Richard V Remigio1, Hao He2, Jochen G Raimann3, Peter Kotanko4, Frank W Maddux5, Amy Rebecca Sapkota1, Xin-Zhong Liang6, Robin Puett1, Xin He7, Amir Sapkota8. 1. Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA. 2. Department of Atmospheric and Oceanic Sciences, University of Maryland, College Park, MD, USA. 3. Research Division, Renal Research Institute, New York, NY, USA. 4. Research Division, Renal Research Institute, New York, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA. 5. Fresenius Medical Care North America, Waltham, MA, USA. 6. Department of Atmospheric and Oceanic Sciences, University of Maryland, College Park, MD, USA; Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD, USA. 7. Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA. 8. Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA. Electronic address: amirsap@umd.edu.
Abstract
BACKGROUND: Increasing number of studies have linked air pollution exposure with renal function decline and disease. However, there is a lack of data on its impact among end-stage kidney disease (ESKD) patients and its potential modifying effect from extreme heat events (EHE). METHODS: Fresenius Kidney Care records from 28 selected northeastern US counties were used to pool daily all-cause mortality (ACM) and all-cause hospital admissions (ACHA) counts. County-level daily ambient PM2.5 and ozone (O3) were estimated using a high-resolution spatiotemporal coupled climate-air quality model and matched to ESKD patients based on ZIP codes of treatment sites. We used time-stratified case-crossover analyses to characterize acute exposures using individual and cumulative lag exposures for up to 3 days (Lag 0-3) by using a distributed lag nonlinear model framework. We used a nested model comparison hypothesis test to evaluate for interaction effects between air pollutants and EHE and stratification analyses to estimate effect measures modified by EHE days. RESULTS: From 2001 to 2016, the sample population consisted of 43,338 ESKD patients. We recorded 5217 deaths and 78,433 hospital admissions. A 10-unit increase in PM2.5 concentration was associated with a 5% increase in ACM (rate ratio [RRLag0-3]: 1.05, 95% CI: 1.00-1.10) and same-day O3 (RRLag0: 1.02, 95% CI: 1.01-1.03) after adjusting for extreme heat exposures. Mortality models suggest evidence of interaction and effect measure modification, though not always simultaneously. ACM risk increased up to 8% when daily ozone concentrations exceeded National Ambient Air Quality Standards established by the United States, but the increases in risk were considerably higher during EHE days across lag periods. CONCLUSION: Our findings suggest interdependent effects of EHE and air pollution among ESKD patients for all-cause mortality risks. National level assessments are needed to consider the ESKD population as a sensitive population and inform treatment protocols during extreme heat and degraded pollution episodes.
BACKGROUND: Increasing number of studies have linked air pollution exposure with renal function decline and disease. However, there is a lack of data on its impact among end-stage kidney disease (ESKD) patients and its potential modifying effect from extreme heat events (EHE). METHODS: Fresenius Kidney Care records from 28 selected northeastern US counties were used to pool daily all-cause mortality (ACM) and all-cause hospital admissions (ACHA) counts. County-level daily ambient PM2.5 and ozone (O3) were estimated using a high-resolution spatiotemporal coupled climate-air quality model and matched to ESKD patients based on ZIP codes of treatment sites. We used time-stratified case-crossover analyses to characterize acute exposures using individual and cumulative lag exposures for up to 3 days (Lag 0-3) by using a distributed lag nonlinear model framework. We used a nested model comparison hypothesis test to evaluate for interaction effects between air pollutants and EHE and stratification analyses to estimate effect measures modified by EHE days. RESULTS: From 2001 to 2016, the sample population consisted of 43,338 ESKD patients. We recorded 5217 deaths and 78,433 hospital admissions. A 10-unit increase in PM2.5 concentration was associated with a 5% increase in ACM (rate ratio [RRLag0-3]: 1.05, 95% CI: 1.00-1.10) and same-day O3 (RRLag0: 1.02, 95% CI: 1.01-1.03) after adjusting for extreme heat exposures. Mortality models suggest evidence of interaction and effect measure modification, though not always simultaneously. ACM risk increased up to 8% when daily ozone concentrations exceeded National Ambient Air Quality Standards established by the United States, but the increases in risk were considerably higher during EHE days across lag periods. CONCLUSION: Our findings suggest interdependent effects of EHE and air pollution among ESKD patients for all-cause mortality risks. National level assessments are needed to consider the ESKD population as a sensitive population and inform treatment protocols during extreme heat and degraded pollution episodes.
Authors: Jessie L C Shmool; Jennifer F Bobb; Kazuhiko Ito; Beth Elston; David A Savitz; Zev Ross; Thomas D Matte; Sarah Johnson; Francesca Dominici; Jane E Clougherty Journal: Environ Res Date: 2015-10 Impact factor: 6.498
Authors: Richard V Remigio; Rodman Turpin; Jochen G Raimann; Peter Kotanko; Frank W Maddux; Amy Rebecca Sapkota; Xin-Zhong Liang; Robin Puett; Xin He; Amir Sapkota Journal: Environ Res Date: 2021-09-25 Impact factor: 6.498
Authors: Amir Sapkota; Yan Dong; Linze Li; Ghassem Asrar; Yuyu Zhou; Xuecao Li; Frances Coates; Adam J Spanier; Jonathan Matz; Leonard Bielory; Allison G Breitenother; Clifford Mitchell; Chengsheng Jiang Journal: JAMA Netw Open Date: 2020-07-01
Authors: Richard V Remigio; Chengsheng Jiang; Jochen Raimann; Peter Kotanko; Len Usvyat; Frank W Maddux; Patrick Kinney; Amir Sapkota Journal: JAMA Netw Open Date: 2019-08-02
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