Association of air pollution and risk of chronic kidney disease: A systematic review and meta-analysis

Although epidemiological studies have evaluated the association between ambient air pollution and chronic kidney disease (CKD), the results remain mixed. To clarify the nature of the association, we conducted a comprehensive systematic review and meta-analysis to assess the global relationship between air pollution and CKD. The Web of Science, PubMed, Embase and Cochrane Library databases systematically were searched for studies published up to July 2023 and included 32 studies that met specific criteria. The random effects model was used to derive overall risk estimates for each pollutant. The meta-analysis estimated odds ratio (ORs) of risk for CKD were 1.42 (95% confidence interval [CI]: 1.31-1.54) for each 10 mu g/m3 increase in PM2.5; 1.20 (95% CI: 1.14-1.26) for each 10 mu g/m3 increase in PM10; 1.07 (95% CI: 1.05-1.09) for each 10 mu g/m3 increase in NO2; 1.03 (95% CI: 1.02-1.03) for each 10 mu g/m3 increase in NOX; 1.07 (95% CI: 1.01-1.12) for each 1 ppb increase in SO2; 1.03 (95% CI: 1.00-1.05) for each 0.1 ppm increase in CO. Subgroup analysis showed that this effect varied by gender ratio, age, study design, exposure assessment method, and income level. Furthermore, PM2.5, PM10, and NO2 had negative effects on CKD even within the World Health Organization-recommended acceptable concentrations. Our results further confirmed the adverse effect of air pollution on the risk of CKD. These findings can contribute to enhance the awareness of the importance of reducing air pollution among public health officials and policymakers. The meta-analysis reveals air pollutants, excluding O3, significantly raise chronic kidney disease risk. Subgroup analysis showed that this effect varied by gender ratio, age, study design, exposure assessment method, and income level.image