As daily temperatures increase, so does the number of patients seeking treatment for kidney stones. In a study that may both reflect and foretell a warming planet's impact on human health, a research team found a link between hot days and kidney stones in 60,000 patients in several U.S. cities with varying climates.
"We found that as daily temperatures rise, there is a rapid increase in the probability of patients presenting over the next 20 days with kidney stones," said study leader Gregory E. Tasian, M.D., M.Sc., M.S.C.E., a pediatric urologist and epidemiologist at The Children's Hospital of Philadelphia (CHOP), who is on the staff of the Hospital's Kidney Stone Center as well as the Hospital's Center for Pediatric Clinical Effectiveness (CPCE).
Tasian, senior author Ron Keren, M.D., MPH, also of CHOP and CPCE, and colleagues from other centers published their results today in Environmental Health Perspectives, the journal of the National Institute of Environmental Health Sciences. The Urologic Diseases in America Project, supported by the National Institute of Diabetes and Digestive and Kidney Diseases, sponsored the study.
The study team analyzed medical records of more than 60,000 adults and children with kidney stones between 2005 and 2011 in Atlanta, Chicago, Dallas, Los Angeles and Philadelphia, in connection with weather data. Tasian and colleagues described the risk of stone presentation for the full range of temperatures in each city. As mean daily temperatures rose above 50 F (10 C), the risk of kidney stone presentation increased in all the cities except Los Angeles. The delay between high daily temperatures and kidney stone presentation was short, peaking within three days of exposure to hot days.
"These findings point to potential public health effects associated with global climate change," said Tasian. "However," cautions Tasian, "although 11 percent of the U.S. population has had kidney stones, most people have not. It is likely that higher temperatures increase the risk of kidney stones in those people predisposed to stone formation." Higher temperatures contribute to dehydration, which leads to a higher concentration of calcium and other minerals in the urine that promote the growth of kidney stones.
A painful condition that brings half a million patients a year to U.S. emergency rooms, kidney stones have increased markedly over the world in the past three decades. While stones remain more common in adults, the numbers of children developing kidney stones have climbed at a dramatically high rate over the last 25 years. The factors causing the increase in kidney stones are currently unknown, but may be influenced by changes in diet and fluid intake. When stones do not pass on their own, surgery may be necessary.
The study team also found that very low outdoor temperatures increased the risk of kidney stones in three cities: Atlanta, Chicago and Philadelphia. The authors suggest that as frigid weather keeps people indoors more, higher indoor temperatures, changes in diet and decreased physical activity may raise their risk of kidney stones.
The researchers argue that the number of hot days in a given year may better predict kidney stone risk than the mean annual temperature. Atlanta and Los Angeles share the same annual temperature (63 F, or 17 C), but Atlanta has far more hot days than Los Angeles, along with nearly twice the prevalence of kidney stones.
Tasian added that while the five U.S. cities have climates representative of those found throughout the world, future studies should explore how generalizable the current findings are. Other studies should analyze how risk patterns vary in different populations, including among children, represented by a small sample size in the current study.
The study's broader context is in patterns of global warming. The authors note that other scientists have reported that overall global temperatures between 2000 and 2009 were higher than 82 percent of temperatures over the past 11,300 years. Furthermore, increases in greenhouse gas emissions are projected to raise earth's average temperatures by 2 to 8 F (1 to 4.5 C) by 2100. "Kidney stone prevalence has already been on the rise over the last 30 years, and we can expect this trend to continue, both in greater numbers and over a broader geographic area, as daily temperatures increase," concluded Tasian. "With some experts predicting that extreme temperatures will become the norm in 30 years, children will bear the brunt of climate change."
Funds from the National Institutes of Health (grants HD060550 and DK70003), supported this study, along with a research fellowship from the Medical Research Council, U.K. In addition to their CHOP titles, Tasian and Keren are on the faculty of the Perelman School of Medicine at the University of Pennsylvania.
Co-authors of the study are Christopher Saigal, M.D., MPH, of UCLA who is a co-principal investigator of the Urologic Diseases in America Project; Antonio Gasparrini, Ph.D., of the London School of Hygiene and Tropical Medicine; Benjamin Horton, Ph.D., of Rutgers University; Rodger Madison, M.A., of the RAND Corporation; and Jose Pulido, M.D., and J. Richard Landis, Ph.D., both of the University of Pennsylvania.
Taisan GE et al, "Daily Mean Temperature and Clinical Kidney Stone Presentation in Five U.S. Metropolitan Areas: A Time Series Analysis," Environmental Health Perspectives, published July 10, 2014.
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