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Sci Rep. 2019;9(1):2230.

The impact of sunlight exposure on mortality of patients with end stage renal disease.

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제1저자 Una Amelia Yoon, 김용철 · 교신저자 이정표, 김호

PMID 30778098 PMC6379426 DOI 10.1038/s41598-019-38522-w IF 4.9 신장내과
소속 (12)
  1. Department of Biostatistics and Epidemiology, School of Public Health, Seoul National University, Seoul, Korea.
  2. Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
  3. Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea.
  4. Institute of Health and Environment, Seoul National University, Seoul, Korea.
  5. Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
  6. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
  7. Kidney Research Institute, Seoul National University Hospital, Seoul, Korea.
  8. Department of Medical Science, Seoul National University College of Medicine, Seoul, Korea.
  9. Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea. nephrolee@gmail.com.
  10. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. nephrolee@gmail.com.
  11. Department of Biostatistics and Epidemiology, School of Public Health, Seoul National University, Seoul, Korea. hokim@snu.ac.kr.
  12. Institute of Health and Environment, Seoul National University, Seoul, Korea. hokim@snu.ac.kr.

Abstract

Recent data suggest that reduced sunlight exposure is associated with increased mortality in the general population. To date, the association between sunlight exposure and mortality in dialysis patients has not been examined. Among 134,478 dialysis patients in the Korean end-stage renal disease (ESRD) cohort from 2001 to 2014, 31,291 patients were enrolled from seven metropolitan cities, and data were analyzed using bi-directional case-crossover design. We examined the association between short-term sunlight exposure and mortality in ESRD patients. We adjusted for temperature, humidity, and daily concentrations of nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), carbon monoxide (CO), and particle matter (PM10) as confounders. The characteristics of the study population included age (65.6 ± 12.26 (mean ± standard deviation [SD]) years), sex (male, 59.96%; female, 41.04%), comorbidity (diabetes, 53.58%; hypertension, 40.5%), and kidney dialysis type (hemodialysis, 73.02%; peritoneal dialysis, 26.98%). The mean ± SD follow-up time was 4.68 ± 4.37 years. The daily sunlight exposure was significantly decreased in the case group compared with the control group (P = 0.004). Sunlight exposure was associated with all-cause death overall (ORs [95% CI]: 0.99 [0.98-0.99], P = 0.042) in a fully adjusted model. Patients with diabetes (ORs [95% CI]: 0.98 [0.97-0.99], P = 0.016) or aged higher than 75 years (ORs [95% CI]; 0.97 [0.96-0.99], P = 0.020) had higher risks of mortality than patients without diabetes or aged below 75 years, respectively. These findings suggest that sunlight exposure is inversely correlated with all-cause mortality in dialysis patients.

Figures

Figure 1
Figure 1 The trend of all-cause mortality and sunlight. The time-series plot indicates the daily number of mortality cases of ESRD patients from 2001 to 2014, (top panel) and daily hours of sunlight during 2001–2014 (bottom panel) which was collected from the Korea Meteorological Administration.
Figure 2
Figure 2 Percent decrease in odds ratios of sunlight exposures for all-cause death. Forest plot showing the associations of sunlight exposures and mortality of ESRD patients (adjusted for temperature, humidity and PM10), according to diabetes, dialysis modality, and old age (over 75 years). Abbreviations: ESRD, end-stage renal disease; PD, peritoneal dialysis; HD, hemodialysis.
Figure 3
Figure 3 Penalized spline terms on exposure. An estimated exposure-response curve for short-term exposures to sunlight was created to assess the percentage increase in daily mortality at various daily sunlight exposure hours. The solid line represents the predicted log relative risk, and dashed lines indicate 95% confidence intervals.
Figure 4
Figure 4 Bi-directional sampling of control time in the case-crossover study. A bi-directional case-crossover study was conducted, which sampled control periods as the exposure seven days before and seven days after the event day (the day of mortality), producing four control days per case.

그림 출처: PubMed Central 공개 논문 (PMC6379426)

Conflict of interest statement

The authors declare no competing interests.

그 밖의 정보
출판 형태
Journal Article, Research Support, Non-U.S. Gov't
저널
Scientific reports · eISSN 2045-2322
전자 출판
2019-02-18
MeSH
Aged · Aged, 80 and over · Air Pollution · Cause of Death · Comorbidity · Environmental Exposure* · Female · Humans · Kidney Failure, Chronic / epidemiology / mortality / therapy · Male · Middle Aged · Mortality · Odds Ratio · Public Health Surveillance · Republic of Korea / epidemiology · Sunlight*
참고문헌
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