Kidney Week

Abstract: FR-PO412

Multiple Air Pollutant Exposure Is Associated with Higher Risk of All-Cause Mortality in Patients on Dialysis: A French Registry-Based Nationwide Study

Session Information

• Hemodialysis Epidemiology and Outcomes
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Hamroun, Aghiles, Centre Hospitalier Universitaire de Lille, Lille, Hauts-de-France, France

Aghiles Hamroun

• Génin, Michaël, Centre Hospitalier Universitaire de Lille, Lille, Hauts-de-France, France

Michaël Génin

• Glowacki, François, Centre Hospitalier Universitaire de Lille, Lille, Hauts-de-France, France

François Glowacki, MD, PhD

• Couchoud, Cécile, Agence de la biomedecine, La Plaine Saint-Denis, France

Cécile Couchoud, MD, PhD

• Occelli, Florent, Centre Hospitalier Universitaire de Lille, Lille, Hauts-de-France, France

Florent Occelli, PhD

Background

Little is known about the effect of combined exposure to different air pollutants on mortality in dialysis patients. This study aims to investigate the association of multiple exposure to air pollutants with all-cause and cause-specific death in dialysis patients.

Methods

This registry-based nationwide cohort study included 90,373 adult kidney failure patients initiating maintenance dialysis between 2012 and 2020 identified from the French REIN registry. Estimated mean annual municipality-levels of PM_2.5, PM₁₀ and NO₂ between 2009 and 2020 were combined in different composite air pollution scores to estimate each participant’s exposure at the residential place one to three years before dialysis initiation. Adjusted cause-specific Cox proportional hazard models were used to estimate hazard ratios per interquartile range (IQR) greater air pollution score. Effect measure modification was assessed for age, sex, dialysis modality, and baseline comorbidities.

Results

Higher levels of the main air pollution score were associated with a greater rate of all-cause deaths (HR, 1.074 [95% CI, 1.053-1.095] per IQR increase), regardless of the exposure lag. This association was also confirmed in cause-specific analyses, most markedly for infectious mortality (HR, 1.559 [95% CI, 1.365-1.781]). Sensitivity analyses with alternative composite air pollution scores showed consistent findings.
Subgroup analyses revealed a significantly stronger association among women and less comorbid patients (Figure 1).

Conclusion

Long-term multiple air pollutant exposure is associated with all-cause and cause-specific mortality among patients receiving maintenance dialysis, suggesting that air pollution may be a significant contributor in the increasing trend of CKD-attributable mortality worldwide.

Figure 1. Association between air pollution PCA score and all-cause mortality according to different subgroups.

Funding

• Private Foundation Support