End-stage renal disease in the World Trade Center Clinical Centers of Excellence General Responders

Objectives Hazardous environmental exposures, including those experienced by responders to the 11 September 2001 attacks on the World Trade Center (WTC), can increase the risk of end-stage renal disease (ESRD). This cohort study compared ESRD in the WTC Health Program Clinical Centers of Excellence General Responders (CCEGR) with that of the US general population. We also investigated whether ESRD risk was associated with WTC exposures among the CCEGR. Methods ESRD case status (2002–2021) was confirmed by matched combinations of name, date of birth and (if appropriate) death, sex and social security numbers (as available) with the United States Renal Data System. All-cause ESRD was compared between the CCEGR and the US general population using an indirect age and sex standardised-incidence ratios (SIR). Covariate-adjusted multivariable Cox proportional hazards models assessed the associations of ESRD with four measures of WTC exposure between 2002 and 2021; sensitivity analyses were conducted. Results CCEGR-to-US SIR was 0.64 (95% CI 0.57 to 0.72). ESRD hazard ratios (HR) were 1.24 (95% CI 0.94 to 1.65) comparing high/very high with low/intermediate WTC exposures and 1.23 (95% CI 0.93 to 1.62) comparing responders reporting and not reporting WTC dust cloud exposure. The sensitivity analysis HRs were very similar. Conclusions CCEGR ESRD was significantly lower than expected compared with the general population. While not significant, the HRs indicate that WTC dust cloud exposure may increase CCEGR ESRD risk. A pooled or future assessment would increase statistical power to more definitively determine the association of WTC dust cloud exposure and ESRD.