The adverse effects of air pollution can be observed in respiratory, circulatory systems but also in renal function. The kidney is particularly vulnerable to toxic effects from environmental pollutants owing to its filtration functions; environmental and occupational exposures to pollutants remain common causes of kidney disease worldwide, especially in developing countries. Up to 22% of the global burden of disease and 23% of deaths are attributable to environmental pollution; the general public is inevitably exposed to environmental pollutants.
There is no good community data from India. However studies from other parts of the world have shown that long-term exposure to particulate matter <2.5 μm in mean aerodynamic diameter (PM2.5) is associated with increased risk of membranous nephropathy and more rapid decline in renal function. Membranous Nephroptahy is a kidney disease which happens because of damage to kidney filters resulting in massive leakage of protein in the urine. It is believed that thus damage is due to the particulate matter. In a research study published recently in th the Journal of the American Society of Nephrology air pollution has been implicated in the increasing risk of new cases of kidney disease, and quicker progression of CKD to dialysis .This study evaluated 2.5 million veterans who did not have kidney disease when they were screened in 2003 and 2004. Their cases were “followed” across the country for an average of 8.5 years and compared to air pollution levels across the country being monitored by the Environmental Protection Agency (EPA) and the National Aeronautics and Space Administration (NASA). For accuracy, researchers also took into account recent improvement in air quality in the U.S., and patients’ kidney disease risk factors (age, race, sex, heart disease, lung disease, diabetes, high blood pressure, smoking, obesity, and poverty).
The study found that for every increase in pollution of 10 micrograms per cubic meter of air, there was a 25 to 37% increase in the number of veterans with new kidney disease, a 36% increase in rapid loss of kidney function, and a 31% increase in risk of kidney failure followed by dialysis. The study also estimated that pollution, could have caused about 45,000 new cases of CKD and 2438 patients starting dialysis during the time of the study. Similarly studies in Taiwanese and Korean adults have also observed associations between higher PM air pollution levels and reduced renal function, an increased risk of developing CKD, In a study done in Europe short-term exposure to elevated air pollution levels was associated with a decrease in eGFR. The main pollutants affecting the kidneys were PMs and SO2. In medium-term an increase in annual concentration of PM2.5 and NO2 resulted in an increased number of patients with chronic kidney disease.
The incidence of CKD is increasing in our country . Data from the registry of Indian Society of Nephrology shows that a large number (16%)of patients have CKD due to unknown causes and is possible that air pollution could be contributing to unexplained CKD.
Dr. Sanjeev Gulati, Executive Director – Nephrology & Kidney Transplant, Fortis Escorts, Okhla Road, New Delhi
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