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Sandal S, Ethier I, Onu U, Fung W, Bajpai D, Bilchut WH, Bagasha P, De Chiara L, Hafiz E, Smyth B, Kelly D, Pippias M, Jha V. Climate Change, Kidney Health, and Environmentally Sustainable Kidney Care: A Multinational Survey of Health Care Professionals. J Am Soc Nephrol 2024; 35:1084-1094. [PMID: 38768364 DOI: 10.1681/asn.0000000000000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/14/2024] [Indexed: 05/22/2024] Open
Abstract
Key Points
A multinational survey of health care professionals on the kidney health impacts of climate change and the environmental burden of kidney care was conducted.Most participants reported knowledge gaps and high level of concern on these interconnected issues.Only a minority report personal or organizational initiatives in environmentally sustainable kidney care; this did not vary by country income level.
Background
Given the threat of climate change to kidney health and the significant environmental effect of kidney care, calls are increasing for health care professionals and organizations to champion climate advocacy and environmentally sustainable kidney care. Yet, little is known about their engagement, and existing literature is primarily emerging from high-income countries.
Methods
We conducted a cross-sectional survey to understand the knowledge, attitude, and practice of health care professionals on the interconnectedness of climate change and kidney health; to identify personal and organizational initiatives in sustainable kidney care and strategies to increase their engagement; and to compare responses by their country's income level as classified by the World Bank.
Results
Participants (n=972) represented 108 countries, with 64% from lower- or middle-income countries. Ninety-eight percent believed that climate change is happening, yet <50% possessed knowledge about the effect of climate change on kidney health or the environmental effect of kidney care. Only 14% were involved in climate change and kidney health initiatives (membership, knowledge/awareness, research, and advocacy), 22% in sustainable kidney care initiatives (education/advocacy, preventative nephrology, sustainable dialysis, promoting transplant/home therapies, and research), and 26% reported organizational initiatives in sustainable kidney care (sustainable general or dialysis practices, preventative/lean nephrology, and focused committees). Participants from lower-income countries generally reported higher knowledge and variable level of concern. Engagement in sustainable kidney care did not vary by income level. Guidance/toolkit (79%), continuing education (75%), and opportunities (74%) were the top choices to increase engagement. National initiatives (47%), preventative measures (35%), and research endeavors (31%) were the top avenues for organizational engagement. These varied by income level, suggesting that the vision and priorities vary by baseline resource setting.
Conclusions
We have identified knowledge and practice gaps among health care professionals on the bidirectional relationship between kidney disease and climate change in a multinational context and several avenues to increase their engagement.
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Affiliation(s)
- Shaifali Sandal
- Divisions of Nephrology and Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- MEDIC, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Isabelle Ethier
- Division of Nephrology, Department of Medicine, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Health Innovation and Evaluation hub, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Ugochi Onu
- Department of Medicine, University of Nigeria Teaching Hospital Enugu, Ituku-Ozalla, Nigeria
| | - Winston Fung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Divya Bajpai
- Department of Nephrology, Seth G.S.M.C. and K.E.M. Hospital, Mumbai, India
| | | | - Peace Bagasha
- Directorate of Internal Medicine, Department of Internal Medicine, Mulago National Referral Hospital l and College of Health Sciences, Makerere University, Kampala, Uganda
| | - Letizia De Chiara
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio," University of Florence, Florence, Italy
| | - Ehab Hafiz
- Theodor Bilharz Research Institute, Giza, Egypt
| | - Brendan Smyth
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Dearbhla Kelly
- Oxford Critical Care, John Radcliffe Hospital, Oxford, United Kingdom
| | - Maria Pippias
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Renal Unit, North Bristol NHS Trust, Bristol, United Kingdom
| | - Vivekanand Jha
- The George Institute for Global Health, UNSW, New Delhi, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
- Faculty of Medicine, Imperial College London, London, United Kingdom
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Wang L, Song Y, Zhang P, Chen W, Xiao F, Zhou P, Yang X, Dai H. Hypoxia-inducible factor prolyl hydroxylase inhibitor alleviates heatstroke-induced acute kidney injury by activating BNIP3-mediated mitophagy. FASEB J 2024; 38:e23723. [PMID: 38865198 DOI: 10.1096/fj.202400047r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 06/14/2024]
Abstract
Hypoxia-induced inflammation and apoptosis are important pathophysiological features of heat stroke-induced acute kidney injury (HS-AKI). Hypoxia-inducible factor (HIF) is a key protein that regulates cell adaptation to hypoxia. HIF-prolyl hydroxylase inhibitor (HIF-PHI) stabilizes HIF to increase cell adaptation to hypoxia. Herein, we reported that HIF-PHI pretreatment significantly improved renal function, enhanced thermotolerance, and increased the survival rate of mice in the context of HS. Moreover, HIF-PHI could alleviate HS-induced mitochondrial damage, inflammation, and apoptosis in renal tubular epithelial cells (RTECs) by enhancing mitophagy in vitro and in vivo. By contrast, mitophagy inhibitors Mdivi-1, 3-MA, and Baf-A1 reversed the renoprotective effects of HIF-PHI. Mechanistically, HIF-PHI protects RTECs from inflammation and apoptosis by enhancing Bcl-2 adenovirus E18 19-kDa-interacting protein 3 (BNIP3)-mediated mitophagy, while genetic ablation of BNIP3 attenuated HIF-PHI-induced mitophagy and abolished HIF-PHI-mediated renal protection. Thus, our results indicated that HIF-PHI protects renal function by upregulating BNIP3-mediated mitophagy to improve HS-induced inflammation and apoptosis of RTECs, suggesting HIF-PHI as a promising therapeutic agent to treat HS-AKI.
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Affiliation(s)
- Ling Wang
- Department of Rheumatology and Clinical Immunology, Daping Hospital, Army Medical University, Chongqing, China
| | - Yongwei Song
- Department of Rheumatology and Clinical Immunology, Daping Hospital, Army Medical University, Chongqing, China
| | - Pan Zhang
- Department of Tropical Medicine, Army Medical University, Chongqing, China
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Army Medical University, Chongqing, China
| | - Wenting Chen
- Department of Rheumatology and Clinical Immunology, Daping Hospital, Army Medical University, Chongqing, China
| | - Fei Xiao
- Department of Rheumatology and Clinical Immunology, Daping Hospital, Army Medical University, Chongqing, China
| | - Ping Zhou
- Department of Rheumatology and Clinical Immunology, Daping Hospital, Army Medical University, Chongqing, China
| | - Xuesen Yang
- Department of Tropical Medicine, Army Medical University, Chongqing, China
- Key Laboratory of Extreme Environmental Medicine, Ministry of Education of China, Army Medical University, Chongqing, China
| | - Huanzi Dai
- Department of Rheumatology and Clinical Immunology, Daping Hospital, Army Medical University, Chongqing, China
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Matte T, Lane K, Tipaldo JF, Barnes J, Knowlton K, Torem E, Anand G, Yoon L, Marcotullio P, Balk D, Constible J, Elszasz H, Ito K, Jessel S, Limaye V, Parks R, Rutigliano M, Sorenson C, Yuan A. NPCC4: Climate change and New York City's health risk. Ann N Y Acad Sci 2024. [PMID: 38922909 DOI: 10.1111/nyas.15115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 06/28/2024]
Abstract
This chapter of the New York City Panel on Climate Change 4 (NPCC4) report considers climate health risks, vulnerabilities, and resilience strategies in New York City's unique urban context. It updates evidence since the last health assessment in 2015 as part of NPCC2 and addresses climate health risks and vulnerabilities that have emerged as especially salient to NYC since 2015. Climate health risks from heat and flooding are emphasized. In addition, other climate-sensitive exposures harmful to human health are considered, including outdoor and indoor air pollution, including aeroallergens; insect vectors of human illness; waterborne infectious and chemical contaminants; and compounding of climate health risks with other public health emergencies, such as the COVID-19 pandemic. Evidence-informed strategies for reducing future climate risks to health are considered.
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Affiliation(s)
- Thomas Matte
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Kathryn Lane
- New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Jenna F Tipaldo
- CUNY Graduate School of Public Health and Health Policy and CUNY Institute for Demographic Research, New York, New York, USA
| | - Janice Barnes
- Climate Adaptation Partners, New York, New York, USA
| | - Kim Knowlton
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Emily Torem
- New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Gowri Anand
- City of New York, Department of Transportation, New York, New York, USA
| | - Liv Yoon
- School of Kinesiology, The University of British Columbia, Vancouver, Canada
| | - Peter Marcotullio
- Department of Geography and Environmental Science, Hunter College, CUNY, New York, New York, USA
| | - Deborah Balk
- Marxe School of Public and International Affairs, Baruch College and also CUNY Institute for Demographic Research, New York, New York, USA
| | | | - Hayley Elszasz
- City of New York, Mayors Office of Climate and Environmental Justice, New York, New York, USA
| | - Kazuhiko Ito
- New York City Department of Health and Mental Hygiene, New York, New York, USA
| | - Sonal Jessel
- WE ACT for Environmental Justice, New York, New York, USA
| | - Vijay Limaye
- Natural Resources Defense Council, New York, New York, USA
| | - Robbie Parks
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Mallory Rutigliano
- New York City Mayor's Office of Management and Budget, New York, New York, USA
| | - Cecilia Sorenson
- Mailman School of Public Health, Columbia University, New York, New York, USA
- Global Consortium on Climate and Health Education, Columbia University, New York, New York, USA
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Ariel Yuan
- New York City Department of Health and Mental Hygiene, New York, New York, USA
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Bein T. [Pathophysiology and management of heat illness]. Med Klin Intensivmed Notfmed 2024; 119:373-380. [PMID: 37831067 DOI: 10.1007/s00063-023-01072-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/13/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND The frequency and intensity of heat waves are currently increasing due to climate change. Hence more cases of heat illness are being observed, a potentially life-threatening disease, which requires rapid and expert management. OBJECTIVES An overview of the pathophysiology and acute management of heat illness is presented. MATERIALS AND METHODS Analysis and evaluation of important, recently published contributions, studies, and reviews regarding heat illness without claim for completeness or fulfilling the criteria for a 'systematic meta-analysis'. Presentation of a recommended clinical-practical classification and management of heat illness in emergency departments or intensive care units. RESULTS The manifestation of heat illness arising from prolonged exposure to heat prevaries (heat cramps, heat edema, heat exhaustion, heat stroke). The main pathophysiologic mechanisms are disruption of thermoregulation, peripheral vasodilation of the skin surface, hypoperfusion of visceral organs, and brain, and cardiac stress. Uncompensated heat stress can result in multiorgan dysfunction/failure syndrome due to the initiation of cytokine pathways, specifically in at-risk and/or chronically ill patients. The manifestation of uncompensated heat stroke is associated with a hospital mortality > 50%. Rapid identification, classification and targeted management are crucial for the outcome, in particular the initiation of adequate cooling measures. CONCLUSION In the future, increasing numbers of patients suffering from prolonged heat exposure will require treatment in emergency departments and intensive care units. Sufficient professional knowledge regarding pathophysiology and management are decisive for successful therapy. Hence, the topic heat illness should be implemented in training and education.
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Affiliation(s)
- Thomas Bein
- Universität Regensburg, Regensburg, Deutschland.
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Stem AD, Gibb M, Roncal-Jimenez CA, Johnson RJ, Brown JM. Health burden of sugarcane burning on agricultural workers and nearby communities. Inhal Toxicol 2024; 36:327-342. [PMID: 38349733 PMCID: PMC11260540 DOI: 10.1080/08958378.2024.2316875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/05/2024] [Indexed: 04/11/2024]
Abstract
Sugarcane is the most widely cultivated crop in the world, with equatorial developing nations performing most of this agriculture. Burning sugarcane is a common practice to facilitate harvest, producing extremely high volumes of respirable particulate matter in the process. These emissions are known to have deleterious effects on agricultural workers and nearby communities, but the extent of this exposure and potential toxicity remain poorly characterized. As the epidemicof chronic kidney disease of an unknown etiology (CKDu) and its associated mortality continue to increase along with respiratory distress, there is an urgent need to investigate the causes, determine viable interventions to mitigate disease andimprove outcomes for groups experiencing disproportionate impact. The goal of this review is to establish the state of available literature, summarize what is known in terms of human health risk, and provide recommendations for what areas should be prioritized in research.
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Affiliation(s)
- Arthur D. Stem
- Department of Pharmaceutical Sciences, University of
Colorado Anschutz Medical Campus, Aurora, CO
| | - Matthew Gibb
- Department of Pharmaceutical Sciences, University of
Colorado Anschutz Medical Campus, Aurora, CO
| | - Carlos A. Roncal-Jimenez
- Division of Renal Diseases and Hypertension,University of
Colorado Anschutz Medical Campus, Aurora, CO
| | - Richard J. Johnson
- Division of Renal Diseases and Hypertension,University of
Colorado Anschutz Medical Campus, Aurora, CO
| | - Jared M. Brown
- Department of Pharmaceutical Sciences, University of
Colorado Anschutz Medical Campus, Aurora, CO
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Stoneman S, Balmer F, Moore L, Fontana M, Kielstein JT, Woywodt A. Meet and greet but avoid the heat: a reflection on the carbon footprint of congresses prompted by ERA2023. Clin Kidney J 2024; 17:sfae062. [PMID: 38699480 PMCID: PMC11063956 DOI: 10.1093/ckj/sfae062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Indexed: 05/05/2024] Open
Affiliation(s)
- Sinead Stoneman
- Department of Nephrology, Cork University Hospital, Cork, Ireland
| | - Frances Balmer
- Sustainability Fellow, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - Louise Moore
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | | | - Jan T Kielstein
- Medical Clinic V, Nephrology, Rheumatology and Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
| | - Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
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Stem AD, Brindley S, Rogers KL, Salih A, Roncal-Jimenez CA, Johnson RJ, Newman LS, Butler-Dawson J, Krisher L, Brown JM. Exposome and Metabolome Analysis of Sugarcane Workers Reveals Predictors of Kidney Injury. Kidney Int Rep 2024; 9:1458-1472. [PMID: 38707825 PMCID: PMC11069010 DOI: 10.1016/j.ekir.2024.01.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Sugarcane workers are exposed to potentially hazardous agrochemicals, including pesticides, heavy metals, and silica. Such occupational exposures present health risks and have been implicated in a high rate of kidney disease seen in these workers. Methods To investigate potential biomarkers and mechanisms that could explain chronic kidney disease (CKD) among this worker population, paired urine samples were collected from sugarcane cutters at the beginning and end of a harvest season in Guatemala. Workers were then separated into 2 groups, namely those with or without kidney function decline (KFD) across the harvest season. Urine samples from these 2 groups underwent elemental analysis and untargeted metabolomics. Results Urine profiles demonstrated increases in silicon, certain pesticides, and phosphorus levels in all workers, whereas heavy metals remained low. The KFD group had a reduction in estimated glomerular filtration rate (eGFR) across the harvest season; however, kidney injury marker 1 did not significantly change. Cross-harvest metabolomic analysis found trends of fatty acid accumulation, perturbed amino acid metabolism, presence of pesticides, and other known signs of impaired kidney function. Conclusion Silica and certain pesticides were significantly elevated in the urine of sugarcane workers with or without KFD. Future work should determine whether long-term occupational exposure to silica and pesticides across multiple seasons contributes to CKD in these workers. Overall, these results confirmed that multiple exposures are occurring in sugarcane workers and may provide insight into early warning signs of kidney injury and may help explain the increased incidence of CKD among agricultural workers.
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Affiliation(s)
- Arthur D Stem
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Stephen Brindley
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Keegan L Rogers
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Adil Salih
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Carlos A Roncal-Jimenez
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lee S Newman
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Jaime Butler-Dawson
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Lyndsay Krisher
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Jared M Brown
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Iba T, Maier CL, Levi M, Levy JH. Thromboinflammation and microcirculation damage in heatstroke. Minerva Med 2024; 115:191-202. [PMID: 38240696 DOI: 10.23736/s0026-4806.23.08919-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Rising temperatures associated with climate change have significantly increased the risk of heatstroke. Unfortunately, the trend is anticipated to persist and increasingly threaten vulnerable populations, particularly older adults. According to Japan's environment ministry, over 1000 people died from heatstroke in 2021, and 86% of deaths occurred in those above 65. Since the precise mechanism of heatstroke is not fully understood, we examined the pathophysiology by focusing on the microcirculatory derangement. Online search of published medical literature through MEDLINE and Web of Science using the term "heatstroke," "heat-related illness," "inflammation," "thrombosis," "coagulation," "fibrinolysis," "endothelial cell," and "circulation." Articles were chosen for inclusion based on their relevance to heatstroke, inflammation, and thrombosis. Reference lists were reviewed to identify additional relevant articles. Other than preexisting conditions (genetic background, age, etc.), factors such as hydration status, acclimatization, dysregulated coagulation, and inflammation are the additional major factors that promote tissue malcirculation in heatstroke. The fundamental pathophysiologic mechanisms significantly overlap with those seen in the systemic inflammatory response to sepsis, and as a result, coagulation-predominant coagulopathy develops during heat stress. Although a bleeding tendency is not common, bleeding frequently occurs in the microcirculation, causing additional injury. Sterile inflammation is mediated by proinflammatory cytokines, chemokines, and other humoral mediators in concert with cellular factors, including monocytes, neutrophils, platelets, and endothelial cells. Excess inflammation results in inflammatory cell death, including pyroptosis and necroptosis, and the release of danger signals that further propagate systemic inflammation and coagulopathy. Consequently, thromboinflammation is the critical factor that induces microcirculatory disturbance in heatstroke.
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Affiliation(s)
- Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan -
| | - Cheryl L Maier
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Marcel Levi
- Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Department of Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jerrold H Levy
- Department of Anesthesiology, Critical Care and Surgery, Duke University School of Medicine, Durham, NC, USA
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Zhang Z, Heerspink HJL, Chertow GM, Correa-Rotter R, Gasparrini A, Jongs N, Langkilde AM, McMurray JJV, Mistry MN, Rossing P, Toto RD, Vart P, Nitsch D, Wheeler DC, Caplin B. Ambient heat exposure and kidney function in patients with chronic kidney disease: a post-hoc analysis of the DAPA-CKD trial. Lancet Planet Health 2024; 8:e225-e233. [PMID: 38580424 DOI: 10.1016/s2542-5196(24)00026-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND 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. METHODS 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 m2. 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. FINDINGS 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 m2; 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 m2 (95% CI 0·1 to 7·0) loss of eGFR per year in a patient with an eGFR of 45 mL per 1·73 m2 located in a very hot versus a temperate environment. INTERPRETATION 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. FUNDING None.
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Affiliation(s)
- Zhiyan Zhang
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, Netherlands; The George Institute for Global Health, Sydney, NSW, Australia
| | - Glenn M Chertow
- Department of Medicine, Department of Epidemiology and Population Health, and Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Ricardo Correa-Rotter
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Antonio Gasparrini
- Environment & Health Modelling Lab, Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Niels Jongs
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, Netherlands
| | | | - John J V McMurray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Malcolm N Mistry
- Environment & Health Modelling Lab, Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK; Department of Economics, Ca' Foscari University of Venice, Venice, Italy
| | - Peter Rossing
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Robert D Toto
- Department of Internal Medicine, UT Southwestern Medical Centre, Dallas, TX, USA
| | - Priya Vart
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, Netherlands
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - David C Wheeler
- Department of Renal Medicine, University College London, London, UK
| | - Ben Caplin
- Department of Renal Medicine, University College London, London, UK.
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10
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Mano Y, Yuan L, Ng CFS, Hashizume M. Association between ambient temperature and genitourinary emergency ambulance dispatches in Japan: A nationwide case-crossover study. Environ Epidemiol 2024; 8:e298. [PMID: 38617428 PMCID: PMC11008653 DOI: 10.1097/ee9.0000000000000298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/29/2024] [Indexed: 04/16/2024] Open
Abstract
Background Although the effects of temperature on genitourinary morbidity and mortality have been investigated in several countries, it remains largely unexplored in Japan. We investigated the association between ambient temperature and genitourinary emergency ambulance dispatches (EADs) in Japan and the modifying roles of sex, age, and illness severity. Methods We conducted a time-stratified case-crossover study with conditional quasi-Poisson regression to estimate the association between mean temperature and genitourinary EADs in all prefectures of Japan between 2015 and 2019. A mixed-effects meta-analysis was used to pool the association at the country level. Subgroup analyses were performed to explore differences in associations stratified by sex, age, and illness severity. Results We found an increased risk of genitourinary EAD associated with higher temperatures. The cumulative relative risk (RR) at the 99th temperature percentile compared with that at the 1st percentile was 1.74 (95% confidence interval (CI) = [1.60, 1.89]). We observed higher heat-related RRs in males (RR = 1.89; 95% CI = [1.73, 2.07]) than females (RR = 1.56; 95% CI = [1.37, 1.76]), and in the younger (RR = 2.13; 95% CI = [1.86, 2.45]) than elderly (RR = 1.39; 95% CI = [1.22, 1.58]). We found a significant association for those with mild or moderate cases (RR = 1.77; 95% CI = [1.62, 1.93]), but not for severe or life-threatening cases (RR = 1.20; 95% CI = [0.80, 1.82]). Conclusion Our study revealed heat effects on genitourinary EADs in Japan. Men, youth, and mild-moderate illnesses were particularly vulnerable subgroups. These findings underscore the need for preventative measures aimed at mitigating the impact of temperature on genitourinary emergencies.
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Affiliation(s)
- Yasuko Mano
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Lei Yuan
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chris Fook Sheng Ng
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Wang W, Wang F, Yang C, Wang J, Liang Z, Zhang F, Li P, Zhang L. Associations between heat waves and chronic kidney disease in China: The modifying role of land cover. ENVIRONMENT INTERNATIONAL 2024; 186:108657. [PMID: 38626496 DOI: 10.1016/j.envint.2024.108657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/18/2024]
Abstract
The increasing frequency of heat waves under the global urbanization and climate change background poses elevating risks of chronic kidney disease (CKD). Nevertheless, there has been no evidence on associations between long-term exposures to heat waves and CKD as well as the modifying effects of land cover patterns. Based on a national representative population-based survey on CKD covering 47,086 adults and high spatial resolution datasets on temperature and land cover data, we found that annual days of exposure to heat waves were associated with increased odds of CKD prevalence. For one day/year increases in HW_975_4d (above 97.5 % of annual maximum temperature and lasting for at least 4 consecutive days), the odds ratio (OR) of CKD was 1.14 (95 %CI: 1.12, 1.15). Meanwhile, stronger associations were observed in regions with lower urbanicity [rural: 1.14 (95 %CI: 1.12, 1.16) vs urban: 1.07 (95 %CI: 1.03, 1.11), Pinteraction < 0.001], lower water body coverage [lower: 1.14 (95 %CI: 1.12, 1.16) vs higher: 1.02 (95 %CI: 0.98, 1.05), Pinteraction < 0.001], and lower impervious area coverage [lower: 1.16 (95 %CI: 1.14, 1.18) vs higher: 1.06 (95 %CI: 1.03, 1.10), Pinteraction = 0.008]. In addition, this study found disparities in modifying effects of water bodies and impervious areas in rural and urban settings. In rural regions, the associations between heat waves and CKD prevalence showed a consistent decreasing trend with increases in both proportions of water bodies and impervious areas (Pinteraction < 0.05). Nevertheless, in urban regions, we observed significant effect modification by water bodies, but not by impervious areas. Our study indicates the need for targeted land planning as part of adapting to the kidney impacts of heat waves, with a focus on urbanization in rural regions, as well as water body construction and utilization in both rural and urban regions.
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Affiliation(s)
- Wanzhou Wang
- National Institute of Health Data Science at Peking University, Beijing 100191, China; Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China
| | - Fulin Wang
- National Institute of Health Data Science at Peking University, Beijing 100191, China; Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China
| | - Chao Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing 100034, China; Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing 100034, China; Advanced Institute of Information Technology, Peking University, Hangzhou 311215, China
| | - Jinwei Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing 100034, China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Peking University, Ministry of Education of the People's Republic of China, Beijing, China
| | - Ze Liang
- Key Laboratory for Earth Surface Processes of the Ministry of Education, College of Urban and Environmental Sciences, Peking University, Beijing 100871, China
| | - Feifei Zhang
- National Institute of Health Data Science at Peking University, Beijing 100191, China; Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China
| | - Pengfei Li
- Advanced Institute of Information Technology, Peking University, Hangzhou 311215, China
| | - Luxia Zhang
- National Institute of Health Data Science at Peking University, Beijing 100191, China; Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing 100034, China; Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing 100034, China; Advanced Institute of Information Technology, Peking University, Hangzhou 311215, China.
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12
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Hajat S, Casula A, Murage P, Omoyeni D, Gray T, Plummer Z, Steenkamp R, Nitsch D. Ambient heat and acute kidney injury: case-crossover analysis of 1 354 675 automated e-alert episodes linked to high-resolution climate data. Lancet Planet Health 2024; 8:e156-e162. [PMID: 38453381 DOI: 10.1016/s2542-5196(24)00008-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND As global temperatures continue to rise, the effects of ambient heat on acute kidney injury (AKI) are of growing concern. We used a novel nationwide electronic alert (e-alert) system to detect increases in AKI risk associated with high temperatures. METHODS We used a case-crossover design to link 1 354 675 AKI episodes occurring in England between April and September in years 2017-2021 to daily maximum temperature data at postcode sector level. AKI episode data were obtained from the UK Renal Registry. There were no further inclusion or exclusion criteria. Conditional logistic regression employing distributed lag non-linear models was used to assess odds of AKI episode on case days compared with day-of-week matched control days. Effects during heatwaves were also assessed using heat-episode analysis. FINDINGS There were strongly increased odds of AKI episode associated with high temperatures, with odds ratio (OR) 1·623 (95% CI 1·319-1·997) on a day of temperature 32°C compared with one of 17°C, the effects being strongest on a lag of 1 day. There was an OR of 1·020 (1·019-1·020) per 1°C increase in temperature above 17°C. The odds of a heat-related AKI episode were similar between AKI stages 1 and 2, but considerably lower for stage 3 events. A 7-day heatwave in July 2021 was associated with a 28·6% increase in AKI counts (95% CI 26·5-30·7). INTERPRETATION Heat-related AKI is a growing public health challenge. As even small changes in renal function can affect patient outcomes, susceptible individuals should be advised to take preventive measures whenever hot weather is forecast. Use of an e-alert system allows effects in milder cases that do not require secondary care to also be detected. FUNDING National Institute for Health and Care Research (NIHR).
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Affiliation(s)
- Shakoor Hajat
- London School of Hygiene & Tropical Medicine, London, UK.
| | - Anna Casula
- UK Renal Registry, UK Kidney Association, Bristol, UK
| | - Peninah Murage
- London School of Hygiene & Tropical Medicine, London, UK
| | - Daniel Omoyeni
- London School of Hygiene & Tropical Medicine, London, UK
| | - Tom Gray
- UK Renal Registry, UK Kidney Association, Bristol, UK
| | - Zoe Plummer
- UK Renal Registry, UK Kidney Association, Bristol, UK
| | | | - Dorothea Nitsch
- London School of Hygiene & Tropical Medicine, London, UK; UK Renal Registry, UK Kidney Association, Bristol, UK
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13
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De Chiara L, Ronco P, Rovin BH. Green nephrology: an editor's journey. J Nephrol 2024; 37:3-5. [PMID: 38401016 DOI: 10.1007/s40620-024-01890-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2024]
Affiliation(s)
- Letizia De Chiara
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy.
| | - Pierre Ronco
- Sorbonne Université and Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche, Paris, S1155, France
- Department of Nephrology, Centre Hospitalier du Mans, Le Mans, France
| | - Brad Harris Rovin
- Division of Nephrology, The Ohio State University, Columbus, OH, USA
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14
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AlSahow A. The Impact of Hot Ambient Temperature and Prolonged Fasting Duration during Ramadan on Patients with Chronic Kidney Disease: A Literature Review. Int J Nephrol 2023; 2023:2636507. [PMID: 38106546 PMCID: PMC10725313 DOI: 10.1155/2023/2636507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/14/2023] [Accepted: 11/18/2023] [Indexed: 12/19/2023] Open
Abstract
The Islamic (lunar) calendar has 11 fewer days each year than the Gregorian (solar) calendar. Consequently, ambient temperatures during the month of Ramadan and the duration of the presunrise-to-sunset fast will change each year. At some point, individuals observing Ramadan will experience prolonged periods of fasting during the hot summer months. In this manuscript, findings published in the English-language medical literature that address the impact of prolonged fasting during the warmer summer months on patients with chronic kidney disease, including dialysis and transplantation patients, are reviewed. This is of particular concern given the accelerated pace of global warming. The limitations of the evidence that is currently available are also discussed, and an approach that might be used to standardize future evaluations of the impact of fasting on kidney health is suggested.
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Affiliation(s)
- Ali AlSahow
- Division of Nephrology, Jahra Hospital, Jahra, Kuwait
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15
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Wang L, Fu X, He M, Shi L, Wan D, Wang Y, Wu Q, Yang J, Cai B, Xia H, Chen H, Zhang G, Lei X, Zhang W, Feng Z, Wang B, Zhang Z. Risk Factor Analysis and Nomogram for Predicting In-Hospital Mortality in ICU Patients with Heat Stroke: A National Multicenter Study. J Multidiscip Healthc 2023; 16:3189-3201. [PMID: 37915977 PMCID: PMC10617527 DOI: 10.2147/jmdh.s428617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/19/2023] [Indexed: 11/03/2023] Open
Abstract
Objective The aim of this nationwide multicenter study was to ascertain the risk factors associated with in-hospital mortality in patients with heat stroke admitted to intensive care units (ICUs) and to develop a nomogram for prognostic prediction. Methods A retrospective analysis was conducted on clinical data collected from ICU patients diagnosed with heat stroke across multiple centers nationwide. Univariate and multivariate logistic regression analyses were performed to identify significant risk factors for in-hospital mortality. Based on the results of the multivariate analysis, a nomogram was constructed to estimate the individualized probability of mortality. Internal validation of the nomogram was performed, and its performance was assessed using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). Results A total of 292 ICU patients with heat stroke were included in this study. Three risk factors, namely Cr (creatinine), AST (aspartate aminotransferase), and SBP (systolic blood pressure), were found to be significantly associated with in-hospital mortality. These risk factors were incorporated into the nomogram, which exhibited good discriminative ability (area under the ROC curve of the training and validation cohorts were 0.763 and 0.739, respectively) and calibration. Internal validation and decision curve analysis confirmed the stability and reliability of the nomogram. Conclusion This nationwide multicenter study identified key risk factors for in-hospital mortality in ICU patients with heat stroke. The developed nomogram provides an individualized prediction of mortality risk and can serve as a valuable tool for clinicians in the assessment and management of ICU patients with heat stroke.
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Affiliation(s)
- Lietao Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Xin Fu
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Min He
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Lvyuan Shi
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Dingyuan Wan
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Yucong Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Qin Wu
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Jing Yang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Bayuan Cai
- Department of Critical Care Medicine, The People’s Hospital of Jiajiang, Leshan, People’s Republic of China
| | - Hongtao Xia
- Department of Critical Care Medicine, Suining Central Hospital, Suining, People’s Republic of China
| | - Hongxu Chen
- Department of Critical Care Medicine, The Hospital of Traditional Chinese Medicine of Leshan, Leshan, People’s Republic of China
| | - Ge Zhang
- Department of Critical Care Medicine, The First People’s Hospital of Longquanyi District, Chengdu, People’s Republic of China
| | - Xianying Lei
- Department of Critical Care Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
| | - Wei Zhang
- Department of Critical Care Medicine, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, People’s Republic of China
| | - Zhongxue Feng
- Department of Critical Care Medicine, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, People’s Republic of China
| | - Bo Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Zhongwei Zhang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - On behalf of Heat Stroke Research Group in Southwestern China
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
- Department of Critical Care Medicine, The People’s Hospital of Jiajiang, Leshan, People’s Republic of China
- Department of Critical Care Medicine, Suining Central Hospital, Suining, People’s Republic of China
- Department of Critical Care Medicine, The Hospital of Traditional Chinese Medicine of Leshan, Leshan, People’s Republic of China
- Department of Critical Care Medicine, The First People’s Hospital of Longquanyi District, Chengdu, People’s Republic of China
- Department of Critical Care Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, People’s Republic of China
- Department of Critical Care Medicine, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, People’s Republic of China
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16
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Wijkström J, Annadata KC, Elinder CG, Kolla PK, Sarvepalli NR, Ring A, Swaminathan R, Gunabooshanam B, Söderberg M, Venugopal V, Wernerson A. Clinical findings and kidney morphology in chronic kidney disease of unknown cause in India. J Intern Med 2023; 294:492-505. [PMID: 37400986 DOI: 10.1111/joim.13690] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND Chronic kidney disease of unknown cause (CKDu) is an emerging health problem in India and other countries worldwide. However, clinical descriptions, including kidney pathology, are scarce. METHODS This is a descriptive case series of patients with CKDu from an endemic region in India, with a focus on clinical and biochemical characteristics, kidney biopsy findings, and environmental exposure. Patients with suspected CKDu, aged 20-65, and eGFR 30-80 mL/min/1.73 m2 from rural areas with endemic prevalence of CKDu were included. The exclusion criteria were diabetes mellitus, uncontrolled hypertension, proteinuria >1 g/24 h, or other known kidney diseases. The participants underwent kidney biopsies, and blood and urine samples were collected. RESULTS Fourteen participants (3 females, 11 males) with a mean eGFR of 53 (range 29-78) mL/min/1.73 m2 were included. Kidney biopsies showed a combination of chronic tubulointerstitial damage, glomerulosclerosis, and glomerular hypertrophy, with varying degrees of interstitial inflammation. Eight participants had polyuria (diuresis ≥ 3 L/day). The urinary sediments were bland, with no haematuria. Serum potassium and sodium levels were, in most cases, normal but within the lower reference interval. CONCLUSION The kidney morphology and clinical characteristics in patients with CKDu in India were similar to those described for CKDu in Central America and Sri Lanka.
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Affiliation(s)
- Julia Wijkström
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | | | - Carl-Gustaf Elinder
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | | | | | - Anneli Ring
- Department of Clinical Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Rajendiran Swaminathan
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Barathi Gunabooshanam
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Magnus Söderberg
- Clinical Pharmacology and Safety Sciences, AstraZeneca R&D, Gothenburg, Sweden
| | - Vidhya Venugopal
- Department of Environmental Health Engineering, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Annika Wernerson
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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17
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Karam S, Wong MM, Jha V. Sustainable Development Goals: Challenges and the Role of the International Society of Nephrology in Improving Global Kidney Health. KIDNEY360 2023; 4:1494-1502. [PMID: 37535906 PMCID: PMC10617794 DOI: 10.34067/kid.0000000000000237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/27/2023] [Indexed: 08/05/2023]
Abstract
The United Nations 2030 agenda for sustainable development includes 17 sustainable development goals (SDGs) that represent a universal call to end poverty and protect the planet, and are intended to guide government and private sector policies for international cooperation and optimal mobilization of resources. At the core of their achievement is reducing mortality by improving the global burden of noncommunicable diseases (NCDs), the leading causes of death and disability worldwide. CKD is the only NCD with a consistently rising age-adjusted mortality rate and is rising steadily up the list of the causes of lives lost globally. Kidney disease is strongly affected by social determinants of health, with a strong interplay between CKD incidence and progression and other NCDs and SDGs. Tackling the shared CKD and NCD risk factors will help with progress toward the SDGs and vice versa . Challenges to global kidney health include both preexisting socioeconomic factors and natural and human-induced disasters, many of which are intended to be addressed through actions proposed in the sustainable development agenda. Opportunities to address these challenges include public health policies focused on integrated kidney care, kidney disease surveillance, building strategic partnerships, building workforce capacity, harnessing technology and virtual platforms, advocacy/public awareness campaigns, translational and implementation research, and environmentally sustainable kidney care.
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Affiliation(s)
- Sabine Karam
- Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, Minnesota
| | - Michelle M.Y. Wong
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vivekanand Jha
- George Institute for Global Health, UNSW, New Delhi, India
- School of Public Health, Imperial College, London, United Kingdom
- Prasanna School of Public Health, Manipal Academy of Medical Education, Manipal, India
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18
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Chapman CL, Holt SM, O'Connell CT, Brazelton SC, Howells WAB, Medved HN, Reed EL, Needham KW, Halliwill JR, Minson CT. Acute kidney injury biomarkers and hydration assessments following prolonged mild hypohydration in healthy young adults. Am J Physiol Renal Physiol 2023; 325:F199-F213. [PMID: 37318992 PMCID: PMC10396285 DOI: 10.1152/ajprenal.00086.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/17/2023] Open
Abstract
The high prevalence of inadequate hydration (e.g., hypohydration and underhydration) is concerning given that extreme heat increases excess hospitalizations for fluid/electrolyte disorders and acute kidney injury (AKI). Inadequate hydration may also be related to renal and cardiometabolic disease development. This study tested the hypothesis that prolonged mild hypohydration increases the urinary AKI biomarker product of insulin-like growth factor-binding protein 7 and tissue inhibitor of metalloproteinase-2 ([IGFBP7·TIMP-2]) compared with euhydration. In addition, we determined the diagnostic accuracy and optimal cutoffs of hydration assessments for discriminating positive AKI risk ([IGFBP·TIMP-2] >0.3 (ng/mL)2/1,000). In a block-randomized crossover design, 22 healthy young adults (11 females and 11 males) completed 24 h of fluid deprivation (hypohydrated group) or 24 h of normal fluid consumption (euhydrated group) separated by ≥72 h. Urinary [IGFBP7·TIMP-2] and other AKI biomarkers were measured following the 24-h protocols. Diagnostic accuracy was assessed via receiver operating characteristic curve analysis. Urinary [IGFBP7·TIMP-2] [1.9 (95% confidence interval: 1.0-2.8) vs. 0.2 (95% confidence interval: 0.1-0.3) (ng/mL)2/1,000, P = 0.0011] was markedly increased in hypohydrated versus euhydrated groups. Urine osmolality (area under the curve: 0.91, P < 0.0001) and urine specific gravity (area under the curve: 0.89, P < 0.0001) had the highest overall performance for discriminating positive AKI risk. Optimal cutoffs with a positive likelihood ratio of 11.8 for both urine osmolality and specific gravity were 952 mosmol/kgH2O and 1.025 arbitrary units. In conclusion, prolonged mild hypohydration increased urinary [IGFBP7·TIMP-2] in males and females. Urinary [IGFBP7·TIMP-2] corrected to urine concentration was elevated in males only. Urine osmolality and urine specific gravity may have clinical utility for discriminating positive AKI risk following prolonged mild hypohydration.NEW & NOTEWORTHY This study found that prolonged mild hypohydration in healthy young adults increased the Food and Drug Administration approved acute kidney injury (AKI) biomarker urinary insulin-like growth factor-binding protein 7 and tissue inhibitor of metalloproteinase-2 [IGFBP7·TIMP-2]. Urine osmolality and specific gravity demonstrated an excellent ability to discriminate positive AKI risk. These findings emphasize the importance of hydration in protecting renal health and lend early support for hydration assessment as an accessible tool to assess AKI risk.
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Affiliation(s)
- Christopher L Chapman
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Sadie M Holt
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Cameron T O'Connell
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Shaun C Brazelton
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - William A B Howells
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Hannah N Medved
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Emma L Reed
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Karen Wiedenfeld Needham
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - John R Halliwill
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
| | - Christopher T Minson
- Bowerman Sports Science Center, Department of Human Physiology, University of Oregon, Eugene, Oregon, United States
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Abstract
PURPOSE OF REVIEW In the 1990s, a type of chronic kidney disease with unknown cause (CKDu) was identified in Central America and Sri Lanka. Patients lacked hypertension, diabetes, glomerulonephritis, or other usual causes of kidney failure. Affected patients are predominantly male agricultural workers aged 20-60 years, living in economically disadvantaged areas with poor access to medical care. Patients typically present late and progress to end-stage kidney disease within 5 years, resulting in social and economic hardship for families, regions, and countries. This review covers the current state of knowledge for this disease. RECENT FINDINGS The prevalence of CKDu is increasing in known endemic regions and across the globe, reaching epidemic proportions. There is primary tubulointerstitial injury with secondary glomerular and vascular sclerosis. No definitive etiologic factors have been identified, and these may vary or overlap in different geographic locations. The leading hypotheses include exposure to agrochemicals, heavy metals and trace elements, and kidney injury from dehydration/heat stress. Infections and lifestyle factors may play a role, but are likely not key. Genetic and epigenetic factors are beginning to be explored. SUMMARY CKDu is a leading cause of premature death in young-to-middle-aged adults in endemic regions and has become a public health crisis. Studies are underway to investigate clinical, exposome, and omics factors, and hopefully will provide insights into pathogenetic mechanisms resulting in biomarker discovery, preventive measures, and therapeutics.
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Affiliation(s)
- Cynthia C Nast
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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20
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Feng X, Hou N, Chen Z, Liu J, Li X, Sun X, Liu Y. Secular trends of epidemiologic patterns of chronic kidney disease over three decades: an updated analysis of the Global Burden of Disease Study 2019. BMJ Open 2023; 13:e064540. [PMID: 36931681 PMCID: PMC10030786 DOI: 10.1136/bmjopen-2022-064540] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
OBJECTIVES To assess the characteristics of the global death burden imposed by chronic kidney disease (CKD) and the attributable risk factors from 1990 to 2019 to help inform a framework for policy discussions, resource allocation and research priorities. DESIGN A population-based observational study. SETTING The death data and relative risk factors were obtained from the Global Burden of Disease (GBD) Study 2019 database. MAIN OUTCOME MEASURES Based on the GBD database, we estimated the death burden attributable to CKD stratified by sociodemographic index (SDI), geographic location, sex, age group, time period and risk factors from 1990 to 2019. RESULTS Over three decade study period, the global number of CKD-related deaths increased from 0.60 million (95% uncertainty interval (UI): 0.57-0.63 million) in 1990 to 1.43 million (95% UI: 1.31-1.52 million) in 2019. The age-standardised death rate (ASDR) of CKD, among all causes, increased from 15th in 1990 to 10th in 2019. Globally, the ASDR in males was higher than that in females. CKD-related deaths mainly occurred in those aged over 50 years, especially in regions with higher SDIs. The ASDR was negatively related to SDI (ρ=-0.603, p<0.0001). Among risk factors, metabolic risk factors, especially systolic blood pressure, fasting plasma glucose and body mass index, were the main contributors to CKD-related deaths. Although the high-temperature-related death burden was low, the trend increased sharply in lower SDI regions. CONCLUSIONS CKD-related deaths continue to increase, with the majority occurring in elderly adults. The CKD-related death burden is higher in males than in females. Additionally, the increasing high-temperature-related death burdens in lower SDI regions should receive social attention.
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Affiliation(s)
- Xiaojin Feng
- Department of Endocrinology and Metabolism, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
- Department of Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Ningning Hou
- Department of Endocrinology and Metabolism, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Zhenna Chen
- Department of Ophthalmology, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Jing Liu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Xue Li
- Department of Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
- Department of Pathology, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Xiaodong Sun
- Department of Endocrinology and Metabolism, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
- Department of Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Yongping Liu
- Department of Endocrinology and Metabolism, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
- Department of Clinical Research Center, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
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Sun H, Wang X, Zhang X, Wang L, Tao M, Wang Y, Yang J, Lei Y, Jin C, Zhao S, Hu Y, Hu H. High ambient temperature increases the number of emergency visits for upper urolithiasis in Hefei City, China. Heliyon 2023; 9:e12856. [PMID: 36711317 PMCID: PMC9876836 DOI: 10.1016/j.heliyon.2023.e12856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/19/2023] Open
Abstract
Background Few studies have examined the effect of ambient temperature on upper urolithiasis in developing countries, with even fewer considering individual factors. Methods The present study analyzed data on emergency department visits for upper urolithiasis from three hospital sites of a large hospital in Hefei, China, during 2016-2020. Data on environmental factors during the same period were also analyzed. A time series analysis employing a generalized Poisson regression model (GPRM) combined with a distributed lag non-linear model (DLNM) was conducted to evaluate the effect of ambient temperature on the number of emergency department visits for upper urolithiasis. Results We found that ambient temperatures above 9 °C were positively associated with the frequency of upper urolithiasis visits, with the relationship being most significant on the current day and with a one-day lag. In the single-day lag effect, the most significant relative risk (RR) for mild heat (75th percentile) and high heat (95th percentile) was 1.229 (95% CI: 1.100-1.373) and 1.337 (95% CI: 1.134-1.577), respectively. The cumulative lag effect was significantly higher than the single-day lag effect, with maximum relative risks (RRs) of 1.779 (95% CI: 1.356-2.335) and 2.498 (95% CI: 1.688-3.697), respectively. The maximum lag time was 7 days. RRs were also higher among women and individuals aged 30-44 years. Conclusions Increased ambient temperature is a risk factor for upper urolithiasis, and there is a hysteresis effect. Women and individuals aged 30-44 years are the most susceptible.
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Affiliation(s)
- Haoxiang Sun
- Department of General Medicine, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, Anhui Province 230022, China
| | - Xiaosong Wang
- Outpatient Department, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, Anhui Province 230022, China
| | - Xiaoyu Zhang
- Department of Health Management Center, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, Anhui Province 230022, China
| | - Linlin Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, Anhui Province 230032, China
| | - Min Tao
- Information Center, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, Anhui Province 230022, China
| | - Ying Wang
- Department of General Medicine, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, Anhui Province 230022, China
| | - Jidan Yang
- Department of General Medicine, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, Anhui Province 230022, China
| | - Yuting Lei
- Department of Health Management Center, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, Anhui Province 230022, China
| | - Changqing Jin
- Department of Health Management Center, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, Anhui Province 230022, China
| | - Shuang Zhao
- Outpatient Department, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, Anhui Province 230022, China
| | - Yue Hu
- Outpatient Department, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, Anhui Province 230022, China
| | - Huaqing Hu
- Department of General Medicine, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, Anhui Province 230022, China,Outpatient Department, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, Anhui Province 230022, China,Corresponding author. Outpatient Department of the First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei, Anhui Province 230022, China.
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Yoshikawa T, Lee YH, Sato Y, Yanagita M. Tertiary lymphoid tissues in kidney diseases: a perspective for the pediatric nephrologist. Pediatr Nephrol 2022; 38:1399-1409. [PMID: 36251070 DOI: 10.1007/s00467-022-05770-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/05/2022] [Accepted: 09/20/2022] [Indexed: 11/28/2022]
Abstract
Chronic kidney disease (CKD) is a major public health problem worldwide. In the pediatric population, CKD is also an important health issue because it causes several comorbid conditions that can have long-term consequences beyond the pediatric age. Chronic inflammation is a common pathological feature of CKD, irrespective of etiology, and leads to maladaptive repair and kidney dysfunction. Tertiary lymphoid tissues (TLTs) are ectopic lymphoid structures that develop in non-lymphoid organs under chronic inflammation caused by pathological conditions, including infections, autoimmune diseases, and cancers. TLTs in the kidneys have been poorly researched due to the lack of an animal model. We have recently found that, in aged but not young mice, TLTs develop in multiple kidney injury models, and the analysis of age-dependent TLTs has brought about several novel insights into the development and pathogenic impacts of TLTs in the kidney. Age-dependent TLT formation is also observed in human kidneys. In addition to aged kidneys, TLT development is also reported in several human kidney diseases including kidney allografts, lupus nephritis, and IgA nephropathy in both adults and children. In this review, we describe the novel findings on TLTs in the kidney obtained mainly from the analysis of age-dependent TLTs and discuss the clinical relevance of TLTs in kidney diseases.
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Affiliation(s)
- Takahisa Yoshikawa
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yu Ho Lee
- Division of Nephrology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Yuki Sato
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Motoko Yanagita
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan. .,Institute for the Advanced Study of Human Biology (WPI-ASHBi), Kyoto University, Kyoto, Japan.
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Struthers SA, Kribs Z, Butler CR. Policy and Kidney Community Engagement to Advance toward Greener Kidney Care. J Am Soc Nephrol 2022; 33:1811-1813. [PMID: 35981765 PMCID: PMC9528340 DOI: 10.1681/asn.2022070741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Sarah A Struthers
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
| | | | - Catherine R Butler
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
- Department of Hospital and Specialty Medicine and VA Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
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