Heat and risk of acute kidney injury: An hourly-level case-crossover study in queensland, Australia

Zhiwei Xu; Xinxin Hu; Shilu Tong; Jian Cheng

doi:10.1016/j.envres.2019.109058

Heat and risk of acute kidney injury: An hourly-level case-crossover study in queensland, Australia

Environ Res. 2020 Mar:182:109058. doi: 10.1016/j.envres.2019.109058. Epub 2019 Dec 17.

Authors

Zhiwei Xu¹, Xinxin Hu², Shilu Tong³, Jian Cheng⁴

Affiliations

¹ School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia. Electronic address: xzw1011@gmail.com.
² The Third People's Hospital of Hefei, Hefei, China.
³ 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.
⁴ 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.

PMID: 31869688
DOI: 10.1016/j.envres.2019.109058

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.

Keywords: Acute kidney injury; Diabetes; Heat.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acute Kidney Injury* / etiology
Adult
Australia
Cross-Over Studies
Hot Temperature* / adverse effects
Humans
Male
Middle Aged
Queensland