Long-term exposure to high perceived temperature and risk of mortality among patients with chronic kidney disease
Jeonghwan Lee,
Sohee Oh,
Jae-Young Byon,
Whanhee Lee,
Boram Weon,
Ara Ko,
Wencheng Jin,
Dong Ki Kim,
Sejoong Kim,
Yun Kyu Oh,
Yon Su Kim,
Chun Soo Lim,
Jung Pyo Lee
Affiliations
Jeonghwan Lee
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
Sohee Oh
Medical Research Collaborating Center, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
Jae-Young Byon
National Meteorological Satellite Center, Korea Meteorological Administration, Jincheon, Chungcheongbuk-do, Republic of Korea
Whanhee Lee
Data Science, School of Biomedical Convergence Engineering, Pusan National University, Pusan, Republic of Korea
Boram Weon
Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
Ara Ko
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
Wencheng Jin
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
Dong Ki Kim
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
Sejoong Kim
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
Yun Kyu Oh
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
Yon Su Kim
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
Chun Soo Lim
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
Jung Pyo Lee
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea; Corresponding author. Department of Internal Medicine, Seoul National University Boramae Medical Center and Seoul National University College of Medicine 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea.
Health risks due to climate change are emerging, particularly from high-temperature exposure. The perceived temperature is an equivalent temperature based on the complete heat budget model of the human body. Therefore, we aimed to analyze the effect of perceived temperature on overall mortality among patients with chronic kidney disease. In total, 32,870 patients with chronic kidney disease in Seoul participated in this retrospective study (2001–2018) at three medical centers. The perceived temperature during the summer season was calculated using meteorological factors, including the air temperature near the automated weather station, dew point temperature, wind velocity, and total cloud amount. We assessed the association between perceived temperature using Kriging spatial interpolation and mortality in patients with CKD in the time-varying Cox proportional hazards model that was adjusted for sex, age, body mass index, hypertension, diabetes mellitus, estimated glomerular filtration rate, smoking, alcohol consumption, and educational level. During the 6.14 ± 3.96 years of follow-up, 3863 deaths were recorded. In multivariable analysis, the average level of perceived temperature and maximum level of perceived temperature demonstrated an increased risk of overall mortality among patients with chronic kidney disease. The concordance index for mortality of perceived temperature was higher than temperature, discomfort index, and heat index. When stratified by age, diabetes mellitus, and estimated glomerular filtration rate, patients with chronic kidney disease with young age (age <65 years) showed higher hazard ratio for mortality (interaction P = 0.049). Moreover, the risk of death in the winter and spring seasons was more significant compared to that of the summer and autumn seasons. Therefore, long-term exposure to high perceived temperature during summer increases the risk of mortality among patients with chronic kidney disease.
