Kidney Week

Abstract: FR-PO311

Long-Term Impact of PM2.5 Exposure on Diabetic Kidney Disease Patients Considering Time-Dependent Medication Adjustment

Session Information

• Diabetic Kidney Disease: Clinical Modeling, Diagnosis, Education, and More
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diabetic Kidney Disease

• 702 Diabetic Kidney Disease: Clinical

Authors

• Kwon, Soie, Chung Ang University Hospital, Seoul, Korea (the Republic of)

Soie Kwon, MD

• Lee, Jung Pyo, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Dongjak-gu, Seoul, Korea (the Republic of)

Jung Pyo Lee, MD, PhD

Background

Ambient air pollutants adversely affect renal function and increase type-2 diabetes incidence. However, the impact of air pollution on diabetic kidney disease (DKD) patients remains underexplored, with limited consideration of medication-related effects. We assessed the influence of air pollutants on DKD patients while meticulously adjusting for medication usage.

Methods

We retrospectively enrolled DKD patients. Primary and secondary outcomes included end-stage kidney disease (ESKD) and a composite (ESKD, mortality). Nationwide forecasted ultrahigh-resolution air-pollutant data (PM_2.5, PM₁₀, NO₂, CO) were obtained from AiMS-CREATE. Monthly updated ambient air pollutants and medication prescription information were considered time-varying variables in multivariable time-dependent Cox analyses.

Results

Patients (n=9,482) were followed for a median of 9 (ESKD) and 11 (composite outcome) years; 20.6% progressed to ESKD, and 46.7% experienced composite outcomes. The DKD-stage patient distribution was 12.5% (stage 1-2), 35.8% (stage 3), and 51.6% (stage 4-5). Initial RAS blocker use increased from 37.4% to 58.5% during Year 1 then gradually declined.
During follow-up, all four air pollutant concentrations significantly decreased, with CO exhibiting the most pronounced decline. PM_2.5 was significantly associated with greater ESKD progression (aHR=1.19, 95% CI=1.020–1.396) and composite outcome (aHR=1.17, 95% CI=1.055–1.299) risk. Unexpectedly, PM₁₀ increases were associated with decreased ESKD progression and composite outcome risk, potentially influenced more by social factors (e.g., air pollution alerts).

Conclusion

In this study, there was evidence of PM_2.5 exposure-related adverse effects on ESKD progression in DKD even after comprehensive medication usage adjustment.

Association between end-stage kidney disease progression or composite outcome and air pollutant exposure.

Air pollutants were considered time-dependent covariates. All analyses were adjusted for time-fixed covariates and time-dependent confounders (antidiabetic drug usage and renin-angiotensin blocker usage).