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      Associations between Long-Term Particulate Matter Exposure and Adult Renal Function in the Taipei Metropolis

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          Abstract

          Background:

          Studies on the effect of air pollutions on kidney diseases are still limited.

          Objective:

          We aimed to investigate the associations between particulate matter (PM) exposures and renal function among adults.

          Methods:

          We recruited 21,656 adults as participants from 2007 to 2009. The Taiwanese Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation was used to derive the estimated glomerular filtration rate (eGFR). Subjects with an eGFR lower than 60 mL/min/1.73 m 2 were defined as having chronic kidney disease (CKD). Land use regression (LUR) models were used to estimate individual exposures to PM with an aerodynamic diameter < 10 μm (PM 10), coarse particles (PM Coarse), fine particles (PM 2.5), and PM 2.5Absorbance. Generalized linear and logistic regression models were used to estimate the associations between PM exposure and renal function.

          Results:

          An IQR increase in PM 10 (5.83 μg/m 3) was negatively associated with eGFR by –0.69 (95% CI: –0.89, –0.48) mL/min/1.73 m 2 and positively associated with the prevalence of CKD with adjusted OR = 1.15 (95% CI: 1.07, 1.23). An IQR increase in PM Coarse (6.59 μg/m 3) was significantly associated with lower eGFR by –1.07 (95% CI: –1.32, –0.81) mL/min/1.73 m 2 and CKD with OR = 1.26 (95% CI: 1.15, 1.38). In contrast, neither outcome was significantly associated with PM 2.5 or PM 2.5Absorbance. Stratified analyses indicated that associations of CKD with both PM 10 and PM Coarse were limited to participants < 65 years of age, and were stronger (for PM 10) or limited to (PM Coarse) women. Associations also appeared to be stronger in those without (vs. with) hypertension, and in normal versus overweight participants.

          Conclusions:

          Exposure during the previous year to PM 10 and PM Coarse, but not PM 2.5 or PM 2.5Absorbance, was associated with reduced renal function among Taiwanese adults.

          Citation:

          Yang YR, Chen YM, Chen SY, Chan CC. 2017. Associations between long-term particulate matter exposure and adult renal function in the Taipei metropolis. Environ Health Perspect 125:602–607;  http://dx.doi.org/10.1289/EHP302

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          Most cited references37

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          Development of Land Use Regression models for PM(2.5), PM(2.5) absorbance, PM(10) and PM(coarse) in 20 European study areas; results of the ESCAPE project.

          Land Use Regression (LUR) models have been used increasingly for modeling small-scale spatial variation in air pollution concentrations and estimating individual exposure for participants of cohort studies. Within the ESCAPE project, concentrations of PM(2.5), PM(2.5) absorbance, PM(10), and PM(coarse) were measured in 20 European study areas at 20 sites per area. GIS-derived predictor variables (e.g., traffic intensity, population, and land-use) were evaluated to model spatial variation of annual average concentrations for each study area. The median model explained variance (R(2)) was 71% for PM(2.5) (range across study areas 35-94%). Model R(2) was higher for PM(2.5) absorbance (median 89%, range 56-97%) and lower for PM(coarse) (median 68%, range 32- 81%). Models included between two and five predictor variables, with various traffic indicators as the most common predictors. Lower R(2) was related to small concentration variability or limited availability of predictor variables, especially traffic intensity. Cross validation R(2) results were on average 8-11% lower than model R(2). Careful selection of monitoring sites, examination of influential observations and skewed variable distributions were essential for developing stable LUR models. The final LUR models are used to estimate air pollution concentrations at the home addresses of participants in the health studies involved in ESCAPE.
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            Chronic kidney disease as a risk factor for cardiovascular disease and all-cause mortality: a pooled analysis of community-based studies.

            Chronic kidney disease (CKD) is a major public health problem. Conflicting evidence exists among community-based studies as to whether CKD is an independent risk factor for adverse cardiovascular outcomes. After subjects with a baseline history of cardiovascular disease were excluded, data from four publicly available, community-based longitudinal studies were pooled: Atherosclerosis Risk in Communities Study, Cardiovascular Health Study, Framingham Heart Study, and Framingham Offspring Study. Serum creatinine levels were indirectly calibrated across studies. CKD was defined by a GFR between 15 and 60 ml/min per 1.73 m(2). A composite of myocardial infarction, fatal coronary heart disease, stroke, and death was the primary study outcome. Cox proportional hazards models were used to adjust for study, demographic variables, educational status, and other cardiovascular risk factors. The total population included 22,634 subjects; 18.4% of the population was black, and 7.4% had CKD. There were 3262 events. In adjusted analyses, CKD was an independent risk factor for the composite study outcome (hazard ratio [HR], 1.19; 95% confidence interval [CI], 1.07-1.32), and there was a significant interaction between kidney function and race. Black individuals with CKD had an adjusted HR of 1.76 (95% CI, 1.35-2.31), whereas whites had an adjusted HR of 1.13 (95% CI, 1.02-1.26). CKD is a risk factor for the composite outcome of all-cause mortality and cardiovascular disease in the general population and a more pronounced risk factor in blacks than in whites. It is hypothesized that this effect may be due to more frequent or more severe subclinical vascular disease secondary to hypertension or diabetes in black individuals.
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              Lower estimated glomerular filtration rate and higher albuminuria are associated with mortality and end-stage renal disease. A collaborative meta-analysis of kidney disease population cohorts.

              We studied here the independent associations of estimated glomerular filtration rate (eGFR) and albuminuria with mortality and end-stage renal disease (ESRD) in individuals with chronic kidney disease (CKD). We performed a collaborative meta-analysis of 13 studies totaling 21,688 patients selected for CKD of diverse etiology. After adjustment for potential confounders and albuminuria, we found that a 15 ml/min per 1.73 m² lower eGFR below a threshold of 45 ml/min per 1.73 m² was significantly associated with mortality and ESRD (pooled hazard ratios (HRs) of 1.47 and 6.24, respectively). There was significant heterogeneity between studies for both HR estimates. After adjustment for risk factors and eGFR, an eightfold higher albumin- or protein-to-creatinine ratio was significantly associated with mortality (pooled HR 1.40) without evidence of significant heterogeneity and with ESRD (pooled HR 3.04), with significant heterogeneity between HR estimates. Lower eGFR and more severe albuminuria independently predict mortality and ESRD among individuals selected for CKD, with the associations stronger for ESRD than for mortality. Thus, these relationships are consistent with CKD stage classifications based on eGFR and suggest that albuminuria provides additional prognostic information among individuals with CKD.
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                Author and article information

                Journal
                Environ Health Perspect
                Environ. Health Perspect
                EHP
                Environmental Health Perspectives
                National Institute of Environmental Health Sciences
                0091-6765
                1552-9924
                7 October 2016
                April 2017
                : 125
                : 4
                : 602-607
                Affiliations
                [1 ]Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan
                [2 ]Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
                [3 ]Division of Surgical Intensive Care, Department of Critical Care Medicine, E-Da Hospital, Kaohsiung, Taiwan
                Author notes
                []Address correspondence to C.-C. Chan, Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Room 722, No. 17, Xu-Zhou Rd., Taipei, 10020 Taiwan. Telephone: 886-2-3366-8082. E-mail: ccchan@ 123456ntu.edu.tw
                Article
                EHP302
                10.1289/EHP302
                5381984
                27713105
                2dd47cc6-128f-4b66-bb82-e5ce1196fefb

                Publication of EHP lies in the public domain and is therefore without copyright. All text from EHP may be reprinted freely. Use of materials published in EHP should be acknowledged (for example, “Reproduced with permission from Environmental Health Perspectives”); pertinent reference information should be provided for the article from which the material was reproduced. Articles from EHP, especially the News section, may contain photographs or illustrations copyrighted by other commercial organizations or individuals that may not be used without obtaining prior approval from the holder of the copyright.

                History
                : 12 December 2015
                : 17 August 2016
                : 18 August 2016
                Categories
                Research

                Public health
                Public health

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