Association between exposure to air pollution and kidney function decline

ABSTRACT Background and hypothesis Chronic kidney disease is a major global health concern, with air pollution increasingly recognized as a key contributor to kidney function decline. This study hypothesizes that exposure to air pollution accelerates kidney function decline, measured by ≥30% or ≥40% reductions in estimated glomerular filtration rate (eGFR). Methods A nested case-control design was employed using data from the Adult Preventive Healthcare Services database and National Health Insurance claims (2016–2021). The study cohort comprised 871 295 health checkup participants. Cases were defined as participants with an eGFR decline of ≥30% or ≥40% from baseline, matched 1:1 with controls by time density sampling on sex, age, baseline eGFR, and follow-up duration. Air pollution exposure to six pollutants (PM2.5, PM10, NO2, SO2, CO, and O3) was assessed for the 1-, 2-, 3-, and 5-year period prior to the outcome occurrence using land-use regression combined with machine learning algorithms. Multivariate conditional logistic regression models were used to estimate odds ratios (ORs) for eGFR decline per interquartile range (IQR) increase in pollutant concentrations. Results The study included 61 239 cases with eGFR declines ≥30% and 23 330 cases with declines ≥40%. Higher concentrations of all pollutants were associated with significant increases in odds for kidney function decline. CO and PM2.5 exhibited the strongest associations with eGFR decline. For an eGFR decline of ≥30%, an IQR increase in CO was associated with an aOR of 2.78 (95% confidence intervals (CI): 2.69–2.88), while PM2.5 showed an aOR of 2.60 (95% CI: 2.51–2.69). Similarly, for eGFR decline of ≥40%, CO had an aOR of 2.46 (95% CI: 2.33–2.60) and PM2.5 an aOR of 2.35 (95% CI: 2.23–2.48). Compared to 3- and 5-year exposure periods, the associations were strongest in the 1- and 2-year periods. Conclusion Air pollution exposure accelerates kidney function decline, necessitating public health action.