Chronic kidney disease (CKD) is a significant public health concern worldwide, with mortality rates continuing to rise. While the adverse effects of environmental pollutants on respiratory and cardiovascular health are well-documented, the impact on renal outcomes remains unclear.
Ozone, a major component of air pollution, is known to induce oxidative stress and inflammation, which may contribute to the progression of CKD. A recent study aimed to investigate the association between long-term ozone (O3) exposure and mortality in individuals with CKD. This study was published in the journal of BMC Nephrology by Ejin Kim and colleagues.

A cohort of 61,073 participants was included in this study, with researchers employing Cox proportional hazards models to analyze the association between ozone exposure and the risk of end-stage renal disease (ESRD) and mortality. Ozone concentrations were calculated based on exposure one year before enrollment using inverse distance weighting (IDW) for interpolation. Models were adjusted for socioeconomic status and other measured pollutants.
The key findings of the study were:
• In both single and two-pollutant models, long-term ozone exposure was significantly associated with an increased risk of ESRD and all-cause mortality.
• The hazard ratios (HR) for ozone exposure varied depending on the assessment method, with HR values of 1.025 (95% CI: 1.014–1.035) at the district level and 1.04 (95% CI: 1.035–1.045) at the individual address level for ESRD risk.
• Similarly, HR values for all-cause mortality were 1.012 (95% CI: 1.008–1.017) at the district level and 1.04 (95% CI: 1.031–1.05) at the individual address level.
This study provides compelling evidence that long-term ambient ozone exposure increases the risk of end-stage renal disease and mortality in individuals with chronic kidney disease. The findings underscore the importance of implementing strategies to reduce ozone emissions, which would not only benefit public health but also contribute to environmental preservation. Efforts to mitigate ozone pollution are essential in safeguarding the health of vulnerable populations and promoting overall well-being.
Reference:
Kim, E., Huh, H., Mo, Y., Park, J. Y., Jung, J., Lee, H., Kim, S., Kim, D. K., Kim, Y. S., Lim, C. S., Lee, J. P., Kim, Y. C., & Kim, H. Long-term ozone exposure and mortality in patients with chronic kidney disease: a large cohort study. BMC Nephrology,2024;25(1). https://doi.org/10.1186/s12882-024-03500-6