The Environmental Role of Hydration in Kidney Health and Disease.

Clinical Background: Hydration status, which is influenced by environment and self-behavior is associated with kidney health and disease. Epidemiology: Lack of safe water, sanitation, and high temperatures are environmental issues that affect a significant part of the worldwide population. Occupational factors that discourage proper hydration, as well as low water intake in favorable environment conditions, are also highly prevalent. As a consequence, inadequate water intake can lead to several kidney problems ranging from uncomplicated urinary tract infections to kidney stones, acute kidney injury, and chronic disorders with high mortality rates. Challenges: Increasing water intake is an individual effort when self-behavior is the main reason for inadequate hydration status. When the environment is an obstacle, it might require complex changes in a concerted multidisciplinary effort from employers, health authorities, researchers, and governments. Prevention and Treatment: Strategies can be implemented at global, local, and individual levels. Global efforts include actions to decrease poverty and climate change consequences, while increasing access to safe water and sanitation. Local actions can improve working conditions and access to water and toilets to workers. At an individual level, self-monitoring through regular observation of thirst sensation, acute weight loss, urine frequency, and urine color are recommended tools to monitor hydration status.