大氣空氣品質和腎臟透析病人的死亡相關：系統性文獻回顧

Association between ambient air quality and the mortality risk of dialysis patients: a systematic review

10.6288/TJPH.202210_41(5).111038

張佑瑄(Yu-Hsuan Chang)；郭素娥(Su-Er Guo)；許翠華(Tsui-Hua Hsu)；劉嘉玲(Chia-Ling Liu)

血液透析 ； 空氣品質 ； 死亡率 ； 系統性文獻回顧 ； 懸浮微粒 ； hemodialysis ； air quality ； mortality ； systematic review ； particulate matter

台灣公共衛生雜誌

41卷5期（2022 / 10 / 31）

551 - 563

繁體中文

目標：過去的研究顯示長期暴露於空氣中懸浮微粒和罹病與死亡危險有關，包括腎臟疾病的惡化，但少有相關研究統整大氣空氣品質與腎臟疾病死亡的關聯，希冀藉由此系統性文獻回顧及整合，探討空氣品質和洗腎病人健康的相關，提供未來相關研究的實證參考。方法：建立關鍵字並搭配自然語言及Mesh term於五個資料庫進行搜尋2022年6月前的中英文資料庫，總共發現163篇，經排除重複、納入及排除條件篩選後，最終納入5篇符合文章主題之文獻，並以CAPS（Critical Appraisal Skills Programme, CAPS）世代研究評讀工具及Oxford CEBM檢測文章品質及證據等級。結果：共納入5篇研究，結果發現長期暴露於NO_2 7年的洗腎病人的死亡危險增加1.33-3.78倍；暴露於高濃度PM_(2.5) 7年的老年洗腎病人可能會與死亡有關。結論：長期暴露於大氣NO_2、PM_(2.5)可能和洗腎患者的死亡危險有關；SO_2與PM_(10)因有發表偏差問題，可能需要日後更多研究針對此議題再加以探討證實。另受限於目前研究多是探討室外空氣品質和洗腎病人健康的相關，因此日後應針對室內空氣污染做更進一步的臨床試驗實證研究，以提供更全面與系統性的探討與分析。

Objectives: Studies have associated the long-term exposure to ambient particulates with mortality from various types of disease, including kidney disease. However, few studies integrating the relationship between ambient air quality and the mortality risk from kidney disease. The objective of this study is to evaluate this association using systematic literature review to provide empirical references for future research. Methods: Mesh term and free-text words were used for literature search. Articles were retrieved from electronic databases including PubMed, Cochrane Library, ProQuest, EMBASE, and Airiti Library. A total of 163 articles published before June 2022 met the search criteria. After screening the abstract, title, and main text of the studies to delete repetitions, we identified five studies eligible for the qualitative synthesis. Each study was appraised using the CASP-Cohort checklist and Oxford CEBM. Results: We examined the data in these five studies and found that the hazard ratio of mortality from dialysis ranged 1.33-3.78 for population with long-term exposure to NO_2. A study also found that the elderly patients with dialysis exposing to high levels of PM_(2.5) for 7 years were also at an elevated hazard of deaths. Conclusions: These studies showed that long-term exposure to NO_2 and PM_(2.5) might associate with an increased hazard of deaths from dialysis. However, these studies were conducted based on the outdoor air quality. Research based on indoor air quality and experimental study are required to verify the association with the mortality risk.

1. 胡至沛, CP,鄭仁雄, JH(2020)。居家環境室內空氣品質認知與管理策略之探討。物業管理學報，11，1-13。
   連結：
2. Afsar, B,Elsurer Afsar, R,Kanbay, A,Covic, A,Ortiz, A,Kanbay, M(2019).Air pollution and kidney disease: review of current evidence.Clin Kidney J,12,19-32.
3. American Heart Association. How smoking and nicotine damage your body. Available at: https://www.heart.org/en/healthy-living/healthy-lifestyle/quit-smoking-tobacco/how-smoking-and-nicotine-damage-your-body. Accessed November 15, 2021.
4. Bowe, B,Artimovich, E,Xie, Y,Yan, Y,Cai, M,Al-Aly, Z(2020).The global and national burden of chronic kidney disease attributable to ambient fine particulate matter air pollution: a modelling study.BMJ Glob Health,5,e002063.
5. Bowe, B,Xie, Y,Li, T,Yan, Y,Xian, H,Al-Aly, Z(2017).Associations of ambient coarse particulate matter, nitrogen dioxide, and carbon monoxide with the risk of kidney disease: a cohort study.Lancet Planet Health,1,e267-e276.
6. Bowe, B,Xie, Y,Li, T,Yan, Y,Xian, H,Al-Aly, Z(2018).Particulate matter air pollution and the risk of incident CKD and progression to ESRD.J Am Soc Nephrol,29,218-230.
7. Chin, MT(2015).Basic mechanisms for adverse cardiovascular events associated with air pollution.Heart,101,253-256.
8. Critical Appraisal Skills Programme. CASP cohort study checklist. Available at: https://casp-uk.b-cdn.net/wp-content/uploads/2018/03/CASP-Qualitative-Checklist-2018_fillable_form.pdf. Accessed June 28, 2022.
9. Danesh, J,Muir, J,Wong, YK,Ward, M,Gallimore, JR,Pepys, MB(1999).Risk factors for coronary heart disease and acute-phase proteins. A population-based study.Eur Heart J,20,954-959.
10. Feng, Y,Jones, MR,Chu, NM,Segev, DL,McAdams-Demarco, MA(2021).Ambient air pollution and mortality among older patients initiating maintenance dialysis.Am J Nephrol,52,217-227.
11. Gillum, RF(2000).Assessment of serumal bumin concentration as a risk factor for stroke and coronary disease in African Americans and whites.J Natl Med Assoc,92,3-9.
12. Huang, WH,Lin, JH,Weng, CH,Hsu, CW,Yen, TH(2016).Environmental NO2 and CO exposure: ignored factors associated with uremic pruritus in patients undergoing hemodialysis.Sci Rep,6,31168.
13. Huang, WH,Lin, JL,Lin-Tan, DT,Chen, KH,Hsu, CW,Yen, TH(2013).Impact of living environment on 2-year mortality in elderly maintenance hemodialysis patients.PLoS One,8,e74358.
14. Hwang, SL,Guo, SE,Chi, MC(2016).Association between atmospheric fine particulate matter and hospital admissions for chronic obstructive pulmonary disease in southwestern Taiwan: a population-based study.Int J Environ Res Public Health,13,366.
15. Jung, J,Park, JY,Kim, YC(2020).Long-term effects of air pollutants on mortality risk in patients with end-stage renal disease.Int J Environ Res Public Health,17,546.
16. Lin, JH,Yen, TH,Weng, CH,Huang, WH(2015).Environmental NO2 level is associated with 2-year mortality in patients undergoing peritoneal dialysis.Medicine,94,e368.
17. Lin, YT,Lo, YC,Chiang, HY(2020).Particulate air pollution and progression to kidney failure with replacement therapy: an advanced CKD registry-based cohort study in Taiwan.Am J Kidney Dis,76,645-657.
18. Liu, MH,Chan, MJ,Hsu, CW,Weng, CH,Yen, TH,Huang, WH(2017).Association of uremic pruritus in hemodialysis patients with the number of days of high mean 24-hour particulate matter with a diameter of< 2.5 μm.Ther Clin Risk Manag,13,255-262.
19. Lu, X,Ye, Z,Zheng, S(2018).Long-term exposure of fine particulate matter causes hypertension by impaired renal D1 receptor-mediated sodium excretion via upregulation of G-protein-coupled receptor kinase type 4 expression in Sprague-Dawley rats.J Am Heart Assoc,7,e007185.
20. Nair, AS(2019).Publication bias -- importance of studies with negative results!.Indian J Anaesth,63,505-507.
21. Nelson, JJ,Liao, D,Sharrett, AR(2000).Serum albumin level as a predictor of incident coronary heart disease the atherosclerosis risk in communities (ARIC) study.Am J Epidemiol,151,468-477.
22. OCEBM (Oxford Centre for Evidence-Based Medicine) Levels of Evidence Working Group. The Oxford 2011 levels of evidence. Available at: http://www.cebm.net/index.aspx?o=5653. Accessed June 28, 2022.
23. Rosenthal, R(1979).The file drawer problem and tolerance for null results.Psychol Bull,86,638-641.
24. Ross, R(1999).Atherosclerosis -- an inflammatory disease.N Engl J Med,340,115-126.
25. Sterne, JA,Gavaghan, D,Egger, M(2000).Publication and related bias in meta-analysis: power of statistical tests and prevalence in the literature.J Clin Epidemiol,53,1119-1129.
26. Sun, Q,Wang, A,Jin, X(2005).Long-term air pollution exposure and acceleration of atherosclerosis and vascular inflammation in an animal model.JAMA,294,3003-3010.
27. van Donkelaar, A,Martin, RV,Brauer, M,Boys, BL(2015).Use of satellite observations for long-term exposure assessment of global concentrations of fine particulate matter.Environ Health Perspect,123,135-143.
28. WHO.WHO global air quality guidelines: particulate matter (PM2.5 and PM10), ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide.
29. WHO. WHO ambient air quality database: 2022 update status report. Available at: https://cdn.who.int/media/docs/default-source/air-pollution-documents/air-quality-and-health/who-air-quality-database-2022---v7.pdf?sfvrsn=c6d52e7b_7&download=true. Accessed October 20, 2021.
30. WHO. Ambient (outdoor) air pollution. Available at: https://www.who.int/news-room/fact-sheets/detail/ambient-(outdoor)-air-quality-and-health. Accessed October 19, 2021.
31. WHO.Health effects of particulate matter. Policy implications for countries in eastern Europe, Caucasus and central Asia.
32. Wille, SM,Lambert, WE(2004).Volatile substance abuse -- post-mortem diagnosis.Forensic Sci Int,142,135-156.
33. Wolf, K,Popp, A,Schneider, A(2016).Association between long-term exposure to air pollution and biomarkers related to insulin resistance, subclinical inflammation, and adipokines.Diabetes,65,3314-3326.
34. Yang, YR,Chen, YM,Chen, SY,Chan, CC(2017).Associations between long-term particulate matter exposure and adult renal function in the Taipei metropolis.Environ Health Perspect,125,602-607.
35. Zafirah, Y,Lin, YK,Andhikaputra, G,Sung, FC,Deng, LW,Wang, YC(2022).Mortality and morbidity of chronic kidney disease associated with ambient environment in metropolitans in Taiwan.Atmos Environ,289,119317.
36. 台灣腎臟學會：2020台灣腎病年報。https://lib.nhri.edu.tw/NewWeb/nhri/ebook/39000000465141/。引用2021/09/20。 Taiwan Society of Nephrology. Kidney disease in Taiwan, annual report 2020. Available at: https://lib.nhri.edu.tw/NewWeb/nhri/ebook/39000000465141/. Accessed September 20, 2021. [In Chinese]
37. 行政院環保署, Executive Yuan, R.O.C. (Taiwan)(2014).中華民國空氣品質監測報告103年年報.台北=Taipei:行政院環境保護署=Environmental Protection Administration, Executive Yuan, R.O.C. (Taiwan).
38. 行政院環境保護署, Executive Yuan, R.O.C. (Taiwan)(2020).中華民國空氣品質監測報告109年年報.台北=Taipei:行政院環境保護署=Environmental Protection Administration, Executive Yuan, R.O.C. (Taiwan).
39. 梁喬凱, CK,蔡孟裕, MY。,未出版
40. 許超群（編）, CC(Ed.)(2019).空氣污染與肺部健康.台北=Taipei:臻呈文化=Crossroad.