Impact of Extreme Heat on End-Stage Renal Disease Patients in the Northeast US Using Selected Clinical Outcomes

摘要

Many studies on extreme heat and health have shown associations with morbidity and mortality within the general population around the world. However, there is a paucity of data regarding how extreme heat event may impact highly vulnerable populations such as individuals living with end-stage renal disease (ESRD) patients. We investigated the associations between exposure to extreme heat events and clinical parameters in urban ESRD patients undergoing hemodialysis (HD) in three northeastern cities. We used physical and clinical measures collected during HD visits between 2001 to 2012 in three cities: Boston, MA; New York City, NY, and Philadelphia, PA. We extracted meteorological data collected at the nearest meteorological stations from National Oceanic and Atmospheric Agency (NOAA). We identified extreme heat events using same-day (lagO) and one-day lag (lagl) 95thpercentile threshold of the distribution of the daily maximum temperature or heat index values for each location. We analyzed the association between exposure to extreme heat events inter-dialytic weight gain (IDWG), predialysis systolic and diastolic blood pressure (pre-SBP, pre-DBP), and mortality and hospitalization using linear mixed effect regression adjusting for seasonality, long-term trends, and day of the week. We used time stratified case-crossover study design for the analysis of hospitalization and mortality data. Exposure to extreme heat event (both lagO and lagl) was associated with significant decreases in mean IDWG, pre-SBP, and pre-DBP in all three cities. We observed increased mortality among patients residing in Boston, but not in New York or Philadelphia. Findings regarding Hospitalization were not statistically significant. Outdoor extreme heat can affect clinical outcomes among hemodialysis patients. These findings could inform heat management guidelines and treatments for ESRD patients in the context of a changing climate.