Reduction in ambient PM2.5 associated with decreased risk of dialysis and mortality among patients with advanced chronic kidney disease: A population-based retrospective cohort study in Taiwan
Fine particulate matter (PM2.5) is associated with the development of chronic kidney disease (CKD). However, studies validating the beneficial effects of reducing ambient PM2.5 levels on CKD remain limited. The Taiwan government has implemented 'Clean Air Action Plans' since 2015. We aim t...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-07-01
|
| Series: | Ecotoxicology and Environmental Safety |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0147651325007195 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849471811774840832 |
|---|---|
| author | Shih-Feng Chen Ming-Chia Lee Yu-Chin Lai Pau-Chung Chen |
| author_facet | Shih-Feng Chen Ming-Chia Lee Yu-Chin Lai Pau-Chung Chen |
| author_sort | Shih-Feng Chen |
| collection | DOAJ |
| description | Fine particulate matter (PM2.5) is associated with the development of chronic kidney disease (CKD). However, studies validating the beneficial effects of reducing ambient PM2.5 levels on CKD remain limited. The Taiwan government has implemented 'Clean Air Action Plans' since 2015. We aim to investigate the effects of changes in PM2.5 on dialysis incidence and mortality among patients with advanced CKD. This retrospective population-based cohort study recruited 31,027 patients with CKD stage 3b to 5 during 2016–2020 and followed them until December 31, 2021. The change in PM2.5 (ΔPM2.5) was defined by subtracting the 365-day mean concentration before the index date from that before the end of follow-up. Cox regression models were used to assess the hazard of dialysis incidence and mortality per 1-μg/m³ reduction in PM2.5, as well as by dividing ΔPM2.5 into tertiles. Restricted cubic spline analysis was performed to delineate the concentration-response relationship between ΔPM2.5 and the outcomes. We observesed that each 1-μg/m³ reduction in ambient PM2.5 was associated with an 11 % decrease in dialysis incidence and a 14 % decrease in mortality risk. Patients in tertile 1 (with improved PM2.5) experienced a reduced risk of outcomes (hazard ratio for dialysis, 0.70; 95 % confidence interval, 0.65–0.75), while those in tertile 3 (with deteriorated PM2.5) had an increased risks compared to those in tertile 2. An approximately linear relationship between ΔPM2.5 and risk of outcomes was observed. In conclusion, improvement in ambient PM2.5 levels is significantly associated with a reduced risk of dialysis and mortality among advanced CKD patients. |
| format | Article |
| id | doaj-art-05d70622cc2a497aa89de90573f4eb83 |
| institution | Kabale University |
| issn | 0147-6513 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Ecotoxicology and Environmental Safety |
| spelling | doaj-art-05d70622cc2a497aa89de90573f4eb832025-08-20T03:24:43ZengElsevierEcotoxicology and Environmental Safety0147-65132025-07-0129911838310.1016/j.ecoenv.2025.118383Reduction in ambient PM2.5 associated with decreased risk of dialysis and mortality among patients with advanced chronic kidney disease: A population-based retrospective cohort study in TaiwanShih-Feng Chen0Ming-Chia Lee1Yu-Chin Lai2Pau-Chung Chen3Nephrology Department, New Taipei City Hospital, No. 3, Section 1, New Taipei Blvd., Sanchong Dist., New Taipei City 241204, Taiwan; Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, 7F., No. 17, Xuzhou Rd., Zhongzheng Dist., Taipei City 100025, TaiwanDepartment of Pharmacy, New Taipei City Hospital, No. 3, Section 1, New Taipei Blvd., Sanchong Dist., New Taipei City 241204, Taiwan; Department of Nursing, Cardinal Tien College of Healthcare and Management, No. 112, Minzu Rd., Xindian Dist., New Taipei City 231038, TaiwanNephrology Department, New Taipei City Hospital, No. 3, Section 1, New Taipei Blvd., Sanchong Dist., New Taipei City 241204, Taiwan; Nursing Department, New Taipei City Hospital, No. 3, Section 1, New Taipei Blvd., Sanchong Dist., New Taipei City 241204, TaiwanInstitute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, 7F., No. 17, Xuzhou Rd., Zhongzheng Dist., Taipei City 100025, Taiwan; Department of Public Health, National Taiwan University College of Public Health, No. 17, Xuzhou Rd., Zhongzheng Dist., Taipei City 100025, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City 100225, Taiwan; Correspondence to: Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Room 733, 17 Xuzhou Road, Taipei City 100025, Taiwan.Fine particulate matter (PM2.5) is associated with the development of chronic kidney disease (CKD). However, studies validating the beneficial effects of reducing ambient PM2.5 levels on CKD remain limited. The Taiwan government has implemented 'Clean Air Action Plans' since 2015. We aim to investigate the effects of changes in PM2.5 on dialysis incidence and mortality among patients with advanced CKD. This retrospective population-based cohort study recruited 31,027 patients with CKD stage 3b to 5 during 2016–2020 and followed them until December 31, 2021. The change in PM2.5 (ΔPM2.5) was defined by subtracting the 365-day mean concentration before the index date from that before the end of follow-up. Cox regression models were used to assess the hazard of dialysis incidence and mortality per 1-μg/m³ reduction in PM2.5, as well as by dividing ΔPM2.5 into tertiles. Restricted cubic spline analysis was performed to delineate the concentration-response relationship between ΔPM2.5 and the outcomes. We observesed that each 1-μg/m³ reduction in ambient PM2.5 was associated with an 11 % decrease in dialysis incidence and a 14 % decrease in mortality risk. Patients in tertile 1 (with improved PM2.5) experienced a reduced risk of outcomes (hazard ratio for dialysis, 0.70; 95 % confidence interval, 0.65–0.75), while those in tertile 3 (with deteriorated PM2.5) had an increased risks compared to those in tertile 2. An approximately linear relationship between ΔPM2.5 and risk of outcomes was observed. In conclusion, improvement in ambient PM2.5 levels is significantly associated with a reduced risk of dialysis and mortality among advanced CKD patients.http://www.sciencedirect.com/science/article/pii/S0147651325007195Clean air action plansChange in PM2.5 (ΔPM2.5)Advanced CKDDialysis incidenceMortality |
| spellingShingle | Shih-Feng Chen Ming-Chia Lee Yu-Chin Lai Pau-Chung Chen Reduction in ambient PM2.5 associated with decreased risk of dialysis and mortality among patients with advanced chronic kidney disease: A population-based retrospective cohort study in Taiwan Ecotoxicology and Environmental Safety Clean air action plans Change in PM2.5 (ΔPM2.5) Advanced CKD Dialysis incidence Mortality |
| title | Reduction in ambient PM2.5 associated with decreased risk of dialysis and mortality among patients with advanced chronic kidney disease: A population-based retrospective cohort study in Taiwan |
| title_full | Reduction in ambient PM2.5 associated with decreased risk of dialysis and mortality among patients with advanced chronic kidney disease: A population-based retrospective cohort study in Taiwan |
| title_fullStr | Reduction in ambient PM2.5 associated with decreased risk of dialysis and mortality among patients with advanced chronic kidney disease: A population-based retrospective cohort study in Taiwan |
| title_full_unstemmed | Reduction in ambient PM2.5 associated with decreased risk of dialysis and mortality among patients with advanced chronic kidney disease: A population-based retrospective cohort study in Taiwan |
| title_short | Reduction in ambient PM2.5 associated with decreased risk of dialysis and mortality among patients with advanced chronic kidney disease: A population-based retrospective cohort study in Taiwan |
| title_sort | reduction in ambient pm2 5 associated with decreased risk of dialysis and mortality among patients with advanced chronic kidney disease a population based retrospective cohort study in taiwan |
| topic | Clean air action plans Change in PM2.5 (ΔPM2.5) Advanced CKD Dialysis incidence Mortality |
| url | http://www.sciencedirect.com/science/article/pii/S0147651325007195 |
| work_keys_str_mv | AT shihfengchen reductioninambientpm25associatedwithdecreasedriskofdialysisandmortalityamongpatientswithadvancedchronickidneydiseaseapopulationbasedretrospectivecohortstudyintaiwan AT mingchialee reductioninambientpm25associatedwithdecreasedriskofdialysisandmortalityamongpatientswithadvancedchronickidneydiseaseapopulationbasedretrospectivecohortstudyintaiwan AT yuchinlai reductioninambientpm25associatedwithdecreasedriskofdialysisandmortalityamongpatientswithadvancedchronickidneydiseaseapopulationbasedretrospectivecohortstudyintaiwan AT pauchungchen reductioninambientpm25associatedwithdecreasedriskofdialysisandmortalityamongpatientswithadvancedchronickidneydiseaseapopulationbasedretrospectivecohortstudyintaiwan |