Short-term impact of extreme temperatures, relative humidity and air pollution on emergency hospital admissions due to kidney disease and kidney-related conditions in the Greater Madrid area (Spain).

ABSTRACT

While some studies report a possible association between heat waves and kidney disease and kidney-related conditions, there still is no consistent scientific consensus on the matter or on the role played by other variables, such as air pollution and relative humidity. Ecological retrospective time series study 01-01-2013 to 31-12-2018). Dependent variables daily emergency hospitalisations due to kidney disease (KD), acute kidney injury (AKI), lithiasis (L), dysnatraemia (DY) and hypovolaemia (HPV). Independent variables maximum and minimum daily temperature (Tmax, Tmin, °C), and daily relative humidity (RH, %). Other variables were also calculated, such as the daily temperature for risk of kidney disease (Theat, °C) and low daily hazardous relative humidity (HRH%). As variables of air pollution, we used the daily mean concentrations of PM10, PM2.5, NO2 and O3 in µg/m3. Based on these, we then calculated their daily excesses over World Health Organisation (WHO) guideline levels (hPM10, hPM2.5, hNO2 and hO3 respectively). Poisson family generalised linear models (GLMs) (link = log) were used to calculate relative risks (RRs), and attributable risks and attributable admissions. In the models, we controlled for the covariates included seasonalities, trend, autoregressive component, day of the week, month and year. A statistically significant association was found between Theat and all the dependent variables analysed. The greatest AKI disease burden was attributable to Theat (2.2 % (1.7, 2.6) of attributable hospital admissions), followed by hNO2 (1.7 % (0.9, 3.4)) and HRH (0.8 (0.6, 1.1)). In the case of hypovolaemia and dysnatraemia, the greatest disease burden again corresponded to Theat, with 6.9 % (6.2, 7.6) and 5.7 (4.8, 6.6) of attributable hospital admissions respectively. Episodes of extreme heat exacerbate daily emergency hospital admissions due to kidney disease and kidney-related conditions; and attributable risks are likewise seen for low relative humidity and high ozone levels.