Abstract: FR-PO1044
Extreme Heat Exposure and Changes in Predialysis Blood Pressure: A National Assessment
Session Information
- Hemodialysis: Clinical Challenges, Patient-Centered Outcomes, and Quality of Life
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Sieck, Nicole E., University of Maryland, College Park, Maryland, United States
- Liang, Menglu, University of Maryland, College Park, Maryland, United States
- He, Hao, University of Maryland, College Park, Maryland, United States
- Aryal, Samyam, University of Maryland, College Park, Maryland, United States
- Larkin, John W., Renal Research Institute, New York, New York, United States
- Zhang, Hanjie, Renal Research Institute, New York, New York, United States
- Usvyat, Len A., Renal Research Institute, New York, New York, United States
- Kotanko, Peter, Renal Research Institute, New York, New York, United States
- Chatoth, Dinesh K., Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States
- Seliger, Stephen L., University of Maryland Baltimore School of Medicine, Baltimore, Maryland, United States
- Sapkota, Amir, University of Maryland, College Park, Maryland, United States
Background
Extreme heat events (EHEs) are of growing concern in the context of a changing climate. Previous research on EHEs indicates that patients with kidney failure treated with hemodialysis (HD) are at an increased risk of mortality and hospitalization. The biological mechanisms leading from heat exposure to adverse health outcomes have not yet been elucidated. Earlier research indicates blood pressure is inversely associated with temperature; thus, we investigated the association between EHE exposure and decreases in pre-dialysis systolic blood pressure (pre-SBP).
Methods
We obtained HD treatment data from patients who received treatment during 2012-2018 at Fresenius Kidney Care (n=593,959). Our primary outcome, pre-SBP, was measured at the start of each HD treatment session. Weather data were obtained from ERA5-HEAT, which provides an estimate of universal thermal climate index maximum temperature. EHEs for each clinic were defined as days that exceeded the calendar-day specific 95th percentile threshold computed using 30-year baseline (1970-1999). Patients were assigned EHE exposure based on the clinic location. We conducted case-crossover analyses and used conditional quasi-Poisson regression and distributed lag nonlinear models to examine the association between EHE exposure and decreases in pre-SBP in the period of 0-3 days following exposure (lag0-3), including risk of pre-SBP below 100 mmHg as well as for a decline of 20 mmHg using recent (last pre-HD value) and rolling (median of 10 previous pre-HD values) baseline definitions.
Results
EHE exposure was associated with a 6% increase in the risk of pre-SBP of <100 mmHg (rate ratio (RR): 1.06; 95% confidence interval (CI): 1.04-1.08) in the period up to 3 days after exposure. Exposure to an EHE was associated with a 16% (RR: 1.16; 95% CI: 1.15-1.17) and 13% (RR: 1.13; 95% CI: 1.11-1.14) increase in risk of a decline of pre-SBP of >=20 mmHg, based on recent and rolling baselines, respectively.
Conclusion
Among chronic HD patients, EHE exposure was associated with decreases in pre-SBP in analyses accounting for patient characteristics using case-crossover methods. Results were robust to different definitions of decreased and baseline pre-SBP. These findings suggest that heat-induced short-term declines in blood pressure may be a potential mechanistic pathway between heat exposure and morbidity and mortality associated with EHE exposure.
Acknowledgment
This research was supported by the Agency for Healthcare Research and Quality, grant number R01HS029890-01A1.
Funding
- Other NIH Support