Long-Term Exposure to Fine Particulate Matter and the Deterioration of Estimated Glomerular Filtration Rate: A Cohort Study in Patients With Pre-End-Stage Renal Disease

Limited literature has explored the effect of air pollutants on chronic kidney disease (CKD) progression, especially for patients with pre-end-stage renal disease (pre-ESRD). In this study, we reported the linear and nonlinear relationships of air pollutants of particles with diameter 5 ml/min/1.73 m /year. Hybrid kriging/land-use regression models were used to estimate the individual exposure levels of PM and NO . The relationships of air pollutants with eGFR deterioration were evaluated using Cox proportional hazard models. After adjusting for smoking status, baseline eGFR stages, and other traditional clinical factors, the risk of eGFR deterioration was found to increase with increasing PM and NO level ( < 0.0001 and = 0.041, respectively), especially for those exposed to PM ≥ 31.44 μg/m or NO ≥ 15.00 ppb. Similar results were also found in the two-pollutant models. Nonlinear dose-response relationships of eGFR deterioration were observed for concentrations of 26.11 μg/m for PM and 15.06 ppb for NO . In conclusion, linear and nonlinear associations between PM and NO levels and the incidence risk of eGFR deterioration were observed in patients with pre-ESRD.