Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
Am J Kidney Dis. 2024 Nov;84(5):582-592.e1. doi: 10.1053/j.ajkd.2024.04.010. Epub 2024 Jun 12.
RATIONALE & OBJECTIVE: Exposure to extreme heat events has been linked to increased morbidity and mortality in the general population. Patients receiving maintenance dialysis may be vulnerable to greater risks from these events, but this is not well understood. We characterized the association of extreme heat events and the risk of death among patients receiving dialysis in the United States.
Retrospective cohort study.
SETTING & PARTICIPANTS: Data from the US Renal Data System were used to identify adults living in US urban settlements prone to extreme heat who initiated maintenance dialysis between 1997 and 2016.
An extreme heat event, defined as a time-updated heat index (a humid-heat metric) exceeding 40.6°C for≥2 days or 46.1°C for≥1day.
Death.
Cox proportional hazards regression to estimate the elevation in risk of death during a humid-heat event adjusted for age, sex, year of dialysis initiation, dialysis modality, poverty level, and climate region. Interactions between humid-heat and these same factors were explored.
Among 945,251 adults in 245 urban settlements, the mean age was 63 years, and 44% were female. During a median follow-up period of 3.6 years, 498,049 adults were exposed to at least 1 of 7,154 extreme humid-heat events, and 500,025 deaths occurred. In adjusted models, there was an increased risk of death (hazard ratio 1.18 [95% CI, 1.15-1.20]) during extreme humid-heat exposure. The relative mortality risk was higher among patients living in the Southeast (P<0.001) compared with the Southwest.
Possibility of exposure misclassification, did not account for land use and air pollution co-exposures.
This study suggests that patients receiving dialysis face an increased risk of death during extreme humid-heat exposure.
PLAIN-LANGUAGE SUMMARY: Patients who receive dialysis are vulnerable to extreme weather events, and rising global temperatures may bring more frequent extreme heat events. We sought to determine whether extreme heat exposure was associated with an increased risk of death in urban-dwelling patients receiving dialysis across the United States. We found that people receiving dialysis were more likely to die during extreme humid-heat events, defined by a heat index exceeding 40.6°C (105°F) for≥2 days or 46.1°C (115°F) for≥1day. These findings inform the nephrology community about the potential importance of protecting patients receiving maintenance dialysis from the risks associated with extreme heat.
暴露于极端高温事件与普通人群的发病率和死亡率增加有关。接受维持性透析的患者可能面临更大的风险，但目前对此了解甚少。本研究旨在描述美国接受透析治疗的患者暴露于极端高温事件与死亡风险之间的关联。
回顾性队列研究。
使用美国肾脏数据系统的数据，确定了 1997 年至 2016 年间居住在美国易受极端高温影响的城市定居点、开始接受维持性透析的成年人。
极端高温事件定义为湿热指数（湿热指标）超过 40.6°C 持续≥2 天或超过 46.1°C 持续≥1 天的时间更新。
死亡。
使用 Cox 比例风险回归估计湿热事件期间死亡风险的升高，调整因素包括年龄、性别、透析开始年份、透析方式、贫困水平和气候区域。探索了湿热与这些因素之间的交互作用。
在 245 个城市定居点的 945251 名成年人中，平均年龄为 63 岁，44%为女性。在中位随访 3.6 年期间，498049 名成年人至少经历了 7154 次极端湿热事件中的 1 次，有 500025 人死亡。在调整模型中，暴露于极端湿热时死亡风险增加（危险比 1.18[95%CI，1.15-1.20]）。与西南地区相比，生活在东南部的患者（P<0.001）的相对死亡率风险更高。
暴露可能存在错误分类，未考虑土地利用和空气污染的共同暴露。
本研究表明，接受透析的患者在暴露于极端湿热时面临更高的死亡风险。
接受透析的患者易受极端天气事件影响，而全球气温上升可能会带来更频繁的极端高温事件。我们试图确定极端高温暴露是否与美国接受透析的城市居民的死亡风险增加有关。我们发现，在定义为湿热指数超过 40.6°C（105°F）持续≥2 天或超过 46.1°C（115°F）持续≥1 天的极端湿热事件中，接受透析的患者更有可能死亡。这些发现为肾脏病学社区提供了信息，即保护接受维持性透析的患者免受与极端高温相关的风险可能具有重要意义。
