Association of Environmental Exposure During 9/11 Rescue Efforts and Risk of Kidney Function Decline

Background: Emerging evidence suggests that environmental toxins contribute to accelerated decline in estimated glomerular filtration rate (eGFR). However, the long-term effects of high toxic exposures during the 9/11 rescue efforts on kidney function remain unclear. Methods: We conducted a prospective cohort study of World Trade Center (WTC) responders, without baseline chronic kidney disease (CKD) who were followed for a median duration of 5.6 years with annual protocolized eGFR assessments. Exposure levels were determined using detailed WTC exposure questionnaires, which captured information on fine particulate dust and debris exposure, work duration, and use of personal protective equipment (PPE). Responders were categorized into ‘Low’ or ‘High’ exposure groups. A secondary exposure measure incorporated coarse particulate matter exposure from the dust cloud and duration of exposure. Multivariable Poisson regression estimated the association between WTC exposure and kidney outcomes: ‘rapid eGFR decline’ (defined as a loss of >5 mL/min/1.73 m2 per year) and a combined outcome of incident CKD or >20% decline from baseline eGFR. Results: Among 8,699 WTC responders (mean age: 53.8 ± 8.1 years), 3,703 (43%) had high exposure. Individuals with high WTC exposure severity had significantly higher rates of rapid eGFR decline (7 vs. 5%, p < 0.001) and the combined outcome (21% vs 19%, p = 0.017). After adjusting for age, sex, race/ethnicity, comorbidities (hypertension, BMI, diabetes mellitus, and cardiovascular disease) and baseline eGFR, high exposure was significantly associated with rapid eGFR decline (Risk Ratio : 1.23 (95% CI: 1.01 – 1.51), p = 0.041) and had borderline significant association with the combined outcome (Hazard Ratio : 1.11 (95% CI: 1.00 – 1.23), p = 0.051). The risk for rapid eGFR decline was strongest among those with age > 40 years during the 9/11 rescue efforts. Dust cloud exposure was not significantly linked to either outcome. Conclusion: Among 9/11 responders, high exposure at the WTC site was associated with a significantly increased risk of kidney function decline. Mitigating toxic exposures and ensuring the proper use of PPE during disaster rescue operations may help reduce the risk of kidney function impairment in first responders.