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Abstract: TH-OR49

Extreme Heat Exposure and Mortality Among Patients Receiving Dialysis

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis


  • Blum, Matthew F., The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Feng, Yijing, Harvard University T H Chan School of Public Health, Boston, Massachusetts, United States
  • Tuholske, Cascade, Montana State University, Bozeman, Montana, United States
  • Kim, Byoungjun, New York University Grossman School of Medicine, New York, New York, United States
  • McAdams-DeMarco, Mara, New York University Grossman School of Medicine, New York, New York, United States
  • Astor, Brad C., University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Grams, Morgan, New York University Grossman School of Medicine, New York, New York, United States

Patients receiving maintenance dialysis represent a population vulnerable to extreme weather events such as wildfires and hurricanes, but the dangers posed by extreme heat exposure remain to be determined.


In the United States Renal Data System, we identified adults living in US cities prone to extreme heat who initiated maintenance dialysis from 1997 to 2016. We defined an extreme heat event as a heat index of >40.6°C for ≥2 days or >46.1°C for ≥1 day. We estimated the risk of death during a heat event using adjusted Cox proportional hazards regression and tested for effect modification by age, sex, race and ethnicity, year of dialysis initiation, dialysis modality, poverty level, and climate region.


Among 945,437 adults in 246 cities, the median age was 64 years and 44% were female. During a median follow-up of 3.7 years, 519,748 adults were exposed to at least one of 7,152 extreme heat events, and 530,616 deaths occurred. In adjusted models, there was an increased risk of death (HR, 1.18; 95% CI, 1.15 to 1.20) during exposure to extreme heat (Table). Relative mortality risk was higher among patients who were ≥65 years-old (P=0.003), male (P=0.04), and living in the Northern Rockies and Plains (P=0.03), Ohio Valley (P=0.02), Northeast (P=0.01), and Southeast (P<0.001). Relative mortality risk was lower among Hispanic patients (P=0.02) compared to non-Hispanic White patients (Figure).


Patients receiving maintenance dialysis face an increased risk of death during extreme heat.

Risk of death with extreme heat exposure
ModelNDeathsMortality HR (95% CI)P
Unadjusted945,437530,6161.16 (1.13-1.18)<0.001
Demographics915,268512,4451.18 (1.16-1.20)<0.001
Demographics & Socioeconomic Status915,149512,2031.18 (1.15-1.20)<0.001

Demographics model adjusted for age, sex, race and ethnicity, body mass index, dialysis initiation year, dialysis modality, and climate region. Demographics and socioeconomic status model additionally adjusted for education level, poverty level, and housing cost.

Relative risk of death among subgroups accounting for multiplicative effect modification


  • Other NIH Support