Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK.
Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, Netherlands; The George Institute for Global Health, Sydney, NSW, Australia.
Lancet Planet Health. 2024 Apr;8(4):e225-e233. doi: 10.1016/S2542-5196(24)00026-3.
Higher temperatures are associated with higher rates of hospital admissions for nephrolithiasis and acute kidney injury. Occupational heat stress is also a risk factor for kidney dysfunction in resource-poor settings. It is unclear whether ambient heat exposure is associated with loss of kidney function in patients with established chronic kidney disease. We assessed the association between heat index and change in estimated glomerular filtration rate (eGFR) in participants from the DAPA-CKD trial in a post-hoc analysis.
DAPA-CKD was a randomised controlled trial of oral dapagliflozin 10 mg once daily or placebo that enrolled participants aged 18 years or older, with or without type 2 diabetes, with a urinary albumin-to-creatinine ratio of 200-5000 mg/g, and an eGFR of 25-75 mL/min per 1·73 m. In this post-hoc analysis, we explored the association between time-varying daily centre-level heat index (ERA5 dataset) and individual-level change in eGFR in trial participants using linear mixed effect models and case-time series. The DAPA-CKD trial is registered with ClinicalTrials.gov, NCT03036150.
Climate and eGFR data were available for 4017 (93·3%) of 4304 participants in 21 countries (mean age: 61·9 years; mean eGFR: 43·3 mL per 1·73 m; median 28 months follow-up). Across centres, a heat index of more than 30°C occurred on a median of 0·6% of days. In adjusted linear mixed effect models, within each 120-day window, each 30 days' heat index of more than 30°C was associated with a -0·6% (95% CI -0·9% to -0·3%) change in eGFR. Similar estimates were obtained using case-time series. Additional analyses over longer time-windows showed associations consistent with haemodynamic or seasonal variability, or both, but overall estimates corresponded to an additional 3·7 mL per 1·73 m (95% CI 0·1 to 7·0) loss of eGFR per year in a patient with an eGFR of 45 mL per 1·73 m located in a very hot versus a temperate environment.
Higher ambient heat exposure is associated with more rapid eGFR decline in those with established chronic kidney disease. Efforts to mitigate heat exposure should be tested as part of strategies to attenuate chronic kidney disease progression.
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更高的温度与肾结石和急性肾损伤的住院率升高有关。在资源匮乏的环境中，职业热应激也是肾功能障碍的一个风险因素。目前尚不清楚环境热暴露是否与已确诊慢性肾脏病患者的肾功能丧失有关。我们在 DAPA-CKD 试验的一项事后分析中评估了热指数与参与者估算肾小球滤过率（eGFR）变化之间的关系。
DAPA-CKD 是一项口服达格列净 10mg 每日一次或安慰剂治疗的随机对照试验，纳入年龄在 18 岁或以上、有或无 2 型糖尿病、尿白蛋白与肌酐比值为 200-5000mg/g、肾小球滤过率为 25-75ml/min/1.73m²的患者。在这项事后分析中，我们使用线性混合效应模型和病例时间序列，探讨了试验参与者的中心水平日变每日热指数（ERA5 数据集）与个体水平 eGFR 变化之间的关系。DAPA-CKD 试验在 ClinicalTrials.gov 注册，NCT03036150。
在 21 个国家的 4304 名参与者（平均年龄：61.9 岁；平均 eGFR：43.3ml/1.73m²；中位随访 28 个月）中，有 4017 名（93.3%）参与者有气候和 eGFR 数据。在各中心，热指数超过 30°C 的天数中位数为 0.6%。在调整后的线性混合效应模型中，在每 120 天的窗口内，热指数每增加 30 天，eGFR 变化-0.6%（95%CI-0.9%至-0.3%）。使用病例时间序列也得到了类似的估计。更长时间窗口的额外分析显示，与血液动力学或季节性变化相关的关联，但总体估计对应于位于炎热环境中的 45ml/1.73m²的患者每年 eGFR 下降 3.7ml/1.73m²（95%CI0.1 至 7.0）。
较高的环境热暴露与已确诊慢性肾脏病患者的 eGFR 更快下降有关。应该测试减轻热暴露的努力，作为减轻慢性肾脏病进展策略的一部分。
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