1
|
Coppes T, Hazen ACM, Zwart DLM, Koster ES, van Gelder T, Bouvy ML. Characteristics and preventability of medication-related admissions for acute kidney injury and dehydration in elderly patients. Eur J Clin Pharmacol 2024:10.1007/s00228-024-03704-7. [PMID: 38831143 DOI: 10.1007/s00228-024-03704-7] [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: 11/03/2023] [Accepted: 05/24/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE Patients with impaired renal function using medication that affects glomerular filtration rate are at increased risk of developing acute kidney injury (AKI) leading to hospital admissions. The risk increases during periods of dehydration due to diarrhoea, vomiting or fever (so-called "sick days"), or high environmental temperatures (heat wave). This study aims to gain insight into the characteristics and preventability of medication-related admissions for AKI and dehydration in elderly patients. METHODS Retrospective case series study in patients aged ≥ 65 years with admission for acute kidney injury, dehydration or electrolyte imbalance related to dehydration that was defined as medication-related. General practitioner's (GP) patient records including medication history and hospital discharge letters were available. For each admission, patient and admission characteristics were collected to review the patient journey. A case-by-case assessment of preventability of hospital admissions was performed. RESULTS In total, 75 admissions were included. Most prevalent comorbidities were hypertension, diabetes, and known impaired renal function. Diuretics and RAS-inhibitors were the most prevalent medication combination. Eighty percent of patients experienced non-acute onset of symptoms and 60% had contacted their GP within 2 weeks prior to admission. Around 40% (n = 29) of admissions were considered potentially preventable if pharmacotherapy had been timely and adequately adjusted. CONCLUSION A substantial proportion of patients admitted with AKI or dehydration experience non-acute onset of symptoms and had contacted their GP within 2 weeks prior to admission. Timely adjusting of medication in these patients could have potentially prevented a considerable number of admissions.
Collapse
Affiliation(s)
- Tristan Coppes
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Ankie C M Hazen
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Dorien L M Zwart
- Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ellen S Koster
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Teun van Gelder
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Marcel L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.
| |
Collapse
|
2
|
Politis MD, Gutiérrez-Avila I, Just A, Pizano-Zárate ML, Tamayo-Ortiz M, Greenberg JH, Téllez-Rojo MM, Sanders AP, Rosa MJ. Recent ambient temperature and fine particulate matter (PM 2.5) exposure is associated with urinary kidney injury biomarkers in children. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 907:168119. [PMID: 37884142 PMCID: PMC10842020 DOI: 10.1016/j.scitotenv.2023.168119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/10/2023] [Accepted: 10/23/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Limited research has examined associations between exposure to ambient temperature, air pollution, and kidney function or injury during the preadolescent period. We examined associations between exposure to ambient temperature and particulate matter with aerodynamic diameter ≤ 2.5 μm (PM2.5) with preadolescent estimated glomerular filtration rate (eGFR) and urinary kidney injury biomarkers. METHODS Participants included 437 children without cardiovascular or kidney disease enrolled in the Programming Research in Obesity, Growth, Environment and Social Stressors birth cohort study in Mexico City. eGFR and urinary kidney injury biomarkers were assessed at 8-12 years. Validated satellite-based spatio-temporal models were used to estimate mean daily temperature and PM2.5 levels at each participant's residence 7- and 30-days prior to the date of visit. Linear regression and distributed lag nonlinear models (DLNM) were used to examine associations between daily mean temperature and PM2.5 exposure and kidney outcomes, adjusted for covariates. RESULTS In single linear regressions, higher seven-day average PM2.5 was associated with higher urinary alpha-1-microglobulin and eGFR. In DLNM analyses, higher temperature exposure in the seven days prior to date of visit was associated with a decrease in urinary cystatin C of -0.56 ng/mL (95 % confidence interval (CI): -1.08, -0.04) and in osteopontin of -0.08 ng/mL (95 % CI: -0.15, -0.001). PM2.5 exposure over the seven days prior to date of visit was associated with an increase in eGFR of 1.77 mL/min/1.73m2 (95 % CI: 0.55, 2.99) and urinary cystatin C of 0.19 ng/mL (95 % CI: 0.03, 0.35). CONCLUSIONS Recent exposure to ambient temperature and PM2.5 were associated with increased and decreased urinary kidney injury biomarkers that may reflect subclinical glomerular or tubular injury in children. Further research is required to assess environmental exposures and worsening subclinical kidney injury across development.
Collapse
Affiliation(s)
- Maria D Politis
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Iván Gutiérrez-Avila
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Allan Just
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Department of Epidemiology and Department of Earth, Environmental, and Planetary Sciences, Brown University, Providence, RI, United States
| | - María Luisa Pizano-Zárate
- Nutrition and Bioprogramming Coordination, National Institute of Perinatology, Mexico City, Mexico; UMF 4, South Delegation of the Federal District, Mexican Social Security Institute (IMSS), Mexico City, Mexico
| | - Marcela Tamayo-Ortiz
- Occupational Health Research Unit, Mexican Social Security Institute, Mexico City, Mexico; Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, NY, United States
| | - Jason H Greenberg
- Department of Pediatrics, Section of Nephrology, Yale University School of Medicine, New Haven, CT, United States
| | - Martha M Téllez-Rojo
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Alison P Sanders
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Maria José Rosa
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| |
Collapse
|
3
|
Wen B, Xu R, Wu Y, Coêlho MDSZS, Saldiva PHN, Guo Y, Li S. Association between ambient temperature and hospitalization for renal diseases in Brazil during 2000-2015: A nationwide case-crossover study. LANCET REGIONAL HEALTH. AMERICAS 2021; 6:100101. [PMID: 36777886 PMCID: PMC9904055 DOI: 10.1016/j.lana.2021.100101] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/23/2021] [Accepted: 09/27/2021] [Indexed: 12/24/2022]
Abstract
Background Climate change is increasing the risks of injuries, diseases, and deaths globally. However, the association between ambient temperature and renal diseases has not been fully characterized. This study aimed to quantify the risk and attributable burden for hospitalizations of renal diseases related to ambient temperature. Methods Daily hospital admission data from 1816 cities in Brazil were collected during 2000 and 2015. A time-stratified case-crossover design was applied to evaluate the association between temperature and renal diseases. Relative risks (RRs), attributable fractions (AFs), and their confidence intervals (CIs) were calculated to estimate the associations and attributable burden. Findings A total of 2,726,886 hospitalizations for renal diseases were recorded during the study period. For every 1°C increase in daily mean temperature, the estimated risk of hospitalization for renal diseases over lag 0-7 days increased by 0·9% (RR = 1·009, 95% CI: 1·008-1·010) at the national level. The associations between temperature and renal diseases were largest at lag 0 days but remained for lag 1-2 days. The risk was more prominent in females, children aged 0-4 years, and the elderly ≥ 80 years. 7·4% (95% CI: 5·2-9·6%) of hospitalizations for renal diseases could be attributable to the increase of temperature, equating to 202,093 (95% CI: 141,554-260,594) cases. Interpretation This nationwide study provides robust evidence that more policies should be developed to prevent heat-related hospitalizations and mitigate climate change. Funding China Scholarship Council, and the Australian National Health and Medical Research Council.
Collapse
Affiliation(s)
- Bo Wen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rongbin Xu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yao Wu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia,Corresponding authors: Dr Shanshan Li, and Professor Yuming Guo, School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne, VIC, 3004, Australia. Tel: +61 3 9905 6100
| | - Shanshan Li
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia,Corresponding authors: Dr Shanshan Li, and Professor Yuming Guo, School of Public Health and Preventive Medicine, Monash University, Level 2, 553 St Kilda Road, Melbourne, VIC, 3004, Australia. Tel: +61 3 9905 6100
| |
Collapse
|
4
|
Chang JCJ, Yang HY. Epidemiology of chronic kidney disease of undetermined aetiology in Taiwanese farmers: a cross-sectional study from Changhua Community-based Integrated Screening programme. Occup Environ Med 2021; 78:849-858. [PMID: 34108255 DOI: 10.1136/oemed-2021-107369] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/09/2021] [Accepted: 05/03/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Chronic kidney disease of undetermined or non-traditional aetiology (CKDu or CKDnT) has been reported in Mesoamerica among farmers under heat stress. Epidemiological evidence was lacking in Asian countries with similar climatic conditions. The objective of this study was to investigate the prevalence of CKDu and possible risk factors. METHODS We used the data from the Changhua Community-based Integrated Screening programme from 2005 to 2014, which is the annual screening for chronic diseases in Taiwan's largest rice-farming county since 2005. Our study population included farmers and non-farmers aged 15-60 years. CKDu was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 at age under 60 years without hypertension, diabetes, proteinuria, haematuria or using Chinese herbal medicine. We estimated the adjusted prevalence OR (POR) of CKDu by farmers, age, sex, education, urbanisation, smoking, body mass index, hyperuricaemia, hyperlipidaemia, heart disease and chronic liver disease. RESULTS 5555 farmers and 35 761 non-farmers were included in this study. CKDu accounted for 48.9% of all CKD cases. The prevalence of CKDu was 2.3% in the farmers and 0.9% in the non-farmers. The crude POR of CKDu in farmers compared with non-farmers was 2.73 (2.13-3.50), and the adjusted POR was 1.45 (1.10-1.90). Dehydration (blood urea nitrogen-to-creatinine ratio >20) was found in 22% of the farmers and 14% of the non-farmers. CONCLUSIONS Farmers in subtropical Asian countries are at increased risk of CKDu. Governments should take the CKDu epidemics seriously and provide farmers with occupational health education programmes on thermal hazards.
Collapse
Affiliation(s)
- Jerry Che-Jui Chang
- Institute of Occupational and Environmental Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan.,Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiao-Yu Yang
- Institute of Occupational and Environmental Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan .,Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan.,Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan
| |
Collapse
|
5
|
Meade RD, Akerman AP, Notley SR, McGinn R, Poirier P, Gosselin P, Kenny GP. Physiological factors characterizing heat-vulnerable older adults: A narrative review. ENVIRONMENT INTERNATIONAL 2020; 144:105909. [PMID: 32919284 DOI: 10.1016/j.envint.2020.105909] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/24/2020] [Accepted: 06/17/2020] [Indexed: 05/26/2023]
Abstract
More frequent and intense periods of extreme heat (heatwaves) represent the most direct challenge to human health posed by climate change. Older adults are particularly vulnerable, especially those with common age-associated chronic health conditions (e.g., cardiovascular disease, hypertension, obesity, type 2 diabetes, chronic kidney disease). In parallel, the global population is aging and age-associated disease rates are on the rise. Impairments in the physiological responses tasked with maintaining homeostasis during heat exposure have long been thought to contribute to increased risk of health disorders in older adults during heatwaves. As such, a comprehensive overview of the provisional links between age-related physiological dysfunction and elevated risk of heat-related injury in older adults would be of great value to healthcare officials and policy makers concerned with protecting heat-vulnerable sectors of the population from the adverse health impacts of heatwaves. In this narrative review, we therefore summarize our current understanding of the physiological mechanisms by which aging impairs the regulation of body temperature, hemodynamic stability and hydration status. We then examine how these impairments may contribute to acute pathophysiological events common during heatwaves (e.g., heatstroke, major adverse cardiovascular events, acute kidney injury) and discuss how age-associated chronic health conditions may exacerbate those impairments. Finally, we briefly consider the importance of physiological research in the development of climate-health programs aimed at protecting heat-vulnerable individuals.
Collapse
Affiliation(s)
- Robert D Meade
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Ashley P Akerman
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Sean R Notley
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Ryan McGinn
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - Pierre Gosselin
- Institut National de Santé Publique du Québec and Université Laval, Québec, Québec, Canada
| | - Glen P Kenny
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| |
Collapse
|
6
|
Xu Z, Hu X, Tong S, Cheng J. Heat and risk of acute kidney injury: An hourly-level case-crossover study in queensland, Australia. ENVIRONMENTAL RESEARCH 2020; 182:109058. [PMID: 31869688 DOI: 10.1016/j.envres.2019.109058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/10/2019] [Accepted: 12/17/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The effects of hourly differences in temperature on the risk of acute kidney injury have not been investigated so far. This study aimed to examine a very short-term effect of heat on the risk of acute kidney injury at an hourly level and assessed potential modification effects by age, gender and preexisting diseases. METHODS We performed a time-stratified case-crossover design with a conditional logistic regression model to examine the association between hourly temperature and hourly emergency department visits for acute kidney injury (N = 1815) in Queensland state of Australia, 2013-2015. Heat effect on acute kidney injury was reported for temperature increases from 50th percentile (26.1 °C) to 95th percentile (33.6 °C). RESULTS The effect of heat on acute kidney injury occurred in the same hour of heat exposure (odds ratio (OR): 1.37; 95% confidence interval (CI): 1.10, 1.71), with no temperature threshold observed. Males (OR: 2.48; 95% CI: 1.85, 3.32) and those aged >64 years (OR: 2.93; 95% CI: 2.01, 4.27), particularly those with pre-existing diabetes (OR: 2.51; 95% CI: 1.91, 3.30), hypertension (OR: 2.25; 95% CI: 1.61, 3.15), heart failure (OR: 2.21; 95% CI: 1.72, 2.84), or chronic kidney disease (OR: 2.59; 95% CI: 1.89, 3.55), were at great risks of acute kidney injury attack after exposure to heat. CONCLUSIONS General practitioners and specialists should remind their patients about this risk in summer. Tailored heat adaptation strategies protecting adults working outdoors are urgently needed, especially within the context of climate change.
Collapse
Affiliation(s)
- Zhiwei Xu
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia.
| | - Xinxin Hu
- The Third People's Hospital of Hefei, Hefei, China
| | - Shilu Tong
- Shanghai Children's Medical Centre, Shanghai Jiao-Tong University, Shanghai, China; School of Public Health and Institute of Environment and Human Health, Anhui Medical, University, Hefei, China; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia; Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Jian Cheng
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia; Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| |
Collapse
|