Air pollution exposure may heighten risk of heart disease among US adults receiving haemodialysis

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In a retrospective cohort study published in the American Journal of Kidney Diseases (AJKD), researchers have found that US adults receiving haemodialysis who are exposed to higher levels of air pollution have more heart attacks and strokes compared to haemodialysis patients with low levels of exposure.

The strongest associations of air pollution exposure with cardiovascular events were noted among patients who were Asian, older, or had chronic lung disease at dialysis initiation, according to the researchers.

Long-term exposure to air pollution, also called PM2.5, has been linked to adverse cardiovascular outcomes, as per a press release announcing these new data from the National Kidney Foundation (NKF). However, little is known about the association of PM2.5 and outcomes among patients receiving dialysis—who already have heightened cardiovascular disease burdens.

Led by Yuzhi Xi (University of North Carolina, Chapel Hill, USA), researchers conducted an epidemiological study to assess the association between the annual PM2.5 exposure, and cardiovascular events and death, among patients receiving regular outpatient haemodialysis in the USA between 2011 and 2016. A total of more than 314,000 kidney disease patients were identified in the United States Renal Data System (USRDS).

They found a higher risk of heart attacks, strokes and related events in patients receiving maintenance in-centre haemodialysis who were exposed to higher levels of air pollution. Stronger associations between air pollution and adverse health events were observed among patients who were older (≥75 years) at the start of dialysis, had chronic obstructive pulmonary disease, or were Asian.

The NKF press release notes that these findings “bolster the evidence base linking air pollution and adverse health outcomes, and may inform policymakers and clinicians”. It also states that exposure mitigation on the individual level could be beneficial to at-risk patients, and future studies should be conducted to study the potential health impact of additional air pollutants, such as Ozone and NOx, among such vulnerable populations.

These findings are published in full in an article, entitled “Association Between Long-term Ambient PM2.5 Exposure and Cardiovascular Outcomes Among US Hemodialysis Patients”, in AJKD.

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