Heat and Acute Kidney Injury: A Detailed Assessment using Electronic Medical Records and High-Resolution Exposure Modeling

热和急性肾损伤：使用电子病历和高分辨率暴露模型进行详细评估

• 批准号: 10641948
• 负责人: Stefanie Ebelt
• 金额: $ 45.51万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10641948
• 关键词: Accident and Emergency department; Acute Renal Failure with Renal Papillary Necrosis; Address; Admission activity; Affect; Age; Air Pollution; Area; Case Management; Chronic Kidney Failure; Classification; Clinical; Code; Communities; Computerized Medical Record; Creatine; Data; Databases; Dehydration; Diabetes Mellitus; Diagnosis; Diarrhea; Economic Burden; Economic Conditions; Education and Outreach; Educational Activities; Electrolytes; Emergency department visit; Epidemiology; Ethnic Origin; Exposure to; Future; Goals; Health; Heat Waves; High temperature of physical object; Hospitalization; Hospitals; Hypertension; Incidence; Individual; International Classification of Diseases; Intervention; Kidney; Kidney Diseases; Link; Literature; Location; Measures; Medical; Modeling; Monitor; Outcome; Outcome Assessment; Patients; Pharmaceutical Preparations; Population; Population Study; Prevention; Public Health; Race; Recording of previous events; Recurrence; Renal function; Reporting; Resolution; Risk; Risk Assessment; Risk Factors; Serum; Severities; Site; Temperature; Time; United States National Institutes of Health; Universities; Urination; Visit; Vomiting; Vulnerable Populations; Water; Work; care seeking; climate change; clinical care; clinical data warehouse; clinical database; comorbidity; demographics; disease diagnosis; economic evaluation; health data; health disparity populations; improved; improved outcome; patient health information; sex; sociodemographics; socioeconomics

PROJECT SUMMARY Acute kidney injury (AKI) is a sudden decrease of kidney function that is almost always reversible. While reversible, AKI is serious and often requires hospitalization. The economic burden is also substantial, estimated at $5-24 billion annually in the USA. Although AKI can arise within already-hospitalized patients (“hospital- acquired AKI”), an unknown proportion of AKI initiates outside of the hospital (“community-acquired AKI”). One potential contributor to the incidence of community-acquired AKI is exposure to high ambient temperatures, which is thought to impact kidneys largely through volume depletion. Motivated by increasing concerns about climate change, population-level studies using administrative health data have consistently reported positive associations between outdoor heat (high temperatures and heat waves) and emergency department (ED) visits and hospitalizations for AKI. A key limitation of existing studies is the identification of AKI cases through International Classification of Disease (ICD) discharge diagnosis coding. Code-classified AKI, while specific, is not a sensitive marker of AKI; it misses a high percentage of total cases. Moreover, it does not distinguish community-acquired from hospital-acquired AKI, cannot assess AKI severity, and does not provide information on patient context. In addition to these limitations, the majority of population-level studies have relied on spatially crude measures of temperature (e.g., from one or a few monitoring sites) that do not fully capture important urban heat dynamics. As a whole, the misclassification in both AKI outcome and heat exposure contribute to a lack of understanding of the true effect of outdoor heat on AKI. This project is motivated by the need for (1) improved outcome assessment, (2) improved exposure assessment, and (3) the identification of heat-vulnerable populations that can be protected via targeted interventions. To address these needs, we will analyze a highly detailed clinical database of over 1.5 million electronic medical records in Atlanta, Georgia for 2013-2021 linked to a high-resolution, state-of-the-art exposure product that will developed as part of this project. For ascertainment of AKI cases, we will consider ICD diagnosis codes - reflecting what has been used in the heat- AKI literature – as well as via assessment of a KDIGO (Kidney Disease Improving Global Initiative)-based serum creatine (SCr) definition comparing ED ‘first-measured’ SCr to baseline values. The KDIGO definition will enable a specific assessment of community-acquired AKI and severity (i.e., stage). In Aim 1, we will develop of a rich database of ED visits, heat exposure metrics at patient residential address, and individual- and area-level sociodemographic and health risk factors. In Aims 2 and 3, we will estimate associations of short-term outdoor heat exposure and AKI, and will identify individual- and area-level risk factors that increase vulnerability to outdoor heat-related AKI. This work will fill major gaps in the epidemiology of outdoor heat and AKI that will ultimately support targeted outreach and education activities, guide improvements in clinical care, and provide inputs for quantitative risk assessment and economic evaluation of heat-health impacts.

项目摘要 急性肾损伤（阿基）是一种几乎总是可逆的肾功能突然下降。而 阿基是可逆的，严重的，通常需要住院治疗。据估计，经济负担也很大， 在美国每年50 - 240亿美元。虽然阿基可能发生在已经住院的患者（“医院- 获得性阿基”），未知比例的阿基在医院外发生（“社区获得性阿基”）。一 社区获得性阿基发病率的潜在因素是暴露于高环境温度， 其被认为主要通过容量消耗影响肾脏。出于对以下问题的日益关注 气候变化，使用行政卫生数据的人口水平研究一直报告积极的 室外高温（高温和热浪）与急诊（艾德）就诊之间的关联 和因阿基住院治疗。现有研究的一个关键局限性是通过以下方法识别阿基病例： 国际疾病分类（ICD）出院诊断编码。代码分类的阿基，虽然具体， 不是阿基的敏感标志物;它错过了总病例的高百分比。此外，它不区分 来自医院获得性阿基的社区获得性，无法评估阿基严重程度，也未提供信息 患者背景。除了这些限制，大多数人口水平的研究都依赖于空间 温度的粗略测量（例如，从一个或几个监测站点），不能完全捕获重要的 城市热力学总的来说，阿基结果和热暴露的错误分类导致了 缺乏对户外热量对阿基的真实影响的了解。本项目的动机是需要（1） 改善结果评估，（2）改善暴露评估，（3）识别热脆弱性 可以通过有针对性的干预措施保护的人群。为了满足这些需求，我们将分析一个高度 2013-2021年格鲁吉亚亚特兰大市超过150万份电子医疗记录的详细临床数据库 到一个高分辨率，国家的最先进的曝光产品，将开发作为这个项目的一部分。为 在确定阿基病例时，我们将考虑ICD诊断代码-反映热处理中使用的内容- 阿基文献-以及通过评估基于KDIGO（肾脏疾病改善全球倡议）的血清 肌酸（SCr）定义将艾德“首次测量”SCr与基线值进行比较。KDIGO定义将使 对社区获得性阿基和严重程度的具体评估（即，阶段）。在目标1中，我们将开发丰富的 艾德访视数据库、患者居住地址的热暴露指标以及个人和地区水平 社会人口和健康风险因素。在目标2和3中，我们将估计短期户外 热暴露和阿基，并将确定个人和地区一级的风险因素，增加脆弱性， 户外热相关阿基。这项工作将填补户外高温和阿基流行病学的主要空白， 最终支持有针对性的推广和教育活动，指导临床护理的改进，并提供 热健康影响的定量风险评估和经济评估的输入。