气候变化领域集成服务门户(CCPortal): Ambient heat exposure and kidney function in patients with chronic kidney disease: a post-hoc analysis of the DAPA-CKD trial

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	Ambient heat exposure and kidney function in patients with chronic kidney disease: a post-hoc analysis of the DAPA-CKD trial
	Zhang, Zhiyan; Heerspink, Hiddo J. L.; Chertow, Glenn M.; Correa-Rotter, Ricardo; Gasparrini, Antonio; Jongs, Niels; Langkilde, Anna Maria; McMurray, John J., V; Mistry, Malcolm N.; Rossing, Peter; Toto, Robert; Vart, Priya; Nitsch, Dorothea; Wheeler, David C.; Caplin, Ben
发表日期	2024
EISSN	2542-5196
起始页码	8
结束页码	4
卷号	8 期号:4
英文摘要	Background Higher temperatures are associated with higher rates of hospital admissions for nephrolithiasis and acute kidney injury. Occupational heat stress is also a risk factor for kidney dysfunction in resource-poor settings. It is unclear whether ambient heat exposure is associated with loss of kidney function in patients with established chronic kidney disease. We assessed the association between heat index and change in estimated glomerular filtration rate (eGFR) in participants from the DAPA-CKD trial in a post-hoc analysis. Methods DAPA-CKD was a randomised controlled trial of oral dapagliflozin 10 mg once daily or placebo that enrolled participants aged 18 years or older, with or without type 2 diabetes, with a urinary albumin-to-creatinine ratio of 200-5000 mg/g, and an eGFR of 25-75 mL/min per 173 m(2). In this post-hoc analysis, we explored the association between time-varying daily centre-level heat index (ERA5 dataset) and individual-level change in eGFR in trial participants using linear mixed effect models and case-time series. The DAPA-CKD trial is registered with ClinicalTrials.gov, NCT03036150. Findings Climate and eGFR data were available for 4017 (933%) of 4304 participants in 21 countries (mean age: 619 years; mean eGFR: 433 mL per 173 m(2); median 28 months follow-up). Across centres, a heat index of more than 30 degrees C occurred on a median of 06% of days. In adjusted linear mixed effect models, within each 120-day window, each 30 days' heat index of more than 30 degrees C was associated with a -06% (95% CI -09% to -03%) change in eGFR. Similar estimates were obtained using case-time series. Additional analyses over longer time-windows showed associations consistent with haemodynamic or seasonal variability, or both, but overall estimates corresponded to an additional 37 mL per 173 m(2) (95% CI 01 to 70) loss of eGFR per year in a patient with an eGFR of 45 mL per 173 m(2) located in a very hot versus a temperate environment. Interpretation Higher ambient heat exposure is associated with more rapid eGFR decline in those with established chronic kidney disease. Efforts to mitigate heat exposure should be tested as part of strategies to attenuate chronic kidney disease progression.
语种	英语
WOS研究方向	Environmental Sciences & Ecology ; Public, Environmental & Occupational Health
WOS类目	Environmental Sciences ; Public, Environmental & Occupational Health
WOS记录号	WOS:001222452800001
来源期刊	LANCET PLANETARY HEALTH
文献类型	期刊论文
条目标识符	http://gcip.llas.ac.cn/handle/2XKMVOVA/306372
作者单位	University of London; London School of Hygiene & Tropical Medicine; University of London; London School of Hygiene & Tropical Medicine; University of London; London School of Hygiene & Tropical Medicine; University of Groningen; George Institute for Global Health; University of Sydney; Stanford University; Stanford University; Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran - Mexico; AstraZeneca; University of Glasgow; Universita Ca Foscari Venezia; University of Copenhagen; University of Texas System; University of Texas Southwestern Medical Center Dallas; University of London; University College London
推荐引用方式 GB/T 7714	Zhang, Zhiyan,Heerspink, Hiddo J. L.,Chertow, Glenn M.,et al. Ambient heat exposure and kidney function in patients with chronic kidney disease: a post-hoc analysis of the DAPA-CKD trial[J],2024,8(4).
APA	Zhang, Zhiyan.,Heerspink, Hiddo J. L..,Chertow, Glenn M..,Correa-Rotter, Ricardo.,Gasparrini, Antonio.,...&Caplin, Ben.(2024).Ambient heat exposure and kidney function in patients with chronic kidney disease: a post-hoc analysis of the DAPA-CKD trial.LANCET PLANETARY HEALTH,8(4).
MLA	Zhang, Zhiyan,et al."Ambient heat exposure and kidney function in patients with chronic kidney disease: a post-hoc analysis of the DAPA-CKD trial".LANCET PLANETARY HEALTH 8.4(2024).