Particulate Matter Air Pollution Associated with Chronic Kidney Disease

by | Jun 29, 2020 | 2020, Environmental Health, Kidney Health, Pollution

Written by Joyce Smith, BS. The prevalence of chronic kidney disease (CKD) is associated with ambient fine particulate matter (PM2.5) levels above the World health Organization (WHO) guidelines; thus, achieving those air quality standards may help reduce CKD prevalence worldwide.

air pollutionWith WHO now officially recognizing air pollution as a risk factor for non-communicable diseases, there is an increasing awareness of an air pollution crisis and the rapid increase in non-communicable diseases 1.  A 2019 study by Bowe and colleagues demonstrated how high levels of PM2.5 pollution affected a single cohort of 4,522,160 United States veterans. Nine causes of death were associated with PM2.5 exposure; however, the deaths were disproportionally of black individuals from socioeconomically disadvantaged communities and the study could not be generalized to other countries 1.  Almost every death (99.0%) was attributed to non accidental causes and was associated with PM2.5 levels below the standards set by the US Environmental Protection Agency.

In a second 2019 study the authors attempted to characterize an association between exposure to PM2.5 levels and CKD both nationally and worldwide. They used the Global Burden of Disease (GBD) study data and methodologies to estimate the 2016 burden of CKD attributable to PM2.5 in 194 countries and territories. At a global level, PM2.5 was associated with 3,284,358 incident cases of CKD each year. CKD was most prevalent in the disadvantaged countries (low income and lower middle income countries) such as North Africa, several Middle East countries, Southeast Asia, India and China 2.

In their final 2020 study 3, the Bowie team, by integrating evidence of worldwide MP2.5 pollution and evidence of CKD prevalence from their previous work, hoped to address the degree to which the global presence of CKD can be attributed to levels of  PM2.5 air pollution that exceed WHO’s quality standard for PM2.5 of 10 μg/m3. Searching the PubMed and Cochrane library for cohort, case-control and cross-sectional studies on  associations between CKD and  PM2.5 4,5 as well as studies on CKD and second-hand smoke, household air pollution and active smoking 6, they obtained data to build an integrated non-linear exposure-response model.  Researchers then calculated the prevalence of CKD attributable to PM2.5 levels that exceeded the WHO limit of 10 ug/m3.. They found that 72.8% of CKD cases attributable to PM2.5 and 74.2% of disability adjusted life years (DALYs) due to CKD attributable to PM2.5 exceeded the 10 ug/m3 air quality standard.

This study suggests that the major source of global air pollution today are the PM2.5 levels that exceed WHO air quality guidelines for annual mean PM2.5 concentrations. The study also emphasizes that PM2.5 levels are too high in many areas of the world and reinforces the need to reduce these levels to meet WHOs air quality standards in order to reduce the prevalence of CKD worldwide 1,2.

A study limitation is the fact that most of the studies of PM2.5 and CKD were from western countries. Large, high-quality longitudinal studies of PM2.5 and CKD from low income areas with very high PM2.5 concentrations were lacking, yet the prevalence and health consequences of PM2.5 pollution was borne disproportionately by Asia, Africa and countries of the Southern hemisphere. PM2.5 is associated with diabetes and hypertension, both of which are causal drivers of CKD; however, the extent to which these two confounders impact the association between PM2.5 and CKD is not yet known. Furthermore, researchers analyzed only one outdoor pollutant (PM2.5) but no indoor pollutants and analyzed PM2.5 levels only at a global level.

Source: Bowe, Benjamin, Elena Artimovich, Yan Xie, Yan Yan, Miao Cai, and Ziyad Al-Aly. “The global and national burden of chronic kidney disease attributable to ambient fine particulate matter air pollution: a modelling study.” BMJ Global Health 5, no. 3 (2020): e002063.

© Open access article distributed in accordance with the Creative Commons Attribution Non Commercial license (CC BY-NC 4.0). http:// creativecommons. org/ licenses/ by- nc/ 4. 0/

Click here to read the full text study.

Posted June 29, 2020.

Joyce Smith, BS, is a degreed laboratory technologist. She received her bachelor of arts with a major in Chemistry and a minor in Biology from  the University of Saskatchewan and her internship through the University of Saskatchewan College of Medicine and the Royal University Hospital in Saskatoon, Saskatchewan. She currently resides in Bloomingdale, IL.

References:

  1. Bowe B, Xie Y, Yan Y, Al-Aly Z. Burden of Cause-Specific Mortality Associated With PM2.5 Air Pollution in the United States. JAMA Netw Open. 2019;2(11):e1915834.
  2. Bowe B, Xie Y, Li T, Yan Y, Xian H, Al-Aly Z. Estimates of the 2016 global burden of kidney disease attributable to ambient fine particulate matter air pollution. BMJ Open. 2019;9(5):e022450.
  3. Bowe B, Artimovich E, Xie Y, Yan Y, Cai M, Al-Aly Z. The global and national burden of chronic kidney disease attributable to ambient fine particulate matter air pollution: a modelling study. BMJ global health. 2020;5(3):e002063.
  4. He D, Wu S, Zhao H, et al. Association between particulate matter 2.5 and diabetes mellitus: a meta-analysis of cohort studies. J Diabetes Investig 2017;8:687–96.
  5. Yang B-Y, Qian Z, Howard SW, et al. Global association between ambient air pollution and blood pressure: a systematic review and meta-analysis. Environ Pollut 2018;235:576–88.
  6. Burnett RT, Pope CA, 3rd, Ezzati M, et al. An integrated risk function for estimating the global burden of disease attributable to ambient fine particulate matter exposure. Environ Health Perspect. 2014;122(4):397-403.