Transportation noise exposure associates with chronic kidney disease: insights into an under-recognized risk factor for CKM syndrome

Background Cardiovascular-kidney-metabolic (CKM) syndrome is a common systemic disorder with a profound impact on health worldwide. Transportation noise is an established risk factor for both cardiovascular diseases, including ischemic heart disease and heart failure, and cardiometabolic risk factors, including hypertension (HTN), diabetes mellitus (DM). HTN and DM also contribute to chronic kidney disease (CKD); however, the relationship between noise exposure and CKD, a key component of CKM syndrome, has remained unknown. Purpose This study evaluated whether (i) transportation noise exposure independently associates with CKD risk and (ii) development of HTN and DM mediates the noise-CKD link. Methods A total of 99,065 individuals (median age 57 years; 58.1% females) with data on residential transportation noise and CKD status were identified in Mass General Brigham Biobank. Individuals were followed from consent until 2020. Those with baseline (i.e., before consent) kidney disease were excluded. Presence and timing of CKD and confounders were assessed using ICD-10 codes, medical records, and US government data. Annual 24-h average residential transportation noise exposure (as a combination of rail, road, and aircraft noise) at each participant’s home address was assessed using the US Department of Transportation National Transportation Noise Map. Relationships with cardiometabolic risk factors and incident CKD were assessed at noise thresholds of >45, >50, and >55 dBA using adjusted logistic regression. Mediation analyses were performed to assess the role of cardiometabolic risk factors in the noise-CKD relationship. Temporal precedence of diagnoses was considered in all analyses. Results High noise exposure associated with increased risk of CKD across all thresholds. These associations were independent of age, sex, baseline cardiometabolic risk factors, heart failure, smoking, and race across noise thresholds (primary model, odds ratio (ORs) 1.15–1.28, Table 1A) and remained significant with adjustment for socioeconomic factors but inconsistently with air pollution. Noise exposure also independently associated with the development of new cardiometabolic risk factors across noise thresholds (primary model OR 1.15 – 1.21, p<0.05, Table 1B), and those newly developed risk factors associated with subsequent CKD (Table 1C). Further, incident HTN and/or DM mediated the relationship between noise and CKD (indirect pathways all p<0.05, Figure 1) across noise thresholds. Conclusion Chronic transportation noise exposure associates with incident CKD, suggesting that noise exposure is an important and under-recognized contributor to CKM syndrome. This relationship is partially mediated by the development of cardiometabolic risk factors. These findings suggest that individuals with high noise exposure may benefit from intensified screening and treatment of cardiometabolic risk factors to prevent CKD and CKM syndrome.