Long-term exposure to fine particulate matter promotes kidney failure in CKD patients

For patients with chronic kidney disease (CKD), exposure to fine particulate matter (PM_2.5) in the long term may lead to progression to kidney failure with replacement therapy (KFRT), as reported in a recent study.

Researchers followed 6,628 adult CKD patients aged 20–90 years from the Advanced CKD Program in Taiwan. They evaluated the incidences of KFRT (defined as initiation of maintenance haemodialysis, peritoneal dialysis, or kidney transplantation) and all-cause mortality in relation to 1-year PM_2.5 exposure prior to enrolment into the study.

During the follow-up, 941 KFRT events and 1,653 deaths occurred. Multivariable proportional hazard regression analysis revealed an association between the risk of progression to KFRT and PM_2.5 exposure, such that the risk increased by nearly 20 percent per 7.8 μg/m³ greater PM_2.5 (hazard ratio [HR], 1.19, 95 percent confidence interval [CI], 1.08–1.31).

Notably, the association followed a dose-response pattern. The adjusted HR estimates for progression to KFRT associated with low, medium, and high PM_2.5 levels were 1.16 (95 percent CI, 0.90–1.51), 1.19 (95 percent CI, 0.94–1.52), and 1.42 (95 percent CI, 1.12–1.80), respectively.

There was no significant association between PM_2.5 exposure and all-cause mortality (adjusted HR, 1.01, 95 percent CI, 0.95–1.08).

The study was limited by misclassification of PM_2.5 exposure assessment and the potential for residual confounding.