Chronic kidney disease of unknown origin is associated with environmental urbanisation in Belfast, UK

Chronic kidney disease (CKD), a collective term for many causes of progressive renal failure, is increasing worldwide due to ageing, obesity and diabetes. However, these factors cannot explain the many environmental clusters of renal disease that are known to occur globally. This study uses data from the UK Renal Registry (UKRR) including CKD of uncertain aetiology (CKDu) to investigate environmental factors in Belfast, UK. Urbanisation has been reported to have an increasing impact on soils. Using an urban soil geochemistry database of elemental concentrations of potentially toxic elements (PTEs), we investigated the association of the standardised incidence rates (SIRs) of both CKD and CKD of uncertain aetiology (CKDu) with environmental factors (PTEs), controlling for social deprivation. A compositional data analysis approach was used through balances (a special class of log contrasts) to identify elemental balances associated with CKDu. A statistically significant relationship was observed between CKD with the social deprivation measures of employment, income and education (significance levels of 0.001, 0.01 and 0.001, respectively), which have been used as a proxy for socio-economic factors such as smoking. Using three alternative regression methods (linear, generalised linear and Tweedie models), the elemental balances of Cr/Ni and As/Mo were found to produce the largest correlation with CKDu. Geogenic and atmospheric pollution deposition, traffic and brake wear emissions have been cited as sources for these PTEs which have been linked to kidney damage. This research, thus, sheds light on the increasing global burden of CKD and, in particular, the environmental and anthropogenic factors that may be linked to CKDu, particularly environmental PTEs linked to urbanisation.
The Tellus Project was funded by the Department of Enterprise, Trade and Investment (NI) and by the ‘Building Sustainable Prosperity’ fund of the EU Regional Development Programme. Chemical analysis of the urban soil samples was co-financed by the Northern Ireland Environment Agency. The Northern Ireland Statistics and Research Agency (NISRA) is thanked for providing the multiple deprivation measures (MDMs). The study received ethics approval in March 2018, NHS National Research Ethics Committee REC reference: 15/EM/0366. We thank all the UK Renal Centres for providing data to the UK Renal Registry. The views and opinions expressed in this article are those of the authors and do not reflect the views of the UK Renal Registry or UK Renal Association. JJE and VPG received financial support through the project METhods for COmpositional analysis of DAta (CODAMET), Ministerio de Ciencia, Innovación y Universidades, Spain (Ref: RTI2018-095518-B-C21/C22, 2019-2021).
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