Urbanization, ambient air pollution, and prevalence of chronic kidney disease: A nationwide cross-sectional study

Executive summary for the China Kidney Disease Network (CK-NET) 2017-2018 Annual Data Report

Chronic kidney disease (CKD) has become a public health issue. Rapid urbanization in China has been intimately linked to shifts in the spectrum of CKD, particularly as regards CKD related to diabetes mellitus. By amalgamating diverse data streams and harnessing cutting-edge technologies, the China Kidney Disease Network aspires to evolve into a comprehensive surveillance framework for kidney diseases in China. The China Kidney Disease Network 2017-2018 Annual Data Report is the fourth nationwide report produced by the China Kidney Disease Network team. Through the analysis of data from 3 large national databases and 4 provincial dialysis quality control centers, this report seeks to provide a robust foundation for understanding the current state of kidney disease in China. Specifically, in addition to providing epidemiological and economic data on CKD and dialysis from 2017 to 2018, hot topics such as environmental pollution and CKD, as well as digital intelligence in nephrology, have been addressed. This report could serve as a valuable resource for researchers, policymakers, and health care professionals alike, inspiring new ideas, fostering collaborations, and ultimately leading to improved outcomes for those affected by kidney diseases.

Regional burden, trends, and future projections of chronic kidney disease due to type 2 diabetes mellitus in South Asia: insights from the global burden of disease study (1990-2021) and ARIMA forecasting

BACKGROUND

Chronic kidney disease (CKD) due to Type 2Diabetes Mellitus (T2DM) is an increasing health burden in South Asia. This study evaluates the burden, trends, and future projections of CKD from 1990-2021 using Global Burden of Disease (GBD) data and ARIMA modeling.

RESEARCH DESIGN AND METHODS

We analyzed age-standardized rates (ASR) for prevalence, incidence, mortality, and DALYs of CKD due to T2DM in South Asia(India, Pakistan, Bangladesh, Bhutan, Nepal). Join point regression and ARIMAmodels were applied for trend analysis and projections.

RESULTS

From 1990 to 2021, prevalence decreased slightly (e.g. India: 5.4% to 5.2%), while mortality increased (e.g.Pakistan: 33.7 to 42.1 per 100,000). Incidence increased across all countries, with Nepal (1.3% increase) and Bhutan (1.7% increase) showing the highest growth. Projections indicate a continued rise in CKD burden, especially inNepal and India.

CONCLUSION

CKD due to T2DM is increasing, emphasizing the need for targeted interventions.

Role of CD33 basophils in mediating the effect of lipidome on chronic kidney disease: A 2-sample, 2-variable, bidirectional Mendelian randomization analysis

This study aimed to investigate the causal relationship between lipidomes and chronic kidney disease (CKD) and identify and quantify the role of immune cells as a potential mediator. Using summary-level data from a genome-wide association study, a 2-sample Mendelian randomization (MR) analysis of genetically predicted lipidomes (7174 cases) and CKD (406,745 cases) was performed. Furthermore, we used 2-step MR to quantitate the proportion of the effect of immune cells traits-mediated lipidomes on CKD. The MR analysis revealed a causal relationship between lipidomes and CKD, with different lipidomes either increasing or decreasing the risk of CKD. Immune cells may serve as intermediaries in the pathway from lipidomes to CKD. Our study indicates that CD33 on basophils accounts for 3.23% of the reduced risk associated with triacylglycerol (53:3) levels in CKD. In conclusion, our study has identified a causal relationship between lipidomes and CKD, as well as the mediating role of CD33 on basophils. However, other risk factors like potential mediators require further investigation. In clinical practice, particular attention should be paid to lipidomic changes, especially triacylglycerol, in patients with CKD.

Residential Greenness Is Associated with Lower Thyroid Nodule Prevalence: A Nationwide Study in China

Background: The prevalence of thyroid nodules is increasing globally. This study explored the association between residential greenness and thyroid nodule prevalence. Methods: Data were collected from a national cross-sectional survey of 73,728 participants across 31 provinces in mainland China. Residential greenness was assessed with the normalized difference vegetation index (NDVI) and the enhanced vegetation index (EVI). Thyroid nodules >10 mm in diameter were diagnosed via ultrasound. We used quartile comparisons of the NDVI and EVI to compare nodule prevalence and employed logistic regression and restricted cubic spline analyses to examine nodules' associations with greenness. Interaction and sensitivity analyses were performed to test robustness. Results: A total of 73,728 participants were included in this study. The prevalence of 10 mm thyroid nodules decreased across NDVI500 quartiles: Q1: 7.99% (7.59-8.39%), Q2: 10.04% (9.60-10.48%), Q3: 6.59% (6.23-6.95%), and Q4: 5.20% (4.88-5.52%) (p for trend <0.001). The prevalence was 5.25% (95% confidence interval [CI]: 5.02-5.49%) in males and 9.09% (CI: 8.80-9.39%) in females. Logistic regression analysis showed that greater residential greenness was associated with a lower prevalence of thyroid nodules after adjusting for all covariates. This association was observed for both continuous greenness measures (NDVI500: odds ratio [OR] = 0.20, CI: 0.16-0.25; EVI500: OR = 0.08, CI: 0.06-0.12) and across quartiles (NDVI500 Q4: OR = 0.53, CI: 0.48-0.58; EVI500 Q4: OR = 0.55, CI: 0.51-0.60; both compared to Q1). Multiple sensitivity analyses confirmed this negative association, including the use of an alternative thyroid nodule definition (5 mm threshold), exclusion of individuals with cysts on ultrasound, and subgroup analyses excluding individuals with autoimmune thyroid antibody positivity, goiter, or both. In all these sensitivity analyses, NDVI and EVI data were assessed using both 500 m and 1000 m buffers. Conclusion: Our study is the first to identify an association between higher levels of residential greenness and a lower prevalence of thyroid nodules.

Associations of long-term exposure to PM2.5 and its constituents with children renal function: a national retrospective study in China

INTRODUCTION

Ambient fine particulate matter with aerodynamic diameter ≤2.5 μm (PM2.5) harms adult's renal health. However, research on the associations of PM2.5 and its chemical constituents (black carbon (BC), ammonium ( [Formula: see text] ), nitrate (NO3-), organic matter (OM), and sulfate (SO42-)) with children' kidney health is lacking.

OBJECTIVES

The aim of this research was to estimate the associations between long-term exposures to PM2.5 and its constituents and children' estimated glomerular filtration rate (eGFR).

METHODS

We investigated 9770 children from 5 provinces across China during 2016-2017. The eGFR was calculated from serum creatinine. We estimated the mean concentration of PM2.5 and PM2.5 compositions (BC, [Formula: see text] , NO3-, OM, SO42-) during pregnancy, infancy and preschool period for each subject. A generalized linear mixed-effects model was utilized to estimate associations of PM2.5 and its constituents with eGFR. Stratified analyses were conducted to explore effect modifications of sex and urbanicity.

RESULTS

During the full pregnancy, each interquartile range (IQR) increase in PM2.5 mass (49.07 μg/m3), SO42- (9.14 μg/m3), BC (1.85 μg/m3), [Formula: see text] (7.38 μg/m3), NO3- (12.23 μg/m3) and OM (9.02 μg/m3) was associated with decreased eGFR (ml/min/1.73 m2), with changes of -1.80 (95 % CI: -2.82, -0.78), -1.70 (95 % CI: -2.71, -0.69), -1.83 (95 % CI: -2.63, -1.03), -6.87 (95 % CI: -8.44, -5.30), -7.24 (95 % CI: -9.02, -5.45), and -2.20 (95 % CI: -3.12, -1.28), respectively. In infancy, higher levels of BC, [Formula: see text] , NO3-, and OM were negatively associated with eGFR, and similar associations were found during the preschool period for [Formula: see text] , NO3-, and OM. Furthermore, children living in rural areas were particularly sensitive to PM2.5.

CONCLUSION

Long-term exposures to PM2.5 and some constituents were negatively associated with children's eGFR. Additionally, the associations of [Formula: see text] and NO3- constituents were more pronounced with renal health than the other chemical constituents. Targeted policies are needed to protect kidney health from PM2.5 exposure.

Deposition of Air Pollution-Derived Magnetic Nanoparticles in Human Kidney Revealed by High-Resolution Microstructural Characterization

Exposure to air pollutants, especially fine particulate matter (PM2.5), has been recognized as a major contributor to the increasing prevalence of kidney diseases. However, until now, evidence for the translocation of airborne nanoparticles (NPs) in the human kidney has been lacking, hindering the understanding of the relationships between PM2.5 exposure and kidney diseases. Here, we report the discovery and analysis of airborne magnetite nanoparticles in human kidney stones (with mass concentrations ranging from 363 to 740 ng/g dry tissue weight) by high-resolution microstructural characterization. Notably, we established a methodology for highly selective extraction and accurate characterization of distinctive magnetite NPs and identified the abundant presence of these NPs with a distinctive core-shell structure of Fe3O4/SiO2 in both kidney stones and human blood. We demonstrate that such distinctive core-shell magnetite NPs are indicative of a coal-burning source. Hence, magnetite NPs deposited in the human kidneys in this study area most likely derived from air pollution emissions from coal-fired power plants and were transported via blood circulation to the kidney. Our results provide compelling evidence for understanding the systemic health risks of exposure to nanoparticulate, Fe-bearing air pollution and the associations observed between kidney diseases and PM2.5 exposure.

Association between urbanization levels and frailty among middle-aged and older adults in China: evidence from the CHARLS

BACKGROUND

Rapid urbanization is underway in China. However, the impact of urbanization on frailty remains unclear. This study aims to investigate the relationship between urbanization and frailty among middle-aged and older adults.

METHODS

We analyzed nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2011 to 2018. After applying inclusion and exclusion criteria, 10,758 non-frail individuals at baseline were analyzed. The exposure of interest was the comprehensive urbanization level. Urbanization level (0.072-0.689) was assessed using the entropy method. Frailty was assessed using the frailty index (FI), which ranges from 0 to 100. Frailty was defined as FI ≥ 25, and the urbanization-frailty association was assessed using - the restricted cubic spline (RCS) expressions and Cox proportional hazards models. Least absolute shrinkage and selection operator (LASSO) regression were employed to evaluate major factors associated with frailty.

RESULTS

The results revealed a U-shaped nonlinear association between urbanization level and frailty incidence, with a turning point at 0.3 (Pnonlinear < 0.001). In the Cox model, for urbanization scores below 0.3, each ten-percentile increase was associated with an HR of 0.871 (95% CI 0.843-0.900, P < 0.05). Conversely, scores at or above 0.3 had an HR of 1.178 (95% CI 1.053-1.319, P < 0.05) per ten-percentile increase. In the subgroup analysis of participants with urbanization scores below 0.3, there was a significant interaction between current work status and subgroups with dyslipidemia. LASSO regression showed that, for urbanization scores < 0.3, total retail sales (coefficient =  - 0.129) and per capita income (coefficient =  - 0.071) were most protective against frailty. For scores ≥ 0.3, key urbanization factors associated with increased frailty risk included the number of college students per 10,000 people (coefficient = 0.080) and the proportion of built-up land in the urban area (coefficient = 0.060).

CONCLUSIONS

Urbanization level had U-shaped association with frailty incidence. Factors such as total retail sales of consumer goods per capita, per capita disposable income of urban residents, and the number of college students per 10,000 people may be key in formulating a strategy for frailty prevention.

Protective role of vitamin D receptor against mitochondrial calcium overload from PM2.5-Induced injury in renal tubular cells

PURPOSE

This research explores the consequences of being exposed to PM2.5 contribute to renal injury while also evaluating the protective role of Vitamin D-VDR signaling in alleviating mitochondrial calcium imbalance and oxidative stress in renal tubular cells.

METHODS

Animal models of chronic PM2.5 exposure were used to simulate environmental conditions in wild type and VDR-overexpressing mice specific to renal tubules. In parallel, HK-2 cell lines were treated with PM2.5 in vitro. Mitochondrial function, calcium concentration, and oxidative stress markers were assessed. VDR activation, achieved through genetic overexpression and paricalcitol, was induced to examine its effect on mitochondrial calcium uniporter (MCU) expression and mitochondrial calcium regulation.

RESULTS

PM2.5 exposure caused significant mitochondrial damage in renal tubular cells, including mitochondrial calcium overload, increased oxidative stress, reduced membrane potential, and diminished ATP production. Elevated MCU expressions were a key contributor to these disruptions. VDR activation effectively reversed these effects by downregulating MCU, restoring mitochondrial calcium balance, reducing oxidative stress, and improving renal function.

CONCLUSION

This study shows that activating Vitamin D-VDR signaling shields the kidneys from PM2.5-induced damage by reestablishing mitochondrial calcium balance and lowering oxidative stress via inhibition of the MCU. These results unveil a new protective role of VDR in defending against environmental pollutants and suggest that targeting the MCU could offer a potential therapeutic strategy for treating chronic kidney disease linked to pollution exposure.

Per- and Polyfluoroalkyl Substances (PFAS) in Consumer Products: An Overview of the Occurrence, Migration, and Exposure Assessment

Per- and polyfluoroalkyl substances (PFASs) have been widely used in the production of consumer products globally due to the excellent water and oil resistance and anti-fouling properties. The multiple toxic effects of some PFASs also pose a threat to human health and ecosystem, and the frequent use of certain consumer products increased the risk of human exposure to PFASs. More data on the occurrence, concentration, and migration of PFASs in consumer products is urgently needed to address the possible risks posed by exposure to consumer products. This paper reviews the PFAS concentrations found, the migration characteristics known, and the exposure risks of PFASs arising from several types of consumer products over the last five years. The types of consumer products considered here include food contact materials, textiles, and disposable personal hygiene products. The influence of different factors on the migration process of PFASs from these products are summarized and discussed. Additionally, the main approaches and models of exposure assessment are evaluated and summarized. Current challenges and future research prospects in this field are discussed with a view to providing guidance for the future assessment and regulation of PFASs in consumer products.

Harnessing Evolution and Biomimetics to Enhance Planetary Health: Kidney Insights

Planetary health encompasses the understanding that the long-term well-being of humanity is intrinsically linked to the health of global ecological systems. Unfortunately, current practices often overlook this principle, leading to a human-oriented (anthropocentric) worldview that has resulted in heightened greenhouse gas emissions, increased heat stress, lack of access to clean water, and pollution, threatening both the environment and health and survival of Homo sapiens and countless other species. One significant consequence of these environmental changes is the exacerbation of inflammatory and oxidative stressors, which not only contributes to common lifestyle diseases but also accelerates the aging process. We advocate for a shift away from our current anthropocentric frameworks to an approach that focuses on nature's solutions that developed from natural selection over the eons. This approach, which encompasses the field of biomimicry, may provide insights that can help protect against an inflammatory phenotype to mitigate physiological and cellular senescence and provide a buffer against environmental stressors. Gaining insights from how animals have developed ingenious approaches to combat adversity through the evolutionary process of natural selection not only provides solutions for climate change but also confronts the rising burden of lifestyle diseases that accumulate with age.

Does Nonsteroidal Anti-inflammatory Drug Use Modify All-Cause and Cause-Specific Mortality Associated with PM2.5 and Its Components? A Nationally Representative Cohort Study (2007-2017)

Several studies reported that nonsteroidal anti-inflammatory drug (NSAID) use could alleviate subclinical effects of short-term exposure to fine particulate matter (PM2.5). However, whether chronic NSAID use could mitigate the long-term effects of PM2.5 and its components on population mortality has been unknown. Based on a national representative survey of 47,086 adults (2007-2010) with follow-up information on the primary cause of death (until 2017), we investigated the long-term associations of PM2.5 and its major components, including black carbon (BC), ammonium (NH4 +), nitrate (NO3 -), organic matter (OM), and sulfate (SO4 2-), with all-cause and cause-specific mortality using the Cox proportional hazards model. We also evaluated the effect modification by NSAID use (including broad NSAIDs, aspirin, or ibuprofen) on the associations using interaction models. Long-term exposures to PM2.5 and its components were associated with increased risks of all-cause and cause-specific mortality, where BC, OM, and SO4 2- showed stronger associations. Ibuprofen use could mitigate the associations of PM2.5 and its components with mortality risks, while no significant modifying effects of aspirin were observed. For instance, along with per interquartile range increment in PM2.5 concentration (34.8 μg/m3), the hazard ratios (HRs) of all-cause mortality were 1.21 (95% CI: 1.19, 1.22) and 1.10 (95% CI: 1.01, 1.19) in nonibuprofen and ibuprofen use groups (P for interaction = 0.026), respectively. Cause-specific analyses indicated that ibuprofen use could mainly mitigate risks of cardiovascular disease (CVD) especially ischemic heart disease (IHD) mortality attributable to PM2.5 components. Stratified analyses found more apparent mitigating effects of ibuprofen use among participants without chronic diseases, participants ≤50 years, female participants, rural residents, and those with lower education levels. Our findings suggested potential implications in reducing population mortality caused by long-term exposures to PM2.5 and its components through personalized interventions.

Dim blue light at night worsens high-fat diet-induced kidney damage via increasing corticosterone levels and modulating the expression of circadian clock genes

Obesity is a contributing factor that increases the likelihood of developing chronic kidney disease. In recent years, studies have found that light pollution worldwide promoted obesity, which was known to be a consequence of circadian rhythm disruption. Nevertheless, the impact of light pollution on kidney disease associated with obesity remains mostly unknown, and potential processes have been minimally investigated. Herein, we fed mice a high-fat diet and gave them dim white (dWL), blue (dBL), green (dGL), and red (dRL) light for 12 weeks. Our results showed that both dWL and dBL tended to be more susceptible to damage to kidney dysfunction caused by a high-fat diet compared to LD, with more pronounced changes in dBL. The analysis of kidney found that dBL activated the TGF-β1/Smad signaling pathway to promote epithelial-mesenchymal transition (EMT) in the kidney. Additionally, dBL activated the NF-κB signaling pathway and resulted in elevated protein levels of TLR4, p-IκB, p-P65, and TNF-α. Furthermore, dBL increased BAX protein levels and decreased BCL2 protein levels. At the same time, dBL affected the Keap1/Nrf2/HO-1 signaling pathway, elevating KEAP1 and decreasing NRF2 and HO-1 protein levels. We were surprised to find that dBL altered the expression of the circadian clock genes, resulting in a decrease in the positively regulated genes Bmal1, Clock, and an increase in the negatively regulated genes Per1, Per2, Per3. Mechanistically, dBL increased plasma CORT levels as well as decreased renal GR α expression, and in vitro experiments showed that the circadian clock genes were altered by the addition of CORT and returned to normal levels after the addition of the GR inhibitor RU486. Consequently, dBL can exacerbate renal injury by elevating plasma CORT levels and altering rhythmic changes by acting on the biological clock via GR.

Outdoor light at night, air pollution and risk of incident type 2 diabetes

BACKGROUND

Air pollution and outdoor light at night (LAN) have been reported to be related to type 2 diabetes (T2D). However, their interaction with risk of T2D remains uncertain. Therefore, our study aimed to explore the relationship between outdoor LAN, air pollution and incident T2D.

METHODS

Our study included a cohort of 24,147 subjects recruited from 2015 to 2018 in Ningbo, China. Land use regression models were used to evaluate particulate matter with a diameter ≤2.5 μm (PM2.5), ≤10 μm (PM10) and nitrogen dioxide (NO2). Satellite images data with a spatial resolution of 500m was used to estimate outdoor LAN levels. T2D new cases were identified by medical records based on health information system. Cox proportional hazards models were used to estimate Hazard ratios (HRs) and 95% confidence intervals (CIs). Moreover, we investigated the multiplicative and additive interactions between air pollution and outdoor LAN.

RESULTS

During 108,908 person-years of follow-up period, 1016 T2D incident cases were identified. The HRs (95% CIs) were 1.22 (1.15, 1.30) for outdoor LAN, 1.20 (1.00, 1.45) for PM2.5, 1.23 (1.11, 1.35) for PM10 and 1.19 (1.04, 1.37) for NO2 in every interquartile range increase, respectively. Furthermore, significant interactions were observed between outdoor LAN and NO2.

CONCLUSIONS

Our findings indicated that air pollution and outdoor LAN were positively associated with T2D. Moreover, we observed an interaction between outdoor LAN and NO2 suggesting that stronger associations for outdoor LAN and T2D in areas with higher levels of NO2, and for NO2 and T2D in areas with higher levels of outdoor LAN.

Short-Term Effects of NO2 Exposure on Hospitalization for Chronic Kidney Disease

This study investigates the correlation between short-term exposure to nitrogen dioxide (NO2) and hospitalization for chronic kidney disease (CKD) in Lanzhou, China. A distributed lag nonlinear model (DLNM) was employed to examine the relationship between changes in NO2 concentration and CKD hospitalizations. Subgroup analyses were conducted to assess the sensitivity of different populations to NO2 exposure. A total of 35,857 CKD hospitalizations occurred from 1 January 2014 to 31 December 2019. The average daily concentration of NO2 was 47.33 ± 17.27 µg/m3. A significant exposure response relationship was observed between changes in NO2 concentration and the relative risk (RR) of CKD hospitalization. At lag0 (the same day) and lag0-1 (cumulative same day and the previous 1 day) to lag0-4 (cumulative same day and the previous 4 days), NO2 exhibited a harmful effect on CKD hospitalizations, with the maximum effect occurring at lag0-1. For every 10 µg/m3 increase in NO2 concentration, the RR of CKD hospitalization was 1.034 [95% confidence interval (CI): 1.017, 1.050]. Subgroup analyses revealed that the adverse effects of NO2 were more pronounced in females and individuals aged ≥65 years. The harmful effects were also more significant during the cold season. In conclusion, short-term NO2 exposure is associated with an increased relative risk of CKD hospitalization. Continuous efforts to improve air quality are essential to protect public health.

Prolonged exposure to air pollution and risk of acute kidney injury and related mortality: a prospective cohort study based on hospitalized AKI cases and general population controls from the UK Biobank

BACKGROUND

Previous investigations identified a connection between air pollution and kidney diseases. Nevertheless, there is a lack of comprehensive evidence on the long-term risks posed by air pollution with respect to acute kidney injury (AKI) and AKI-related death.

METHODS

This prospective cohort analysis included 414,885 UK Biobank (UKB) participants who did not exhibit AKI at the study's outset. AKI was defined based on ICD-10 codes recorded for hospitalized patients. Cox proportional hazards models were used to assess the association between prolonged exposure to air pollutants (particulate matter with diameters of 2.5 micrometers or less (PM2.5), between 2.5 and 10 micrometers (PM2.5-10), and 10 micrometers or less (PM10), along with nitrogen dioxide (NO2) and nitrogen oxides (NOx)) and the risk of AKI and AKI-related death, adjusting for potential confounders including sex, age, ethnicity, education, income, lifestyle factors, and relevant clinical covariates. Restricted cubic splines were applied to evaluate non-linear dose-response relationships, and stratified analyses were performed to explore potential effect modification across subgroups.

RESULTS

Over an average follow-up duration of 11.7 years, 14,983 cases of AKI and 326 cases of AKI-related death were diagnosed. Quartile analysis showed individuals exposed to higher levels of these air pollutants had a significantly higher risk of developing AKI and AKI-related death compared to those in the lowest quartile (all P < 0.05). The RCS curves depicting the relationship between PM2.5, PM2.5-10, PM10, NO2, NOx, and the risk of AKI showed a significant departure from linearity (P for non-linearity < 0.05), while the relationships between PM2.5, NO2, NOx, and the risk of AKI-related death did not exhibit a significant departure from linearity (P for non-linearity > 0.05). Sensitivity analyses confirmed the robustness of our findings.

CONCLUSION

Our study reveals a direct association between prolonged air pollution exposure and elevated risks of both AKI and AKI-related death. These findings offer scientific validation for the adoption of environmental and public health measures directed towards the reduction of air pollution. Such initiatives could potentially ease the impact associated with AKI and AKI-related death.

Spatial and temporal characteristic of PM2.5 and influence factors in the Yellow River Basin

The Yellow River Basin has been instrumental in advancing ecological preservation and fostering national high-quality development. However, since the advent of China's reform and opening-up policies, the basin has faced severe environmental pollution issues. This study leverages remote sensing data from 1998 to 2019. As per the "Basin Scope and Its Historical Changes" published by the Yellow River Conservancy Commission of the Ministry of Water Resources, the Yellow River Basin is categorized into upstream, midstream, and downstream regions for analysis of their spatial and temporal distribution traits using spatial autocorrelation methods. Additionally, we employed probes to study the effects of 10 factors, including mean surface temperature and air pressure, on PM2.5. The study findings reveal that (1) the annual average concentration of PM2.5 in the Yellow River Basin exhibited a fluctuating trend from 1998 to 2019, initially increasing, then decreasing, followed by another increase before ultimately declining. (2) The air quality in the Yellow River Basin is relatively poor, making it challenging for large-scale areas with low PM2.5 levels to occur. (3) The PM2.5 concentration in the Yellow River Basin exhibits distinct high and low-value concentration areas indicative of air pollution. Low-value areas are predominantly found in the sparsely populated central and southwestern plateau regions of Inner Mongolia, characterized by a better ecological environment. In contrast, high-value areas are prevalent in the inland areas of Northwest China, with poorer natural conditions, as well as densely populated zones with high energy demand and a relatively developed economy. (4) The overall population density in the Yellow River Basin, as well as in the upstream, midstream, and downstream regions, serves as a primary driving factor. (5) The primary drivers in the middle reaches and the entire Yellow River Basin remain consistent, whereas those in the upper and lower reaches have shifted. In the upstream, air pressure emerges as a primary driver of PM2.5, while in the downstream, NDVI and precipitation become the main influencing factors.

Differential associations of fine and coarse particulate air pollution with cause-specific pneumonia mortality: A nationwide, individual-level, case-crossover study

BACKGROUND

The connections between fine particulate matter (PM2.5) and coarse particulate matter (PM2.5-10) and daily mortality of viral pneumonia and bacterial pneumonia were unclear.

OBJECTIVES

To distinguish the connections between PM2.5 and PM2.5-10 and daily mortality due to viral pneumonia and bacterial pneumonia.

METHODS

Using a comprehensive national death registry encompassing all areas of mainland China, we conducted a case-crossover investigation from 2013 to 2019 at an individual level. Residential daily particle concentrations were evaluated using satellite-based models with a spatial resolution of 1 km. To analyze the data, we employed the conditional logistic regression model in conjunction with polynomial distributed lag models.

RESULTS

We included 221,507 pneumonia deaths in China. Every interquartile range (IQR) elevation in concentrations of PM2.5 (lag 0-2 d, 37.6 μg/m3) was associated with higher magnitude of mortality for viral pneumonia (3.03%) than bacterial pneumonia (2.14%), whereas the difference was not significant (p-value for difference = 0.38). An IQR increase in concentrations of PM2.5-10 (lag 0-2 d, 28.4 μg/m3) was also linked to higher magnitude of mortality from viral pneumonia (3.06%) compared to bacterial pneumonia (2.31%), whereas the difference was not significant (p-value for difference = 0.52). After controlling for gaseous pollutants, their effects were all stable; however, with mutual adjustment, the associations of PM2.5 remained, and those of PM2.5-10 were no longer statistically significant. Greater magnitude of associations was noted in individuals aged 75 years and above, as well as during the cold season.

CONCLUSION

This nationwide study presents compelling evidence that both PM2.5 and PM2.5-10 exposures could increase pneumonia mortality of viral and bacterial causes, highlighting the more robust effects of PM2.5 and somewhat higher sensitivity of viral pneumonia.

Associations between long-term exposure to air pollution and kidney function utilizing electronic healthcare records: a cross-sectional study

BACKGROUND

Chronic kidney disease (CKD) affects more than 38 million people in the United States, predominantly those over 65 years of age. While CKD etiology is complex, recent research suggests associations with environmental exposures.

METHODS

Our primary objective is to examine creatinine-based estimated glomerular filtration rate (eGFRcr) and diagnosis of CKD and potential associations with fine particulate matter (PM2.5), ozone (O3), and nitrogen dioxide (NO2) using a random sample of North Carolina electronic healthcare records (EHRs) from 2004 to 2016. We estimated eGFRcr using the serum creatinine-based 2021 CKD-EPI equation. PM2.5 and NO2 data come from a hybrid model using 1 km2 grids and O3 data from 12 km2 CMAQ grids. Exposure concentrations were 1-year averages. We used linear mixed models to estimate eGFRcr per IQR increase of pollutants. We used multiple logistic regression to estimate associations between pollutants and first appearance of CKD. We adjusted for patient sex, race, age, comorbidities, temporality, and 2010 census block group variables.

RESULTS

We found 44,872 serum creatinine measurements among 7,722 patients. An IQR increase in PM2.5 was associated with a 1.63 mL/min/1.73m2 (95% CI: -1.96, -1.31) reduction in eGFRcr, with O3 and NO2 showing positive associations. There were 1,015 patients identified with CKD through e-phenotyping and ICD codes. None of the environmental exposures were positively associated with a first-time measure of eGFRcr < 60 mL/min/1.73m2. NO2 was inversely associated with a first-time diagnosis of CKD with aOR of 0.77 (95% CI: 0.66, 0.90).

CONCLUSIONS

One-year average PM2.5 was associated with reduced eGFRcr, while O3 and NO2 were inversely associated. Neither PM2.5 or O3 were associated with a first-time identification of CKD, NO2 was inversely associated. We recommend future research examining the relationship between air pollution and impaired renal function.

Association between ambient PM1 and the prevalence of chronic kidney disease in China: A nationwide study

Particulate of diameter ≤ 1 µm (PM1) presents a novel risk factor of adverse health effects. Nevertheless, the association of PM1 with the risk of chronic kidney disease (CKD) in the general population is not well understood, particularly in regions with high PM1 levels like China. Based on a nationwide representative survey involving 47,204 adults and multi-source ambient air pollution inversion data, the present study evaluated the association of PM1 with CKD prevalence in China. The two-year average PM1, particulate of diameter ≤ 2.5 µm (PM2.5), and PM1-2.5 values were accessed using a satellite-based random forest approach. CKD was defined as estimated glomerular filtration rate < 60 ml/min/1.73 m2 or albuminuria. The results suggested that a 10 μg/m3 rise in PM1 was related to a higher CKD risk (odds ratio [OR], 1.13; 95% confidence interval [CI] 1.08-1.18) and albuminuria (OR, 1.11; 95% CI, 1.05-1.17). The association between PM1 and CKD was more evident among urban populations, older adults, and those without comorbidities such as diabetes or hypertension. Every 1% increase in the PM1/PM2.5 ratio was related to the prevalence of CKD (OR, 1.03; 95% CI, 1.03-1.04), but no significant relationship was found for PM1-2.5. In conclusion, the present study demonstrated long-term exposure to PM1 was associated with an increased risk of CKD in the general population and PM1 might play a leading role in the observed relationship of PM2.5 with the risk of CKD. These findings provide crucial evidence for developing air pollution control strategies to reduce the burden of CKD.

Temporal trends in prevalence and disability of chronic kidney disease caused by specific etiologies: an analysis of the Global Burden of Disease Study 2019

BACKGROUND

The prevalence of disability in CKD is high. In this context the aim of the present study was to assess the  temporal trends of prevalence and disability progression for chronic kidney disease (CKD) caused by specific etiologies.

METHODS

Using data from the Global Burden of Diseases Study (GBD) 2019, we examined the age-standardized rates of CKD prevalence and disability-adjusted life-years for different etiologies, including Type 1/2 diabetes mellitus (T1DM/T2DM), glomerulonephritis, and hypertension. We also calculated the average annual percentage changes to assess trends. Additionally, we utilized the joinpoint regression model to identify significant shifts over time.

RESULTS

From 1990 to 2019, the global prevalence of CKD due to various etiologies exhibited an overall increasing trend, albeit with fluctuations. Notably, CKD due to T1DM, glomerulonephritis, and hypertension consistently demonstrated a significant upward trend across all continents, while the prevalence of CKD due to T2DM varied across continents. In terms of disability-adjusted life-years, CKD due to T2DM and hypertension exhibited a significant rising trend over the past 30 years. However, changes in age standardized disability-adjusted life-years for CKD due to different etiologies were not consistent across continents, with an upward trend observed in The Americas and a contrasting trend in Asia. Furthermore, both age-standardized prevalence rate and age standardized disability-adjusted life-year trends for CKD varied significantly across 204 countries and territories. Additionally, a negative association was observed between the Socio-demographic Index and the disability progression of CKD.

CONCLUSION

The prevalence and disability burden of CKD caused by specific etiologies show substantial heterogeneity worldwide, highlighting significant disparities in the distribution of CKD. It is crucial to implement geographic and personalized strategies in different regions to alleviate the burden of CKD effectively.

Outdoor Light at Night, Air Pollution, and Risk of Cerebrovascular Disease: A Cohort Study in China

BACKGROUND

We sought to explore the associations of outdoor light at night (LAN) and air pollution with the risk of cerebrovascular disease (CeVD).

METHODS

We included a total of 28 302 participants enrolled in Ningbo, China from 2015 to 2018. Outdoor LAN and air pollution were assessed by Satellite-derived images and land-use regression models. CeVD cases were confirmed by medical records and death certificates and further subdivided into ischemic and hemorrhagic stroke. Cox proportional hazard models were used to estimate hazard ratios and 95% CIs.

RESULTS

A total of 1278 CeVD cases (including 777 ischemic and 133 hemorrhagic stroke cases) were identified during 127 877 person-years of follow-up. In the single-exposure models, the hazard ratios for CeVD were 1.17 (95% CI, 1.06-1.29) for outdoor LAN, 1.25 (1.12-1.39) for particulate matter with an aerodynamic diameter ≤2.5 µm, 1.14 (1.06-1.22) for particulate matter with aerodynamic diameter ≤10 μm, and 1.21 (1.06-1.38) for NO2 in every interquartile range increase. The results were similar for ischemic stroke, whereas no association was observed for hemorrhagic stroke. In the multiple-exposure models, the associations of outdoor LAN and PM with CeVD persisted but not for ischemic stroke. Furthermore, no interaction was observed between outdoor LAN and air pollution.

CONCLUSIONS

Levels of exposure to outdoor LAN and air pollution were positively associated with the risk of CeVD. Furthermore, the detrimental effects of outdoor LAN and air pollution might be mutually independent.

Associations between heat waves and chronic kidney disease in China: The modifying role of land cover

The increasing frequency of heat waves under the global urbanization and climate change background poses elevating risks of chronic kidney disease (CKD). Nevertheless, there has been no evidence on associations between long-term exposures to heat waves and CKD as well as the modifying effects of land cover patterns. Based on a national representative population-based survey on CKD covering 47,086 adults and high spatial resolution datasets on temperature and land cover data, we found that annual days of exposure to heat waves were associated with increased odds of CKD prevalence. For one day/year increases in HW_975_4d (above 97.5 % of annual maximum temperature and lasting for at least 4 consecutive days), the odds ratio (OR) of CKD was 1.14 (95 %CI: 1.12, 1.15). Meanwhile, stronger associations were observed in regions with lower urbanicity [rural: 1.14 (95 %CI: 1.12, 1.16) vs urban: 1.07 (95 %CI: 1.03, 1.11), Pinteraction < 0.001], lower water body coverage [lower: 1.14 (95 %CI: 1.12, 1.16) vs higher: 1.02 (95 %CI: 0.98, 1.05), Pinteraction < 0.001], and lower impervious area coverage [lower: 1.16 (95 %CI: 1.14, 1.18) vs higher: 1.06 (95 %CI: 1.03, 1.10), Pinteraction = 0.008]. In addition, this study found disparities in modifying effects of water bodies and impervious areas in rural and urban settings. In rural regions, the associations between heat waves and CKD prevalence showed a consistent decreasing trend with increases in both proportions of water bodies and impervious areas (Pinteraction < 0.05). Nevertheless, in urban regions, we observed significant effect modification by water bodies, but not by impervious areas. Our study indicates the need for targeted land planning as part of adapting to the kidney impacts of heat waves, with a focus on urbanization in rural regions, as well as water body construction and utilization in both rural and urban regions.

Investigating strontium isotope linkage between biominerals (uroliths), drinking water and environmental matrices

This study presents the mineralogy and strontium isotope ratio (87Sr/86Sr) of 21 pathological biominerals (bladder and kidney stones) collected from patients admitted between 2018 and 2020 at the Department of Urology of the San Pio Hospital (Benevento, southern Italy). Urinary stones belong to the calcium oxalate, purine or calcium phosphate mineralogy types. Their corresponding 87Sr/86Sr range from 0.707607 for an uricite sample to 0.709970 for a weddellite one, and seem to be partly discriminated based on the mineralogy. The comparison with the isotope characteristics of 38 representative Italian bottled and tap drinking waters show a general overlap in 87Sr/86Sr with the biominerals. However, on a smaller geographic area (Campania Region), we observe small 87Sr/86Sr differences between the biominerals and local waters. This may be explained by external Sr inputs for example from agriculture practices, inhaled aerosols (i.e., particulate matter), animal manure and sewage, non-regional foods. Nevertheless, biominerals of patients that stated to drink and eat local water/wines and foods every day exhibited a narrower 87Sr/86Sr range roughly matching the typical isotope ratios of local geological materials and waters, as well as those of archaeological biominerals from the same area. Finally, we conclude that the strontium isotope signature of urinary stones may reflect that of the environmental matrices surrounding patients, but future investigations are recommended to ultimately establish the potential for pathological biominerals as reliable biomonitoring proxies, taking into the account the contribution of the external sources of Sr.

Ambient PM2.5 components and prevalence of chronic kidney disease: a nationwide cross-sectional survey in China

OBJECTIVES

Chronic kidney disease (CKD) is a global public health concern, and accumulating evidence has indicated that air pollution increases the odds of CKD. However, a limited number of studies have examined the long-term effects of ambient fine particulate matter (PM2.5) components on the risk of CKD among general population; thus, major knowledge gaps remain.

METHODS

Using data from a nationwide representative cross-sectional survey in China and a validated PM2.5 composition dataset, we established generalized linear models to quantify the association between five major components of PM2.5 and CKD prevalence.

RESULTS

There were significant associations between long-term exposure to three PM2.5 components [including black carbon (BC), sulfate (SO42-), organic matter (OM)] and increased odds of CKD prevalence. Along with an interquartile range (IQR) increment in BC (3.3 μg/m3), SO42- (9.7 μg/m3), and OM (16.2 μg/m3) at a 4-year moving average, the odds ratios (ORs) for CKD prevalence were 1.28 (95% CI 1.07, 1.54), 1.23 (95% CI 1.03, 1.45), and 1.23 (95% CI 1.02, 1.47), respectively. We did not detect any significant association of the other two PM2.5 components [nitrate (NO3-) or ammonium (NH4+)] with CKD prevalence. Stratified analyses revealed no differences (P ≥ 0.05) in the effect estimates of subgroups based on administrative region, sex, age, and other demographic characteristics. For instance, along with an IQR increment in BC at a 4-year moving average, the ORs of CKD prevalence among males and females were 1.30 (95% CI 0.98, 1.73) and 1.29 (95% CI 1.01, 1.65), respectively. The odds of CKD were generally higher with increasing PM2.5 composition concentration.

CONCLUSIONS

Our study demonstrated that long-term exposure to specific PM2.5 components including BC, SO42-, and OM increased CKD risk in the general population. This study could provide new insights into source-directed PM2.5 control and CKD prevention.

Air pollution and the risk of incident chronic kidney disease in patients with diabetes: An exposure-response analysis

Impact of air pollution on incident chronic kidney disease (CKD) in diabetic patients is insufficiently studied. We aimed to examine exposure-response associations of PM2.5, PM10, PM2.5-10, NO2, and NOX with incident CKD in diabetic patients in the UK. We also widened exposure level of PM2.5 and examined PM2.5-CKD association in diabetic patients across the entire range of global concentration. Based on data from UK biobank cohort, we applied Cox proportional hazards models and the shape constrained health impact function to investigate the associations between air pollutants and incident CKD in diabetic patients. Global exposure mortality model was applied to combine the PM2.5-CKD association in diabetic patients in the UK with all other published associations. Multiple air pollutants were positively associated with incident CKD in diabetic patients in the UK, with hazard ratios (HRs) of 1.034 (95 %CI: 1.015-1.053) and 1.021 (95 %CI: 1.007-1.036) for every 1 μg/m3 increase in PM2.5 and PM10 concentration, and 1.113 (95 %CI: 1.053-1.177) and 1.058 (95 %CI: 1.027-1.091) for every 10 μg/m3 increase in NO2 and NOX concentration, respectively. For PM2.5-10, associations with CKD in diabetic patients did not reach the statistical significance. Exposure-response associations with CKD in diabetic patients showed a near-linear trend for PM2.5, PM10, NO2, and NOX in the UK, whereas PM2.5-DKD associations in the globe exhibited a non-linear increasing trend. This study supports that air pollution could significantly increase the risk of CKD onset in diabetic patients.

Association of fine particulate matter (PM2.5) exposure and chronic kidney disease outcomes: a systematic review and meta-analysis

Several studies have reported an increased risk of chronic kidney disease (CKD) outcomes after long-term exposure (more than 1 year) to particulate matter with an aerodynamic diameter of ≤ 2.5 µm (PM2.5). However, the conclusions remain inconsistent. Therefore, we conducted this meta-analysis to examine the association between long-term PM2.5 exposure and CKD outcomes. A literature search was conducted in PubMed, Scopus, Cochrane Central Register of Controlled trials, and Embase for relevant studies published until August 10, 2023. The main outcomes were incidence and prevalence of CKD as well as incidence of end-stage kidney disease (ESKD). The random-effect model meta-analyses were used to estimate the risk of each outcome among studies. Twenty two studies were identified, including 14 cohort studies, and 8 cross-sectional studies, with a total of 7,967,388 participants. This meta-analysis revealed that each 10 μg/m3 increment in PM2.5 was significantly associated with increased risks of both incidence and prevalence of CKD [adjusted odds ratio (OR) 1.31 (95% confidence interval (CI) 1.24 to 1.40), adjusted OR 1.31 (95% CI 1.03 to 1.67), respectively]. In addition, the relationship with ESKD incidence is suggestive of increased risk but not conclusive (adjusted OR 1.16; 95% CI 1.00 to 1.36). The incidence and prevalence of CKD outcomes had a consistent association across all subgroups and adjustment variables. Our study observed an association between long-term PM2.5 exposure and the risks of CKD. However, more dedicated studies are required to show causation that warrants urgent action on PM2.5 to mitigate the global burden of CKD.

Artificial light at night and risk of depression: a systematic review and meta-analysis

BACKGROUND

Artificial light at night (ALAN) has been increasingly recognized as a potential environmental risk factor for mental health issues. However, no meta-analyses have been conducted to summarize the findings. This study aimed to evaluate the pooled associations between outdoor and indoor ALAN exposures and the risk of depression.

METHODS

Adhering to the PRISMA guideline, we conducted systematic searches across PubMed, Web of Science, EMBASE, Cochrane, and Ovid databases for studies published before May 1st, 2024.

RESULTS

A total of 7 studies (5 for outdoor ALAN and 2 for indoor ALAN) with a combined total of 560,219 participants were included in the meta-analysis. Specifically, a 1 nW/cm2/sr increase in outdoor ALAN was associated with a 0.43% (95% CI: 0.21%, 0.65%) increase in depression risk. Meanwhile, a 1 lux increase in indoor ALAN was associated with a 3.29% (95% CI: 0.85%, 5.79%) increase in depression risk. No potential heterogeneity was observed for outdoor ALAN exposure and indoor ALAN exposure. Subgroup analyses for outdoor ALAN indicated that development level, sample size, age group, sex, study design, modality of depression assessment, or adjustment of sleep-related variables in models may not be potential sources of heterogeneity. Sensitivity analyses confirmed the robustness of the findings, while evidence of publication bias was observed for studies on outdoor ALAN.

CONCLUSIONS

Our findings suggest that both outdoor and indoor ALAN exposures are associated with increased risk of depression. These results underscore the importance of considering outdoor and indoor ALAN in public health strategies aimed at reducing depression risk. Nevertheless, further studies with prospective design are still warranted considering the limited study numbers.

Lower regional urbanicity and socioeconomic status attenuate associations of green spaces with hypertension and diabetes mellitus: a national representative cross-sectional study in China

BACKGROUND

High blood pressure (HBP) and diabetes mellitus (DM) are two of the most prevalent cardiometabolic disorders globally, especially among individuals with lower socio-economic status (SES). Studies have linked residential greenness to decreased risks of HBP and DM. However, there has been limited evidence on whether SES may modify the associations of residential greenness with HBP and DM.

METHODS

Based on a national representative cross-sectional study among 44,876 adults, we generated the normalized difference vegetation index (NDVI) at 1 km spatial resolution to characterize individuals' residential greenness level. Administrative classification (urban/rural), nighttime light index (NLI), individual income, and educational levels were used to characterize regional urbanicity and individual SES levels.

RESULTS

We observed weaker inverse associations of NDVI with HBP and DM in rural regions compared to urban regions. For instance, along with per interquartile range (IQR, 0.26) increment in residential NDVI at 0∼5 year moving averages, the ORs of HBP were 1.04 (95%CI: 0.94, 1.15) in rural regions and 0.85 (95%CI: 0.79, 0.93) in urban regions (P = 0.003). Along with the decrease in NLI levels, there were continuously decreasing inverse associations of NDVI with DM prevalence (P for interaction <0.001). In addition, weaker inverse associations of residential NDVI with HBP and DM prevalence were found among individuals with lower income and lower education levels compared to their counterparts.

CONCLUSIONS

Lower regional urbanicity and individual SES could attenuate the associations of residential greenness with odds of HBP and DM prevalence.

Association of air pollution and risk of chronic kidney disease: A systematic review and meta-analysis

Although epidemiological studies have evaluated the association between ambient air pollution and chronic kidney disease (CKD), the results remain mixed. To clarify the nature of the association, we conducted a comprehensive systematic review and meta-analysis to assess the global relationship between air pollution and CKD. The Web of Science, PubMed, Embase and Cochrane Library databases systematically were searched for studies published up to July 2023 and included 32 studies that met specific criteria. The random effects model was used to derive overall risk estimates for each pollutant. The meta-analysis estimated odds ratio (ORs) of risk for CKD were 1.42 (95% confidence interval [CI]: 1.31-1.54) for each 10 μg/m3 increase in PM2.5 ; 1.20 (95% CI: 1.14-1.26) for each 10 μg/m3 increase in PM10 ; 1.07 (95% CI: 1.05-1.09) for each 10 μg/m3 increase in NO2 ; 1.03 (95% CI: 1.02-1.03) for each 10 μg/m3 increase in NOX ; 1.07 (95% CI: 1.01-1.12) for each 1 ppb increase in SO2 ; 1.03 (95% CI: 1.00-1.05) for each 0.1 ppm increase in CO. Subgroup analysis showed that this effect varied by gender ratio, age, study design, exposure assessment method, and income level. Furthermore, PM2.5 , PM10 , and NO2 had negative effects on CKD even within the World Health Organization-recommended acceptable concentrations. Our results further confirmed the adverse effect of air pollution on the risk of CKD. These findings can contribute to enhance the awareness of the importance of reducing air pollution among public health officials and policymakers.

Exploring the association of PM2.5 with lung cancer incidence under different climate zones and socioeconomic conditions from 2006 to 2016 in China

Air pollution generated by urbanization and industrialization poses a significant negative impact on public health. Particularly, fine particulate matter (PM2.5) has become one of the leading causes of lung cancer mortality worldwide. The relationship between air pollutants and lung cancer has aroused global widespread concerns. Currently, the spatial agglomeration dynamic of lung cancer incidence (LCI) has been seldom discussed, and the spatial heterogeneity of lung cancer's influential factors has been ignored. Moreover, it is still unclear whether different socioeconomic levels and climate zones exhibit modification effects on the relationship between PM2.5 and LCI. In the present work, spatial autocorrelation was adopted to reveal the spatial aggregation dynamic of LCI, the emerging hot spot analysis was introduced to indicate the hot spot changes of LCI, and the geographically and temporally weighted regression (GTWR) model was used to determine the affecting factors of LCI and their spatial heterogeneity. Then, the modification effects of PM2.5 on the LCI under different socioeconomic levels and climatic zones were explored. Some findings were obtained. The LCI demonstrated a significant spatial autocorrelation, and the hot spots of LCI were mainly concentrated in eastern China. The affecting factors of LCI revealed an obvious spatial heterogeneity. PM2.5 concentration, nighttime light data, 2 m temperature, and 10 m u-component of wind represented significant positive effects on LCI, while education-related POI exhibited significant negative effects on LCI. The LCI in areas with low urbanization rates, low education levels, and extreme climate conditions was more easily affected by PM2.5 than in other areas. The results can provide a scientific basis for the prevention and control of lung cancer and related epidemics.

Influence of urbanization on schistosomiasis infection risk in Anhui Province based on sixteen year's longitudinal surveillance data: a spatio-temporal modelling study

BACKGROUND

Urbanization greatly affects the natural and social environment of human existence and may have a multifactoral impact on parasitic diseases. Schistosomiasis, a common parasitic disease transmitted by the snail Oncomelania hupensis, is mainly found in areas with population aggregations along rivers and lakes where snails live. Previous studies have suggested that factors related to urbanization may influence the infection risk of schistosomiasis, but this association remains unclear. This study aimed to analyse the effect of urbanization on schistosomiasis infection risk from a spatial and temporal perspective in the endemic areas along the Yangtze River Basin in China.

METHODS

County-level schistosomiasis surveillance data and natural environmental factor data covering the whole Anhui Province were collected. The urbanization level was characterized based on night-time light data from the Defense Meteorological Satellite Program Operational Linescan System (DMSP-OLS) and the National Polar-Orbiting Partnership's Visible Infrared Imaging Radiometer Suite (NPP-VIIRS). The geographically and temporally weighted regression model (GTWR) was used to quantify the influence of urbanization on schistosomiasis infection risk with the other potential risk factors controlled. The regression coefficient of urbanization was tested for significance (α = 0.05), and the influence of urbanization on schistosomiasis infection risk was analysed over time and across space based on significant regression coefficients. Variables studied included climate, soil, vegetation, hydrology and topography.

RESULTS

The mean regression coefficient for urbanization (0.167) is second only to the leached soil area (0.300), which shows that the urbanization is the most important influence factors for schistosomiasis infection risk besides leached soil area. The other important variables are distance to the nearest water source (0.165), mean minimum temperature (0.130), broadleaf forest area (0.105), amount of precipitation (0.073), surface temperature (0.066), soil bulk density (0.037) and grassland area (0.031). The influence of urbanization on schistosomiasis infection risk showed a decreasing trend year by year. During the study period, the significant coefficient of urbanization level increased from - 0.205 to - 0.131.

CONCLUSIONS

The influence of urbanization on schistosomiasis infection has spatio-temporal heterogeneous. The urbanization does reduce the risk of schistosomiasis infection to some extend, but the strength of this influence decreases with increasing urbanization. Additionally, the effect of urbanization on schistosomiasis infection risk was greater than previous reported natural environmental factors. This study provides scientific basis for understanding the influence of urbanization on schistosomiasis, and also provides the feasible research methods for other similar studies to answer the issue about the impact of urbanization on disease risk.

Associations of multiple air pollutants with kidney function in normal-weight and obese adults and effect modification by free fatty acids

Increasing studies have linked air pollution to kidney dysfunction, however, the associations between the mixture of air pollutants and kidney function and potential effect modifiers remain unclear. We aimed to investigate whether obese adults were more susceptible than normal-weight ones to the joint effects of multiple air pollutants on kidney function and further to explore effect modification by free fatty acids (FFAs). Forty obese and 49 normal-weight adults were recruited from a panel study (252 follow-up visits). Individual exposure levels of air pollutants (PM2.5, PM10, O3, NO2, SO2 and CO) were estimated. Glomerular function (cystatin C (CysC) and estimated glomerular filtration rate (eGFR)) and tubular function (neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1) were evaluated. Plasma levels of FFAs including trans fatty acids (TFAs) and essential fatty acids (EFAs) were quantified using targeted metabolomics. Bayesian kernel machine regression model was applied to estimate the associations between the mixture of air pollutants and kidney function. The results showed significant joint effects of air pollutants on kidney function indicators. In the normal-weight group, the mixture of air pollutants was significantly associated with CysC and eGFRcr-cys when the mixture was at or above its 70 percentile compared with the median, where O3 was identified as the key pollutant. In the obese group, a significantly positive association between the pollutant mixture and NGAL was observed in addition to trends in CysC and eGFRcr-cys, mainly driven by SO2. Interaction analysis suggested that the associations of air pollutants with kidney function were augmented by TFAs in both groups and weakened by EFAs in the normal-weight group. This study highlighted the renal adverse effects of air pollutants and modification of FFAs, which has implications for target prevention for kidney dysfunction associated with air pollution, especially among vulnerable populations.

Long-term ozone exposure is negatively associated with estimated glomerular filtration rate in Chinese middle-aged and elderly adults

Chronic kidney disease (CKD) is an inflammatory disease characterized by the deterioration of renal function, which imposes a significant burden on the healthcare system. In the recent decades, the ageing of the population and the increase of ozone pollution have accelerated. However, epidemiological associations between long-term ozone exposure and renal function in susceptible populations are understudied. In this study, we aimed to investigate the association of 1 y ozone exposure with renal function among the older adults in Xiamen City, China. We recruited 6024 eligible participants with a median age of 65.00 years, estimated their ozone exposure data, and collected questionnaires on demographic status and lifestyle factors as well as information on healthcare access. A generalized linear model was used to assess the association. An increase of 10 μg/m3 of 1 y ozone exposure was negatively associated with the estimated glomerular filtration rate (eGFR) [-3.12 (95% CI: -4.76, -1.48)]. The associations were stronger in men, non-smokers, and those with hypertension or T2DM. Clinical indicators of high-density lipoprotein, low-density lipoprotein, triglycerides, and total cholesterol were the main mediators to regulate the ozone-renal function association. Our results suggested that long-term ozone exposure is a potential risk factor for renal function in Chinese middle-aged and elderly adults.

Associations between exposure to ambient particulate matter and advanced liver fibrosis in Chinese MAFLD patients

BACKGROUND & AIMS

Liver fibrosis is an important feature in patients with metabolic dysfunction-associated fatty liver disease (MAFLD). This study aimed to explore the association between long-term ambient particulate matter (PM) exposure and advanced liver fibrosis (ALF) in MAFLD participants.

METHODS

A cross-sectional study of 23170 adults recruited from 33 provinces of China from 2010 to 2020. ALF was detected using the nonalcoholic fatty liver disease fibrosis score (NFS). The annual average levels of particulate matter with aerodynamic diameters of ≤ 1 µm (PM1), ≤ 2.5 µm (PM2.5) and ≤ 10 µm (PM10) were calculated using validated spatiotemporal models. Generalized additive models were applied to analyze the association between PM and ALF in patients with MAFLD.

RESULTS

One-year exposure to higher levels of all PM was found to increase the risk of ALF, with odds ratios (ORs) of 1.10 (95% CI 1.06-1.14), 1.05 (1.03-1.07), and 1.03(1.02-1.04) for each 10 μg/m3 increase in PM1, PM2.5 and PM10, respectively. With the dissection of the impact of PM1 in PM2.5, PM2.5 in PM10 and PM1 in PM10, we found that PM2.5 had a stronger impact on ALF (both Pinteraction＜0.05) in comparison with PM1 and PM10.

CONCLUSIONS

Long-term exposure to PM is associated with ALF in patients with MAFLD, with PM2.5 playing a dominant role.

Fine and coarse particulate air pollution and out-of-hospital cardiac arrest onset: a nationwide case-crossover study in China

Out-of-hospital cardiac arrest (OHCA) is a global public health concern. Nationwide studies on the effects of short-term exposure to particulate matter (PM) on OHCA risk are rare in regions with high PM levels, and evidence for coarse PM (PM_2.5-10) is limited and inconsistent. To evaluate the associations between fine PM (PM_2.5) and PM_2.5-10 and OHCA onset, a time-stratified case-crossover study was conducted on 77,261 patients with cardiac OHCA in 26 cities across China in 2020. Daily PM_2.5 and PM_2.5-10 concentrations were assessed with high-resolution and full-coverage PM estimations. Conditional logistic regression models were applied in analyses. Each interquartile range of PM increase in 3-day moving average was associated with an increased risk of cardiac OHCA onset of 2.37% (95% CI, 1.20-3.56%) for PM_2.5 and 2.12% (95% CI, 0.70-3.56%) for PM_2.5-10. Stratified analyses showed higher susceptibility in patients over 75 years for PM_2.5 exposure and with diabetes for PM_2.5-10. This first nationwide study in region with high PM levels and great PM variability found not only PM_2.5 but also PM_2.5-10 were associated with a higher risk of OHCA onset, which could add powerful epidemiological evidence to this field and provide new evidence for the formulation of air quality guidelines.

National trends in the prevalence of chronic kidney disease among Korean adults, 2007-2020

Little is known about the prevalence of chronic kidney disease (CKD) during the coronavirus disease 2019 (COVID-19) pandemic. We aimed to investigate the long-term trends in CKD prevalence from South Korea including the early pandemic. We used data from 108,152 Korean adults from 2007 to 2020 obtained from a representative longitudinal serial study. We defined CKD as a condition when the participant's estimated glomerular filtration rate was < 60 mL/min/1.73 m², or one-time spot proteinuria was ≥ 1 +, and then examined the overall trends in the prevalence of CKD. Among the included adults (n = 80,010), the overall national prevalence of CKD was 6.2%. The trend slope gradually increased from 2007 to 2019, however, there was a sudden decrease in 2020 (2007-2010, 5.1% [95% confidence interval (CI) 4.7-5.5]; 2017-2019, 7.1% [95% CI 6.6-7.6]; pandemic period, 6.5% [95% CI 5.7-7.3]; and β_diff, - 0.19; 95% CI - 0.24 to - 0.13). The prevalence of CKD among younger adults and those with poor medical utilization significantly decreased during the early pandemic. This study was the first large-scale study to investigate the longitudinal prevalence of CKD from 2007 to 2020. Further research is needed to fully understand the exact causes for this decline and to identify healthcare policy strategies for preventing and managing CKD.

Light at night and cause-specific mortality risk in Mainland China: a nationwide observational study

BACKGROUND

While epidemiological studies have found correlations between light at night (LAN) and health effects, none has so far investigated the impacts of LAN on population mortality yet. We aimed to estimate the relative risk for mortality from exposure to LAN in Mainland China.

METHODS

This time-stratified case-crossover nationwide study used NPP-VIIRS to obtain daily LAN data of Mainland China between 2015 and 2019. The daily mortality data were obtained from the Disease Surveillance Point System in China. Conditional Poisson regression models were applied to examine the relative risk (RR) for mortality along daily LAN in each county, then meta-analysis was performed to combine the county-specific estimates at the national or regional level.

RESULTS

A total of 579 counties with an average daily LAN of 4.39 (range: 1.02-35.46) were included in the main analysis. The overall RRs per 100 nW/cm²/sr increases in daily LAN were 1.08 (95%CI: 1.05-1.11) for all-cause mortality and 1.08 (95%CI: 1.05-1.11) for natural-cause mortality. A positive association between LAN and all natural cause-specific mortality was observed, of which the strongest effect was observed on mortality caused by neuron system disease (RR = 1.32, 95%CI: 1.14-1.52). The results were robust in both younger and old, as well as in males and females. The more pronounced effect of LAN was observed in median LAN-level regions. Combined with an exposure-response curve, our study suggests a non-linear association between LAN and mortality in China.

CONCLUSIONS

Our study shows LAN is associated with mortality in China, particularly for neuron system disease-related mortality. These findings have important implications for public health policy establishment to minimize the health consequences of light pollution.

Effects of ambient air pollution on cause-specific hospitalizations in Wuhan during 2017-2019

BACKGROUND

Few studies have focused on the associations between air pollutants and multiple organ system diseases in the entire hospitalized population. The present study aims to explore the short-term effects of six routinely monitored air pollutants on the broad causes of hospital admissions and estimate the resulting hospital admission burdens.

METHODS

Daily hospital admission records from 2017 to 2019 were obtained from the Wuhan Information center of Health and Family Planning. Generalized additive models (GAMs) were employed to evaluate the effects of air pollutants on the percent increase in the cause-specific daily number of hospital admissions. Increased hospital admission numbers, days, and expenses were also estimated.

RESULTS

A total of 2636,026 hospital admissions were identified. We found that both PM_2.5 and PM₁₀ increased the risk of hospital admissions for most disease categories. Short-term exposure to PM_2.5 was positively associated with hospitalizations of several rarely studied disease categories, such as diseases of the eye and adnexa (2.83%, 95%CI: 0.96-4.73%, P < 0.01) and diseases of the musculoskeletal system and connective tissue (2.17%, 95% CI: 0.88-3.47%, P < 0.001). NO₂ was observed to have a robust effect on diseases of the respiratory system (1.36%, 95%CI: 0.74-1.98%, P < 0.001). CO was significantly associated with hospital admissions for six disease categories. Furthermore, each 10-μg/m³ increase in PM_2.5 was associated with an annual increase of 13,444 hospital admissions (95% CI: 6239-20,649), 124,344 admission days (95% CI: 57,705-190,983), and 166-million-yuan admission expenses (95% CI: 77-255).

CONCLUSION

Our study suggested that particulate matter (PM) had a short-term effect on hospital admissions of most major disease categories and resulted in a considerable hospital admission burden. In addition, the health effects of NO₂ and CO emissions require more attention in megacities.

Regional urbanicity levels modify the association between ambient air pollution and prevalence of obesity: A nationwide cross-sectional survey

Ambient air pollution exposure may increase the risk of obesity, but the population susceptibility associated with urbanicity has been insufficiently investigated. Based on a nationwide representative cross-sectional survey on 44,544 adults, high-resolution night light satellite remote sensing products, and multi-source ambient air pollution inversion data, the present study evaluated the associations of fine particulate matter (PM_2.5) and nitrogen dioxide (NO₂) concentrations with the prevalence of obesity and abdominal obesity. We further calculated the associations in regions with different urbanicity levels characterized by both administrative classification of urban/rural regions and night light index (NLI). We found that 10 μg/m³ increments in PM_2.5 at 1-year moving average and in NO₂ at 5-year moving average were associated with increased prevalence of obesity [odds ratios (OR) = 1.16 (1.14, 1.19); 1.12 (1.09, 1.15), respectively] and abdominal obesity [OR = 1.08 (1.07, 1.10); 1.07 (1.05, 1.09), respectively]. People in rural regions experienced stronger adverse effects than those in urban regions. For instance, a 10 μg/m³ increment in PM_2.5 was associated with stronger odds of obesity in rural regions than in urban regions [OR = 1.27 (1.23, 1.31) vs 1.10 (1.05, 1.14), P for interaction <0.001]. In addition, lower NLI values were associated with constantly amplified associations of PM_2.5 and NO₂ with obesity and abdominal obesity (all P for interaction <0.001). In summary, people in less urbanized regions are more susceptible to the adverse effects of ambient air pollution on obesity, suggesting the significance of collaborative planning of urbanization development and air pollution control, especially in less urbanized regions.

Air pollutants, genetic factors, and risk of chronic kidney disease: Findings from the UK Biobank

BACKGROUND

Experiment studies have suggested the emerging role of air pollutants in chronic kidney disease (CKD). However, only a few population studies conducted in Asia and North America have assessed their association, and the conclusions remained controversial. This study aims to investigate the effect of air pollutants exposure on CKD in the European population and first explores the modification effect of genetic risk on this association.

METHODS

458,968 participants from the UK Biobank were included in this study. Cox proportional hazards model was used to assess the associations of air pollutants (PM_2.5, PM₁₀, NO₂, and NO_x) with incident CKD. A genetic risk score of 53 single nucleotide polymorphisms was constructed to represent the genetic susceptibility to CKD. To assess the interaction effect between air pollutants and the genetic risk, we added a multiplicative interaction term and did a stratified analysis.

RESULTS

During a median follow-up of 11.7 years, 16,637 incidents of CKD were identified. We observed positive associations between air pollutants exposure and CKD risk with the HRs for CKD were 1.09 (1.07, 1.11), 1.08 (1.06, 1.10), 1.05 (1.03, 1.07), 1.06 (1.04, 1.08) with per IQR (interquartile range) increment in PM_2.5, PM₁₀, NO₂, and NO_x, respectively. Stratified analysis showed that the associations between air pollutants and CKD were modest and marginal in the high genetic risk population (P > 0.05), while the associations were statistically significant in the low and intermediate genetic risk groups.

CONCLUSIONS

Our study indicated that exposure to various air pollutants, including PM_2.5, PM₁₀, NO₂, and NO_x, was associated with an elevated risk of CKD. This finding provide evidence that formulating strategies to improve air quality can be helpful to reduce the burden of CKD.

Multi-pollutant air pollution and renal health in Asian children and adolescents: An 18-year longitudinal study

BACKGROUND

Few studies have examined the effects of multi-pollutant air pollution on renal health, especially in children and adolescents. This study investigated the association between long-term ambient air pollution exposure and renal health in Asian children and adolescents.

METHODS

This study included 10,942 children and adolescents from Taiwan and Hong Kong between 2000 and 2017. PM_2.5, NO₂ and O₃ concentrations were estimated using satellite-based spatiotemporal regression models. Two-year average concentrations, those of the year of visit and the preceding year, were used. Linear mixed models were used to examine the association between air pollution and yearly changes in estimated glomerular filtration rate (eGFR). Cox regression models with time-dependent covariates were used to examine the association between air pollution and the development of chronic kidney disease (CKD).

RESULTS

Median age of the participants was 19 years (range: 2-25). The overall average concentration of PM_2.5, NO₂ and O₃ was 26.7 μg/m³, 44.1 μg/m³ and 51.1 μg/m³, respectively. The mean yearly change in eGFR was 0.37 μL/min/1.73 m² and the incidence rate of CKD was 6.8 per 1,000 person-years. In single-pollutant models, each 10 μg/m³ increase in PM_2.5 was associated with a 0.45 μL/min/1.73 m² [95% confidence interval (CI): 0.28-0.63] reduction in the yearly increase in eGFR and 53% [hazard ratio (HR): 1.53 (95%CI: 1.07-2.2)] greater risk of incident CKD. Each 10 μg/m³ increase in NO₂ was associated with a 7% [HR (95%CI): 1.07 (1.00-1.15)] higher risk of incident CKD, while an equivalent increase in O₃ was associated with a 19% [HR (95%CI): 0.81 (0.67-0.98)] lower risk.

CONCLUSIONS

Long-term exposure to ambient PM_2.5 and NO₂ was associated with a slower growth of eGFR and a higher risk of incident CKD in children and adolescents. Our findings suggest that air pollution control in early life is imperative to improve lifelong renal health and alleviate the CKD burden.

Ambient ozone pollution and prevalence of chronic kidney disease: A nationwide study based on the China National survey of chronic kidney disease

The health hazards of ambient ozone (O₃) pollution are receiving increasing attention worldwide. However, the evidence on the association between O₃ and risks of chronic kidney disease (CKD) remains insufficient and inconsistent, particularly in developing countries where there is an absence of macroscopic investigations at a large population scale. Based on data from a representative nationwide cross-sectional CKD survey in 13 Chinese provinces and a high resolution O₃ air pollution inversion dataset, generalized linear models were used to evaluate the associations of O₃ concentration with prevalence of CKD. The results of this study suggested that long-term O₃ exposure was positively associated with the risk of CKD. A 10 μg/m³ increment in O₃ concentration was associated with an increased odds of CKD prevalence [OR = 1.11 (95% CI: 1.03, 1.21)] among all the 47,086 participants. Stronger associations were found in urban regions, younger adults <65 years, and people with higher socio-economic status (income and education level). A 10 μg/m³ increment in O₃ concentration was associated with a higher increased odds of CKD prevalence in urban regions [OR = 1.31 (95% CI: 1.16, 1.47)] compared to rural regions [OR = 0.95 (95% CI: 0.84, 1.08), P for subgroup difference<0.001]. A stronger association of O₃ concentration with CKD prevalence was found among younger people aged <65 years [OR = 1.21 (95% CI: 1.10, 1.33)] compared to those aged ≥65 years [OR = 0.92 (95% CI: 0.79, 1.07), P for subgroup difference = 0.003]. Our study demonstrated that long-term O₃ exposure may increase risk of CKD in the general Chinese population, and the findings stressed the importance of persistent efforts in air pollution prevention and control.

Joint exposure to outdoor ambient air pollutants and incident chronic kidney disease: A prospective cohort study with 90,032 older adults

OBJECTIVES

There is paucity of studies to investigate the association between combined and long-term exposure to air pollution and the risk of incident chronic kidney disease (CKD) in older adults.

METHODS

A prospective cohort of 90,032 older adults who did not have CKD at baseline were followed up from January 1, 2017, to December 31, 2019. Various pollutant data, including particulate matter with diameters ≤ 2.5 mm (PM2.5), ≤ 10 mm (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), Ozone (O3), and carbon monoxide (CO), from all monitoring stations in Binhai New Area, Tianjin were considered in calculating the mean exposure concentration of each pollutant over 2 years. By summing each pollutant concentration weighted by the regression coefficients, we developed an air pollution score that assesses the combined exposure of these air pollutants. Due to the strong correlation between air pollutants, Principal Component Analysis (PCA) score was also developed. The association between air pollutants and incident CKD in the elderly was analyzed.

RESULTS

A total of 90,032 subjects participated in this study with a median follow-up of 545 days. Among them, 22,336 (24.8%) developed CKD. The HR (95% CI) for air pollution score and incidence of CKD was 1.062 (1.060-1.063) and p <0.001 after adjusting for all confounders. The adjusted HRs for the quartile subgroups of combined air pollution score were: Q2: 1.064 (1.013-1.117); Q3: 1.141 (1.088-1.198); and Q4: 3.623 (3.482-3.770), respectively (p for trend <0.001). The adjusted HRs for the quartile subgroups of air quality index (AQI) were: Q2: 1.035 (0.985-1.086); Q3: 1.145 (1.091-1.201); and Q4: 3.603 (3.463-3.748), respectively (p for trend <0.001). When the risk score was over 86.9, it significantly rose in a steep curve. The subgroup analysis showed that male, younger or exercise were more likely to develop CKD.

CONCLUSION

Combined air pollution score, AQI, and PCA score were associated with an increased risk of CKD in an exposure-response relationship. Our current results might also provide evidence for developing environmental protection policies.

Harnessing the Full Potential of Multi-Omic Analyses to Advance the Study and Treatment of Chronic Kidney Disease

Chronic kidney disease (CKD) was the 12th leading cause of death globally in 2017 with the prevalence of CKD estimated at ~9%. Early detection and intervention for CKD may improve patient outcomes, but standard testing approaches even in developed countries do not facilitate identification of patients at high risk of developing CKD, nor those progressing to end-stage kidney disease (ESKD). Recent advances in CKD research are moving towards a more personalised approach for CKD. Heritability for CKD ranges from 30% to 75%, yet identified genetic risk factors account for only a small proportion of the inherited contribution to CKD. More in depth analysis of genomic sequencing data in large cohorts is revealing new genetic risk factors for common diagnoses of CKD and providing novel diagnoses for rare forms of CKD. Multi-omic approaches are now being harnessed to improve our understanding of CKD and explain some of the so-called 'missing heritability'. The most common omic analyses employed for CKD are genomics, epigenomics, transcriptomics, metabolomics, proteomics and phenomics. While each of these omics have been reviewed individually, considering integrated multi-omic analysis offers considerable scope to improve our understanding and treatment of CKD. This narrative review summarises current understanding of multi-omic research alongside recent experimental and analytical approaches, discusses current challenges and future perspectives, and offers new insights for CKD.

Short-term association of NO2 with hospital visits for chronic kidney disease and effect modification by temperature in Hefei, China: A time series study

BACKGROUND

A large body of evidence has linked air pollution and temperature with chronic kidney disease (CKD) prevalence and hospitalizations. However, most studies have focused on the influence of heat stress on CKD prevalence, and the potential effect modification of temperature on the association between air pollution and CKD has not been well-investigated. In this study, we examined the associations of the whole temperature spectrum and air pollution with CKD-related hospital visits and explored whether temperature modifies the short-term association of air pollution with CKD-related hospital visits.

METHODS AND FINDINGS

We collected 40 276 CKD-related hospital visits from the first Affiliated Hospital of Anhui Medical University and Anhui Provincial Hospital in Hefei, China, during 2015-2019. A two-stage time-series design was conducted to investigate the associations of air pollution and daily mean temperature with CKD-related hospital visits. First, we estimated the associations between air pollution and CKD-related hospital visits as well as temperature and CKD-related hospital visits. Second, we analyzed the associations of air pollution with CKD hospital visits at different temperatures. We found that NO₂ exposure and low temperature were associated with an increased risk of CKD-related hospital visits. Low temperature enhanced the association between NO₂ exposure and CKD-related hospital visits, with an increase of 4.30% (95% CI: 2.47-5.92%) per 10 μg/m³ increment in NO₂ at low temperature. Effect modification of the association between NO₂ and the risk of CKD-related hospital visits was stronger at low temperature across the whole population.

CONCLUSIONS

Our findings indicate that low temperature-related chronic kidney damage should be of immediate public health concern. Impact of NO₂ exposure on the risk of CKD-related hospital visits may increase under the low temperature, which suggests the need for NO₂ exposure mitigation strategies in the context of climate change and an enhanced understanding of the mechanisms underlying the temperature variance of air pollution effect to help reduce the magnitude of the CKD burden on the healthcare systems.

Hydrogels and Hydrogel Nanocomposites: Enhancing Healthcare through Human and Environmental Treatment

Humans are constantly exposed to exogenous chemicals throughout their life, which can lead to a multitude of negative health impacts. Advanced materials can play a key role in preventing or mitigating these impacts through a wide variety of applications. The tunable properties of hydrogels and hydrogel nanocomposites (e.g., swelling behavior, biocompatibility, stimuli responsiveness, functionality, etc.) have deemed them ideal platforms for removal of environmental contaminants, detoxification, and reduction of body burden from exogenous chemical exposures for prevention of disease initiation, and advanced treatment of chronic diseases, including cancer, diabetes, and cardiovascular disease. In this review, three main junctures where the use of hydrogel and hydrogel nanocomposite materials can intervene to positively impact human health are highlighted: 1) preventing exposures to environmental contaminants, 2) prophylactic treatments to prevent chronic disease initiation, and 3) treating chronic diseases after they have developed.

Adverse Effects of fine particulate matter on human kidney functioning: a systematic review

BACKGROUND

Ambient fine particulate matter (PM < 2.5 μm, PM2.5) is gaining increasing attention as an environmental risk factor for health. The kidneys are considered a particularly vulnerable target to the toxic effects that PM2.5 exerts. Alteration of kidney function may lead to a disrupted homeostasis, affecting disparate tissues in the body. This review intends to summarize all relevant knowledge published between January 2000 and December 2021 on the effects of ambient PM2.5 and the adverse effects on kidney function in adults (≥ 18 years).

RESULTS AND DISCUSSION

Studies published in peer-reviewed journals, written in English, regarding the effects of PM2.5 on kidney function and the development and/or exacerbation of kidney disease(s) were included. Of the 587 nonduplicate studies evaluated, 40 were included, comprising of studies on healthy or diagnosed with pre-existing disease (sub)populations. Most of the studies were cohort studies (n = 27), followed by 10 cross-sectional, 1 ecological and 2 time-series studies. One longitudinal study was considered intermediate risk of bias, the other included studies were considered low risk of bias. A large portion of the studies (n = 36) showed that PM2.5 exposure worsened kidney outcome(s) investigated; however, some studies show contradictory results. Measurement of the estimated glomerular filtration rate, for instance, was found to be positively associated (n = 8) as well as negatively associated (n = 4) with PM2.5.

LIMITATIONS AND CONCLUSION

The main limitations of the included studies include residual confounding (e.g., smoking) and lack of individual exposure levels. The majority of included studies focused on specific subpopulations, which may limit generalizability. Evidence of the detrimental effects that ambient PM2.5 may exert on kidney function is emerging. However, further investigations are required to determine how and to what extent air pollution, specifically PM2.5, exerts adverse effects on the kidney and alters its function.

REGISTRATION

The systematic review protocol was submitted and published by the International Prospective Register of Systematic Reviews (PROSPERO; CRD42020175615 ).

Residential greenness and prevalence of chronic kidney disease: Findings from the China National Survey of Chronic Kidney Disease

Green space is associated with many health benefits, but evidence concerning the effects on chronic kidney disease (CKD) has not been investigated. Using the nationwide cross-sectional study of 47,204 adults from the China National Survey of Chronic Kidney Disease dataset and residential greenness assessed by the normalized difference vegetation index (NDVI), this study evaluated the association between residential greenness and CKD prevalence. An interquartile range increase in NDVI_1000m (0.26) was associated with decreased odds of CKD for all participants with an odds ratio (OR) of 0.79 (95% confidence interval [CI]: 0.73-0.86). Subgroup analyses demonstrated more apparent inverse associations in younger adults <65 years, male participants, people in higher socio-economic status, as well as people with smoking and alcohol drinking habit. In addition, more apparent inverse associations were found in regions with higher fine particulate matter (PM_2.5) concentration levels, with OR of 0.56 (95% CI: 0.49, 0.65) for higher pollution regions, and OR of 0.95 (95% CI: 0.83, 1.09) for lower pollution regions (P for interaction <0.001). The exposure-response curves captured more apparent declines in OR of CKD when in lower NDVI_1000m exposure ranges (<0.6), even controlling for the PM_2.5 concentration. Our results indicated that residential greenness might be beneficial for the prevention and control of CKD at the population level, suggesting the positive significance of strengthening green space construction, particularly in regions with low greenness.