Ambient nitrogen dioxide increases risk for hospital-acquired AKI
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Researchers in China found the risk for hospital-acquired AKI increased with higher levels of ambient nitrogen dioxide, according to a retrospective cohort study in Clinical Kidney Journal.
“The transient effect of air pollution on acute kidney diseases has not been fully studied in humans,” Pinghong He, of China’s National Clinical Research Center for Kidney Disease and Guizhou Provincial Institute of Nephritic and Urinary Disease, and colleagues wrote. “[AKI], characterized by an abrupt loss of kidney function, is a common and serious complication observed in hospitalized patients and associated with increased mortality and adverse outcomes, including development and progression of CKD. Maladaptive repairs after repeated AKIs have been recognized as a major pathological cause for CKD.”
He and colleagues analyzed the data of 11,293 adult inpatients (median age, 61.6 years; 67.5% men) with hospital-acquired (HA)-AKI admitted between 2013 and 2015 at 25 tertiary academic medical centers available from the Epidemiology of AKI in Chinese Hospitalized Patients study. They compared these data with particulate matter (PM2.5 and PM10), carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2) and ozone (O3) levels in each medical center’s city during patients’ stay using data collected by the Ministry of Environmental Protection of China from Jan. 1, 2014, to Dec. 31, 2015.
Overall, distribution of exposure level was highly correlated with PM2.5 and PM10 (r = 0.91), intermediately with PM, NO2, SO2 and CO, and less correlated with O3 and other pollutants, the researchers wrote.
In single-pollutant analysis, NO2 and SO2 were significantly linked to HA-AKI risk.
When analyzing all pollutants in one model, investigators found NO2 was the only pollutant associated with HA-AKI risk (RR = 1.063; 95% CI, 1.026-1.101), increasing the risk by 6.3% with each increase of median absolute deviation. It did not have a different effect when accounting for age, gender, baseline eGFR, AKI severity, intensive care needs or season of the year.
While the study was strengthened by accurate determination of AKI onset time and time-stratified case crossover design, it was limited by analysis of pollutants on a city-wide level rather than center-specific and study population from China, which has a higher pollution level than many developed countries, He and colleagues wrote.
“Ambient NO2 is mainly derived from traffic and industrial fuel combustion and has been recognized as an important driver of increasing greenhouse gas emissions globally,” they wrote. “Our findings call for more awareness among policy makers, industries, medical researchers and the public of the adverse effects of air pollution on kidney health.”
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