Associations between long-term exposure to air pollution and kidney function utilizing electronic healthcare records: a cross-sectional study

• Published in: Environmental health Vol. 23; no. 1; p. 43
• Main Authors: Dillon, David, Ward-Caviness, Cavin, Kshirsagar, Abhijit V, Moyer, Joshua, Schwartz, Joel, Di, Qian, Weaver, Anne
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 23.04.2024; BioMed Central; BMC
• Subjects: Adult; Aged; Aged, 80 and over; Air Pollutants - adverse effects; Air Pollutants - analysis; Air pollution; Air Pollution - adverse effects; Air Pollution - analysis; Chronic kidney disease; Chronic kidney failure; Codes; Comorbidity; Creatinine; Creatinine - blood; Cross-Sectional Studies; Development and progression; Diagnosis; Electronic Health Records; Electronic healthcare records; Electronic records; Environmental aspects; Environmental Exposure - adverse effects; Environmental Exposure - analysis; Exposure; Female; Females; Fine particulate matter; Glomerular Filtration Rate; Health aspects; Health care; Humans; Hypertension; Kidney diseases; Kidneys; Male; Medical care; Middle Aged; Mortality; Nitrogen dioxide; Nitrogen Dioxide - adverse effects; Nitrogen Dioxide - analysis; North Carolina - epidemiology; Outdoor air quality; Ozone; Ozone - adverse effects; Ozone - analysis; Particulate matter; Particulate Matter - adverse effects; Particulate Matter - analysis; Patients; Phenotyping; Physiological aspects; Pollutants; Renal function; Renal Insufficiency, Chronic - chemically induced; Renal Insufficiency, Chronic - epidemiology; Risk factors; Standard deviation; Time measurement; Utilization; North Carolina; United States; United States > US; Air pollution; Ozone; Chronic kidney disease; Fine particulate matter; Nitrogen dioxide; Electronic healthcare records
• ISSN: 1476-069X; 1476-069X
• DOI: 10.1186/s12940-024-01080-4

Chronic kidney disease (CKD) affects more than 38 million people in the United States, predominantly those over 65 years of age. While CKD etiology is complex, recent research suggests associations with environmental exposures. Our primary objective is to examine creatinine-based estimated glomerular filtration rate (eGFR ) and diagnosis of CKD and potential associations with fine particulate matter (PM ), ozone (O ), and nitrogen dioxide (NO ) using a random sample of North Carolina electronic healthcare records (EHRs) from 2004 to 2016. We estimated eGFR using the serum creatinine-based 2021 CKD-EPI equation. PM and NO data come from a hybrid model using 1 km grids and O data from 12 km CMAQ grids. Exposure concentrations were 1-year averages. We used linear mixed models to estimate eGFR per IQR increase of pollutants. We used multiple logistic regression to estimate associations between pollutants and first appearance of CKD. We adjusted for patient sex, race, age, comorbidities, temporality, and 2010 census block group variables. We found 44,872 serum creatinine measurements among 7,722 patients. An IQR increase in PM2.5 was associated with a 1.63 mL/min/1.73m (95% CI: -1.96, -1.31) reduction in eGFRcr, with O and NO showing positive associations. There were 1,015 patients identified with CKD through e-phenotyping and ICD codes. None of the environmental exposures were positively associated with a first-time measure of eGFR  < 60 mL/min/1.73m . NO was inversely associated with a first-time diagnosis of CKD with aOR of 0.77 (95% CI: 0.66, 0.90). One-year average PM was associated with reduced eGFR , while O and NO were inversely associated. Neither PM or O were associated with a first-time identification of CKD, NO was inversely associated. We recommend future research examining the relationship between air pollution and impaired renal function.