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Abstract: FR-PO462

Risk of Hospitalization and Mortality Following Extreme Heat Events in Patients Undergoing In-Center Hemodialysis in the Western United States

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Sieck, Nicole E., The University of Maryland, College Park, Maryland, United States
  • Song, Hyeonjin, The University of Maryland, College Park, Maryland, United States
  • Raimann, Jochen G., Renal Research Institute, New York, New York, United States
  • Kotanko, Peter, Renal Research Institute, New York, New York, United States
  • Maddux, Franklin W., Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States
  • He, Hao, The University of Maryland, College Park, Maryland, United States
  • Sapkota, Amir, The University of Maryland, College Park, Maryland, United States
Background

Climate change is increasing the frequency of extreme heat events (EHEs) and this trend is projected to continue into the foreseeable future. Previous research indicates that patients undergoing hemodialysis treatment are at an increased risk of both hospitalization and mortality following exposure to EHEs, although earlier analyses were limited in scope to the Northeastern U.S. Here, we investigated the risk of hospitalization and mortality following exposure to EHEs in the Western U.S. among patients that receive in-center hemodialysis treatment.

Methods

We identified EHEs as days where the daily maximum temperature (Tmax) exceeded the 95th percentile distribution of daily Tmax values specific to the location and calendar day over a 20-year baseline (1980-1999). We linked EHE data with health records of 79,963 patients undergoing in-center hemodialysis treatment at Fresenius Kidney Care clinics (n=191) in Washington, Oregon, and California during the warm season (May-September) of 2001-2018. We conducted a time-stratified case-crossover analysis with conditional Poisson regression to investigate the association EHE exposure and the risk of hospitalization and mortality.

Results

We observed a total of 7,242 EHE days at the county scale during the study period. EHEs were associated with a 7% higher risk of all-cause hospitalization (rate ratio (RR): 1.07, 95% CI: 1.02, 1.1), and a 6% higher risk of all-cause mortality (RR: 1.06, 95% CI: 1.00, 1.13).

Conclusion

We observed an increase in the risk of both hospitalization and mortality following EHE exposure in the Western U.S., which agrees with earlier findings from the Northeastern U.S. These findings indicate that interventions, such as the implementation of early heat warning systems, are needed to improve outcomes for patients undergoing in-center hemodialysis.

Funding

  • Other U.S. Government Support