Impact of climate change on cognitive and physical aging of older kidney transplant recipients

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Kidney transplantation (KT) is increasingly a treatment option for older (≥65) patients end-stage kidney disease and KT recipients experience accelerated physical and cognitive aging due to years of reliance on dialysis, as well as chronic disease comorbidity and immunosuppression to prevent graft loss. This has led us to explore novel risk factors like climate change that may cause accelerated physical/cognitive aging and post- KT outcomes. We hypothesize that various dimensions of climate change may cause accelerated physical/cognitive aging and post-KT clinical outcomes among KT recipients and specifically older recipients. First, rising ambient temperatures and frequent heatwaves lead to increased dehydration, hyperosmolality, and electrolyte imbalances, all of which are known risks of graft loss and mortality. Our preliminary study shows that exposure to high PM2.5 level, a cause of systemic inflammation, increases post-KT mortality 15%. The meteorological interactions between climate change and air pollution may exacerbate the adverse impacts. Second, older KT recipients are most vulnerable to climate change due to a lower physiological reserve, slower metabolism, and decreased immune system. Air pollution and heatwaves may increase the risk for delirium as well as cognitive declines which are the prevalent post-KT complications. Lastly, extreme weather events, such as hurricane and ice storm, can increase risks for injuries and falls, especially among older adults with limited physical functioning. To study climate change and health (CCH) in KT, we will leverage our ongoing prospective cohort study, Frailty Assessment in Renal Disease (FAIR), which captures pre- and post-KT measures of physical/cognitive aging and post-KT clinical outcomes on 1,469 adult (age≥18) KT recipients residing in 39 states. We will glean 4 markers of climate change (long-term temperature change, heatwaves, extreme weather events, and ambient air pollution levels) from publicly available data from the US National Oceanic and Atmospheric Administration, National Aeronautics, and Space Administration Socioeconomic Data and Applications Center. We will conduct a health effects epidemiology, one of the Core Pillars of CCH/Diverse Areas of Science identified by the NIH. This supplement is highly relevant to CCH because we seek to: 1. Quantify the impact of climate change on physical aging among KT recipients; 2. Test whether climate change is associated with cognitive aging among KT recipients. 3. Estimate the risk of post-KT clinical outcomes among recipients who experience climate change. The parent K02 proposal incorporates training goals to establish novel risk factors for cognitive and physical functioning among KT recipients, and our findings will enhance the K02 goals by incorporating novel aging risk factors, namely climate changes. This supplement addresses a topic of interest to the National Institute on Aging: short- and long-term health impacts of extreme weather and climate change on the health and wellbeing of older adults in the US.