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Post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI) are considered the signature wounds of the wars in Afghanistan and Iraq. It is estimated that 500,000 veterans live with the symptoms of PTSD; around 320,000 have a TBI. These trauma-related issues can contribute significantly to suicidal thoughts or tendencies. It is estimated more than 20 veterans take their life each day. There are few proven methods to accurately diagnose and treat PTSD and TBI. Today, Wounded Warrior Project® (WWP) and Cohen Veterans Bioscience (CVB) announced a shared initiative to better diagnose and treat PTSD and TBI. The collaboration, known as Research Alliance for PTSD/TBI Innovation and Discovery Diagnostics (RAPID-Dx), is a public-private partnership led by CVB with WWP supporting biomarker research. Biomarkers help doctors measure the effectiveness of treatment better than what a patient reports on his or her own health. RAPID-Dx helps discover, replicate, and qualify biomarkers for PTSD and TBI care. "Identifying biomarkers is an important step in care for PTSD and TBI," said Mike Richardson, WWP vice president of mental health and independence services. "We can better target treatment to individual patients and see improved results." The partnership between RAPID-Dx and Warrior Care Network® will help expand this important research. Warrior Care Network is an innovative partnership between WWP, four top academic medical centers, and the Department of Veterans Affairs (VA). Warrior Care Network treats the invisible wounds of war through intensive outpatient programs. "RAPID-Dx will provide vital information for the precision treatment of patients with PTSD and TBI," said Dr. Magali Haas, CEO of Cohen Veterans Bioscience. "This partnership represents a best-in-class approach to helping the thousands of veterans in need, as well as others affected by these debilitating injuries." About Wounded Warrior Project Wounded Warrior Project® (WWP) connects, serves, and empowers wounded warriors. Read more at http://newsroom.woundedwarriorproject.org/about-us. About Cohen Veterans Bioscience Cohen Veterans Bioscience is a national, nonpartisan research organization dedicated to fast-tracking the development of diagnostic tests and personalized therapeutics for the millions of veterans and civilians who suffer the devastating effects of trauma-related and other brain disorders. To support & learn more about our research efforts, visit www.cohenveteransbioscience.org CONTACT: Wounded Warrior Project, Rob Louis, Public Relations, rlouis@woundedwarriorproject.org, 904.627.0432; Cohen Veterans Bioscience. press@cohenbio.org
Gulf War veterans with low-level exposure to chemical weapons show lasting adverse effects on brain structure and memory function, reports a study in the October Journal of Occupational and Environmental Medicine. In previous research, Linda Chao, PhD, and colleagues of San Francisco VA Medical Center reported decreased volume of the hippocampus—a brain area involved in memory processing—in Gulf War veterans exposed to the Khamisiyah plume. In that 1991 event, demolition of an Iraqi munitions depot caused US soldiers to be exposed to low levels of nerve agents, carried downwind in a smoke plume. The previous studies had some key limitations, including a lack of data on other risk factors. The new study compared an independent group of 113 veterans with predicted exposure to the Khamisiyah plume, based on Department of Defense models, and 62 nonexposed veterans. On brain magnetic resonance imaging scans, the hippocampus was significantly smaller in veterans with predicted exposure. The difference remained significant even after accounting for a wide range of other factors, including meeting criteria for Gulf War illness, the presence of an Alzheimer's disease risk gene (ApoE4), brain injury, or depression. Among veterans with predicted exposure to the Khamisiyah plume, smaller hippocampus volume was correlated with lower scores on a test of verbal learning and memory. Scores on the memory test were also lower for veterans with higher estimated exposure and those with self-reported memory difficulties. The finding that these effects are still present 25 years later, after adjusting for potential confounding factors, supports the conclusion that exposure to the Khamisiyah plume had lasting adverse effects on Gulf War veterans. Since memory problems and smaller hippocampal volumes have both been linked to the risk of late life dementia, Dr. Chao and colleagues believe that exposed veterans should receive regular follow-up, especially as they approach old age. ### About the Author Dr. Chao may be contacted for interviews at linda.chao(at)ucsf.edu. About ACOEM ACOEM (www.acoem.org), an international society of 4,500 occupational physicians and other health care professionals, provides leadership to promote optimal health and safety of workers, workplaces, and environments. About the Journal of Occupational and Environmental Medicine The Journal of Occupational and Environmental Medicine (www.joem.org) is the official journal of the American College of Occupational and Environmental Medicine. Edited to serve as a guide for physicians, nurses, and researchers, the clinically oriented research articles are an excellent source for new ideas, concepts, techniques, and procedures that can be readily applied in the industrial or commercial employment setting.
It's undeniable: a cancer diagnosis rocks the patient's family to its core. But what role does communication within the family play? Research by Wayne Beach, Ph.D., a professor of communication at San Diego State University, has proven that how a family communicates from diagnosis through cancer treatment plays a critical role in the patient's overall well-being and health. In recognition of October as National Breast Cancer Awareness Month, we spoke with Dr. Beach about his 10 years of research on communication and cancer, and we gathered his tips for communicating with a cancer patient. "How family members communicate when coping (with a diagnosis) is important," Beach says. Patients have reported feeling empowered when communication is comprehensive and constant in their home and medical surroundings, Beach explains. The American Cancer Society estimates three of four U.S. families have at least one member who is a cancer survivor, confirming the widespread impact and value of Beach's research. He and his team of researchers have and continue to study phone and face-to-face interactions between cancer patients and their families, and interactions between patients and healthcare professionals. "If you hear someone has been diagnosed with cancer, our natural inclination tends to be to think of it as a death sentence," he says.  This is why initial findings were surprising to Beach. Much of the communication observed between family members and cancer patients "focused on life, rather than death," he says. "It is so much more about hope than despair. I really didn't expect that going in." "So we're looking at how good and bad news relating to cancer gets delivered and responded to," he adds.  A Focus on Life, Hope Through communication, we share our fears and uncertainties with one another, but also our hope and optimism, which makes all the difference in a patient's well-being and outlook on life and their disease, Beach explains. Sharing stories and memories, in particular, serve as effective coping mechanisms for both patient and supporter.  Beach's studies, initially funded by the American Cancer Society, took on a personal meaning when his mother was diagnosed with lung cancer in 1998. She died just four months later. Now, Beach is working alongside collaborators at UC San Diego, San Diego State University and the National Health Institute to spread the word about communication and its critical role in a cancer patient's diagnosis, management and well-being. He has also developed, "When Cancer Calls…," a theatrical production based on his book "A Natural History of Family Cancer," which follows one family's telephone conversations following a member's cancer diagnosis. "Cancer patients do cope and heal better depending on their communication within their families. Without this proper communication, these patients don't heal as well or as long," he says. "Having a dysfunctional environment around you is not good, it's stressful." The Power of Positivity When someone you know is battling cancer, Do: Offer encouraging and positive words Communicate frequently Express your emotions  Actively listen to the patient's concerns and thoughts Communicate frequently; cancer patients need to be able and encouraged to vent and share their concerns, feats and fears. Do not: Stay silent Ignore the diagnosis and avoid speaking about anything cancer-related Focus on or introduce negativity 
The health effects of where people live, work, and interact are well documented, as are the value of neighborhood-level structural interventions designed to improve health. But place-based characteristics that contribute to disparities in HIV transmission and disease burden are poorly understood, possibly resulting in less-effective HIV risk reduction interventions and programming. A new study from the University of Pennsylvania School of Nursing (Penn Nursing) is helping to better understand the contextual social and structural factors that drive disparate HIV/AIDS rates and how place-based interventions can be more effective in fighting the HIV/AIDS pandemic. The 22-month pilot study – recently published in the Journal of Urban Health – explored racial/ethnic and geographic differences in mode of HIV transmission in Philadelphia, an urban HIV epicenter. Data indicated that certain geographic locations appear to have different modes of transmission profiles, with nuanced differences by gender and race/ethnicity. “Underlying geographical factors that contribute to disparities in HIV transmission and disease burden are poorly understood,” explains Bridgette M. Brawner, PhD, APRN, Assistant Professor of Nursing, and the lead author of the study. “‘One size’ does not fit all for individual-level interventions; the same is true in disproportionately affected neighborhoods, particularly when risk profiles differ by neighborhood characteristics and population demographics. The data generated from this research support a much needed paradigm shift to acknowledge the role negative social and structural factors like limited social cohesion, inadequate health-related resources and poverty have on the HIV/AIDS pandemic. The findings will also better inform the development of neighborhood-level structural interventions to address HIV/AIDS in overly burdened communities.”  Co-authors of the study include: Penn Nursing’s Robin Stevens, PhD, MPH; Barbara Guthrie, PhD, RN, FAAN, Bouvé College of Health Sciences at Northeastern University; Lynne Taylor, PhD, MS, Biostatistics Analysis Center at the University of Pennsylvania; Michael Eberhart, MPH, Philadelphia Department of Public Health; and Jean J. Schensul, PhD, Institute for Community Research at Yale University. The study was supported by funding through the National Institute of Mental Health R25MH087217.
It is now well known that up to 75 percent of women experience deficits in their intellectual capacity (i.e., cognitive impairment) during or after breast cancer treatment. Patients typically complain that they are “forgetful” and have “trouble concentrating or remembering” details like names, dates, and important events. They have difficulty multi-tasking, and it takes them longer to complete a task. Unfortunately for some women, these symptoms can persist for many months or years. These mental deficits are variable; they may be subtle or striking and temporary or permanent. Given that we continue to make strides in medicine to improve survival rates in breast cancer, there will be many more women living with cognitive impairment and it is important to not only be aware of but to address these issues, so that the quality of life for these women is maintained. Previously these cognitive difficulties were all attributed to chemotherapy such that the term “chemo brain” was coined. However, we now know that it is multifactorial. The menopausal status of the woman and endocrine (hormonal) therapy she receives for treatment can also influence cognitive function. Studies show that breast cancer patients who received chemotherapy and the anti-estrogen therapy tamoxifen have greater difficulty than those who received chemotherapy alone. Typical risk factors that can impact cognitive impairment from breast cancer treatment include being of elderly age and the intensity or number of chemotherapy doses received. There are also psychosocial risk factors like fatigue, anxiety, and depression. Other factors that can worsen the symptoms include drugs like pain killers, sleep disturbances, anemia and poor nutrition. Currently, there is no known way to prevent the cognitive difficulties caused by treatment. Medications like psychostimulants which can be prescribed by a doctor may help, but there are non-medicinal options that patients can explore. They include mind training exercises like puzzles, as well as games that use memory or learning a new language. Exercise, stress management, good nutrition filled with antioxidant-containing foods such as fruits and vegetables have also been recommended. Organization can be very helpful. Patients should set up and follow structured routines and use a detailed daily planner to keep track of appointments and schedules. Patients may sometimes feel embarrassed and not reach out for help. It is important to remember that these mental difficulties are a side effect that can be managed. Patients should ask for help from friends and loved ones and importantly inform their doctors for additional support.
Using a form of low-impulse electrical stimulation to the brain, documented by neuroimaging, researchers at the University of California San Diego School of Medicine, Veterans Affairs San Diego Healthcare System (VASDHS) and collaborators elsewhere, report significantly improved neural function in participants with mild traumatic brain injury (TBI).Their findings are published online in the current issue of the journal Brain Injury.TBI is a leading cause of sustained physical, cognitive, emotional and behavioral problems in both the civilian population (primarily due to motor vehicle accidents, sports, falls and assaults) and among military personnel (blast injuries). In the majority of cases, injury is deemed mild (75 percent of civilians, 89 percent of military), and typically resolves in days.But in a significant percentage of cases, mild TBI and related post-concussive symptoms persist for months, even years, resulting in chronic, long-term cognitive and/or behavioral impairment. Much about the pathology of mild TBI is not well understood, which the authors say has confounded efforts to develop optimal treatments. However, they note the use of passive neuro-feedback, which involves applying low-intensity pulses to the brain through transcranial electrical stimulation (LIP-tES), has shown promise. In their pilot study, which involved six participants who had suffered mild TBI and experienced persistent post-concussion symptoms, the researchers used a version of LIP-tES called IASIS, combined with concurrent electroencephalography monitoring (EEG). The treatment effects of IASIS were assessed using magnetoencephalography (MEG) before and after treatment. MEG is a form of non-invasive functional imaging that directly measures brain neuronal electromagnetic activity, with high temporal resolution (1 ms) and high spatial accuracy (~3 mm at the cortex). “Our previous publications have shown that MEG detection of abnormal brain slow-waves is one of the most sensitive biomarkers for mild traumatic brain injury (concussions), with about 85 percent sensitivity in detecting concussions and, essentially, no false-positives in normal patients,” said senior author Roland Lee, MD, professor of radiology and director of Neuroradiology, MRI and MEG at UC San Diego School of Medicine and VASDHS. “This makes it an ideal technique to monitor the effects of concussion treatments such as LIP-tES.”The researchers found that the brains of all six participants displayed abnormal slow-waves in initial, baseline MEG scans. Following treatment using IASIS, MEG scans indicated measurably reduced abnormal slow-waves. The participants also reported a significant reduction in post-concussion scores. “For the first time, we’ve been able to document with neuroimaging the effects of LIP-tES treatment on brain functioning in mild TBI,” said first author Ming-Xiong Huang, PhD, professor in the Department of Radiology at UC San Diego School of Medicine and a research scientist at VASDHS. “It’s a small study, which certainly must be expanded, but it suggests new potential for effectively speeding the healing process in mild traumatic brain injuries.”Co-authors include: Ashley Robb Swan, Annemarie Angeles Quinto, Scott Matthews, Deborah L. Harrington, Sharon Nichols, Charles W. Huang, and Dewleen G. Baker, UC San Diego and VASDHS; Barry J. Bruder, IASIS Technologies, Los Angeles; and Corey C. Snook, Mind-Brain Training Institute, Mount Dora, FL. Funding for this research came, in part, from the U.S. Department of Veterans Affairs (I01-CX000499, I01-RX001988, MHBA-010-14F, NURC-022-10F, NEUC-044-065).
Highlights Among hemodialysis patients admitted to the hospital, nearly a quarter of admissions were followed by an unplanned readmission within 30 days. Most readmissions were for a diagnosis different than the one for the initial hospitalization. A small proportion of patients accounted for a disproportionate number of readmissions. A new analysis found that nearly one-quarter of dialysis patients who are admitted to the hospital are readmitted soon after discharge, often for a diagnosis that is different than the one that led to the initial hospitalization. The analysis, which appears in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN), also identified certain patient characteristics linked to hospital readmissions. More than half a million people in the United States receive treatment for kidney failure, mostly through hemodialysis. On average, hemodialysis patients are admitted to the hospital nearly twice a year, and they have double the 30-day readmission rate as patients without kidney dysfunction. In 2017, the Centers for Medicare and Medicaid Services began penalizing outpatient dialysis units for excessive readmissions. Despite these efforts, there is a lack of information regarding characteristics and predictors of readmission. To investigate, a team led by Girish Nadkarni, MD, MPH and Lili Chan, MD, MS (Icahn School of Medicine at Mount Sinai) set out to determine the nationwide readmission rate in dialysis patients and to examine reasons for initial admissions and readmissions. When the researchers analyzed 2013 data from the Nationwide Readmission Database, they found 390,627 initial hospitalizations of hemodialysis patients, and 22% of these initial hospitalizations were followed by an unplanned readmission within 30 days. Readmission rates were similar across the top 10 initial admission diagnoses, and only 20% of readmissions were for the same diagnosis as the initial admission. “Regardless of what patients initially were admitted for, they had similar readmission rates. This along with the low concordance suggests that we need to focus on the patient as a whole rather than their admission diagnoses,” said Dr. Chan. The investigators also found that patient characteristics that were associated with a high likelihood of readmission included female gender, younger age, depression, liver disease, congestive heart failure, and drug abuse. Importantly, only a small proportion (2%) of all patients accounted for 20% of all readmissions. “To reduce readmissions in dialysis patients, perhaps a good starting place would be to institute interventions targeted at high utilizers and create a validated risk score incorporating likely risk factors,” said Dr. Nadkarni. In an accompanying editorial, Magdalene Assimon, PharmD, MS and Jennifer Flythe, MD, MPH (UNC School of Medicine) noted that there is surprisingly little published data evaluating interventions designed to reduce readmissions and stressed “the need for innovative, integrative data analytics in readmission risk modeling and a greater emphasis on testing and refining readmission prevention strategies.” They also quoted the American philosopher John Dewey, who said, “A problem well put, is half-solved.” “The problem of 30-day hospital readmissions among individuals receiving maintenance hemodialysis is increasingly ‘well put.’ The next step is to see that the problem is also well-solved,” they wrote. Study co-authors include Kinsuk Chauhan MD, Priti Poojary MD, Aparna Saha MD, Elizabeth Hammer, MD, Joseph Vassalotti, MD, Lindsay Jubelt, MD, Bart Ferket MD, PhD, and Steven Coca DO, MS. Disclosures: L.C. is supported in part by the National Institutes of Health. B.F is supported in part by American Heart Association. G.N. is supported in part by the National Institutes of Health. The article, entitled “National Estimates of Thirty Day Unplanned Readmissions of Patients on Maintenance Hemodialysis,” will appear online at http://cjasn.asnjournals.org/ on September 28, 2017, doi: 10.2215/CJN.02600317. The editorial, entitled “Thirty-Day Hospital Readmissions in the Hemodialysis Population: A Problem Well Put, But Half-Solved,” will appear online at http://cjasn.asnjournals.org/ on September 28, 2017. The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies. Since 1966, ASN has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients. ASN has nearly 17,000 members representing 112 countries. For more information, please visit www.asn-online.org or contact the society at 202-640-4660.
A novel psychological therapy that encourages addressing emotional experiences related to trauma, conflict and relationship problems has been found helpful for people with the chronic pain condition fibromyalgia. A research team led by Mark A. Lumley, Ph.D., professor of psychology in the College of Liberal Arts and Sciences at Wayne State University, in collaboration with a team from the University of Michigan Medical Center led by David A. Williams, Ph.D., professor of anesthesiology, has released the results of its research in the prestigious journal, PAIN. In the randomized clinical trial, 230 adults with fibromyalgia received one of three treatments, each of which was presented for eight weekly sessions to small groups of patients. The new therapy, which Lumley and co-developer Howard Schubiner, M.D., director of the Mind Body Medicine Program at Providence Hospital, call Emotional Awareness and Expression Therapy (EAET), helps patients view their pain and other symptoms as stemming from changeable neural pathways in the brain that are strongly influenced by emotions. EAET helps patients process emotional experiences, such as disclosing important struggles, learning how to adaptively express important feelings — especially anger and sadness but also gratitude, compassion, and forgiveness — and empowering people to be more honest and direct in relationships that have been conflicted or problematic. The EAET intervention was compared to both an educational intervention as well as the gold standard psychological approach in the field, cognitive behavioral therapy. Six months after treatments ended, patients were evaluated for the severity and extent of their pain and other problems that people with fibromyalgia often experience. Patients who received EAET had better outcomes — reduced widespread pain, physical impairment, attention and concentration problems, anxiety, and depression and more positive emotions and life satisfaction — than patients who received the education intervention. More than twice as many people in EAET (34.8 percent) reported that they were “much better” or “very much better” than before treatment, compared to 15.4 percent of education patients. An important additional finding was that the new emotion therapy also had greater benefits than cognitive behavior therapy in reducing widespread pain and in the number of patients who achieved at least 50 percent pain reduction. “Many people with fibromyalgia have experienced adversity in their lives, including victimization, family problems and internal conflicts, all of which create important emotions that are often suppressed or avoided. Emerging neuroscience research suggests that this can contribute strongly to pain and other physical symptoms,” Lumley said. “We developed and tested an approach that tries to help people overcome these emotional and relationship problems and reduce their symptoms, rather than just help people manage or accept their fibromyalgia. Although this treatment does not help all people with fibromyalgia, many patients found it to be very helpful, and some had dramatic improvements in their lives and their health.” More information about the research study, “Emotional awareness and expression therapy, cognitive behavioral therapy, and education for fibromyalgia: a cluster-randomized controlled trial,” can be found in PAIN, a journal published by the International Association for the Study of Pain (doi: 10.1097/j.pain.0000000000001036). About Wayne State University Wayne State University is one of the nation’s pre-eminent public research universities in an urban setting. Through its multidisciplinary approach to research and education, and its ongoing collaboration with government, industry and other institutions, the university seeks to enhance economic growth and improve the quality of life in the city of Detroit, state of Michigan and throughout the world. For more information about research at Wayne State University, visit research.wayne.edu.   SEE ORIGINAL STUDY
NYU Langone Hospital – Brooklyn recently opened a new unit specializing in the diagnosis and treatment of epilepsy, the fourth most common neurological illness and one that is newly diagnosed in more than 2 million individuals annually in the U.S.  “The need for epilepsy care in the community is immense.  To facilitate access at NYU Langone Hospital – Brooklyn we have opened a dedicated epilepsy monitoring unit,” says Blanca Vazquez, MD, director of clinical trials in the Department of Neurology at NYU Langone Health and head of the epilepsy program in Brooklyn. Vazquez is an epileptologist, a neurologist who specializes in epilepsy.   The epilepsy unit is equipped with state-of-the-art diagnostic and digital video monitoring technology and complements the hospital’s newly renovated neurology suite. Admission and procedures can be scheduled in advance, making it more convenient for patients and their families.  “The various forms of epilepsy usually stem from uncontrolled electrical activity in the brain,” says Vazquez, who has been with NYU Langone Health for 26 years and in Brooklyn since 2010. “Many things can trigger seizures in an epilepsy patient, including fever, alcohol withdrawal, or sleep deprivation. Epilepsy can have a genetic component, and can result from malformations of development, brain trauma, tumors, infections, dementia, or stroke.”  In addition to epileptologists, the unit team also includes neuropsychologists, psychiatrists, neurosurgeons, specially trained nurses and nurse practitioners, dieticians, physical, occupational and speech therapists, social workers, imaging technologists, and researchers. The team collaborates with colleagues at NYU Langone’s Comprehensive Epilepsy Center in Manhattan, where patients can be transferred if surgery or other more specialized procedures are necessary.  “Epilepsy can severely impact a patient’s safety, quality of life, and work and school activities,” says Orrin Devinsky, MD, professor of psychiatry, neurosurgery and neurology at NYU Langone and director of the Comprehensive Epilepsy Center. “We recommend drugs that are easy to use with other medications and which minimally impact a patient’s activities of daily living.”  Monitoring Effectiveness of Treatment  If a patient does not achieve a desired seizure control after trying three different epileptic drugs on an outpatient basis, a hospital stay is usually recommended to monitor administration of a single drug or a combination of drugs. The unit’s video capabilities allow staff to closely monitor for evidence of seizure activity that can help pinpoint the precise type of seizure, and which part of the brain is involved.  In addition, brain mapping on the unit helps determine the source of seizures and areas of the brain involving movement, speech, vision and memory that need to be protected.  Uncontrolled shaking is the most common symptom with epilepsy – yet in many cases there are no overt signs. “These are the most challenging cases,” Vasquez says. “Patients can be misdiagnosed and treated inappropriately. Establishing a definitive diagnosis is critical to the successful management of epilepsy.”  The opening of the new epilepsy unit continues a transformation initiative under way at NYU Langone Hospital – Brooklyn. “We are proud to reach another milestone with the opening of the neurology unit and now a specially equipped area for epilepsy,” says Bret J. Rudy, MD, executive hospital director and senior vice president, NYU Langone Hospital – Brooklyn. “Patients will benefit greatly being cared for by our outstanding team of experts in this brand new unit.”    For more information about epilepsy and NYU Langone’s Comprehensive Epilepsy Center and the epilepsy program at NYU Langone Hospital – Brooklyn, please call 718-630-8600.  
Outdoor air pollution has long been linked to major health conditions such as heart disease, stroke, cancer, asthma and chronic obstructive pulmonary disease. A new study now adds kidney disease to the list, according to researchers at Washington University School of Medicine in St. Louis and the Veterans Affairs (VA) St. Louis Health Care System. Pollution may increase the risk of chronic kidney disease and, ultimately, contribute to kidney failure, according to the researchers. The Washington University team, in collaboration with scientists at the Veterans Affairs’ Clinical Epidemiology Center, culled national VA databases to evaluate the effects of air pollution and kidney disease on nearly 2.5 million people over a period of 8.5 years, beginning in 2004. The scientists compared VA data on kidney function to air-quality levels collected by the Environmental Protection Agency (EPA) as well as the National Aeronautics and Space Administration (NASA). The EPA derived its data from land-based air-monitoring stations across the U.S. The findings suggest that 44,793 new cases of kidney disease and 2,438 new cases of kidney failure may be attributed to levels of air pollution that exceed the EPA’s threshold of 12 micrograms per cubic meter of air, which is the highest level of air pollution considered safe for the public, as set by the Clean Air Act of 1990 and updated in 2012. The study is published Sept. 21 in the Journal of the American Society of Nephrology. “Data on the relationship between air pollution and kidney disease in humans has been scarce,” said Ziyad Al-Aly, MD, the study’s senior author and an assistant professor of medicine at Washington University. “However, once we analyzed the data, the link between air pollution and the development of kidney disease was clear.” Fine particles can damage the kidneys in the same way they damage other organs such as the heart and lungs. Airborne and invisible, microscopic pieces of dust, dirt, smoke, soot and liquid droplets often become destructive when they invade the bloodstream. The kidneys filter the blood, and these harmful particles can disrupt normal kidney function. The study found that even low levels of particulate matter may adversely affect the kidneys. And those adverse effects increase as pollution levels increase. “The higher the levels of air pollution, the worse it is for the kidneys,” said Al-Aly, who is also the VA’s director of clinical epidemiology in St. Louis. “However, no level is completely safe. Even at relatively low levels, there was a relationship between particulate matter concentrations below the EPA thresholds and kidney disease.” Researchers also linked the VA data to space-borne sensors from NASA satellites. “NASA data and EPA data yielded consistent results,” Al-Aly said. “The beauty of using both EPA and NASA data is that the agencies used two distinct techniques for collecting data, yet the results were similar,” he said. “This constellation of findings suggests that chronic exposure to air pollution is a significant risk factor for the development and progression of kidney disease.” Study results placed Southern California and large regions in the South, Midwest and Northeast at the greatest risk for kidney decline attributed to air pollution. Over the years, unsafe levels of outdoor air pollution have decreased in the U.S. Still, more than half of the U.S. population lives in areas — from industrialized big cities to farming communities to coal-mining towns — with unhealthy levels of outdoor air pollution, according to a 2016 study by the American Lung Association. In many places across the globe, including China and India, outdoor air pollution is significantly worse than in the U.S. “In our analyses, the risk of chronic kidney disease and its progression was most pronounced at the highest levels of fine particulate matter concentration,” Al-Aly said. “This suggests further study is needed for a broader assessment of the global burden of kidney disease attributable to air pollution.”