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)给美国人带来了巨大的健康负担：15%的美国成年人， 也就是3700万人，估计患有CKD。在CKD的可修改环境风险因素中， 在美国和全球，暴露在高环境高温下与肾病有关，特别是在 全球气候变化的背景。我们目前对热暴露对肾病影响的认识 在美国人口中的比例是有限的，因为我们只有关于急性肾脏损伤的极端高温暴露的数据 以及来自急诊室或医院就诊的死亡率。此应用程序旨在评估这一关系 在环境高温和新发的慢性肾脏病之间，其进展为终末期肾病(ESKD)，以及 在一个没有肾脏疾病的大规模全国队列中，潜在的病理生理途径。我们会 独立斜坡模型中格网参数-高程关系的时空链接 (PRISM)具有种族和心血管风险健康结果的计量变量数据集 退伍军人中CKD(RCAV)队列中的异常以实现我们的目标。我们计划使用物流混合- 用三次回归样条法确定滞后环境之间的关联 温度与CKD和ESKD的关联及因果中介分析探讨生物标志物的中介作用 重要的病理生理途径的影响。我们的建议将理清环境热量对环境的影响 肾病的新发展和新进展，提高对发病机制的认识 环境高温相关肾病的途径─是对美国和全球新出现的公共健康威胁 社区。我们的结果将对临床医生、公共卫生人员设计热适应性干预措施产生积极影响 管理人员和普通公众，因为我们可能会随着环境的增加而生活在更长的天数中 在不断变化的气候中，未来的高温。

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.