Abstract：
The impact of environmental risk factors on chronic kidney disease (CKD) remains unclear. This systematic review aims to provide an overview of the literature on the association between the general external exposome and CKD development or progression. We searched MEDLINE and EMBASE for case-control or cohort studies, that investigated the association of the general external exposome with a change in eGFR or albuminuria, diagnosis or progression of CKD, or CKD-related mortality. The risk of bias of included studies was assessed using the Newcastle-Ottawa Scale. Summary effect estimates were calculated using random-effects meta-analyses. Most of the 66 included studies focused on air pollution (n = 33), e.g. particulate matter (PM) and nitric oxides (NOx), and heavy metals (n = 21) e.g. lead and cadmium. Few studies investigated chemicals (n = 7) or built environmental factors (n = 5). No articles on other environment factors such as noise, food supply, or urbanization were found. PM2.5 exposure was associated with an increased CKD and end-stage kidney disease incidence, but not with CKD-related mortality. There was mixed evidence regarding the association of NO2 and PM10 on CKD incidence. Exposure to heavy metals might be associated with an increased risk of adverse kidney outcomes, however, evidence was inconsistent. Studies on effects of chemicals or built environment on kidney outcomes were inconclusive. In conclusion, prolonged exposure to PM2.5 is associated with an increased risk of CKD incidence and progression to kidney failure. Current studies predominantly investigate the exposure to air pollution and heavy metals, whereas chemicals and the built environment remains understudied. Substantial heterogeneity and mixed evidence were found across studies. Therefore, long-term high-quality studies are needed to elucidate the impact of exposure to chemicals or other (built) environmental factors and CKD.
摘要：
环境危险因素对慢性肾脏病（CKD）的影响尚不清楚。本系统综述旨在提供有关一般外部暴露与CKD发展或进展之间关联的文献概述。我们搜索了MEDLINE和EMBASE病例对照或队列研究，调查了一般外部暴露与eGFR或蛋白尿变化的相关性，CKD的诊断或进展，或CKD相关死亡率。使用纽卡斯尔-渥太华量表评估纳入研究的偏倚风险。使用随机效应荟萃分析计算汇总效应估计值。66项纳入的研究大多集中在空气污染(n=33)，例如颗粒物(PM)和一氧化氮(NOx)，和重金属（n=21），例如铅和镉。很少有研究调查化学品(n=7)或建筑环境因素(n=5)。没有关于噪音等其他环境因素的文章，食物供应,或城市化被发现。PM2.5暴露与CKD和终末期肾病发病率增加有关。但与CKD相关的死亡率无关。关于NO2和PM10与CKD发病率的相关性存在混合证据。暴露于重金属可能与肾脏不良结局的风险增加有关。然而,证据不一致。关于化学物质或建筑环境对肾脏结局的影响的研究尚无定论。总之,长期暴露于PM2.5与CKD发病和进展为肾衰竭的风险增加相关.目前的研究主要调查暴露于空气污染和重金属，而化学品和建筑环境仍未得到充分研究。在研究中发现了大量异质性和混合证据。因此,需要长期高质量的研究来阐明暴露于化学品或其他(内置)环境因素和CKD的影响.
