Patients with End-Stage Renal Disease Are Vulnerable to Extreme Heat

Patients with end-stage renal disease (ESRD) are susceptible to being admitted to the hospital and dying during extreme heat events (EHEs), according to a study published in JAMA Network Open.

In this study, researchers assessed 7,445 patients with ESRD (57% men, mean age 61) utilizing a combination of hospital admission and mortality records of patients with ESRD who underwent hemodialysis treatment at Fresenius Kidney Care clinics in Boston, Philadelphia, or New York City, respectively, between 2001 and 2012. Study exposures comprised calendar and location specific 95^th-percentile temperature thresholds, which the researchers calculated using daily meteorological data over the duration of nearly 30 years (1960-1989). The thresholds were subsequently used to discern EHEs in each of the study’s three cities. The key outcome of this study was defined as daily all-cause mortality, and the researchers analyzed all data from July 2017 to March 2019 using a time-stratified case-crossover design with conditional Poisson regression.

According to the study results, among 2,953 patients ESRD who died (39.7%) and 44,941 hospital admissions, extreme heat events were linked to an augmented risk of same-day hospital admission (rate ratio [RR]=1.27; 95% CI, 1.13 to 1.43) as well same-day mortality (R 1.31; 95% CI, 1.01-1.70). Moreover, the results suggest some heterogeneity in risk, with patients in Boston exhibiting an increased risk for hospitalization that was deemed statistically significant (RR=1.15; 95% CI, 1.00 to 1.31) and mortality (RR= 1.45; 95% CI, 1.04-2.02) associated with cumulative exposure to EHEs, while in Philadelphia such risk was absent.

ESRD Management Should Account for EHEs

Furthermore, while increases in EHE risks were similar among non-Hispanic black and non-Hispanic white patients, the effects on Hispanic and Asian patients were inconclusive. Subsequent to stratifying by preexisting comorbidities, cumulative lag exposure to EHEs was associated with increased risk of mortality among patients with ESRD living with congestive heart failure (RR=1.55; 95% CI, 1.27 to 1.89), chronic obstructive pulmonary disease (RR=1.60; 95% CI, 1.24 to 2.06), or diabetes (RR=1.83; 95% CI, 1.51 to 2.21).

“Our results showed that EHEs were associated with increased risk of hospital admission or mortality among patients with ESRD and that such risks may vary by city, race/ethnicity, and comorbidity,” the researchers wrote in their conclusion.

“With the projected increases in frequency, duration, and intensity of extreme weather events, future ESRD management guideline need to incorporate EHEs as part of the adaptation measures to minimize morbidity and mortality among patients with ESRD in a changing climate.”