Higher ambient heat exposure may be tied to faster eGFR decline in adults with CKD
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Key takeaways:
- In the study, each additional 30 days with a heat index above 30°C was tied to a 0.6% eGFR drop.
- Patients in hotter environments had an annual eGFR loss of 3.7 mL per 1.73 m2.
Higher ambient heat exposure may be associated with accelerated eGFR decline in patients with chronic kidney disease, according to a post-hoc analysis of the Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease trial.
“We already knew individuals with kidney disease have worse outcomes in many hot, poor countries around the world,” Ben Caplin, PhD, of the University College London division of medicine and senior author of the study, said in a press release. “But until now it’s been impossible to say whether temperature and humidity are important drivers of disease progression or whether this was accounted for by access to quality health care, living conditions, diet, diabetes and a whole host of other factors.”
Researchers conducted an evaluation of the AstraZeneca-funded Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease (DAPA-CKD) study to assess the relationship between heat index and change in eGFR. The international, controlled, phase 3 trial involved 4,304 adults with or without type 2 diabetes, with a urinary albumin-to-creatinine ratio of 200 to mg/g to 5000 mg/g, an eGFR of 25 mL/min/1.73 m2 to 75 mL/min/1.73 m2, and who were randomly selected to either 10 mg of oral dapagliflozin once daily or placebo.
For the post-hoc analysis, climate and eGFR data were available for 4,017 patients (mean age, 61.9 years; mean eGFR, 43.3 mL/min/1.73 m2) across 393 centers in 21 countries. Patients were followed-up for a median of 28 months. Investigators explored the link between time-varying daily center-level heat index and individual-level change in eGFR within the cohort using linear mixed-effect models and case-time series.
A heat index of more than 30°C occurred on a median of 0.6% of days across the study centers, according to the findings. Within each 120-day period, every additional 30 days with a heat index above 30°C was tied to a 0.6% decrease in eGFR.
The analysis showed similar estimates using case-time series. Extended analyses during longer periods showed associations consistent with hemodynamic or seasonal variability, or both. Researchers underlined that patients in hotter environments experienced an annual eGFR loss of 3.7 mL/1.73 m2 compared with those in more moderate climates.
“Clearly, this is concerning given that the planet is getting hotter due to climate change,” Caplin said. “But now that the evidence suggests heat is important, we can test interventions to do something about it, whether this is through hydration, avoiding direct sun exposure or other measures to combat the effects of extreme heat.”
References:
Chronic kidney disease progresses faster in patients living in hot countries. https://www.ucl.ac.uk/news/2024/apr/chronic-kidney-disease-progresses-faster-patients-living-hot-countries. Published Apr. 5, 2024. Accessed Apr. 9, 2024.
Farxiga approved in the US for the treatment of chronic kidney disease in patients at risk of progression with and without type-2 diabetes. https://www.astrazeneca.com/media-centre/press-releases/2021/farxiga-approved-in-the-us-for-ckd.html#. Published Apr. 30, 2021. Accessed Apr. 9, 2024.
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