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

项目总结

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.