Abstract
BackgroundThe aging kidney manifests structural, functional as well as pharmacological changes, rendering elderly patients more susceptible to adverse environmental influences on their health, dehydration in particular.HypothesisHigher temperature is associated with renal function impairment in patients 65 years and older who routinely take thiazide and/or ACE-inhibitors/ARBs.MethodsWe obtained health data of patients older than 65 who were admitted to a large tertiary center during the years 2006–2011, with a previous diagnosis of hypertension, and treated with thiazide, ACE-inhibitors/ARBs or both. We collected environmental data of daily temperature, available from collaborative public and governmental institutions. In order to estimate the effect of daily temperature on renal function we performed linear mixed models, separately for each treatment group and creatinine change during hospital admission.ResultsWe identified 26,286 admissions for 14, 268 patients with a mean age of 75.6 (±6.9) years, of whom 53.6% were men. Increment in daily temperature on admission of 5°C had significant effect on creatinine increase in the no treatment (baseline creatinine adjusted 0.824 mg/dL, % change 1.212, % change 95% C.I 0.082–2.354) and dual treatment groups (baseline creatinine adjusted 1.032mg/dL, % change 3.440, % change 95% C.I 1.227–5.700). Sub-analysis stratified by advanced age, chronic kidney disease and primary diagnosis on hospital admission, revealed a significant association within patients admitted due to acute infection and treated with dual therapy.ConclusionWhereas previous studies analyzed sporadic climate effects during heat waves and/or excluded older population taking anti-hypertensive medications, the present study is novel by showing a durable association of temperature and decreased renal function specifically in elderly patients taking anti-hypertensive medications.
Highlights
People are more susceptible to environmental influences on their health including dehydration [1]
Increment in daily temperature on admission of 5 ̊C had significant effect on creatinine increase in the no treatment and dual treatment groups
Sub-analysis stratified by advanced age, chronic kidney disease and primary diagnosis on PLOS ONE | DOI:10.1371/journal.pone
Summary
People (over 65 years old) are more susceptible to environmental influences on their health including dehydration [1]. The use of antihypertensive medications, commonly prescribed for elderly patients, may augment the risk for insensible loss, dehydration and eventually impaired kidney functions in several mechanisms. Elderly patients are more vulnerable to dehydration and insensible loss, especially during high temperature periods even when they stay indoors [8]. The aging kidney manifests structural, functional as well as pharmacological changes, rendering elderly patients more susceptible to adverse environmental influences on their health, dehydration in particular. Higher temperature is associated with renal function impairment in patients 65 years and older who routinely take thiazide and/or ACE-inhibitors/ARBs
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