Long-term effects of air pollution on end stage renal disease

越来越多的研究表明，长期暴露在环境空气污染环境中与各种慢性病有关，其中包括心血管疾病和糖尿病。尽管肾脏疾病的疾病负担很高，因此与公共卫生相关，但迄今为止在这方面几乎没有受到关注，可能也是因为合适的数据有限。几乎每个人都或多或少地暴露在较高的空气污染物浓度中，到目前为止还没有确定慢性病的明确阈值，这可能会导致可归因于空气污染的疾病负担相对较高。具有肾脏疾病信息的大型人群队列很少见，迄今为止获得的少数相关空气污染研究大多使用粗略空间尺度的暴露数据。到目前为止，只有一项研究调查了终末期肾病(ESRD)，并发现对200万美国退伍军人(即大多数老年男性)有重要影响。作者估计，在美国，13%的终末期呼吸窘迫可归因于环境空气污染，其颗粒物的直径小于10μm。该项目的目的是调查长期暴露在空气污染中对普通成年人中两个大队列的ESRD发病率的影响，一个来自奥地利，一个来自意大利。将对氮氧化物、臭氧、颗粒物及其包括金属在内的几种成分和交通指标进行调查。要使用的暴露估计值具体到每个人的家庭住址，对于研究人口的一部分，居住史可以被考虑在内。除整体ESRD外，还将研究具有不同基础病理的ESRD，如糖尿病或高血压。目前由美国健康影响研究所资助的“低水平空气污染的影响：欧洲的一项研究”(EAPSE)项目预计将产生重要的协同效应。为研究导致ESRD的特定中介效应而开发的技术将非常有用，不仅对于其他环境风险的进一步应用，而且对于调查生活方式因素的影响也非常有用。

Long-term exposure to ambient air pollution is more and more shown to be related to various chronic diseases, among them, cardiovascular diseases and diabetes. Despite its high burden of disease and therefore public health relevance, renal disease has received so far little attention in this context, probably also because of limited availability of suitable data. The fact that almost everybody is exposed to more or less high air pollutant concentrations and no clear threshold has been identified for chronic diseases so far, may lead to a relatively high burden of disease attributable to air pollution.Large population-based cohorts with information on renal disease are rare and the few related air pollution studies available to date mostly used exposure data on a coarse spatial scale. To date, only one study investigated end stage renal disease (ESRD) and found an important effect in 2 millions of US-veterans (i.e. mostly older men). The authors estimated that 13 % of the incidence of ESRD in the US could be attributable to ambient air pollution with particles of less than 10 μm in diameter. The aim of this project is to investigate the effects of long-term exposure to air pollution on the incidence of ESRD in two large cohorts from the general adult population, one from Austria and one from Italy. Nitrogen oxides, ozone, particulate matter and several of its components including metals, and traffic indicators will be investigated. The exposure estimates to be used are specific to each person’s home address and for a part of the study population residential history can be taken into account. Besides overall ESRD, ESRD with different underlying pathologies such as diabetes or hypertension will be studied. Important synergies are expected with the current project "Effects of Low-Level Air Pollution: A Study in Europe" (ELAPSE) which is financed by the Health Effects Institute in the US. The techniques developed for studying specifically mediating effects leading to ESRD will be very useful for further application not only regarding other environmental risks but also for investigating the influence of life-style factors.