Long-term exposure to ambient air pollutants and increased risk of end-stage renal disease in patients with type 2 diabetes mellitus and chronic kidney disease: a retrospective cohort study in Beijing, China

Limited data have examined the association between air pollution and the risk of end-stage renal disease (ESRD) in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). We aimed to investigate whether long-term exposure to air pollutants is related to the development of ESRD among patients with T2DM and CKD. A total of 1,738 patients with T2DM and CKD hospitalized in Peking University Third Hospital from January 1, 2013, to December 31, 2021 were enrolled in this study. The outcome was defined as the occurrence of ESRD. Data on six air pollutants (PM 2.5 , PM 10 , CO, NO 2 , SO 2, and O 3 ) from 35 monitoring stations were obtained from the Beijing Municipal Ecological and Environmental Monitoring Center. Long-term exposure to air pollutants during the follow-up period was measured using the ordinary Kriging method. During a mean follow-up of 41 months, 98 patients developed ESRD. Multivariate logistic regression analysis showed that an increase of 10 μg/m 3 in PM 2.5 (odds ratio [OR] 1.19, 95% confidence interval [CI] 1.03–1.36) and PM 10 (OR 1.15, 95% CI 1.02–1.30) concentration were positively associated with ESRD. An increase of 1 mg/m 3 in CO (2.80, 1.05–7.48) and an increase of 1 μg/m 3 in SO 2 (1.06, 1.00–1.13) concentration were also positively associated with ESRD. Apart from O 3 and NO 2 , all the above air pollutants have additional predictive value for ESRD in patients with T2DM and CKD. The results of Bayesian kernel machine regression and the weighted quantile sum regression all showed that PM 2.5 was the most important air pollutant. Backward stepwise logistic regression showed that PM 2.5 was the only pollutant remaining in the prediction model. In patients with T2DM and CKD, long-term exposure to ambient PM 2.5 , PM 10 , CO, and SO 2 was positively associated with the development of ESRD.