Associations of diverse green space metrics with chronic kidney disease: a systematic review and meta-analysis of observational evidence

 

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https://storage.unitedwebnetwork.com/files/1099/aba235b6492aa9c94199147d0df4922c.pdf
Associations of diverse green space metrics with chronic kidney disease: a systematic review and meta-analysis of observational evidence

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Zichen
Ye
Zichen Ye ye18700579760@163.com Chinese Academy of Medical Sciences and Peking Union Medical College School of Health Policy and Management Beijing China *
Wanzhou Wang xjswangwanzhou@pku.edu.cn Peking University Health Science Center Institute of Medical Technology Beijing China - Peking University National Institute of Health Data Science Beijing China Peking University First Hospital Center for Digital Health and Artificial Intelligence Beijing China
Keyu Han 13515231601@163.com Chinese Academy of Medical Sciences and Peking Union Medical College School of Health Policy and Management Beijing China -
He Zhu 7897698@163.com Chinese Academy of Medical Sciences and Peking Union Medical College School of Health Policy and Management Beijing China -
Manman Chen chenmm@pumc.edu.cn Chinese Academy of Medical Sciences and Peking Union Medical College School of Population Medicine and Public Health Beijing China -
Ze Liang liangze@hit.edu.cn Harbin Institute of Technology School of Economics and Management Heilongjiang China -
Chao Yang yangchao@bjmu.edu.cn Peking University Health Science Center Institute of Medical Technology Beijing China - Peking University National Institute of Health Data Science Beijing China Peking University First Hospital Renal Division, Department of Medicine Beijing China
Yu Jiang jiangyu@pumc.edu.cn Chinese Academy of Medical Sciences and Peking Union Medical College School of Health Policy and Management Beijing China -
 
 
 
 
 
 
 

Growing evidence suggests that exposure to green space may reduce the risk of chronic kidney disease (CKD), but the overall strength and consistency of this association are unclear. We therefore conducted systematic review and meta-analysis to synthesize the available observational evidence and provide pooled quantitative estimates of the association between various metrics of green space and CKD risk.

We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library for studies published up to August 2025 on the association between green space exposure and CKD outcomes. Using the random-effects meta-analysis model, we calculated the pooled percent change and 95% confidence intervals (CIs) in risk ratio (RR) of CKD associated with per 0.1 increase in normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI), per 10% in fractional vegetation coverage (FVC), and per 100 m increase in distance to the nearest green space. The study is registered with PROSPERO (CRD420251138922).

Our search identified 3,361 records, from which eight studies were eligible for the systematic review and seven were included in the meta-analysis. These studies were predominantly cohort (n=5) or cross-sectional (n=3) designs. Overall, a standardized increase in vegetation-based green space (combining NDVI, EVI, and FVC) was associated with a lower risk of CKD (pooled RR=0.972, 95%CI 0.958-0.987). Specifically, per 10% increase in FVC was significantly protective (pooled RR=0.968, 95%CI 0.941-0.996), per 0.1 increase in NDVI was statistically significant (pooled RR=0.967, 95%CI 0.945-0.989), and per 100 m increase in distance to green space was associated with a higher risk of CKD (pooled OR=1.039, 95%CI 1.001-1.077). Dose-response analyses from four studies (three cohort, one cross-sectional) consistently indicated that higher green space exposure levels were associated with a lower risk of adverse kidney outcomes.

This meta-analysis demonstrates a significant, dose-dependent protective association between green space and the risk of CKD. However meta-analyse results are limited by a small number of studies and high levels of heterogeneity. These findings support the promotion of urban greening as a public health intervention for CKD, though further prospective research is needed to establish causality and clarify the underlying mechanisms.

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