The results of the BKMR method showed that the estimated risk of ESRD increased with a simultaneous increase of the six air pollutants, from 25th percentile to 75th percentile after adjusting for sex, age of DM onset, duration of diabetes, hyperlipidemia, using of lipid-lowering drugs, smoking status, insulin treatment, HF, baseline eGFR, MAP, BMI, anemia, urinary protein, and serum ALB, indicating a positive joint effect of pollutant mixtures (Fig. 3A). Here, INS is linked to hyperlipidemia.