Heat and Acute Kidney Injury: A Detailed Assessment using Electronic Medical Records and High-Resolution Exposure Modeling

热和急性肾损伤：使用电子病历和高分辨率暴露模型进行详细评估

基本信息

批准号：
10504603
负责人：
Stefanie Ebelt
金额：
$ 52.9万
依托单位：
EMORY UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-07-01 至 2027-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10504603
关键词：
Accident and Emergency department Acute Renal Failure with Renal Papillary Necrosis Address Affect Age Air Pollution Area Caring Case Management Chronic Kidney Failure Clinical Code Communities Computerized Medical Record Creatine Data Databases Dehydration Diabetes Mellitus Diagnosis Diarrhea Economic Burden Education and Outreach Electrolytes Emergency department visit Epidemiology Ethnic Origin Exposure to Future Goals Health Heat Waves High temperature of physical object Hospitalization Hospitals Hypertension Incidence Individual International Classification of Diseases Intervention Kidney Kidney Diseases Link Literature Location Measures Medical Meteorology Modeling Monitor Outcome Outcome Assessment Patients Pharmaceutical Preparations Population Population Study Prevention Public Health Race Recording of previous events Recurrence Renal function Reporting Resolution Risk Risk Assessment Risk Factors Serum Severities Site Temperature Time United States National Institutes of Health Universities Urination Visit Vomiting Vulnerable Populations Water Work base climate change clinical care clinical data warehouse clinical database comorbidity demographics disease diagnosis economic evaluation health data health disparity populations improved improved outcome patient health information sex sociodemographics socioeconomics

项目摘要

PROJECT SUMMARY Acute kidney injury (AKI) is a sudden decrease of kidney function that is almost always reversible. While reversible, AKI is serious and often requires hospitalization. The economic burden is also substantial, estimated at $5-24 billion annually in the USA. Although AKI can arise within already-hospitalized patients (“hospital- acquired AKI”), an unknown proportion of AKI initiates outside of the hospital (“community-acquired AKI”). One potential contributor to the incidence of community-acquired AKI is exposure to high ambient temperatures, which is thought to impact kidneys largely through volume depletion. Motivated by increasing concerns about climate change, population-level studies using administrative health data have consistently reported positive associations between outdoor heat (high temperatures and heat waves) and emergency department (ED) visits and hospitalizations for AKI. A key limitation of existing studies is the identification of AKI cases through International Classification of Disease (ICD) discharge diagnosis coding. Code-classified AKI, while specific, is not a sensitive marker of AKI; it misses a high percentage of total cases. Moreover, it does not distinguish community-acquired from hospital-acquired AKI, cannot assess AKI severity, and does not provide information on patient context. In addition to these limitations, the majority of population-level studies have relied on spatially crude measures of temperature (e.g., from one or a few monitoring sites) that do not fully capture important urban heat dynamics. As a whole, the misclassification in both AKI outcome and heat exposure contribute to a lack of understanding of the true effect of outdoor heat on AKI. This project is motivated by the need for (1) improved outcome assessment, (2) improved exposure assessment, and (3) the identification of heat-vulnerable populations that can be protected via targeted interventions. To address these needs, we will analyze a highly detailed clinical database of over 1.5 million electronic medical records in Atlanta, Georgia for 2013-2021 linked to a high-resolution, state-of-the-art exposure product that will developed as part of this project. For ascertainment of AKI cases, we will consider ICD diagnosis codes - reflecting what has been used in the heat- AKI literature – as well as via assessment of a KDIGO (Kidney Disease Improving Global Initiative)-based serum creatine (SCr) definition comparing ED ‘first-measured’ SCr to baseline values. The KDIGO definition will enable a specific assessment of community-acquired AKI and severity (i.e., stage). In Aim 1, we will develop of a rich database of ED visits, heat exposure metrics at patient residential address, and individual- and area-level sociodemographic and health risk factors. In Aims 2 and 3, we will estimate associations of short-term outdoor heat exposure and AKI, and will identify individual- and area-level risk factors that increase vulnerability to outdoor heat-related AKI. This work will fill major gaps in the epidemiology of outdoor heat and AKI that will ultimately support targeted outreach and education activities, guide improvements in clinical care, and provide inputs for quantitative risk assessment and economic evaluation of heat-health impacts.

项目概要急性肾损伤（AKI）是肾功能的突然下降，几乎总是可逆的。可逆性，AKI严重，往往需要住院治疗，估计经济负担也很大。尽管 AKI 可能发生在已住院的患者中（“医院- 获得性 AKI”），医院外发生的 AKI 比例未知（“社区获得性 AKI”）。暴露于高环境温度是社区获得性 AKI 发生的潜在因素，人们认为，这主要是通过容量不足对肾脏产生影响，这是由于人们越来越担心。气候变化，使用行政健康数据的人口层面研究一致报告了积极的结果室外高温（高温和热浪）与急诊科 (ED) 就诊之间的关联现有研究的一个主要局限性是通过 AKI 病例的识别。国际疾病分类 (ICD) 出院诊断编码代码分类的 AKI 虽然具体，但具有特定性。不是 AKI 的敏感标记；它错过了很高比例的总病例。社区获得性来自医院获得性 AKI，无法评估 AKI 严重程度，并且不提供信息除了这些限制之外，大多数人群水平的研究还依赖于空间。粗略的温度测量（例如，从一个或几个监测点）没有完全捕捉到重要的信息总体而言，AKI 结果和热暴露的错误分类导致了城市热动态。缺乏对室外热量对 AKI 的真正影响的了解，该项目的动机是 (1)。改进的结果评估，(2) 改进的暴露评估，以及 (3) 热脆弱性的识别为了满足这些需求，我们将高度分析可以通过有针对性的干预措施来保护的人群。 2013-2021 年佐治亚州亚特兰大超过 150 万份电子病历的详细临床数据库已链接到将作为该项目的一部分开发的高分辨率、最先进的曝光产品。确定 AKI 病例后，我们将考虑 ICD 诊断代码 - 反映热病中使用的内容 - AKI 文献 – 以及基于 KDIGO（改善肾脏疾病全球倡议）的血清的评估肌酸 (SCr) 定义将 ED“首次测量的”SCr 与基线值进行比较，KDIGO 定义将启用。对社区获得性 AKI 和严重程度（即阶段）的具体评估在目标 1 中，我们将制定丰富的评估。急诊室就诊、患者居住地址的热暴露指标以及个人和区域级别的数据库在目标 2 和 3 中，我们将估计短期户外活动的关联。热暴露和 AKI，并将识别个人和区域层面的风险因素，这些因素会增加对 AKI 的脆弱性这项工作将填补室外热和 AKI 流行病学的主要空白。最终支持有针对性的外展和教育活动，指导临床护理的改进，并提供高温-健康影响的定量风险评估和经济评估的输入。