Linking the Effects of 9/11 to Kidney Disease (WTC Kidney Link)

Details

• Personal Author:
  Coca S ; Crane M ; Iyengar-Kapuganti RL ; McLaughlin MA ; Wyatt C
• Description:
  Significant associations between 9/11 exposure and several medical conditions, including obstructive sleep apnea (OSA) exist, but until now, studies of kidney damage are limited. Both kidney disease (characterized by albuminuria and impaired estimated glomerular filtration rate (eGFR)) and OSA are important public health issues due to their impact on cardiovascular outcomes. Prior researchers have found trends toward increased albuminuria in residents with higher PM exposure over 20 years. Mechanisms by which particulate matter (PM) causes toxic effects are not adequately understood, and different mechanisms may be responsible for acute vs. chronic effects. Findings from this research addresses a critical knowledge gap about the risk of kidney damage among WTC-exposed individuals, and the association of chronic kidney disease (CKD) with a defined WTC-related diagnosis, OSA. Current evidence supports a strong interaction between OSA and CKD in those with end stage renal disease (ESRD), but evidence is lacking among those with early CKD. Our study provides a unique opportunity to analyze the relationship between prevalence of OSA and CKD in this unique population of middle-aged men and women with a relatively high prevalence of both conditions. Between November 2017 and October 2020, a one-time evaluation was performed on 555 participants (513 WTC-exposed and 42 unexposed). Urine albumin:creatinine ratio (UACR) and eGFR were used to evaluate kidney function. Clinically relevant albuminuria was defined as UACR ≥30 mg/g and eGFR was calculated using the Chronic Kidney Disease Epidemiology Consortium (CKD-EPI) equations. PM exposure was categorized into four levels based on proximity to Ground Zero, time of arrival, and duration of exposure (XP4). To investigate the association between kidney disease and OSA, participants underwent evaluation that included medical history, measurement of blood pressure, height, weight, waist, hip and neck circumference, lipid panel, complete blood count, HbA1c, serum creatinine and cystatin-C and sleep apnea screening (Berlin questionnaire). Participants never diagnosed with OSA and screened positive for high risk OSA were evaluated with home sleep apnea test device. Participants diagnosed with OSA provided latest sleep study results. To evaluate proposed mechanisms of kidney injury, biomarkers of inflammation (hsCRP, TNF-a, interferon-gamma and other cytokines), renal tubular injury (KIM-1, IL-18, B-2-microglobulin, NGAL, Uromodulin, MCP-1) and heavy metal assays were performed. Binary and categorical variables were summarized using frequency and percentage. Continuous variables were summarized using mean and standard deviation. Binary variables were compared between studies using logistic models and continuous variables were compared using general linear models. WTC-exposed individuals were more likely to have decreased renal function (eGFR) compared with nonexposed New York cohort after adjusting for gender, ethnicity, race, smoking status, history of diabetes and hypertension (p=0.002). Moreover, WTC-exposed participants with OSA had decreased eGFR after adjusting for age, ethnicity, diabetes, hypertension and smoking (p=0.0491). In light of the finding that reduction in kidney function was associated with exposure to particulate matter at Ground Zero, we recommend continued monitoring of kidney function in this population. These novel findings pave the way for future studies of environmental exposures in the pathogenesis of chronic kidney disease. [Description provided by NIOSH]
• Subjects:
  Cohort Studies Dust Occupational Health Particulate Matter Safety September 11 Terrorist Attacks
• Keywords:
  Cohort Studies Kidney Damage Kidney Function Kidneys Particulate Dust World Trade Center WTC
• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Final Cooperative Agreement Report
• Place as Subject:
  New York ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OEP - Office of Extramural Programs
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-34
• NIOSHTIC Number:
  nn:20067569
• Citation:
  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, U01-OH-011326, 2021 Sep; :1-34
• Contact Point Address:
  Mary Ann McLaughlin, MD, MPH, Associate Professor of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029
• Email:
  maryann.mclaughlin@mountsinai.org
• Federal Fiscal Year:
  2021
• Performing Organization:
  Icahn School of Medicine at Mount Sinai, New York
• Peer Reviewed:
  False
• Start Date:
  20170701
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20200630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:841da98819a957bdc2f428f2af1b91d94a9cd186519753919db1e49c143540994f23ec9ed2923c63c790079971493a1ffa82991140bfe553fafb68beb08347ad
• Download URL:
  https://stacks.cdc.gov/view/cdc/219199/cdc_219199_DS1.pdf
• File Type:
  [PDF - 1.01 MB ]