生不利影响，并增加2型糖尿病的发病率。然而，空气污染对糖尿病肾病（DKD）患者的影响仍未得到充分研究，对药物相关影响的考虑也有限。我们在仔细调整药物使用情况的同时，评估了空气污染物对DKD患者的影响。
我们回顾性纳入了DKD患者。主要和次要结局包括终末期肾病（ESKD）以及一个综合结局（ESKD和死亡率）。从空气污染、温度及所有类型环境暴露的人工智能机器学习统计协作研究集成（AiMS-CREATE）中获取了全国范围预测的超高分辨率空气污染物数据[2.5微米颗粒物（PM）、10微米颗粒物（PM）、二氧化氮（NO）、一氧化碳（CO）]。在多变量时间依赖性Cox分析中，每月更新的环境空气污染物和药物处方信息被视为随时间变化的变量。
对9482例患者进行了中位数为9年（ESKD）和11年（综合结局）的随访；20.6%的患者进展为ESKD，46.7%的患者出现综合结局。DKD分期患者分布为12.5%（1-2期）、35.8%（3期）和51.6%（4-5期）。初始使用肾素-血管紧张素系统阻滞剂的比例在第1年从37.4%增加到58.5%，然后逐渐下降。在随访期间，所有四种空气污染物浓度均显著下降，其中CO下降最为明显。滞后1个月的PM暴露（Lag1_PM）与ESKD进展风险较高显著相关{调整后风险比[aHR]为1.28[95%置信区间（CI）为1.085-1.508]}，而PM本身无显著意义[aHR为1.05（95%CI为0.872-1.260）]。两种暴露均增加了综合结局风险（PM的aHR为1.16，Lag1_PM的aHR为1.15）。PM和Lag1_PM与ESKD进展或综合结局均无显著关联。NO暴露增加了ESKD进展风险，但与综合结局无关。
即使在全面调整药物使用后，较高的PM暴露仍与DKD患者ESKD进展风险和综合结局增加独立相关。
