Climate Change and the Emergent Epidemic of CKD from Heat Stress in Rural Communities: The Case for Heat Stress Nephropathy

Abstract

Climate change has led to significant rise of 0.8˚C-0.9˚C in global mean temperature over the last century and has been linked with significant increases in the frequency and severity of heat waves (extreme heat events). Climate change has also been increasingly connected to detrimental human health. One of the consequences of climate-related extreme heat exposure is dehydration and volume loss, leading to acute mortality from exacerbations of pre-existing chronic disease, as well as from outright heat exhaustion and heat stroke. Recent studies have also shown that recurrent heat exposure with physical exertion and inadequate hydration can lead to CKD that is distinct from that caused by diabetes, hypertension, or GN. Epidemics of CKD consistent with heat stress nephropathy are now occurring across the world. Here, we describe this disease, discuss the locations where it appears to be manifesting, link it with increasing temperatures, and discuss ongoing attempts to prevent the disease. Heat stress nephropathy may represent one of the first epidemics due to global warming. Government, industry, and health policy makers in the impacted regions should place greater emphasis on occupational and community interventions.

Metabolic and Kidney Diseases in the Setting of Climate Change, Water Shortage, and Survival Factors

“…When needed, the turtle reabsorbs the water through the bladder wall, while at the same time, excreting some of its wastes into it, and over time, the osmolarity of the bladder urine increases. 9 Reduced Urinary Water Losses Homer Smith 6 proposed that the evolution from aquatic to terrestrial environments required efficient ways to excrete nitrogen to help minimize loss of water. 10 Most aquatic animals excrete ammonia, the simplest nitrogen product, as their means for eliminating nitrogen waste products (ammoniotely).…”

“…For example, there is increasing evidence that climate change may have a role in epidemics of CKD that are occurring among workers in hot environments. 6 While this latter paper focuses on the sites of these epidemics and their relationship to local temperatures and changing climate, space constraints prevented it from being able to address a more central question on the biology of water conservation and how it relates to disease. Here we review how various species protect themselves from dehydration, and we identify nutrient, hormonal and metabolic pathways triggered by hyperosmolarity that link water conservation with survival.…”

Acute heat stress activated inflammatory signaling in porcine oxidative skeletal muscle

“…2015) to potentially life‐threatening diseases, including kidney pathology (Glaser et al. 2016), coronary artery disease, or cardiac arrest (Kones 2011). This chronic hyperthermic stress can affect not only human health, but also agricultural animal welfare and decrease agricultural productivity and growth efficiency implicating hyperthermic muscle injury in this process.…”

Hyperuricemia as a potential risk factor for type 2 diabetes and diabetic nephropathy

“…One recently proposed risk factor is heat stress and dehydration, that may be more common among individuals living in hot environments. 12 There are some limitations of the study worth mentioning. First, it is unclear if the elevated serum uric acid in subjects with type 2 diabetes simply reflects worse renal function among this group.…”