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- Exposure to higher amounts of fine particulate air pollution was associated with higher death rates among patients with kidney failure.
Wildfires generate high levels of tiny particles of air pollution—called fine particulate matter—that can have a range of effects on health. When inhaled, fine particulate matter can travel into the respiratory tract and bloodstream and trigger oxidative stress and inflammation. Because of their frailty, patients with kidney failure might be especially susceptible to this environmental stressor, but little is known about the effects of air pollution exposures in these individuals.
To investigate, a team led by Ana Rappold, PhD (the US Environmental Protection Agency), along with Yuzhi Xi, MSPH and Abhijit V. Kshirsagar, MD, MPH (University of North Carolina at Chapel Hill), analyzed information from 253 US counties near a major wildfire between 2008 and 2012.
“This study was possible because the US Renal Disease System, a registry of patients with kidney failure, included vital records on almost all US patients receiving in-center hemodialysis, as well as the counties of the dialysis clinics. Secondly, we utilized an air quality model to estimate daily exposure to wildfire fine particulate matter across the country at the counties of the dialysis units,” explained Ms. Xi.
The researchers found 48,454 deaths among patients with kidney failure who were receiving dialysis in the 253 counties. Each 10 μg/m3 increase in the concentration of wildfire fine particulate matter in the air was associated with a 4% higher death rate on the same day and a 7% higher rate over the next month. On days with wildfire fine particulate matter greater than 10 μg/m3, exposure to the pollution accounted for 8.4% of daily mortality.
“The findings highlight the impact of air pollution exposure in individuals receiving hemodialysis, and they support the need for more research to develop and implement interventions to manage exposure during wildfire smoke episodes in this population,” said Dr. Rappold.
Study co-authors include Timothy J. Wade, PhD, David B. Richardson, PhD, M. Alan Brookhart, PhD, and Lauren Wyatt, PhD.
Disclosures: The authors reported no financial disclosures.
The article, titled “Mortality in US Hemodialysis Patients Following Exposure to Wildfire Smoke,” will appear online at http://jasn.asnjournals.org/ on July 16, 2020, doi: 10.1681/ASN.2019101066.
The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.
Since 1966, ASN has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients. ASN has more than 21,000 members representing 131 countries. For more information, visit www.asn-online.org.
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