Extreme heat events (EHE) are associated with increases in hospital admission and death for patients with kidney failure, reports a study in JAMA Network Open.
The study included data on 7445 patients with kidney failure treated at dialysis facilities in the Boston, New York City, and Philadelphia areas from 2001 through 2012. Meteorologic records were used to identify EHEs, based on 95th percentile maximum temperature thresholds specific to each calendar day and location. The researchers examined the associations of EHEs with daily all-cause hospital admissions and all-cause mortality.
The analysis included data on 2953 deaths and 44,941 hospital admissions. The annual mean number of EHEs was 37.4 days in Boston, 14.2 days in New York, and 11.9 days in Philadelphia.
EHEs were associated with increased rates of both outcomes of interest: rate ratio (RR) 1.27 for same-day hospital admission and 1.31 for same-day mortality. Cumulative exposure to EHEs was associated with increased risks in Boston—RR 1.15 for hospital admission and 1.45 for mortality—but not in Philadelphia.
The associations were similar for black patients and white patients, although the impact of Hispanic or Asian race/ethnicity was less clear. Cumulative lag exposure to EHEs was associated with increased mortality for kidney failure patients with comorbid congestive heart failure, RR 1.55; chronic obstructive pulmonary disease, RR 1.60; or diabetes, RR 1.83.
Extreme heat events are becoming more frequent owing to the effects of ongoing climate change. It is unclear how EHEs may affect the health of vulnerable populations, such as those with kidney failure.
This analysis of dialysis patients in cities of the northeast United States suggests that EHEs are associated with increased rates of hospital admission and death among patients with kidney failure. The investigators conclude, “[F]uture ESKD management guidelines need to incorporate EHEs as part of the adaptation measures to minimize morbidity and mortality among patients with kidney failure in a changing climate” [Remigio RV, et al. Association of extreme heat events with hospital admission or mortality among patients with end-stage renal disease. JAMA Netw Open 2019; 2:e198904].