Fine particulate matter and cause-specific mortality in the Hong Kong elder patients with chronic kidney disease

Chemosphere. 2020 May;247:125913. doi: 10.1016/j.chemosphere.2020.125913. Epub 2020 Jan 13.


Emerging epidemiologic studies suggested that particulate matter (PM) was a risk factor for the incidence of chronic kidney disease (CKD). However, few studies were conducted to examine whether PM was associated with cause-specific deaths in the CKD progression. This study aimed to estimate the association between fine particulate matter (PM2.5) and a spectrum of deaths among CKD patients. We took leverage of the Elderly Health Service cohort (n = 66,820), a large Hong Kong elderly cohort followed up till 2010. A total of 902 CKD incident patients in the cohort were identified during the follow-up period. We estimated yearly PM2.5 at the residential address for each CKD patient based on a satellite-based spatiotemporal model. We used Cox proportional hazards models with attained age as the underlying timescale to assess the association between long-term exposure to PM2.5 and cause-specific mortality among CKD patients. A total of 496 patients died during the follow-up, where 147 died from cardiovascular disease, 61 from respiratory disease and 154 from renal failure. The mortality hazard ratio (HR) per interquartile-range increase in PM2.5 (4.0 μg/m3) was 1.97 (95% confidence interval (CI): 1.34 to 2.91) for ischemic heart disease (IHD) among CKD patients, and was 1.42 (95%CI: 1.05 to 1.93) for CKD among those patients concomitantly with hypertension. Associations were not of statistical significance between PM2.5 and mortality hazard ratios of all-cause, stroke, and pneumonia among CKD patients. Our findings suggest that long-term exposure to PM2.5 may contribute to the CKD progression into ischemic heart diseases.

Keywords: Chronic kidney disease; Cohort study; Fine particulate matter; Ischemic heart disease.

MeSH terms

  • Aged
  • Air Pollution / adverse effects
  • Air Pollution / statistics & numerical data*
  • Cardiovascular Diseases / chemically induced
  • Cardiovascular Diseases / epidemiology
  • Cause of Death
  • Cohort Studies
  • Environmental Exposure / analysis
  • Environmental Exposure / statistics & numerical data*
  • Female
  • Hong Kong / epidemiology
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Particulate Matter / analysis
  • Particulate Matter / chemistry*
  • Proportional Hazards Models
  • Renal Insufficiency, Chronic / chemically induced
  • Renal Insufficiency, Chronic / mortality*
  • Respiratory Tract Diseases / chemically induced
  • Respiratory Tract Diseases / epidemiology
  • Risk Factors


  • Particulate Matter