Air Pollution Alleviation During COVID-19 Pandemic is Associated with Renal Function Decline in Stage 5 CKD Patients

Abstract

Chun-Yi Wu,1,2 Chia-Tien Hsu,1 Mu-Chi Chung,1,3 Cheng-Hsu Chen,1,4– 6 Ming-Ju Wu1,3– 5,7– 9 1Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; 2Department of Nursing, Asia University, Taichung, Taiwan; 3PhD Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan; 4Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; 5School of Medicine, China Medical University, Taichung, Taiwan; 6Department of Life Science, Tunghai University, Taichung, Taiwan; 7School of Medicine, Chung Shan Medical University, Taichung, Taiwan; 8Graduate Institute of Clinical Medical Sciences, School of Medicine, China Medical University, Taichung, Taiwan; 9RongHsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, TaiwanCorrespondence: Ming-Ju Wu, Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Blvd., Xitun Dist, Taichung City, 407219, Taiwan, Email [email protected]: Air pollution is a novel environmental risk factor for chronic kidney disease (CKD). Air quality improved during COVID-19 lockdowns; however, the effects of these lockdowns on PM2.5 concentrations and renal function remain unclear.Methods: We conducted a retrospective cohort study to compare air pollution and estimated glomerular filtration rate (eGFR) decline in patients with stage 5 CKD between a year-long period of lockdown (2020; n = 724) and a similar period before lockdown (2019, n = 758).Results: Compared with 2019, a 17.5% reduction in the average PM2.5 concentration (from 17.36% to 14.32%; P 35 μg/m3 were noted in 2020. Moreover, a 93% reduction in PM2.5 air quality index > 150 per station-day (from 0.43% to 0.03%) was observed in 2020. From 2019 to 2020, the yearly incidence of eGFR decline ≥ 5 mL/min/1.73 m2 decreased by 33.7% (24.6% vs 16.3%; P < 0.001). Similarly, the proportion of patients who started undergoing regular dialysis also decreased by 32.7% in 2020 (from 20.8% to 14.0%; P = 0.001).Conclusion: Our findings suggest that fewer events of renal function decline during the COVID-19 pandemic may be associated with a decline in PM2.5 concentrations, supporting the global strategy of reducing air pollution to prevent CKD progression.Keywords: COVID-19 pandemic, chronic kidney disease, air pollution, PM2.5, air quality index

Keywords

• covid-19 pandemic
• chronic kidney disease
• air pollution
• pm2.5
• air quality index