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

Environ Health. 2024 Apr 23;23(1):43. doi: 10.1186/s12940-024-01080-4.

Abstract

Background: 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.

Methods: Our primary objective is to examine creatinine-based estimated glomerular filtration rate (eGFRcr) and diagnosis of CKD and potential associations with fine particulate matter (PM2.5), ozone (O3), and nitrogen dioxide (NO2) using a random sample of North Carolina electronic healthcare records (EHRs) from 2004 to 2016. We estimated eGFRcr using the serum creatinine-based 2021 CKD-EPI equation. PM2.5 and NO2 data come from a hybrid model using 1 km2 grids and O3 data from 12 km2 CMAQ grids. Exposure concentrations were 1-year averages. We used linear mixed models to estimate eGFRcr 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.

Results: 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/1.73m2 (95% CI: -1.96, -1.31) reduction in eGFRcr, with O3 and NO2 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 eGFRcr < 60 mL/min/1.73m2. NO2 was inversely associated with a first-time diagnosis of CKD with aOR of 0.77 (95% CI: 0.66, 0.90).

Conclusions: One-year average PM2.5 was associated with reduced eGFRcr, while O3 and NO2 were inversely associated. Neither PM2.5 or O3 were associated with a first-time identification of CKD, NO2 was inversely associated. We recommend future research examining the relationship between air pollution and impaired renal function.

Keywords: Air pollution; Chronic kidney disease; Electronic healthcare records; Fine particulate matter; Nitrogen dioxide; Ozone.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Air Pollutants* / adverse effects
  • Air Pollutants* / analysis
  • Air Pollution* / adverse effects
  • Air Pollution* / analysis
  • Creatinine / blood
  • Cross-Sectional Studies
  • Electronic Health Records*
  • Environmental Exposure* / adverse effects
  • Environmental Exposure* / analysis
  • Female
  • Glomerular Filtration Rate*
  • Humans
  • Male
  • Middle Aged
  • Nitrogen Dioxide* / adverse effects
  • Nitrogen Dioxide* / analysis
  • North Carolina / epidemiology
  • Ozone* / adverse effects
  • Ozone* / analysis
  • Particulate Matter* / adverse effects
  • Particulate Matter* / analysis
  • Renal Insufficiency, Chronic* / chemically induced
  • Renal Insufficiency, Chronic* / epidemiology

Substances

  • Air Pollutants
  • Particulate Matter
  • Nitrogen Dioxide
  • Ozone
  • Creatinine