Journal Article Epublish
PubMed: 40747240 DOI: 10.1093/ckj/sfaf216
Long-term impact of PM 2.5 exposure on diabetic kidney disease patients considering time-dependent medication adjustment.
Clin Kidney J 18(7):sfaf216
Authors: Soie Kwon, Hyunman Sim, Ara Ko, Whanhee Lee, Ho Kim, Seung Hyun Han, Hyeon Seok Hwang, Dong Ki Kim, Chun Soo Lim, Yon Su Kim, Jung Pyo Lee, Woojoo Lee
Affiliations
- Department of Internal Medicine, Chung-Ang University Seoul Hospital, Seoul, Republic of Korea. Department of Internal Medicine, Chung-Ang University, Seoul, Republic of Korea.
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
- School of Biomedical Convergence Engineering, Pusan National University, Yangsan, Republic of Korea.
- Department of Internal Medicine, Division of Nephrology, Inje University, Ilsan-Paik Hospital, Goyang, Republic of Korea.
- Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea.
- Department of Internal Medicine, Seoul National Hospital, Seoul, Republic of Korea. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Abstract
Background
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.
Methods
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 2.5), 10-μm particulate matter (PM 10), nitrogen dioxide (NO 2), 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.
Results
Patients (n = 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 2.5 exposure (Lag1_PM 2.5) was significantly associated with higher ESKD progression risk {adjusted hazard ratio [aHR] 1.28 [95% confidence interval (CI) 1.085-1.508]}, whereas PM 2.5 itself showed no significance [aHR 1.05 (95% CI 0.872-1.260)]. Both exposures increased the composite outcome risk (PM 2.5 aHR 1.16 Lag1_PM 2.5 aHR 1.15). PM 10 and Lag1_PM 10 showed no significant associations with either ESKD progression or composite outcomes. NO 2 exposure increased ESKD progression risk but was not associated with composite outcomes.
Conclusion
Even after comprehensive medication use adjustment, higher PM 2.5 exposure was independently associated with an increased risk of ESKD progression and composite outcome in DKD patients.
MeSH
Kidney Diseases, Environmental Pollutants, Diabetic Nephropathies, Kidney, Air, Environmental Pollution, Air Pollutants, Particulate Matter