Assessing proximate intermediates between ambient temperature, hospital admissions, and mortality in hemodialysis patients.
Assessing proximate intermediates between ambient temperature, hospital admissions, and mortality in hemodialysis patients.
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评估血液透析患者的环境温度，住院和死亡率之间的近距离中间体。
DOI：
10.1016/j.envres.2021.112127
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发表时间：
2022-03
影响因子：
8.3
通讯作者：
Sapkota A
中科院分区：
文献类型：
--
作者：
Remigio RV;Turpin R;Raimann JG;Kotanko P;Maddux FW;Sapkota AR;Liang XZ;Puett R;He X;Sapkota A
健康人对温度升高的典型体温调节反应包括血压降低和出汗。终末期肾病(ESKD)患者容易受到环境温度变化引起的全身波动的影响，这可能会增加发病率和死亡率。我们调查了透析前收缩压(PreSBP)和透析间期体重增加(IDWG)是否可以独立地调节环境温度、全因住院(ACHA)和全因死亡率(ACM)之间的关系。研究人群包括2011至2019年在宾夕法尼亚州费城费森尤斯医疗机构接受血液透析治疗的ESKD患者(n=1981)。在时间到事件的框架内，我们估计了日最高干球温度(TMAX)与较温暖日历月份的ACHA和ACM之间的关联。使用线性混合效应模型估计临床测量的前SBP和IDWG对体温升高的反应。我们使用差分(c-c‘)方法分解ACHA和ACM的总效应模型，将前SBP和IDWG作为时间依赖中介。暴露介体、总效应和直接效应模型的协变量调整包括年龄、种族、民族、血压药物使用、治疗地点、SBP前期和IDWG。为了确保暴露-结果模型之间的时间性，我们考虑了暴露最多两天的滞后和中介变量的一天滞后(滞后2-滞后1)。还对2天(仅滞后2)和1天(仅滞后1)滞后结构进行了敏感性分析。根据滞后2-滞后1的时间顺序，每日Tmax增加1°C与ACHA1.4%(调整后的危险比，1.014；95%可信区间，1.007-1.021)和ACM7.5%(调整后的HR，1.075，1.050-1.100)的风险增加相关。温度升高1°C的短期滞后暴露预测IDWG和前SBP的平均降幅分别为0.013-0.015%和0.168-0.229毫米汞柱。对ACHA的中介分析发现，三条通路(preSBP、IDWG和preSBP+IDWG)对ACM均有显著的间接效应，而对IDWG和联结的preSBP+IDWG通路对ACM有显著的间接效应。值得注意的是，只有1.03%的温度和ACM之间的关联是通过前SBP介导的。IDWG的机制路径不依赖于前SBP，表现出不一致的调节，因此，基于联合路径模型，ACHA(15.5%)和ACM(6.3%)具有潜在的抑制效应。在ACHA和ACM结果的联合路径分析中，来自前SBP+IDWG通路的比例中介估计分别达到2.2%和0.3%。滞后2离散时间ACM中介模型对所有三条途径的中介作用一致，表明IDWG和前SBP反应的2天滞后分别可以解释温度与死亡率之间总效应关联的2.11%和4.41%。我们证实了先前报道的环境温度、ACHA和ACM之间的关联。我们的结果促进了对可能解释或抑制温度驱动的入院和死亡风险的潜在生理联系的理解。值得注意的是，在联合通路模型中分析时，伴随的前SBP和IDWG的变化可能没有什么中介作用。这些发现推进了我们对减少室外温度变化对ESKD患者影响的候选干预措施的评估。
Typical thermoregulatory responses to elevated temperatures among healthy individuals include reduced blood pressure and perspiration. Individuals with end-stage kidney disease (ESKD) are susceptible to systemic fluctuations caused by ambient temperature changes that may increase morbidity and mortality. We investigated whether pre-dialysis systolic blood pressure (preSBP) and interdialytic weight gain (IDWG) can independently mediate the association between ambient temperature, all-cause hospital admissions (ACHA), and all-cause mortality (ACM). The study population consisted of ESKD patients receiving hemodialysis treatments at Fresenius Medical Care facilities in Philadelphia County, PA, from 2011 to 2019 (n = 1981). Within a time-to-event framework, we estimated the association between daily maximum dry-bulb temperature (TMAX) and, as separate models, ACHA and ACM during warmer calendar months. Clinically measured preSBP and IDWG responses to temperature increases were estimated using linear mixed effect models. We employed the difference (c-c’) method to decompose total effect models for ACHA and ACM using preSBP and IDWG as time-dependent mediators. Covariate adjustments for exposure-mediator and total and direct effect models include age, race, ethnicity, blood pressure medication use, treatment location, preSBP, and IDWG. We considered lags up to two days for exposure and 1-day lag for mediator variables (Lag 2-Lag 1) to assure temporality between exposure-outcome models. Sensitivity analyses for 2-day (Lag 2-only) and 1-day (Lag 1-only) lag structures were also conducted. Based on Lag 2- Lag 1 temporal ordering, 1 °C increase in daily TMAX was associated with increased hazard of ACHA by 1.4% (adjusted hazard ratio (HR), 1.014; 95% confidence interval, 1.007–1.021) and ACM 7.5% (adjusted HR, 1.075, 1.050–1.100). Short-term lag exposures to 1 °C increase in temperature predicted mean reductions in IDWG and preSBP by 0.013–0.015% and 0.168–0.229 mmHg, respectively. Mediation analysis for ACHA identified significant indirect effects for all three studied pathways (preSBP, IDWG, and preSBP + IDWG) and significant indirect effects for IDWG and conjoined preSBP + IDWG pathways for ACM. Of note, only 1.03% of the association between temperature and ACM was mediated through preSBP. The mechanistic path for IDWG, independent of preSBP, demonstrated inconsistent mediation and, consequently, potential suppression effects in ACHA (15.5%) and ACM (6.3%) based on combined pathway models. Proportion mediated estimates from preSBP + IDWG pathways achieved 2.2% and 0.3% in combined pathway analysis for ACHA and ACM outcomes, respectively. Lag 2 discrete-time ACM mediation models exhibited consistent mediation for all three pathways suggesting that 2-day lag in IDWG and preSBP responses can explain 2.11% and 4.41% of total effect association between temperature and mortality, respectively. We corroborated the previously reported association between ambient temperature, ACHA and ACM. Our results foster the understanding of potential physiological linkages that may explain or suppress temperature-driven hospital admissions and mortality risks. Of note, concomitant changes in preSBP and IDWG may have little intermediary effect when analyzed in combined pathway models. These findings advance our assessment of candidate interventions to reduce the impact of outdoor temperature change on ESKD patients.
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DOI：
10.1023/a:1026595011371
发表时间：
2000-12-01
期刊：
Prevention science : the official journal of the Society for Prevention Research
影响因子：
--
作者：
MacKinnon, D P;Krull, J L;Lockwood, C M
通讯作者：
Lockwood, C M
影响因子：
4.7
作者：
Boyle, Suzanne M.;Zhao, Yuzhe;Harhay, Meera N.
通讯作者：
Harhay, Meera N.
DOI：
10.1097/ede.0000000000000910
发表时间：
2018-11
期刊：
Epidemiology (Cambridge, Mass.)
影响因子：
--
作者：
Gronlund CJ;Sheppard L;Adar SD;O'Neill MS;Auchincloss A;Madrigano J;Kaufman J;Diez Roux AV
通讯作者：
Diez Roux AV
影响因子：
120.7
作者：
Klassen, PS;Lowrie, EG;Owen, WF
通讯作者：
Owen, WF
DOI：
10.1186/s12940-017-0331-4
发表时间：
2017-10-27
期刊：
Environmental health : a global access science source
影响因子：
--
作者：
Borg M;Bi P;Nitschke M;Williams S;McDonald S
通讯作者：
McDonald S