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Abstract: TH-PO277

Exposure to Elevated Temperature Is Associated with Elevated Risk for Cardiovascular Disease (CVD) Outcomes and Mortality Among Hemodialysis Patients in the United States

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis


  • Xi, Yuzhi, Emory University, Atlanta, Georgia, United States
  • Wettstein, Zachary S., University of Washington, Seattle, Washington, United States
  • Kshirsagar, Abhijit V., The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
  • Liu, Yang, Emory University, Atlanta, Georgia, United States
  • Zhang, Danlu, Emory University, Atlanta, Georgia, United States
  • Hang, Yun, Emory University, Atlanta, Georgia, United States
  • Rappold, Ana G., United States Environmental Protection Agency, Washington, District of Columbia, United States

Ambient temperatures have increased due to climate change in many parts of the world. Adaptation and resilience to changing conditions is particularly concerning among individuals with chronic kidney disease, due to loss of renal function which impacts regulation of thermoregulatory mechanisms. The aim of this study is to assess the effect of heat on mortality and health care utilization among US hemodialysis patients.


We conducted a retrospective time-series analysis (2011-2016) of daily mortality, hospital admission, and emergency department visits identified in the United States Renal Data System. Daily ambient temperature was estimated on a 1 km grid and assigned to ZIP-code. Conditional-Poisson models were used to assess the risk of developing adverse health outcomes associated with temperature exposure.


Overall, daily ambient temperature increase is associated with elevated risk for both mortality and health care utilization among hemodialysis patients. The rate ratios for all-cause mortality and daily temperature was 1.07 (95% CI: 1.03-1.11), 1.17 (1.14-1.21) for fluid disorder-related hospital admissions, and 1.19 (1.16-1.22) for cardiovascular event-related emergency department visits, comparing 99th percentile vs. 50th percentile daily temperatures. Larger effects were observed for cumulative lagged exposure three-days prior to the outcome and for Southwest and Northwest climate regions.


Heat exposure is associated with elevated risk for mortality and health care utilization among this vulnerable population. Furthermore, the effect appears to be potentially cumulative in the short-term, and varies geographically. Disclammer: this abstract does not represent EPA policy nor USRDS position.