Long-term exposure to air pollution and chronic kidney disease incidence in adults: The Danish Nurse Cohort.

Authors

Gonzalo B Hevia-Ramos, Jiawei Zhang, Stéphane Tuffier, Rina So, George Napolitano, Marie Bergmann, Jørgen Brandt, Tanya Andersson Nystedt, Cale Lawlor, Kajsa Pira, Matthias Ketzel, Ebba Malmqvist, Anna Oudin, Zorana Jovanovic Andersen, Youn-Hee Lim

Published in

Journal of exposure science & environmental epidemiology. Jul 11, 2026. Epub Jul 11, 2026.

Abstract

Air pollution is an established risk factor for cardiovascular and metabolic diseases, but evidence on chronic kidney diseases (CKD) remains limited.
We aim to examine the association between long-term exposure to air pollutants and CKD incidence.
We followed 24,581 female nurses from the Danish Nurse Cohort, recruited in 1993 or 1999, for their first-ever hospital contact with a primary or secondary CKD diagnosis until 2018. We estimated annual mean levels of particulate matter with a diameter < 2.5 µm (PM_2.5) and 10 µm (PM₁₀), nitrogen dioxide (NO₂), and black carbon (BC) at nurses' residential addresses using the DEHM/UBM/AirGIS modeling system. We used Cox regression models to examine the association of 14-year running means of air pollutants with CKD incidence and to explore the effect modification of this association by lifestyles.
Over 521,211 person-years of follow-up, 429 nurses developed CKD. We found positive associations of modest magnitude between long-term exposure to air pollutants and CKD, with hazard ratios (95% confidence intervals) per interquartile range: 1.18 (0.93-1.50) per 2.86 µg/m³ for PM_2.5, 1.14 (0.93-1.40) per 3.33 µg/m³ for PM₁₀, 1.13 (0.99-1.28) per 8.09 µg/m³ for NO₂, and 1.09 (1.00-1.20) per 0.34 µg/m³ for BC. The associations between long-term exposure to NO₂ and CKD incidence were greater in never smokers than in ever-smokers. Associations with NO₂ and BC remained unchanged in two-pollutant models, whereas those with PM₁₀ and PM_2.5 attenuated.
Our study adds important new findings to the growing evidence suggesting that air pollution may be associated with CKD incidence.
This study provides longitudinal evidence that long-term exposure to ambient air pollution contributes to chronic kidney disease (CKD) incidence, even in a relatively healthy occupational cohort and at comparatively low pollution levels. Although effect sizes were modest, consistent positive associations, particularly for NO₂ and black carbon, highlight traffic-related pollution as a potential renal risk factor. Stronger associations among never-smokers suggest that environmental exposures may independently influence kidney health. These findings reinforce the need to integrate air pollution into CKD risk assessment and prevention strategies. Strengthening air quality policies and reducing long-term residential exposure could help lower CKD burden and protect kidney health at the population level.

PMID:
42436292
Bibliographic data and abstract were imported from PubMed on 12 Jul 2026.

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