Division of Nephrology, Stanford University School of Medicine, Palo Alto, California.
Department of Marine Sciences, University of Connecticut, Mansfield, Connecticut, USA.
Curr Opin Nephrol Hypertens. 2024 Jan 1;33(1):122-129. doi: 10.1097/MNH.0000000000000938. Epub 2023 Oct 25.
Geographically localized areas with a high prevalence of kidney disease exist currently in several regions of the world. Although the exact cause is unclear, environmental exposures accelerated by climate change, particularly heat exposure and ground water contamination, are hypothesized as putative risk factors. Aiming to inform investigations of water-related exposures as risk factors for kidney disease, we excavate the history of major water sources in three regions that are described as hotspots of kidney disease: the low-lying coastal regions in El Salvador and Nicaragua, the dry central region in Sri Lanka, and the Central Valley of California.
Historic data indicate that these regions have experienced water scarcity to which several human-engineered solutions were applied; these solutions could be hypothesized to increase residents' exposure to putative kidney toxins including arsenic, fluoride, pesticides, and cyanobacteria. Combined with heat stress experienced in context of climate change, there is potential for multistressor effects on kidney function. Climate change will also amplify water scarcity, and even if regional water sources are not a direct risk factor for development of kidney disease, their scarcity will complicate the treatment of the relatively larger numbers of persons with kidney disease living in these hotspots.
Nephrologists and kidney disease researchers need to engage in systematic considerations of environmental exposures as potential risk factors for kidney disease, including water sources, their increasing scarcity, and threats to their quality due to changing climate.
目前，世界上有几个地区存在肾脏疾病高发的地域集中区域。尽管确切原因尚不清楚，但气候变化加速的环境暴露，特别是热暴露和地下水污染，被认为是潜在的危险因素。为了调查与水有关的暴露是否是导致肾脏疾病的危险因素，我们挖掘了三个被描述为肾脏疾病热点地区的主要水源的历史：萨尔瓦多和尼加拉瓜的低洼沿海地区、斯里兰卡干燥的中部地区以及加利福尼亚州的中央山谷。
历史数据表明，这些地区经历了水资源短缺，人类为此采用了多种人工解决方案；这些解决方案可能会增加居民接触砷、氟化物、农药和蓝藻等潜在肾脏毒素的暴露风险。再加上气候变化背景下的热应激，对肾功能可能会产生多因素影响。气候变化还将加剧水资源短缺，如果区域水源不是导致肾脏疾病发展的直接危险因素，那么它们的短缺将使生活在这些热点地区的更多肾脏疾病患者的治疗更加复杂。
肾脏病学家和肾脏疾病研究人员需要系统地考虑环境暴露作为肾脏疾病的潜在危险因素，包括水源、水源日益短缺以及由于气候变化对水源质量的威胁。
