$1.8M Funding Boosts UMD Research on Climate-Related Health Challenges for Kidney Patients

As intense heat and rising air pollution from wildfires pose increasing threats to human health, new research led by the University of Maryland School of Public Health aims to understand the risk for a particularly vulnerable group, and to identify solutions.

A new project, funded by a $1.8 million grant from the federal Agency for Healthcare Research and Quality (AHRQ) and directed by Professor Amir Sapkota, will study how these hazards influenced by climate change independently and jointly impact those with end-stage kidney disease (ESKD).

“During extreme heat, the damaged kidneys of people with ESKD do not regulate fluid levels very well, leading to electrolyte imbalances and other potential complications,” said Sapkota, chair of the Department of Epidemiology and Biostatistics and an expert on climate change and health.

Such patients require hemodialysis, which filters waste and water from the blood during multiple in-person treatments that can last up to five hours three times per week, and they are highly vulnerable to heat and air pollution exposure, Sapkota said.

“Most people can cool down by staying hydrated, but the liquid intake of a person with dialysis is strictly monitored and limited, so this is not an option,” he said.

Recent evidence from the Intergovernmental Panel on Climate Change suggests extreme weather events are becoming more frequent, more intense and longer-lasting. Evidence generated from this new AHRQ-funded research could help to minimize the health burden of these extreme events among the 35 million Americans living with chronic kidney disease, Sapkota said.

The study is being conducted in partnership with investigators from the Renal Research Institute (RRI), Indiana University School of Public Health and UMD School of Medicine and colleagues within the UMD School of Public Health.

The team will analyze 25 years of U.S. electronic health records data from Fresenius Medical Care (FME), the world’s largest provider of products and services for individuals with renal diseases, to understand how wildfire-related air pollution as well as extreme heat events affect the risk of hospitalization and death among people living with ESKD. The study will also examine how these risks vary for ESKD patients in different climate regions, and who experience differing sociodemographic factors and preexisting conditions.

Sapkota says the study will help identify patient populations most at risk of being hospitalized or dying during compound hazard events such as wildfires and heat waves.

People with chronic kidney disease undergoing hemodialysis are “predisposed to a range of comorbidities, notably cardiovascular disease, which heightens their susceptibility to the adverse effects of climate change, including heatwaves and wildfire-related air pollution,” said Peter Kotanko, M.D., RRI’s research director.