Long-term effects of air pollution on end stage renal disease

• Applicant: Dr. Gudrun Weinmayr
• Subject Area: Epidemiology and Medical Biometry/Statistics ; Public Health, Healthcare Research, Social and Occupational Medicine
• Term: since 2019
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 431967689

Long-term exposure to ambient air pollution has been related to various chronic diseases including cardiovascular diseases and diabetes. In recent years, relations with chronic kidney disease (CKD) have also been found. Far less studied is end stage kidney disease (ESKD), despite the high burden on patients, their families, and the health systems related to the need for dialysis and transplants. Partly this lack of studies may be related to the limited availability of suitable data. To date, only four studies have investigated the relation between air pollution and incident ESKD. The study on 2 million US veterans found important associations and estimated that 13 % of the incidence of ESKD in the US could be attributable to ambient air pollution with particles of less than 10 μm in diameter. Most of the m in diameter. Most of the studies used exposure data on a coarse spatial scale and none of them investigated particle composition. In our precursor project we therefore investigated the effects of long-term exposure to air pollution on the incidence of ESKD) in two large cohorts from the general adult population, one from Austria and one from Italy. Home address specific exposures of nitrogen dioxide, ozone, particulate matter (PM) and several of its elemental constituents were investigated. Besides overall ESKD, ESKD with different underlying pathologies such as diabetes or hypertension were studied. We found positive associations with PM smaller than 2.5μm (PM2.5), nitrogen dioxide, and several PM2.5-constituents such as black carbon, iron, copper, potassium and sulphur, however with somewhat different patterns between the two cohorts. This may be caused by differences in the air pollution mixes between Vorarlberg (a mountainous area in Austria) and Rome (capital of Italy) – indeed air pollution and PM are complex mixtures with components of different toxicity and from various sources. Moreover, components may be highly correlated when they reflect the same source making it difficult to disentangle single effects. In term of prevention, it is important to understand which sources contribute most to the observed health effects. While elemental constituents can give first impressions as indicators of certain sources, they can originate from several sources and partly correlate very highly. Absolute principal component analysis constitutes a successful approach to identify underlying sources that are not correlated with each other. For the proposed project, we therefore aim to investigate the associations of source-specific PM2.5 with incident ESKD, in particular to understand which sources are most relevant. In addition, we aim to improve our data base for the smaller VHM&PP cohort by increasing time of follow-up and obtaining important individual socioeconomic indicators lacking so far. Important synergies exist with the project “Effects of Low-Level Air Pollution: A Study in Europe” (ELAPSE). where we can draw upon relevant data and methods

• DFG Programme: Research Grants
• International Connection: Italy
• Co-Investigator: Professorin Dr. Gabriele Nagel
• Cooperation Partner: Dr. Massimo Stafoggia