Adverse Effects of fine particulate matter on human kidney functioning: a systematic review

Abstract

Background: Ambient fine particulate matter (PM < 2.5 μm, PM 2.5) is gaining increasing attention as an environmental risk factor for health. The kidneys are considered a particularly vulnerable target to the toxic effects that PM 2.5 exerts. Alteration of kidney function may lead to a disrupted homeostasis, affecting disparate tissues in the body. This review intends to summarize all relevant knowledge published between January 2000 and December 2021 on the effects of ambient PM 2.5 and the adverse effects on kidney function in adults (≥ 18 years). Results and Discussion: Studies published in peer-reviewed journals, written in English, regarding the effects of PM 2.5 on kidney function and the development and/or exacerbation of kidney disease(s) were included. Of the 587 nonduplicate studies evaluated, 40 were included, comprising of studies on healthy or diagnosed with pre-existing disease (sub)populations. Most of the studies were cohort studies (n = 27), followed by 10 cross-sectional, 1 ecological and 2 time-series studies. One longitudinal study was considered intermediate risk of bias, the other included studies were considered low risk of bias. A large portion of the studies (n = 36) showed that PM 2.5 exposure worsened kidney outcome(s) investigated; however, some studies show contradictory results. Measurement of the estimated glomerular filtration rate, for instance, was found to be positively associated (n = 8) as well as negatively associated (n = 4) with PM 2.5. Limitations and Conclusion: The main limitations of the included studies include residual confounding (e.g., smoking) and lack of individual exposure levels. The majority of included studies focused on specific subpopulations, which may limit generalizability. Evidence of the detrimental effects that ambient PM 2.5 may exert on kidney function is emerging. However, further investigations are required to determine how and to what extent air pollution, specifically PM 2.5 , exerts adverse effects on the kidney and alters its function. Registration: The systematic review protocol was submitted and published by the International Prospective Register of Systematic Reviews (PROSPERO; CRD42 02017 5615).