Sulfur dioxide exposure is associated with kidney dysfunction and creatinine abnormalities in Chinese patients with cardiovascular disease or hypertension

By Wu, Li, Huang +2BMC Cardiovascular DisordersOct 5, 2026

Score████░░░░░░4.3

Key numbers

95% CI
10,048 participants

VerdictWorth a reader's time today.

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Abstract

This observational study examined the association between long-term ambient air pollution exposure and renal dysfunction among middle-aged and elderly Chinese individuals with hypertension or heart disease. Although previous studies have mainly focused on particulate matter and nitrogen dioxide, the epidemiological relevance of SO₂-related exposure patterns to creatinine abnormality and clinically identified cardiovascular disease or hypertension complicated by kidney dysfunction in cardiovascular populations remains insufficiently clarified. A total of 10,048 participants aged ≥ 45 years from the China Health and Retirement Longitudinal Study (CHARLS) were included. Long-term exposure was estimated using residentially matched annual average Air Quality Index (AQI) and seven major air pollutants from 2015 to 2020. Abnormal creatinine was defined according to age- and sex-specific serum creatinine reference ranges, and cardiovascular disease or hypertension complicated by kidney dysfunction was operationally defined as cardiovascular disease complicated by clinically identified renal disease in the CHARLS setting. Multivariable logistic regression, restricted cubic spline analysis, and six machine-learning models with SHAP interpretation were applied. AQI exposure was positively associated with abnormal creatinine and clinically identified cardiovascular disease or hypertension complicated by kidney dysfunction. In the fully adjusted model, each 1-unit increase in AQI was associated with higher odds of abnormal creatinine (OR = 1.0129, 95% CI: 1.0102–1.0157, P < 0.0001) and cardiovascular disease or hypertension complicated by kidney dysfunction (OR = 1.0084, 95% CI: 1.0055–1.0113, P < 0.0001). Restricted cubic spline analysis suggested a non-linear exposure–response relationship, with increased odds particularly when AQI exceeded approximately 80. XGBoost and LightGBM showed the best discrimination for abnormal creatinine and cardiovascular disease or hypertension complicated by kidney dysfunction, respectively. SHAP analysis suggested that SO₂ was an important contributor to model prediction; however, this finding reflects predictive importance rather than causal evidence. Long-term air pollution exposure, particularly SO₂-related exposure patterns, was associated with renal dysfunction among Chinese patients with cardiovascular disease. These findings support the need for environmental risk assessment in cardiorenal prevention, while further longitudinal studies with repeated renal measurements, albuminuria, eGFR, personal exposure assessment, and mechanistic biomarkers are needed to validate causality and biological pathways.

Zhixiong Wu, Jieshuang Li, Qiaorong Huang, Xiaoli Lin, Ying Wang

The editor's rubric

Heuristic review

Dimension	Level	Weight	What that level means
Leverage	██░░░ 2	16%	Reusable within one subfield (a technique, dataset, or protocol a few groups will adopt).
Magnitude	███░░ 3	20%	Large gain: roughly 2x, or a clear new state of the art on a hard, unsaturated problem.
Evidence	████░ 4	20%	Strong: large scale, preregistered, independently replicated, or a well-powered randomized trial.
Novelty	███░░ 3	10%	A genuinely new approach to an open problem.
Trajectory	██░░░ 2	14%	Some room to improve with obvious engineering.
Stakes	██░░░ 2	20%	Benefits a professional community (practitioners, clinicians, engineers).

Editor’s rationale

Heuristic triage from title and abstract text only, not a reading of the paper. Cues found: gains (outperforms); novelty (alternative to status quo, open problem); verification (confidence interval, p-value).

How the score was computed

rank-2026-09-29

Score████░░░░░░4.3

Score = 10 × (75% × adjusted merit / 10 + 15% × attention + 10% × freshness)

Merit: 5.4 / 10; Weighted rubric, evidence-gated.
Adjusted merit: 4.6 / 10; Shrunk toward the desk prior by editor confidence (40%).
Attention: 0%; Citations, upvotes, points, mentions.
Freshness: 85%; Half-life decay since publication.

Citations0 (reference 15, via openalex, Oct 7, 2026, 07:29 UTC)
Field-weighted citation impact0 (reference 3, via openalex, Oct 7, 2026, 07:29 UTC)

The record

Reviewed by heuristic-v2 on Oct 7, 2026, 07:29 UTC. Paper type: clinical.
Categories: Air Quality and Health Impacts, Chronic Kidney Disease and Diabetes, Blood Pressure and Hypertension Studies, Health, Toxicology and Mutagenesis, Environmental Science
BRIEF, No.3 in the Climate & Energy edition of October 7, 2026.