Associations of PM2.5 components with dynamic and accelerated progression of different kidney function states and subsequent cardiovascular events: The GOLD-Health cohort.

BACKGROUND

Fine particulate matter (PM2.5) has been associated with an increased risk of chronic kidney disease (CKD) and cardiovascular disease (CVD). However, the relationships between specific PM2.5 components and the dynamic cardiorenal trajectory remain uncertain.

METHODS

Employing multistate and accelerated failure time (AFT) modeling in a prospective cohort of 307,639 participants, we examined the associations of 2-year exposure to PM2.5 and its components (sulfate [SO42-], nitrate [NO3-], ammonium [NH4+], organic matter [OM], and black carbon [BC]) with dynamic and accelerated progression from different kidney function categories (1-4, according to estimated glomerular filtration rate [eGFR] and self-reported CKD) to CVD, and ultimately to cardiovascular death.

RESULTS

Over 1,058,210 person-years of follow-up, we documented 23,948 CVD cases and 7763 cardiovascular death cases. We observed that PM2.5 and its components were significantly associated with the dynamic cardiorenal trajectory, with SO42-, NO3-, and NH4+ exhibiting larger hazard ratios (HRs). Per-interquartile range (IQR) increments in SO42-, NO3-, and NH4+ were positively correlated with the transition from kidney function category 2 to 3, and the HRs were 1.273 (95% confidence interval [CI]: 1.257-1.289), 1.304 (95% CI: 1.290-1.317), and 1.280 (95% CI: 1.267-1.294), respectively. The AFT model indicated that higher levels of PM2.5 and its constituents significantly accelerated the dynamic cardiorenal trajectory. The predictive transition times from kidney function category 2 to 3 for 2-year NO3- exposure were 1727.43 days at 4.2 μg/m3 and 868.56 days at 7.0 μg/m3.

CONCLUSIONS

Our findings revealed that PM2.5 components (2-year exposure) may be important risk factors for adverse cardiorenal outcomes.