Helena Joyce
Environmental pollution is a pressing issue that poses significant risks to human health and welfare, including kidney diseases. The Clean Air Act mandates the EPA to establish primary and secondary NAAQS for criteria pollutants, aiming to safeguard public health and welfare. Among the pollutants of concern are NO2, a highly reactive gas that contributes to smog formation, and elevated SO2 concentrations, which can lead to particulate matter pollution and harm vegetation. Additionally, long-term exposure to air pollution has been linked to an increased risk of membranous nephropathy in China, highlighting the global impact of air pollution on kidney health.
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What You'll Learn
Particulate matter air pollution and the risk of CKD
The industrial revolution of the mid-19th century introduced new sources of pollution, and by the mid-20th century, air pollution had become a global concern. Air pollution is a known risk factor for stroke, cardiovascular disease, and insulin resistance. It also poses a risk for kidney disease, with studies showing a link between air pollution and the occurrence of type 2 diabetes, as well as chronic kidney disease (CKD).
Particulate matter, specifically fine particles with an aerodynamic diameter of less than 2.5 µm (PM2.5), has been identified as a particular concern for respiratory and renal health. Exposure to PM2.5 is associated with an increased risk of cardiovascular outcomes and death. However, the association between PM2.5 and the risk of CKD and end-stage renal disease (ESRD) is less clear and requires further investigation.
A 2020 study by Blum et al. examined the association between PM2.5 exposure and the risk of incident CKD and progression to ESRD. They analysed data from a cohort of 2,482,737 US veterans, finding that a 10 µg/m3 increase in PM2.5 concentration was associated with an increased risk of reduced kidney function. This risk was present even when PM2.5 exposure levels were within the recommended range of the US Environmental Protection Agency (EPA), suggesting that current standards may not be sufficient to protect renal health.
Another study by Chang et al. in 2021 investigated the association between ambient fine particulate matter air pollution and kidney transplant outcomes. They found a link between air pollution and adverse kidney transplant outcomes, suggesting that air pollution may not only impact the development of CKD but also influence kidney function in patients with transplanted kidneys.
These findings highlight the importance of further research to fully understand the impact of particulate matter air pollution on kidney health and to develop interventions to mitigate its effects. Understanding the mechanisms by which air pollution affects renal function can help inform public health policies and strategies to reduce the burden of CKD and improve kidney health outcomes, especially in vulnerable populations.
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Cardiovascular disease
Environmental pollution is a major cause of kidney injury and disease worldwide, particularly in developing countries. The kidney is vulnerable to environmental pollutants because it concentrates most toxins during filtration. This vulnerability means that the kidney is susceptible to a range of pollutants, including air pollution, heavy metal pollution, and other environmental risk factors.
Air pollution, for instance, is a primary factor in the development and progression of kidney diseases. Short-term exposure to air pollution is associated with an increased risk of hospital admissions and death, especially for those with pre-existing heart and lung conditions. Long-term exposure, even at low to moderate levels, may lead to chronic systemic inflammation and oxidative stress, contributing to the development of kidney disease. Fine particulate matter (PM2.5) in the air, with diameters less than 2.5 µm, can increase the risk of cardiovascular events. Exposure to increased concentrations of PM2.5 over a few hours to weeks can trigger cardiovascular disease-related heart attacks and death.
Longitudinal studies are required to establish causal relationships and dose-response associations between exposure to environmental pollutants and kidney disease. These studies should include specific and quantified measurements of environmental exposure to implement effective environmental protection strategies. Regulatory strategies are necessary to control pollution and reduce or prevent exposure to environmental health risks.
People exposed to smoke from wildland fires, including wildfires and prescribed fires, are at risk of inhaling pollutants such as PM2.5, which is a main component of smoke. This exposure can lead to adverse health effects, especially for those with pre-existing cardiovascular conditions. Similarly, exposure to secondhand smoke from tobacco products has harmful health consequences, including cardiovascular disease, lung cancer, and sudden infant death syndrome.
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Diesel exhaust particles
Diesel exhaust is the gas produced by a diesel engine, along with any contained particulates. Diesel exhaust particles (DEP), also known as diesel particulate matter (DPM), are the particulate component of diesel exhaust. This includes diesel soot and aerosols such as ash particulates, metallic abrasion particles, sulfates, and silicates.
DPM can take the form of individual particles or chain aggregates, with most in the invisible sub-micrometer range of 100 nanometers, also known as ultrafine particles (UFP) or PM0.1. The main particulate fraction of diesel exhaust consists of fine particles. Because of their small size, inhaled particles may easily penetrate deep into the lungs. The polycyclic aromatic hydrocarbons (PAHs) in the exhaust stimulate nerves in the lungs, causing reflex coughing, wheezing, and shortness of breath. The rough surfaces of these particles make it easy for them to bind with other toxins in the environment, thus increasing the hazards of particle inhalation.
DPM is highly respirable and has a large surface area where organics can easily adsorb. Exposure to DPM can cause acute irritation and neurophysiological, respiratory, and asthma-like symptoms, and can exacerbate allergenic responses to known allergens. Lung cancer risk is elevated among workers in occupations where diesel engines are used. Additionally, DPM contributes to cardiopulmonary morbidity and mortality.
Methods exist to reduce the emission of DPM, such as the use of particle traps and oxidation catalysts. However, the impact of diesel trucks on public health is more harmful than previously believed. Exposure to diesel exhaust is an occupational hazard for truckers, railroad workers, people living near rail yards, and miners using diesel-powered equipment in underground mines. Studies have shown that underground miners exposed to high levels of diesel fumes have a threefold increased risk of lung cancer compared to those exposed to low levels.
The composition of diesel exhaust may vary depending on the fuel type, rate of consumption, speed of engine operation, and the type of application the engine is used for. Diesel exhaust emissions are a source of atmospheric soot and fine particles, which are implicated in human cancer, heart and lung damage, and mental functioning. It contains contaminants listed as carcinogenic for humans by the IARC, a part of the World Health Organization of the United Nations. Diesel exhaust is a Group 1 carcinogen, causing lung cancer and associated with bladder cancer.
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Nitrogen oxides (NOx)
NOx gases are typically produced from the reaction between nitrogen and oxygen during the combustion of fuels like hydrocarbons, especially at high temperatures, such as in car engines. In areas with high motor vehicle traffic, like large cities, emitted nitrogen oxides can significantly contribute to air pollution. NOx gases are also produced naturally by lightning, and this accounts for a substantial amount of NOx production globally.
The formation of NOx through the combustion of fuels is highly temperature-dependent. During combustion, nitrogen oxides are formed through the oxidation of diatomic nitrogen found in the air. The rate of formation is influenced by temperature and the duration of nitrogen's exposure to that temperature. Fuel NOx tends to dominate during the combustion of fuels with significant nitrogen content, such as coal.
Another source of NOx is agricultural fertilization. The use of nitrogen-fixing plants and fertilizers promotes nitrogen fixation by microorganisms in the soil, leading to increased NOx emissions. The nitrification process transforms ammonia into nitrate, and denitrification is the reverse process. During denitrification, nitrate is reduced to nitrite, then NO, then N2O, and finally nitrogen.
The presence of NOx in the atmosphere has significant implications. In addition to contributing to smog and acid rain, NOx emissions impact the composition of forests. A 2018 study found that increases in NOx levels in the eastern United States could lead to changes in the predominant tree species, with maples, sassafras, and tulip poplars associated with ammonia-oxidizing bacteria, pushing out oak, beech, and hickory, which absorb reactive nitrogen oxides.
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The prevalence of CKD in Europe
Nephrology is a branch of internal medicine that deals with the study of the kidneys. A nephrologist is a doctor who specializes in treating diseases of the kidney.
Chronic kidney disease (CKD) is a significant global health problem that disproportionately affects poor, vulnerable, and marginalized populations. It is a key driver of premature mortality, and its prevalence is increasing worldwide. CKD prevalence varies across the European general population. According to the CaReMe CKD study, which examined 2.4 million patients with CKD across 11 countries, the pooled prevalence of possible CKD was estimated to be 10% in adult populations in Europe, Canada, and Israel. Of those, two out of three had not been diagnosed with CKD, and many were not treated with renin-angiotensin aldosterone system inhibitors. The costs associated with CKD are also substantial, with CKD-related costs in Europe estimated at 1.3% of total healthcare costs.
The ISN has established a regional board in each of its 10 regions, including Western Europe and Eastern and Central Europe, to address the growing burden of kidney disease. The low awareness of kidney disease at the population level further underscores the need to increase knowledge and implement sustainable solutions for early detection, as it is a crucial strategy to prevent kidney disease and its progression.
In Europe, the aggregated annual healthcare costs of CKD are estimated to be higher than those of cancer or diabetes mellitus. The high costs of CKD care are attributed to the increased prevalence of CKD and the complexity of patients with CKD. The economic and epidemiological data highlight the urgency of addressing kidney disease as a global public health priority.
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Frequently asked questions
Nephrology is the study of the kidneys, including kidney function and diseases.
There is evidence to suggest that environmental pollution can cause kidney diseases.
Examples include particulate matter air pollution, combustion-derived nanoparticles, and diesel exhaust particles.
Studies include Xu, X. et al. (2016), which found a link between long-term exposure to air pollution and increased risk of membranous nephropathy in China. Another study by Bowe, B. et al. (2017) examined the relationship between particulate matter air pollution and the risk of uncident CKD.
These findings suggest that reducing environmental pollution may help prevent kidney diseases, highlighting the importance of implementing measures to improve air quality and protect public health.
