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

肾移植（KT）越来越多地成为老年（≥65岁）终末期肾病患者的治疗选择。 疾病和KT接受者经历加速的身体和认知衰老， 透析，以及慢性疾病合并症和免疫抑制，以防止移植物丢失。这导致我们 探索新的风险因素，如气候变化，可能会导致加速身体/认知老化和后 KT结果。我们假设，气候变化的各个方面可能会导致加速 物理/认知老化和KT接受者，特别是老年接受者的KT后临床结果。 首先，不断上升的环境温度和频繁的热浪导致脱水、高渗和低渗的增加。 电解质失衡，所有这些都是已知的移植物丢失和死亡的风险。我们的初步研究显示 暴露于高PM2.5水平，全身炎症的原因，增加KT后死亡率15%。的 气候变化和空气污染之间的气象相互作用可能加剧不利影响。 其次，年龄较大的KT接受者最容易受到气候变化的影响，因为他们的生理储备较低， 新陈代谢和免疫系统下降。空气污染和热浪可能会增加谵妄的风险， 以及认知能力下降，这是普遍的KT后并发症。最后，极端天气事件，如 如飓风和冰暴，会增加受伤和福尔斯的风险，特别是在老年人中， 身体机能为了研究KT的气候变化和健康（CCH），我们将利用我们正在进行的 前瞻性队列研究，肾脏疾病虚弱评估（FAIR），采集KT前后 对1，469名成人（年龄≥18岁）KT接受者的身体/认知老化和KT后临床结局进行测量 居住在39个国家。我们将收集气候变化的4个标志（长期温度变化，热浪， 极端天气事件和环境空气污染水平）从美国国家 海洋和大气管理局、国家航空航天局 数据和应用中心。我们将进行健康影响流行病学，这是 CCH/NIH确定的不同科学领域。该补充与CCH高度相关，因为我们 寻求：1.量化气候变化对KT接受者身体衰老的影响; 2.测试是否 气候变化与KT接受者的认知老化有关。3.估计KT后临床风险 在经历气候变化的受援国中取得的成果。母K 02提案包含培训 我们的目标是在KT接受者中建立认知和身体功能的新风险因素， 研究结果将通过纳入新的衰老风险因素，即气候变化，来提高K 02的目标。这 一份补充材料涉及国家老龄问题研究所感兴趣的一个主题：短期和长期健康影响 极端天气和气候变化对美国老年人健康和福祉的影响。

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.