Chronic kidney disease of unknown origin is associated with environmental urbanisation in Belfast, UK

Abstract

Chronic kidney disease (CKD), a collective term for many causes of progressive renal failure, is increasing worldwide due to ageing, obesity and diabetes. However, these factors cannot explain the many environmental clusters of renal disease that are known to occur globally. This study uses data from the UK Renal Registry (UKRR) including CKD of uncertain aetiology (CKDu) to investigate environmental factors in Belfast, UK. Urbanisation has been reported to have an increasing impact on soils. Using an urban soil geochemistry database of elemental concentrations of potentially toxic elements (PTEs), we investigated the association of the standardised incidence rates (SIRs) of both CKD and CKD of uncertain aetiology (CKDu) with environmental factors (PTEs), controlling for social deprivation. A compositional data analysis approach was used through balances (a special class of log contrasts) to identify elemental balances associated with CKDu. A statistically significant relationship was observed between CKD with the social deprivation measures of employment, income and education (significance levels of 0.001, 0.01 and 0.001, respectively), which have been used as a proxy for socioeconomic factors such as smoking. Using three alternative regression methods (linear, generalised linear and Tweedie models), the elemental balances of Cr/Ni and As/Mo were found to produce the largest correlation with CKDu. Geogenic and atmospheric pollution deposition, traffic and brake wear emissions have been cited as sources for these PTEs which have been linked to kidney damage. This research, thus, sheds light on the Electronic supplementary material The online version of this article (

Urban living and chronic diseases in the presence of economic growth: Evidence from a long-term study in southeastern China

“…Coefficients (Cr) of residence location for type 2 diabetes (Cr = 0.8148, p < 0.01), hyperlipidemia (Cr = 1.1550, p < 0.01), and hypertension (Cr = 0.7498, p < 0.01) indicate a significantly positive relationship between urban living and the prevalence of chronic diseases ( Table 2 ). For the control variables, age was positively correlated with the dependent variables (Cr: 0.0085–0.0660), which is consistent with previous studies ( 15 , 18 ) and implies the challenges to the efficiency of the healthcare system posed by China's remarkable demographic shift ( 38 ).…”

“…This study makes several contributions to the literature. First, the relationship between living in urban areas and chronic disease has been studied by many authors, but most have focused on a specific mediator (e.g., nutritional transition, depression) (13)(14)(15)(16)(17)(18). We adopted a broader range of potential mediators from the literature and make the contributions between risk factors comparable.…”

Harnessing the Full Potential of Multi-Omic Analyses to Advance the Study and Treatment of Chronic Kidney Disease

“…Closer proximity to open and green spaces may result in improved air quality, increased access to physical recreation and relaxation areas, or reduced noise pollution, with these factors each individually associated with improved kidney function (178,(181)(182)(183)(184). Many of these factors change as a result of urbanisation, with urbanisation also shown to modify the presence of potentially toxic elements (PTEs) within the soil, with such PTEs associated with CKD incidence, including CKD attributed to unknown aetiology (185,186). Urbanisation also modifies the association between air pollutants (namely fine particulate matter and nitrogen dioxide) and CKD (187).…”

Pandemics, economic freedom, and institutional trade-offs

“…For example, the top five comorbidities from COVID-19 (which we can consider a disease of commerce) are (ordered by fatality rate) obesity, liver diseases, kidney diseases, chronic obstructive pulmonary disease and cardiovascular diseases (Ejaz et al, 2020). While some studies find comorbidities such as obesity are positively associated with economic growth (Egger et al, 2012), others such as kidney disease tend to fall with income (McKinley et al, 2020). 10 If the diseases of poverty make people more vulnerable to diseases of commerce, economic freedom (by promoting economic growth) may indirectly reduce diseases of commerce by reducing comorbidities associated with poverty, even if it also constrains states' ability to deploy public health measures due to well-protected property rights.…”