Abstract：
Emerging evidence suggests that air pollution is a significant contributor to the global burden of kidney disease. Although acute kidney injury (AKI) is a common secondary event in ill patients, evidence regarding the association between air pollution and AKI accompanied by specific comorbidities is limited. This study aimed to estimate the association between short-term exposure to air pollution (fine particulate matter ≤2.5 μm [PM2.5] and ozone [O3]) and incident AKI by comorbid diseases using the Korea National Health Information Database (NHID). Total of 160,390 incident AKI cases, defined as an emergency department (ED) visit due to AKI, were observed within the period 2015-2021 in inland South Korea. A time-stratified case-crossover design was applied for PM2.5 and O3 individually, using a conditional logistic regression model within each case and its own control (three or four days of the same day of the week in the same month) to estimate the association between short-term air pollution exposure and ED visits due to AKI. Short-term exposure to PM2.5 and O3 was associated with ED visits due to AKI with ORs of 1.008 (95% confidence interval [CI]: 0.999, 1.017) and 1.019 (95% CI: 1.005, 1.033) for an interquartile range (IQR) increase in lag 0-1 day PM2.5 and O3 respectively, although OR for PM2.5 was marginally significant. The odds of incident AKI associated with PM2.5 was evident in conjunction with ischemic heart disease, cerebrovascular disease, gastrointestinal bleeding, and pneumonia. For O3, the estimated odds was prominent for AKI with ischemic heart disease. In addition, the comorbid disease-specific odds of AKI attributed to air pollution varied by sex and age. Our findings provide epidemiological evidence of a plausible mechanism between air pollution and incident AKI and suggest the need for personalized AKI prevention strategies attributed to air pollution.
摘要：
新出现的证据表明，空气污染是造成全球肾脏疾病负担的重要因素。尽管急性肾损伤（AKI）是患病患者常见的继发事件，关于空气污染与伴有特定合并症的AKI之间关联的证据有限.这项研究旨在使用韩国国家健康信息数据库（NHID）估算短期暴露于空气污染（细颗粒物≤2.5μm[PM2.5]和臭氧[O3]）与合并症发生的AKI之间的关联。总计160,390例AKI事件，定义为由于AKI导致的急诊科（ED）就诊，在2015-2021年期间在韩国内陆观察到。对PM2.5和O3分别进行了时间分层的案例交叉设计，在每个病例及其自身对照(同一个月的一周中的同一天的3天或4天)内使用条件逻辑回归模型来估计短期空气污染暴露与AKI导致的ED访视之间的关联.由于AKI，短期暴露于PM2.5和O3与ED访问相关，OR分别为1.008（95％置信区间[CI]：0.999，1.017）和1.019（95％CI：1.005，1.033），四分位数范围（IQR）分别在滞后0-1天时增加PM2.5和O3，尽管PM2.5的OR值微不足道。与PM2.5相关的事件性AKI与缺血性心脏病相关的几率很明显，脑血管疾病，消化道出血,和肺炎。对于O3，估计的AKI合并缺血性心脏病的几率很高。此外,空气污染导致的AKI的合并症特异性几率因性别和年龄而异.我们的发现提供了流行病学证据，证明空气污染与事件性AKI之间存在合理的机制，并表明需要针对空气污染的个性化AKI预防策略。
