Divison of Nephrology, University Hospital Bern, Bern, Switzerland.
Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland.
J Nephrol. 2024 Jan;37(1):95-105. doi: 10.1007/s40620-023-01715-8. Epub 2023 Aug 23.
Exposure to high ambient temperatures is associated with a risk of acute kidney injury. However, evidence comes from emergency departments or extreme weather exposures. It is unclear whether temperature-related adverse kidney outcomes can also be detected at a community level in a temperate climate zone.
In a 9.5-year retrospective cohort study we correlated estimated glomerular filtration rate (eGFR) values of Swiss adult primary care patients from the FIRE cohort (Family medicine Research using Electronic medical records) with same-day maximum local ambient temperature data. We investigated 5 temperature groups (< 15 °C, 15-19 °C, 20-24 °C, 25-29 °C and ≥ 30 °C) as well as possible interactions for patients with increased kidney vulnerability (chronic heart failure, diabetes, chronic kidney disease, therapy with renin-angiotensin-aldosterone-system (RAAS) inhibitors, diuretics or non-steroidal anti-inflammatory drugs).
We included 18,000 primary care patients who altogether provided 132,176 creatinine measurements. In the unadjusted analysis, higher ambient temperatures were associated with lower eGFR across all age and vulnerability groups. In the adjusted models, we did not find a consistent association.The highest ambient temperature differences (> 25 or > 30 versus < 15 °C) were associated with marginally reduced kidney function only in patients with ≥ 3 risk factors for kidney vulnerability, with a maximum estimated glomerular filtration rate reduction of -2.9 ml/min/1.73m (SE 1.0), P 0.003.
In a large primary care cohort from a temperate climate zone, we did not find an association between ambient temperatures and kidney function. A marginal inverse association in highly vulnerable patients is of unclear clinical relevance.
暴露于高温环境与急性肾损伤的风险相关。然而，这些证据来自急诊科或极端天气暴露。在温带气候区，社区层面是否也能检测到与温度相关的不良肾脏结局尚不清楚。
在一项为期 9.5 年的回顾性队列研究中，我们将瑞士初级保健患者的估算肾小球滤过率（eGFR）值与 FIRE 队列（家庭医学电子病历研究）的当日最大当地环境温度数据相关联。我们研究了 5 个温度组（<15°C、15-19°C、20-24°C、25-29°C 和≥30°C）以及对肾脏脆弱性增加的患者（慢性心力衰竭、糖尿病、慢性肾脏病、肾素-血管紧张素-醛固酮系统（RAAS）抑制剂、利尿剂或非甾体抗炎药治疗）可能存在的相互作用。
我们纳入了 18000 名初级保健患者，他们共提供了 132176 次肌酐测量值。在未调整的分析中，所有年龄和脆弱性组中，较高的环境温度与较低的 eGFR 相关。在调整后的模型中，我们没有发现一致的关联。最高环境温度差异（>25°C 或>30°C 与<15°C 相比）仅与肾脏脆弱性≥3 个危险因素的患者的肾脏功能略有降低相关，最大估计肾小球滤过率降低-2.9ml/min/1.73m（SE 1.0），P<0.003。
在一个来自温带气候区的大型初级保健队列中，我们没有发现环境温度与肾功能之间的关联。在高度脆弱的患者中，边际负相关的临床意义尚不清楚。
