Mounting studies over the last few decades have demonstrated the inextricable connection between weather and human health within the general population. Though not much focus has been given to individuals living with end-stage renal disease (ESRD). Given this, there is a pressing need to understand how adverse weather events can impact highly vulnerable populations such as ESRD patients undergoing hemodialysis (HD). Heat- related health effects for the ESRD population is not relatively understood when compared to the general population. Also, the role of inclement weather on adherence to HD appointments is critical to assure on-time healthcare delivery and treatment. Such studies are critically needed to inform future treatment protocols and management strategies that take into account variability within the ESRD population. The overall goal in Aim 1 is to measure the extent of inclement weather events as an adherent to HD treatments. ESRD patients that receive outpatient dialysis are highly vulnerable to increased morbidity and mortality from missing critical treatments. Our approach will estimate the population-averaged risk in missing appointments on the same day as an inclement weather event across multiple locations and individual-level characteristics (e.g., race/ethnicity).
In Aim 2, we are interested in studying the effects of extreme heat events among ESRD patients using mortality and hospital admission as health endpoints. We will conduct epidemiological studies consistent with preliminary work by using a case-crossover design with time-varying lag structures to account for delayed effects. In this aim, we will also conduct stratification analyses based on race/ethnicity and co-morbidities. And in Aim 3, we seek to characterize potential mechanistic pathways between extreme heat exposure and mortality and hospitalization risks through selected clinical measurements taken before HD treatments. We are leveraging high-quality meteorological data through the National Oceanic and Atmospheric Agency (NOAA) and electronic health records through Fresenius Kidney Care (FKC) to conduct analyses for each aim by focusing on the northeastern US region. The long-term goal is to reduce mortality and morbidity by understanding environmental health risks driven by meteorological and climatic trends among ESRD patients. Under this proposal, the overall objective to measure the potential risks that extreme heat and inclement weather may have among ESRD patients. The central hypothesis is that rainfall, snow, and wind will have significant effects on missed appointments but will vary across locations. Also, extreme heat events will increase mortality and hospitalization risks, but its magnitudes will vary across location, race/ethnicity, and co-morbidities. Also, we will observe some explainable risk increase between extreme heat exposures and mortality and hospitalization risk when mediated by reduced blood pressure, but possible risk reduction when mediated by reduced inter-dialytic weight gain.
Understanding extreme weather vulnerability among populations living with chronic diseases is an imperative need. This proposed project has promise for preventing unintended missed appointments due to inclement weather and health complications due to extreme heat. Our overarching future goal is to develop data-driven location-specific heat management plans and inclement weather response directives specifically for hemodialysis populations.
