Impact of Environmental Particulate Matter and Peritoneal Dialysis-related Infection in Patients Undergoing Peritoneal Dialysis

Abstract

In patients undergoing peritoneal dialysis (PD), PD-related infection is a major cause of PD failure and hospital admission. Good air quality is required when dialysate exchange or exit site wound care is performed. To our knowledge, investigation of air pollution as a factor for PD-related infection in patients undergoing dialysis is limited. This study aimed to assess the effect of environmental particulate matter (PM) and other important risk factors on 1-year PD-related infection in patients undergoing PD.A total of 175 patients undergoing PD were recruited in this 1-year retrospective observational study. Differences in environmental PMs (PM10 and PM2.5) were analyzed with respect to the patients’ living areas. The patients undergoing PD were categorized into 2 groups according to PM2.5 exposure: high (n = 61) and low (n = 114). Demographic, hematological, nutritional, inflammatory, biochemical, and dialysis-related data were analyzed. Multivariate binary logistic and multivariate Cox regression analyses were used to analyze 1-year PD-related infection.A total of 175 patients undergoing PD (50 men and 125 women) were enrolled. Thirty-five patients had PD-related infection within 1 year. Multivariate Cox regression analysis showed that high environmental PM2.5 exposure (hazard ratio (HR): 2.0, 95% confidence interval [CI] [1.03–3.91]; P = .04) and female sex (HR: 2.77, 95% CI [1.07–7.19]; P = .03) were risk factors for 1-year PD-related infection.Patients undergoing PD with high environmental PM2.5 exposure had a higher 1-year PD-related infection rate than that in those with low exposure. Therefore, air pollution may be associated with PD-related infection in such patients.

Prolonged Pulmonary Exposure to Diesel Exhaust Particles Exacerbates Renal Oxidative Stress, Inflammation and DNA Damage in Mice with Adenine-Induced Chronic Renal Failure

“…Recently kidney transplant recipients and those undergoing peritoneal dialysis have been reported to be more susceptible to PM 2.5 [8,27]. We have recently reported the effect of acute and subacute exposure to DEP in rat model of acute renal failure induced by cisplatin [11][12][13].…”

“…Moreover, it is well-established that elderly people and those with pre-existing chronic diseases such as diabetes or hypertension are more vulnerable to the adverse effect of air pollution [6]. Since patients with CRF exhibit state of increased inflammation and oxidative stress, it is, therefore, conceivable that these patients are more susceptible to particulate air pollution [7,8]. In fact, it has been recently demonstrated that living near a major roadway contributes to reduced renal function [9].…”

ISPD Catheter-Related Infection Recommendations: 2017 Update

“…Common clinical sense dictates that one should achieve a reasonable glycemic control in diabetic PD patients. One study reported that patients undergoing PD in an area of high air pollution and environmental particulate matter exposure had a higher infection rate than those with low exposure (151). It seems logical to advise patients to perform PD and exit-site care in a clean environment.…”

Association Between Environmental Particulate Matter and Carpal Tunnel Syndrome in Patients Undergoing Hemodialysis

“…Air pollution levels, especially particulate matter with an aerodynamic diameter of <2.5 mm (PM 2.5), are significantly associated with elevation of systemic inflammatory markers [3-5]. We have previously showed that air pollution was significantly associated with arterial stiffness, systemic inflammation, infection, secondary hyperparathyroidism, and even mortality in MHD patients [6-10]. In the current study, we hypothesize that there might be a correlation between environment particulate matter and carpal tunnel syndrome (CTS) in MHD which has not been surveyed previously.…”