Abstract: FR-PO391
Long-Term Exposure to Nitrogen Dioxide on Cardiovascular Event Risks in Patients with CKD Using Machine Learning-Based Ultra High-Resolution Air Pollution Forecasts
Session Information
- Hypertension, CVD, and the Kidneys: Epidemiology
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Han, Seung hyun, Seoul National University Boramae Medical Center, Seoul, Korea (the Republic of)
- Weon, Boram, Seoul National University Boramae Medical Center, Seoul, Korea (the Republic of)
- Ko, Ara, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
- Lee, Jeonghwan, Seoul National University Boramae Medical Center, Seoul, Korea (the Republic of)
- Kim, Dong Ki, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
- Kim, Yon Su, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
- Lim, Chun Soo, Seoul National University Boramae Medical Center, Seoul, Korea (the Republic of)
- Lee, Jung Pyo, Seoul National University Boramae Medical Center, Seoul, Korea (the Republic of)
Background
Preliminary studies have suggested that nitrogen dioxide (NO2) is linked to increased cardiovascular risks, yet its impact on individuals with chronic kidney disease (CKD) is not well-documented. This study aims to assess the effect of long-term NO2 exposure on the risk of major adverse cardiovascular events (MACE) in CKD patients.
Methods
A retrospective cohort study was conducted on CKD patients from two major medical centers in seoul, who visited between 2001 and 2016. Participants without prior cardiovascular diseases history were included, with follow-up until February 2023. Machine learning-based forecasts were used to predict NO2 exposure levels. The association between NO2 exposure and MACE (acute myocardial infarction, ischemic stroke, cardiovascular death, or revascularization) was analyzed using a time-varying Cox proportional hazards model.
Results
A total of 39,022 CKD patients were included, and 3,446 of them experienced MACE. After adjusting for multivariable covariates, CKD patients showed a significant increased risk of MACE with each 10 ppb increase in NO2 concentrations (HR, 1.005; 95% CI, 1.002-1.008). Each MACE component analysis, except for cardiovascular death, showed significant results. In subgroup analyses based on kidney function, non-dialysis CKD patients exhibited a significant increased in MACE incidence risk (HR, 1.006; 95% CI, 1.002-1.010), particularly those with an estimated glomerular filtration rate between 15 and 30 mL/min/1.73m2 (HR, 1.033, 95% CI, 1.020-1.045).
Conclusion
Chronic NO2 exposure significantly correlates with an elevated risk of cardiovascular events in CKD patients. This underscores the importance of addressing air pollution as a factor in managing cardiovascular risk among CKD patients, especially for those with CKD stage 4.
Association of NO2 Exposure with MACE and MACE components in CKD patients
| Univariate Model | Multivariate Model | |||
| HR (95% CI) | p-value | HR (95% CI | p-value | |
| MACE, total | 1.01 (1.007,1.013) | < 0.001 | 1.005 (1.002,1.008) | 0.002 |
| Each MACE component | ||||
| CV deah | 1.008(0.999,1.018) | 0.086 | 1.008(0.998,1.018) | 0.115 |
| AMI | 1.015(1.007,1.024) | < 0.001 | 1.010(1.002,1.019) | 0.021 |
| Coronary revascularization | 1.007(1.001,1.013) | 0.022 | 1.006(1.000,1.012) | 0.041 |
| Ischemic stroke | 1.011(1.007,1.015) | < 0.001 | 1.005(1.001,1.009) | 0.012 |