Estimates of the 2016 global burden of kidney disease attributable to ambient fine particulate matter air pollution

Abstract

ObjectiveTo quantitate the 2016 global and national burden of chronic kidney disease (CKD) attributable to ambient fine particulate matter air pollution ≤ 2.5 μm in aerodynamic diameter (PM2.5).DesignWe used the Global Burden of Disease (GBD) study data and methodologies to estimate the 2016 burden of CKD attributable to PM2.5in 194 countries and territories. Population-weighted PM2.5levels and incident rates of CKD for each country were curated from the GBD study publicly available data sources.SettingGBD global and national data on PM2.5and CKD.Participants194 countries and territories.Main outcome measuresWe estimated the attributable burden of disease (ABD), years living with disability (YLD), years of life lost (YLL) and disability-adjusted life-years (DALYs).ResultsThe 2016 global burden of incident CKD attributable to PM2.5was 6 950 514 (95% uncertainty interval: 5 061 533–8 914 745). Global YLD, YLL and DALYs of CKD attributable to PM2.5were 2 849 311 (1 875 219–3 983 941), 8 587 735 (6 355 784–10 772 239) and 11 445 397 (8 380 246–14 554 091), respectively. Age-standardised ABD, YLL, YLD and DALY rates varied substantially among geographies. Populations in Mesoamerica, Northern Africa, several countries in the Eastern Mediterranean region, Afghanistan, Pakistan, India and several countries in Southeast Asia were among those with highest age-standardised DALY rates. For example, age-standardised DALYs per 100 000 were 543.35 (391.16–707.96) in El Salvador, 455.29 (332.51–577.97) in Mexico, 408.41 (283.82–551.84) in Guatemala, 238.25 (173.90–303.98) in India and 178.26 (125.31–238.47) in Sri Lanka, compared with 5.52 (0.82–11.48) in Sweden, 6.46 (0.00–14.49) in Australia and 12.13 (4.95–21.82) in Canada. Frontier analyses showed that Mesoamerican countries had significantly higher CKD DALY rates relative to other countries with comparable sociodemographic development.ConclusionsOur results demonstrate that the global toll of CKD attributable to ambient air pollution is significant and identify several endemic geographies where air pollution may be a significant driver of CKD burden. Air pollution may need to be considered in the discussion of the global epidemiology of CKD.

Preventing CKD in Developed Countries

“…13 The contribution of environmental and other nontraditional causes of CKD, including air pollution, smoking, kidney stones, infections, AKI, and other factors are increasingly being recognized. 15,51 A holistic approach to disease prevention, as highlighted by the United Nations Sustainable Development Goals, is therefore likely to have a positive impact on the CKD burden from diverse causes (Figure 1). 38 In 2019, in high-income countries, 10.4% of people aged 20-79 years are living with diabetes, which translates into 95.2 million individuals, 38.2% whom are undiagnosed.…”

“…Exposure to particulate matter (small particles including dust and dirt w2.5-10 mm or smaller) also is associated with the risk of developing de novo CKD at the general population level. 15,107 Public health strategies that target these nontraditional factors while promoting better control of traditional factors, such as hypertension, CVD, and diabetes, may significantly impact the future population-based burden of CKD in industrialized nations. 10 Secondary Prevention of CKD in the Developed World Considering the public health burden of CKD and the availability of evidence-based treatment for its management, health systems in developed countries must implement prevention strategies to reduce population impacts of the disease.…”

“…2,14 The burden of CKD attributable to these risk factors is likely considerable, given that many coexist with the more traditional risk factors. [15][16][17][18][19][20][21] A comprehensive approach to CKD prevention begins with understanding the breadth of CKD risk factors, their frequency and distribution, identifying populations at risk, and subsequently implementing mitigation strategies. Screening for kidney disease has been shown to be cost-effective in high-income countries.…”

PM2.5 exposure induced renal injury via the activation of the autophagic pathway in the rat and HK-2 cell

“…Recently, some epidemiological studies have reported a strong and consistent association between PM 2.5 exposure and renal function decline (Chen et al, 2018;Mehta et al, 2016). Bowe et al estimated that the global burden of incident chronic kidney disease (CKD) attributable to PM 2.5 was about 6.95 million in 2016, and air pollution may be an important risk factor for the prevalence of kidney disease (Bowe et al, 2019). Experimental studies have also shown that mid-/long-term exposure to high levels of PM 2.5 can induce kidney damage in rodent models (Aztatzi-Aguilar et al, 2016;Ge et al, 2018).…”

Diabetes Minimally Mediated the Association Between PM2.5 Air Pollution and Kidney Outcomes

“…The Global Burden of Disease study estimated that 82 million disability-adjusted life-years, a measure www.nature.com/scientificreports www.nature.com/scientificreports/ of the number of years of healthy life lost, are attributable to PM 2.5 in 2016, with 10.1 million due to diabetes 12 . Disability-adjusted life-years due to CKD attributable to PM 2.5 globally in 2016 has been estimated to be 11.5 million 13 . Our results provides a quantitative estimation of the portion of relationship between PM 2.5 and kidney disease that is mediated by diabetes, and suggests that burdens of diabetes and CKD attributable to PM 2.5 may only marginally overlap.…”