Ph.D. Program in Toxicology, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Internal Medicine, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.
PLoS One. 2020 Jul 2;15(7):e0235607. doi: 10.1371/journal.pone.0235607. eCollection 2020.
Global climate change has led to a significant increase in temperature over the last century and has been associated with significant increases in the severity and frequency of heat injury (HI). The consequences of HI included dehydration and rhabdomyolysis, leading to acute kidney injury, which is now recognized as a clear risk factor for chronic kidney disease (CKD). We aimed to investigate the effects of HI on the risk of CKD. This nationwide longitudinal population-based retrospective cohort study utilized the Taiwan National Health Insurance Research Database (NHIRD) data. We enrolled patients with HI who were followed in NHIRD system between 2000 and 2013.We excluded patients diagnosed with CKD or genital-urinary system-related disease before the date of the new HI diagnosis. The control cohort consisted of individuals without HI history. The patients and control cohort were selected by 1:4 matching according to the following baseline variables: sex, age, index year, and comorbidities. The outcome measure was CKD diagnosis. In total, 815 patients diagnosed with HI were identified. During the 13 year observation period, we identified 72 CKD events (8.83%) in the heat stroke group and 143 (4.38%) CKD events in the control group. Patients with heat stroke had an increased risk of CKD than the control patients (adjusted HR = 4.346, P < 0.001) during the follow-up period. The risk of end-stage renal disease was also significantly increased in the heat stroke group than in the control group (adjusted hazards ratio: 9.078, p < 0.001). HI-related CKD may represent one of the first epidemics due to global warming. When compared to those without HI, patients with HI have an increased CKD risk.
全球气候变化导致上个世纪气温显著升高，并与热损伤（HI）的严重程度和频率显著增加有关。HI 的后果包括脱水和横纹肌溶解，导致急性肾损伤，现在已被认为是慢性肾脏病（CKD）的明确危险因素。我们旨在研究 HI 对 CKD 风险的影响。这项全国性纵向基于人群的回顾性队列研究利用了台湾全民健康保险研究数据库（NHIRD）的数据。我们纳入了 2000 年至 2013 年间在 NHIRD 系统中接受 HI 治疗的患者。我们排除了在新 HI 诊断日期之前诊断为 CKD 或生殖泌尿系统相关疾病的患者。对照组由无 HI 病史的个体组成。根据以下基线变量：性别、年龄、索引年和合并症，通过 1:4 匹配选择患者和对照组。结局测量是 CKD 诊断。共确定了 815 名 HI 患者。在 13 年的观察期间，在热射病组中发现了 72 例 CKD 事件（8.83%），在对照组中发现了 143 例（4.38%）CKD 事件。与对照组相比，热射病患者在随访期间发生 CKD 的风险增加（调整后的 HR=4.346，P<0.001）。热射病组发生终末期肾病的风险也明显高于对照组（调整后的危害比：9.078，p<0.001）。与全球变暖相关的 CKD 可能是由于全球变暖导致的首批流行病之一。与没有 HI 的患者相比，患有 HI 的患者发生 CKD 的风险增加。
