Wildfire smoke exposure linked to mortality in patients with kidney failure
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Recently published findings suggest patients receiving in-center hemodialysis may experience increased mortality risk following exposure to air pollution from wildfire smoke.
Ana Rappold, PhD, of the Center for Public Health and Environmental Assessment, clinical research branch at the U.S. Environmental Protection Agency, told Healio Nephrology that while the impact was greatest immediately following exposure, mortality rates remained elevated for up to 30 days.
Citing the recent wildfires that occurred in California and Washington state, Rappold contended that “wildfires are a growing public health hazard in this country and worldwide.
“In addition to the destruction of property, wildfires produce high concentrations of fine particulate matter (PM2.5), an air pollutant linked to increased morbidity and mortality when inhaled,” she said. “Greater health impacts have been observed consistently in sensitive populations including the elderly and individuals with chronic health conditions.”
Speculating that patients with end-stage kidney disease could therefore be especially susceptible to adverse health impacts from this source of air pollution, Rappold and colleagues considered daily exposure to wildfire-originated PM2.5 and mortality risk by linking data from the community multiscale air quality (CMAQ) model with the U.S. Renal Data System. In total, researchers examined 48,454 deaths of patients receiving hemodialysis in 253 counties between 2008 and 2012.
Rappold noted that patients who received peritoneal dialysis were excluded from the study because their disease status likely differs from those on hemodialysis.
“Their exposure may [also] be substantially different from the exposure at the location of the dialysis clinic,” she added.
Results of the analysis demonstrated a positive association between exposure to wildfire smoke and all-cause mortality, with researchers observing a 4% increase in daily mortality (rate ratio [RR] = 1.04) per 10 g/m3 in wildfire PM2.5 and a 7% increase in mortality during the course of 30 days following exposure (RR = 1.07).
Further findings indicated that on days with wildfire PM2.5 greater than 10 g/m3, fires accounted for 8.4% of daily mortality.
Rappold emphasized that although patients receiving chronic dialysis have a mortality rate higher than an age-matched group of Medicare eligible patients, not many modifiable medical risk factors have been proven to effectively reduce the risk.
However, she is encouraged by the knowledge obtained in the last decade regarding the impact of the environment on health, most notably PM2.5, which she said can be regulated through legislative action.
“At this moment, very little is known about how PM2.5 affects patients on dialysis,” she said. “The[se] findings support the need for more research to develop and implement interventions to manage exposure to particulate matter during wildfire smoke episodes in this and other populations with a high prevalence of frailty.”
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