Spatiotemporal Heterogeneity and the Impact of PM1 and Nitrogen Oxides on Chronic Kidney Disease Mortality in 39 European Countries (1990-2022): A Multi-Model Analysis.

Authors

Yuhe Si, Chunbao Mo, Qianqian Zhang, Yuchang Ma, Yukai Ye, Yunhao Jia, Jiahua Qian, Yihao Chen, Dian Wang, Jianxiong Ma

Published in

International journal of nephrology and renovascular disease. Volume 19. Pages 609735. Epub Jul 08, 2026.

Abstract

Chronic kidney disease (CKD) has become a significant public health burden in Europe, with marked spatiotemporal heterogeneity. Nitrogen oxides (NOx) and fine particulate matter (PM) are considered important environmental risk factors; however, the association of submicron particulate matter (PM1) with CKD mortality and the potential non-linear exposure-response patterns of these pollutants remain insufficiently characterized.
In this ecological study, national-level aggregated data from 39 European countries from 1990 to 2022 were analyzed. Environmental exposure was assessed using population-density-weighted exposure estimates, and spatial heterogeneity was analyzed using a Geodetector approach. Linear mixed-effects models (LMM) and generalized additive mixed models (GAMM) were used to investigate the associations between environmental factors and age-standardized CKD mortality rates (ASMR). XGBoost, combined with SHAP interpretation tools, quantified the relative contributions and identified non-linear thresholds. Finally, a partial correlation network analysis revealed the interaction structures among environmental factors.
After adjusting for confounders, NOx and particulate matter exposures showed significant positive correlations with CKD mortality risk. LMM revealed a pronounced "particle size effect": the coefficient for PM1 (β = 0.220 deaths per 100,000 population on the raw ASMR scale) was higher than that for PM2.5 (0.199) and PM10 (0.141). GAMM results supported the robustness of these associations on the logit-transformed proportional scale, and higher HDI was inversely associated with CKD mortality (β_IQR = -0.056). XGBoost and LOESS analyses further revealed non-linear characteristics: particulate matter exposure exhibited an S-shaped saturation curve, whereas NOx exposure displayed a J-shaped threshold effect (with risk steeply increasing beyond 9 ppb). Network analysis indicated a strong positive correlation between high temperatures and CKD mortality (r = 0.42), whereas humidity was inversely correlated. Spatial detection further identified PM1 as the strongest explanatory factor of spatial variation in European CKD mortality rates (q = 0.243). Conversely, a higher Human Development Index (HDI) exhibited relatively robust protective effects against CKD mortality (β = -0.056).
Our findings suggest that CKD mortality in Europe may be associated with NOx and fine PM (particularly PM1) exposure, which exhibit complex non-linear relationships. These findings support further evaluation of submicron particulate matter in environmental monitoring frameworks and suggest that transport-related pollution and heat-related climatic conditions warrant attention in strategies aimed at reducing regional CKD mortality disparities.

PMID:
42438792
Bibliographic data and abstract were imported from PubMed on 13 Jul 2026.

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