Ping-Fang Chiu1,2,3,4, Chin-Hua Chang1, Chia-Lin Wu1, Teng-Hsiang Chang1, Chun-Chieh Tsai1, Chew-Teng Kor5, Jhao-Rong Li5, Cheng-Ling Kuo3, Ching-Shan Huang3, Cheng Chung Chu6, Chia-Chu Chang1,2,3,7,8,9. 1. Nephrology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan. 2. School of Medicine, Chung Shan Medical University, Taichung, Taiwan. 3. Vascular and Genomic Research Center, Changhua Christian Hospital, Changhua, Taiwan. 4. Center of General Education, Tunghai University, Taichung, Taiwan. 5. Internal Medicine Research Center, Changhua Christian Hospital, Changhua, Taiwan. 6. Department of computer science, Tunghai University, Taichung, Taiwan. 7. Ph.D. Program for Aging, College of Medicine, China Medical University, Taichung, Taiwan. 8. Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan. 9. Department of Nutrition, Hungkuang University, Taichung, Taiwan.
Abstract
BACKGROUND: Numerous studies have shown that exposure to air pollution, especially particulate matter (PM) with a diameter <2.5 μm (PM2.5), was associated with various diseases. We tried to determine the impact of PM2.5 and other weather factors on acute lung edema in patients with Stage 5 nondialysis chronic kidney disease (CKD Stage 5-ND). METHODS: In total, 317 CKD Stage 5-ND (estimated glomerular filtration rate 6.79 ± 4.56 mL/min) patients residing in central Taiwan who developed acute lung edema and initiated long-term dialysis were included in this case-crossover study. Pearson's correlation test was used to examine the relationship of acute lung edema cases with PM2.5 levels and ambient temperature separately. RESULTS: The average PM2.5 level within the 7-day period correlated with acute lung edema incidence in the fall [adjusted odds ratio (OR) 3.23, P = 0.047] and winter (adjusted OR 1.99, P < 0.001). In winter, even a 3-day exposure to PM2.5 was associated with increased risk (adjusted OR 1.55, P < 0.001). The average temperatures within 3 days in spring and summer were correlated positively with the risk (adjusted OR 2.77 P < 0.001 and adjusted OR 2.72, P < 0.001, respectively). In the fall and winter, temperatures were correlated negatively with the risk (adjusted OR 0.36, P < 0.001 and adjusted OR 0.54, P < 0.001, respectively). CONCLUSIONS: A high PM2.5 level was associated with an increased risk of acute lung edema. High ambient temperature in hot seasons and low ambient temperature in cold seasons were also associated with increased risk. It is essential to educate these patients to avoid areas with severe air pollution and extreme ambient temperature.
BACKGROUND: Numerous studies have shown that exposure to air pollution, especially particulate matter (PM) with a diameter <2.5 μm (PM2.5), was associated with various diseases. We tried to determine the impact of PM2.5 and other weather factors on acute lung edema in patients with Stage 5 nondialysis chronic kidney disease (CKD Stage 5-ND). METHODS: In total, 317 CKD Stage 5-ND (estimated glomerular filtration rate 6.79 ± 4.56 mL/min) patients residing in central Taiwan who developed acute lung edema and initiated long-term dialysis were included in this case-crossover study. Pearson's correlation test was used to examine the relationship of acute lung edema cases with PM2.5 levels and ambient temperature separately. RESULTS: The average PM2.5 level within the 7-day period correlated with acute lung edema incidence in the fall [adjusted odds ratio (OR) 3.23, P = 0.047] and winter (adjusted OR 1.99, P < 0.001). In winter, even a 3-day exposure to PM2.5 was associated with increased risk (adjusted OR 1.55, P < 0.001). The average temperatures within 3 days in spring and summer were correlated positively with the risk (adjusted OR 2.77 P < 0.001 and adjusted OR 2.72, P < 0.001, respectively). In the fall and winter, temperatures were correlated negatively with the risk (adjusted OR 0.36, P < 0.001 and adjusted OR 0.54, P < 0.001, respectively). CONCLUSIONS: A high PM2.5 level was associated with an increased risk of acute lung edema. High ambient temperature in hot seasons and low ambient temperature in cold seasons were also associated with increased risk. It is essential to educate these patients to avoid areas with severe air pollution and extreme ambient temperature.
Authors: Lauren H Wyatt; Yuzhi Xi; Abhijit Kshirsagar; Qian Di; Cavin Ward-Caviness; Timothy J Wade; Wayne E Cascio; Ana G Rappold Journal: BMJ Open Date: 2020-12-15 Impact factor: 2.692