Effect of ambient heat on chronic kidney disease and end-stage kidney disease among US veterans

项目摘要 慢性肾脏疾病（CKD）对美国人口构成重大健康负担：15%的美国成年人， 估计有3700万人患有CKD。在CKD可改变的环境风险因素中， 在美国和全球范围内，暴露于高环境热量与肾病有关，特别是在 全球气候变化的背景下。我们目前对热暴露对肾病影响的认识 在美国人群中的应用是有限的，因为我们只有极端高温暴露对急性肾损伤的数据。 以及急诊室或医院就诊的死亡率。此应用程序旨在评估关系 环境热与新发CKD之间的关系，其进展为终末期肾病（ESKD），以及 潜在的病理生理学途径在一个大规模的全国性队列谁没有肾脏疾病。我们将 连接时空连接独立斜坡模型上的格网参数-高程关系 （PRISM）具有种族和心血管风险健康结局的多变量数据集 VA人群中CKD（RCAV）队列的异常，以实现我们的目标。我们计划使用物流混合- 用三次回归样条进行效果回归，以确定滞后环境之间的关联 温度与CKD和ESKD事件，以及因果中介分析，以探索生物标志物介导的 重要的病理生理途径的影响。我们的建议将解开环境热量对 肾病的新发展和进展并增加我们对机制的了解 环境热相关肾病的途径-对美国和全球的新公共卫生威胁 社区.我们的研究结果将对临床医生设计热适应干预措施，公共卫生 管理人员和公众，因为我们可能会生活在更多的日子里， 在未来气候变化的情况下。

Project Summary Chronic kidney disease (CKD) poses a significant health burden for the US population: 15% of the US adults, or 37 million people, are estimated to have CKD. Among CKD's modifiable environmental risk factors, exposure to high ambient heat has been linked to nephropathies in the US and globally, particularly in the context of global climate change. Our current understanding of the effect of heat exposure on nephropathies among the US population is limited, as we have only data on extreme heat exposure on acute kidney damage and mortality from the emergency room or hospital visits. This application aims to evaluate the relationship between ambient heat and new-onset CKD, its progression to end-stage kidney disease (ESKD), and the underlying pathophysiological pathways in a large-scale nationwide cohort who had no kidney disease. We will link spatiotemporally link the gridded Parameter-elevation Relationships on Independent Slopes Model (PRISM) dataset of metrological variables with the health outcomes of the Racial and Cardiovascular Risk Anomalies in CKD (RCAV) cohort of the VA population to accomplish our goal. We plan to use logistic mixed- effect regression with cubic regression splines to determine the association between lagged ambient temperature with incident CKD and ESKD, and causal mediation analyses to explore the biomarkers' mediated effects of significant pathophysiological pathways. Our proposal will disentangle the role of ambient heat on the new development and progression of nephropathies and increase our understanding of the mechanistic pathways of ambient heat-related nephropathies ─ an emerging public health threat to the US and global communities. Our results will positively impact designing heat adaptive interventions by clinicians, public health managers, and the general public, as we will likely live with a higher number of days with increased ambient heat in the future in a changing climate.