WASHINGTON—Increases in fine particulate matter with a diameter of less than 2.5 µm (PM2.5) increases the risk for hospitalization and readmission for hemodialysis patients, Lauren Wyatt, PhD, of ORISE at the Environmental Protection Agency in Chapel Hill, North Carolina, and colleagues reported at the American Society of Nephrology’s Kidney Week 2019 meeting. PM2.5 also increases death from chronic kidney disease, hypertension, cardiovascular disease, type 2 diabetes, and 5 other conditions, according to separate research from Ziyad Al-Aly, MD, of Veterans Affairs St. Louis Health Care System, and peers published in JAMA Network Open.

Using data from the US Renal Data System 2008 to 2012 representing 552 US counties, Dr Wyatt and her peers calculated admission rates for 1,799,928 inpatient hospitalizations. They also evaluated the same day and delayed effects of a 10 μg/m3 increase in PM2.5 on overall and cardiovascular, respiratory, and cerebrovascular health. Cox proportional hazard models controlled for meteorology and patient- and event-specific variables.

A same day elevation in PM2.5 was associated with a significant 0.4% increase in the risk of admissions and even greater risk for increased 30-day readmission. Daily risks increased by 1.1% for all-cause and 4.9% for cerebrovascular readmissions. At delayed exposure times, elevated cardiovascular and respiratory readmission risks were also observed.

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“These findings suggest that daily ambient air quality may impact morbidity and healthcare costs for patients with end stage renal disease,” Dr Wyatt’s team stated.

In the JAMA Network Open study, Dr Al-Aly’s team examined PM2.5 exposure for 4.5 million US veterans (median age 64; 94% male) followed up between 2006 and 2016. PM2.5 exposure was associated with excess burden of death due to 9 causes, including cardiovascular disease (56,070.1 deaths), cerebrovascular disease (40,466.1 deaths), chronic kidney disease (7175.2 deaths), chronic obstructive pulmonary disease (645.7 deaths), dementia (19,851.5 deaths), type 2 diabetes (501.3 deaths), hypertension (30,696.9 deaths), lung cancer (17,545.3 deaths), and pneumonia (8854.9 deaths). Black individuals and socioeconomically disadvantaged communities were particularly affected.

Nearly all of the the burden was associated with PM2.5 levels below the 12 μg/m3 standard set by the US Environmental Protection Agency.

Outdoors, fine particles emanate from vehicle exhausts, fuel burning operations, forest and grass fires, and power plants. Indoor sources of fine particles include tobacco smoke, cooking, burning candles or oil lamps, and operating fireplaces and fuel-burning space heaters.


Wyatt L, Xi Y, Kshirsagar AV, Wade TJ, Rappold AG. Elevated PM2.5 increases daily hospital admission and readmission risk in chronic hemodialysis patients. Presented at the American Society of Nephrology’s Kidney Week 2019 meeting held November 5 to 10, 2019 in Washington DC. Abstract FR-PO432.

Bowe B, Xie Y, Yan Y, Al-Aly Z. Burden of Cause-Specific Mortality Associated With PM2.5 Air Pollution in the United States. JAMA Netw Open. 2019;2(11):e1915834. doi:10.1001/jamanetworkopen.2019.15834

Fine Particles (PM 2.5) Questions and Answers. New York State Dept of Health. Accessed at https://www.health.ny.gov/environmental/indoors/air/pmq_a.htm