대한신장학회

논문분류	춘계학술대회 초록집
제목	Outdoor carbon monoxide with the risk of mortality of ESRD patients: Comparison the results of control selection in the case-crossover designs
저자	Yong Chul Kim, Una Amelia Yoon, Jung Nam An, Dong Ki Kim, Yon Su Kim, Chun Soo Lim, Ho Kim, Jung Pyo Lee
출판정보	2019; 2019(1):
키워드	carbon monoxide \| mortality \| end stage renal disease
초록	There is a growing evidence that environmental air pollution adversely effects kidney health. Recent data suggest that higher concentrations of carbon monoxide is associated with increased risk of worse renal outcome. To date, the association between carbon monoxide and mortality in ESRD patients has not been examined. Among 134,478 dialysis patients in the Korean end-stage renal disease (ESRD) cohort from 2001 to 2014, 31,291 patients were enrolled from seven metropolitan cities, and data were analyzed using bi-directional, uni-directional and time-stratified case-crossover design. We examined the association between short-term CO concentrations and mortality in ESRD patients. We adjusted for temperature, humidity, sunlight hours and daily concentrations of nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and particle matter (PM10) as confounders. The characteristics of the study population included age (65.6 ± 12.26 (mean ± standard deviation [SD]) years), sex (male, 59.96%; female, 41.04%), comorbidity (diabetes, 53.58%; hypertension, 40.5%), and kidney dialysis type (hemodialysis, 73.02%; peritoneal dialysis, 26.98 %). The mean ± SD follow-up time was 4.68 ± 4.37 years. The CO concentrations were significantly increased in the case group compared with the control group (P<0.001). CO concentrations were significantly associated with all-cause death in three different case-crossover design (Bi-directional: ORs [95%CI]: 1.45 [1.21-1.75], P<0.001, Uni-directional: 1.44 [1.13-1.83], P=0.003, Time-strafified: 1.44 [1.18-1.76], P<0.001) in a fully adjusted model. Patients with diabetes (ORs [95%CI]: 0.98 [0.97-0.99], P=0.016) or aged higher than 75 years (ORs [95%CI]; 0.97 [0.96 – 0.99], P=0.020) had higher risks of mortality than patients without diabetes or aged below 75 years, respectively. These findings suggest that higher CO concentrations are correlated with increased all-cause mortality in dialysis patients, especially in high-risk patients with diabetes and older adults.
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