Kidney Week

Abstract: SA-PO759

Mediation of the Association Between Particulate Matter Air Pollution and Renal Disease by Diabetes

Session Information

• CKD: Epidemiology, Risk Factors, Prevention - III
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Bowe, Benjamin Charles, VA Saint Louis Health Care System, Saint Louis, Missouri, United States

Benjamin Charles Bowe,

• Xie, Yan, VA Saint Louis Health Care System, Saint Louis, Missouri, United States

Yan Xie,

• Al-Aly, Ziyad, VA Saint Louis Health Care System, Saint Louis, Missouri, United States

Ziyad Al-Aly,

• Li, Tingting, VA Saint Louis Health Care System, Saint Louis, Missouri, United States

Tingting Li,

• Yan, Yan, VA Saint Louis Health Care System, Saint Louis, Missouri, United States

Yan Yan,

• Xian, Hong, VA Saint Louis Health Care System, Saint Louis, Missouri, United States

Hong Xian,

Group or Team Name

• Clinical Epidemiology Center

Background

Evidence suggests that elevated levels of fine particulate matter of <2.5 µm in aerodynamic diameter (PM_2.5) are associated with increased risk of kidney disease. However, PM_2.5 is also associated with risk of diabetes, which is a major driver of CKD. Whether and to what extent the association of PM_2.5 and CKD is mediated by diabetes is unknown.

Methods

Databases from the Environmental Protection Agency (EPA) and National Aeronautics and Space Administration (NASA) were linked with those from Department of Veterans Affairs. Inverse odds ratio-weighted estimations for mediation analyses were undertaken to quantitate the proportion of the association between PM_2.5 and risk of CKD outcomes that is mediated by diabetes. CKD outcomes included incident eGFR < 60 mL/min/1.73m², incident CKD, incident eGFR decline ≥ 30%, and time until end stage renal disease (ESRD) or eGFR decline ≥ 50%.

Results

In a cohort of 2,444,157 United States Veterans followed for a median of 8.5 years, using EPA data, the proportion of the association (between PM_2.5 and risk of CKD outcomes) mediated by diabetes was 4.7%, 4.8%, 5.8%, and 16.5% for risk of incident eGFR less than 60 mL/min/1.73m², risk of incident CKD, risk of eGFR decline of 30% or more, and risk of ESRD or eGFR decline ≥50%, respectively. Results were consistent when exposure was defined according to NASA data.

Conclusion

Our findings demonstrate that a small proportion of the association between PM_2.5 and CKD was mediated by diabetes, suggesting that the presence of other mediators or a direct effect between PM_2.5 and CKD may drive the association between PM_2.5 and CKD.

Funding

• Veterans Affairs Support