Kidney News | 3
Total Page：16
File Type：pdf, Size：1020Kb
September 2019 | Vol. 11, Number 9 Kidney Risks of Climate Change: A Growing Concern By Bridget M. Kuehn n epidemic of CKD among agricultural work- like much, it’s contributing to heat waves and other ex- ers in different parts of the world has scientists treme weather events. searching for the potential cause. Among the Achief suspects—although not the only one—is climate Canary in a coal mine? change–related heat stress. When alarming numbers of young agricultural workers As scientists work to verify whether climate change is without traditional risk factors like diabetes, hyperten- contributing to the epidemic, concern about the poten- sion, or glomerular disease started showing up in Central tial health impacts of climate change around the world American hospitals in the 1990s with ESKD, clinicians is growing. A 2017 report from the United Nations out- were concerned, noted Johnson and colleagues in a re- lined the health risks associated with climate change, in- cent review in the New England Journal of Medicine (2). cluding increases in vector-borne diseases and extreme Johnson explained that the cases were clustered among weather events, both of which can contribute to new laborers likely exposed to heat stress, which is a known kidney disease and put patients with existing kidney dis- risk factor for AKI. The initial reports led to the identi- ease at risk (1). There is also growing evidence that rising fication of clusters of CKD in Honduras, Nicaragua, El temperatures increase the risk of kidney stones and AKI. Salvador, and Guatemala, he said. “Temperatures are increasing throughout the world, “The thing that was striking was that there are so and whether or not we think it’s manmade, everyone many people developing this condition, and it looks like acknowledges that temperatures have been increasing,” it’s been increasing,” Johnson said. “These countries now said Richard Johnson, MD, Tomas Berl Professor in the have some of the highest rates of kidney failure in the Division of Renal Diseases and Hypertension at the Uni- world. It’s partly because of this.” versity of Colorado in Aurora. He noted that tempera- Similar clusters of CKD have since been identified in agricultural workers in Sri Lanka and India. But not tures have increased about 1 degree Centigrade over the past 50 to 100 years, and although that may not sound Continued on page 3 > Expediting Transplant with Technology Drone Delivery, Organ Tracking and Matching Inside Technologies Put to the Test Promoting Excellence in AKI Treatment, Prevention By Bridget M. Kuehn AKI!Now initiative will focus on early recognition, biomarkers, the patient ou can order just about anything online and track at the University of Maryland Medical Center in Balti- perspective, and more it every step of the way until it reaches your door- more. During that time the organ is chilled and kept in a Y step thanks to modern logistics and technology. solution to protect it from injury, but each hour it spends Findings Now, those same technologies are being applied to kidney this way increases the risk of poor outcomes like delayed Rituximab vs. cyclosporine for transplants to speed the process and enable more trans- graft function after transplant or failure of the transplant- membranous nephropathy plants. ed organ. It currently takes on average about 18 to 20 hours to “You can get a pizza on-demand and figure out exactly ESKD Frailty and Exercise get a kidney from the donor to the transplant patient, ex- when it’s going to arrive at your house,” Scalea said. “For Addressing frailty in ESKD through plained Joseph Scalea, MD, assistant professor of surgery Continued on page 5 professionally guided in-center > exercise programs NOW 510(k) CLEARED you could experience the next generation in CRRT? Experience the innovation behind the new PRISMAX System, including: • Intelligent fluid management with an auto-effluent drain option • Integrated THERMAX blood warmer • Powerful data tracking with TRUEVUE Analytics FOR MORE INFORMATION renalacute.com/prismax 800-525-2623 DESIGNED FOR ACCURACY AND SIMPLICITY. CRRT BUILT FOR YOUR ICU. The PRISMAX control unit is intended for: Continuous Renal Replacement Therapy (CRRT) for patients weighing 20 kilograms or more with acute renal failure and/or fluid overload. Therapeutic Plasma Exchange Therapy (TPE) for patients with diseases where removal of plasma components is indicated. Rx Only. For the safe and proper use of the devices mentioned herein, please refer to the appropriate Operator’s Manual. Baxter, Prismax, Prismaflex, Thermax, and TrueVue are trademarks of Baxter International Inc. or its subsidiaries. USMP/MG207/18-0015 02/19 September 2019 | ASN Kidney News | 3 Kidney Risks of Climate Prevention emphasized Barraclough also recommended that kidney patients Whereas climate-related CKD risks continue to be in- and nephrologists get involved in efforts to help curb Change vestigated, the growing risk of kidney stones and AKI climate change. She noted in her review that it may Continued from page 1 linked to rising temperatures and extreme weather events not be possible to stop climate change in the near has been well established, noted Barraclough in a recent term, but a concerted global effort may be able to review in Kidney International (5). For example, in the limit warming to 2 degrees Centigrade. Additionally, United States, scientists have linked rising temperatures many interventions to combat climate change may all areas where agricultural workers log long hours in to an increased risk of kidney stones (6), and scientists in have other health benefits as well, she noted. For ex- hot conditions have seen an uptick in CKD, Johnson Australia have linked heat waves to increased emergency ample, adopting a plant-based diet or walking or bi- noted. Scientists are exploring several potential culprits department admissions for AKI and kidney stones (7). cycling instead of driving may contribute to improved that might contribute to kidney damage, including toxic “There is an increased risk of both AKI and [kid- overall health and well-being in addition to reducing agricultural chemicals, heavy metal exposure, silica inha- ney stones] with rising temperatures—this is clear and emissions that contribute to climate change. Barra- lation, infectious diseases that may cause kidney injury, well documented,” she emphasized. She noted that the clough noted that clinicians in particular can be pow- genetic vulnerabilities, repeated heat stress, or some com- elderly, patients with CKD or existing kidney stones, erful advocates. bination of these risk factors. and those taking certain medications like diuretics, “I personally think speaking out is our responsi- “The jury is still very much out on whether heat is the β-blockers, and angiotensin-converting enzyme inhibi- bility—it is our job to protect health, and we must primary driver,” said Katherine Barraclough, MD, a con- tors are at increased risk for those heat-related harms. speak on behalf of those with less of a voice—this in- sultant nephrologist at the Royal Melbourne Hospital Barraclough emphasized the importance of nephrologists cludes those vulnerable populations who will be most and associate professor at the University of Melbourne in advising their patients to stay well hydrated and cool, to impacted by the health effects of climate change and Australia. “It is reasonable to assume, though, that even avoid strenuous activity, and to follow their physician’s future generations,” she said. if heat turns out to not be the primary driver, it has the recommendations about medication adjustments during potential to contribute to or exacerbate kidney dysfunc- extreme heat events. References tion from any cause, and therefore needs to be treated as In addition to rising temperatures, climate change is 1. United Nations Climate Change. Climate change a risk factor and managed.” contributing to extreme weather events like hurricanes, impacts human health. April 12, 2017. https://unfc- Johnson and his colleagues are testing their hypothesis which pose considerable risks to patients with ESKD cc.int/news/climate-change-impacts-human-health. that repeated heat stress and dehydration in the workers who rely on dialysis. When Hurricanes Irma and Maria 2. Johnson RJ, et al. Chronic kidney disease of un- are contributing to low-grade kidney injury by compar- clobbered the Caribbean in 2017, emergency personnel known cause in agricultural communities. N Engl J ing the weather and climate maps with the clinical data and clinicians scrambled to evacuate dialysis patients or Med 2019; 380:1843–1852. they are collecting in workers in Central America. John- to piece together care for them in the absence of elec- 3. Moyce S, et al. Heat strain, volume depletion and son doesn’t rule out other potential contributing factors, tricity and with medications hard to access (8). In the kidney function in California agricultural workers. but he believes that heat is playing a substantial role. aftermath of Hurricane Katrina in 2005, the Kidney Occup Environ Med 2017; 74:402–409. “If I’m right, we’re going to continue to see these Community Emergency Response Coalition developed 4. Mix J, et al. Hydration status, kidney function, and outbreaks occurring in more and more places as climate recommendations for dialysis centers and their patients kidney injury in Florida agricultural workers. J Oc- change occurs,” Johnson said. (9). Barraclough highlighted the report’s recommenda- cup Environ Med 2018; 60:e253–e260. Already, scientists in the United States have identified tions that both facilities and patients have emergency 5. Barraclough KA, et al. Climate change and kid- high rates of AKI among agricultural workers in Califor- plans in advance. ney disease—threats and opportunities. Kidney Int nia (3) and Florida (4), who may also be exposed to ex- “Nephrologists need to be involved at all stages, either 2017; 92:526–530.