Rising Global Temperatures Pose Risk for ESRD Patients,  Study Finds

Sweltering heat and rising average temperatures around the globe are posing serious health risks for people living with kidney failure, according to a new study by researchers at the University of Maryland School of Public Health and the Renal Research Institute.

The first-of-its-kind study of information on 7,000 Fresenius Kidney Care patients found that on high heat days there was a 27 percent increase in the rate of same-day hospital admission and a 31 percent increase in the rate of same-day mortality among patients with end stage renal disease (ESRD). The study was published online on JAMA Network Open.

The risks were even more severe for patients living with comorbidities. For patients living with ESRD and diabetes, the risk of death on the identified high heat days increased by 83 percent. For those living with ESRD and chronic obstructive pulmonary disease or congestive heart failure, the risk increased by 60 percent and 55 percent, respectively.

“The results have validated our work to identify safety signals and implement safety guidelines that consider the risks of extreme heat conditions in our patients’ care plans,” said Dr. Frank Maddux, Global Chief Medical Officer for Fresenius Medical Care. “We are committed to ensuring that our patients have the tools and education to live full, stable and successful lives with advanced kidney disease.”

ESRD patients in particular may be at increased risk because one of the body’s responses to heat—lowered blood pressure—can be problematic for end-stage kidney disease patients. ESRD patients must also limit their fluid intake, making proper hydration on hot days challenging.

The study’s authors emphasized the dangers associated with climate change and global warming, particularly for medically vulnerable people.

“Climate change is not just about future scenarios and distant communities," Amir Sapkota, PhD, of the Maryland Institute for Applied Environmental Health. "It is here and now, and it is adversely impacting our community’s health in more ways than we realize.” 

In examining the particular risk to medically vulnerable patients, and then breaking that group down by race and geography, this study aims to give public health leaders the tools to appropriately apply resources that will counteract the effects of climate change.

"Having a better understanding about the localized health risks and how risks do not apply universally across the country is quite illuminating in terms of understanding our preparedness and outreach to those who have pre-existing conditions," Vijay Limaye, PhD, climate change and health science fellow at the Natural Resources Defense Council, told Medscape Medical News. "A one-size fits all public health approach won't achieve the same benefits as a tailored approach."

The study’s researchers examined 30 years of meteorological data to determine specific temperature thresholds in three major U.S. cities. They used these thresholds to identify extreme heat events in Boston, New York City and Philadelphia from 2001 to 2012. Researchers then cross-referenced the extreme heat days with information from Fresenius Kidney Care patient records.