Environment/Climate Change
Increased Mortality Following Extreme Heat Events Among Patients with End-Stage Renal Disease: A National Study, 2010-2019 Rebecca Fillipo* Rebecca Fillipo Fillipo Fillipo Fillipo Department of Population Health Sciences,Duke University School of Medicine, Durham, NC, USA
Introduction: Extreme heat events (EHEs) secondary to climate change are a growing public health concern. Individuals with end-stage renal disease (ESRD), already a medically complex and vulnerable population, may be particularly susceptible to heat-related adverse events. We aimed to estimate the effect of EHE exposure on 14-day mortality in patients with ESRD using a quasi-experimental design.
Methods: We identified EHEs as ≥2 consecutive days at the 99th percentile of county-level heat index and matched each EHE to comparable non-EHE county-day periods within a 3-year window during warm months (2010-2019). Patient data were obtained from the United States Renal Data System. We used conditional logistic regression, using county-level EHE-control pairs as strata, to estimate the relative risk of mortality. We also examined risk stratified by climate region and treatment modality.
Results: We analyzed 2,761,746 observations from 715,328 individuals and 10,931 EHEs. Overall, exposure to EHEs increased the relative risk of 14-day mortality by 5% (RR = 1.05, 95% CI: 1.03, 1.08) compared to the matched non-EHE periods. Regional analyses revealed a greater risk increase in the West (RR 1.12, 95% CI: 1.05, 1.20), South (RR: 1.12, 95% CI: 1.04, 1.21), Northern Rockies and Plains (RR: 1.35, 95% CI: 1.02, 1.80), and Northwest (RR:1.18, 95% CI: 1.03, 1.35). Patients receiving hemodialysis (RR 1.05, 95% CI:1.02, 1.08) and those with kidney transplant (RR 1.19, 95% CI: 1.073, 1.31) also appeared to be at heightened risk.
Discussion: Patients with ESRD face increased risk mortality following EHE exposure. Substantial regional variation in heat vulnerability exists, and risk differs by treatment modality. As temperatures continue to rise, these findings underscore the urgent need for targeted, region-specific interventions to protect this high-risk population from heat-related mortality.
