| Summary: | Long-term exposure to air pollutants significantly increases the morbidity and mortality associated with various diseases. However, little is known about the relationship between air pollutants and end-stage renal disease (ESRD)-related mortality. A total of 5041 patients who started dialysis between 2008 and 2015 were prospectively enrolled in the Clinical Research Center for End-Stage Renal Disease (CRC-ESRD) cohort study. We assigned a daily mean concentration of air pollutants (PM<sub>10</sub>, NO<sub>2</sub>, and SO<sub>2</sub>) to each participant. Time-varying Cox models were used to investigate the relationship between air pollutants and mortality in ESRD patients. During the follow-up period (mean 4.18 years), 1475 deaths occurred among 5041 participants. We found a significant long-term relationship between mortality risk and PM<sub>10</sub> (HR 1.33, CI 1.13−1.58), NO<sub>2</sub> (HR 1.46, CI 1.10−1.95), and SO<sub>2</sub> (HR 1.07, CI 1.03−1.11). Elderly patients and patients who lived in metropolitan areas had an increased risk associated with PM<sub>10</sub>. Elderly patients also had increased risks associated NO<sub>2</sub> and SO<sub>2</sub>. Long-term exposure to air pollutants had negative effects on mortality in ESRD patients. These effects were prominent in elderly patients who lived in metropolitan areas, suggesting that ambient air pollution, in addition to traditional risk factors, is important for the survival of these patients.
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