Role of air pollution in chronic kidney disease: an update on evidence, mechanisms and mitigation strategies

The impact of PM2.5 on kidney

“…PM2.5 can impair renal function by inducing renal tubular atrophy, glomerulosclerosis, renal vascular injury, and interstitial fibrosis (Shubham et al, 2021). A retrospective study including 2,482,737 American veterans demonstrated that there was an obvious correlation between PM2.5 exposure and eGFR decline, CKD, and ESRD There is a positive association between the risk of progression to KFRT in patients with CKD and long-term PM2.5 exposure (end stage renal disease), which meant that in baseline analysis of average 11.8 μg/m 3 exposure, a 10 μg/m 3 increase in PM2.5 concentration was related with increased risk of eGFR < 60 ml/min per 1.73 m 2 , eGFR decline ≥30%, CKD, and ESRD (Bowe et al, 2018).…”

“…5.2 | PM2.5 exposure causes oxidative stress, inflammatory response and DNA damage in kidney PM2.5 could induce renal toxicity by a variety of interrelated signaling pathways and regulatory responses, including oxidative stress, mitochondrial and endoplasmic reticulum damage, and systemic inflammation (Shubham et al, 2021). The expression of IL-18, IL-6, IL-1β, TACE, TNF-α, TNFR2, p-NF-κB, and p-IκBα were obviously increased in mice with exposure to PM2.5 (Chenxu et al, 2018;Wu et al, 2021).…”

Invited Perspective: Still Hazy? Air Pollution and Acute Kidney Injury

“… 1 Beyond its well-recognized role in respiratory and cardiovascular diseases, studies have now linked air pollution to numerous other illnesses, including chronic kidney disease (CKD). 2 Defined as kidney damage or abnormal function persisting for at least 3 months, 3 CKD afflicts people worldwide and is most commonly detected by routine blood testing showing a decline in glomerular filtration rate (GFR) estimated from serum creatinine concentration (eGFR) or elevated urinary albumin excretion. 4 Epidemiological evidence over the last few years has associated long-term exposure to air pollutants—including fine [ in aerodynamic diameter ( )] and coarse particulate matter [ in aerodynamic diameter ( )], nitrogen dioxide ( ), and carbon monoxide (CO)—with increased risk of incident CKD, eGFR decline, and progression to kidney failure, 5 – 7 which requires dialysis or kidney transplantation for survival.…”

“…The authors’ work draws welcome attention to the potential impact of air pollution on kidney disease, which had been relatively overlooked until the past few years. Most published studies have examined CKD, 2 , 5 – 7 whereas AKI is a related but distinct condition ( Figure 1 ), defined by an abrupt (within 48 h) and often reversible decline in GFR. 9 Although prior work has associated short-term exposure to air pollution with increased risk of AKI, 10 the broader causal and temporal relationships between air pollution and kidney disease remain to be defined.…”

“…The underlying biological mechanisms by which chronic exposure to air pollution could result in AKI are not fully clear, although a few possibilities exist. First, the proposed mechanisms that link air pollution to a gradual reduction in eGFR to result in CKD 2 —oxidative stress, systemic inflammation, DNA damage, and atherosclerosis—may increase susceptibility for AKI. The causes of AKI itself are vast and heterogenous, from hypotension and dehydration (accounting for up to 40% of hospital-acquired AKI globally 11 ) to drugs, infection, ischemia, inflammation, vascular injury, and outflow obstruction.…”