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Elevated Nitrogen Emissions Linked to Kidney Damage

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A new study suggests that elevated levels of nitrogen pose a risk to kidneys. This link has been revealed by a research project involving more than 143,000 inhabitants of the northern Netherlands, carried out by UMCG nephrologists and researchers.

Chronic kidney damage is a major health problem, the most serious forms of which are associated with a significant strain on the patient and high costs for society. It has been known for some time that the incidence of chronic kidney damage varies considerably between countries. Identifying the causes of these geographical differences may provide a better understanding of the causes of kidney damage, thus providing a basis for better prevention. So far, little is known about such regional differences in the Netherlands when it comes to kidney damage. This study was the first to investigate whether regional areas could be identified with relatively low or high frequency of cases of kidney damage and potential determinants thereof.

Conducting the research

For their study, the researchers used the Lifelines cohort. Lifelines is the data repository and biobank in which information about the health of three generations of inhabitants of the northern Netherlands is being collected over a period of thirty years. The researchers estimated renal function, which indicates the speed at which the kidneys filter waste products from the blood, of no fewer than 143,735 Lifelines participants. They then correlated those results with postcodes to find out where renal function was the poorest or the best and related that to environmental exposure.

Nitrogen emissions are a decisive factor

The results showed that, in the north of the Netherlands, the extent to which chronic kidney damage occurs varied significantly between regions. These differences were not easily explained by known risk factors such as age, high blood pressure and diabetes. The spatial analyses showed that exposure to nitrogen dioxide was a major factor. The greater the exposure to nitrogen, the poorer the renal function.

Risk of kidney damage

This indicates that a high level of nitrogen emission not only poses a risk to the respiratory tract but also to the kidneys. According to the researchers, the results indicate that spatial analysis can be a useful tool to guide strategies for the prevention of chronic kidney diseases.


Cai et al. (2019) Intraregional differences in renal function in the Northern Netherlands: The Lifelines Cohort Study. PLOS One. DOI: https://doi.org/10.1371/journal.pone.0223908

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