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：
10641948
负责人：
Stefanie Ebelt
金额：
$ 45.51万
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/10641948
关键词：
Accident and Emergency department Acute Renal Failure with Renal Papillary Necrosis Address Admission activity Affect Age Air Pollution Area Case Management Chronic Kidney Failure Classification Clinical Code Communities Computerized Medical Record Creatine Data Databases Dehydration Diabetes Mellitus Diagnosis Diarrhea Economic Burden Economic Conditions Education and Outreach Educational Activities 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 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 care seeking 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

Accident and Emergency department Acute Renal Failure with Renal Papillary Necrosis Address Admission activity Affect Age Air Pollution Area Case Management Chronic Kidney Failure Classification Clinical Code Communities Computerized Medical Record Creatine Data Databases Dehydration Diabetes Mellitus Diagnosis Diarrhea Economic Burden Economic Conditions Education and Outreach Educational Activities 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 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 care seeking 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

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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.

项目摘要急性肾脏损伤（AKI）是肾功能的突然降低，几乎总是可逆的。尽管可逆的AKI是认真的，通常需要住院。经济燃烧也是巨大的，估计每年在美国为5-24亿美元。尽管在已经住院的患者中可能会出现AKI（医院 - Aki获得了Aki”，这是AKI在医院以外的AKI启动（“社区获得的Aki”）。社区获得AKI事件的潜在贡献者是暴露于高环境温度，人们认为这在很大程度上会因体积耗竭而影响肾脏。越来越担心的动机气候变化，使用行政健康数据的人口级研究一直报告为正面室外热量（高温和热浪）与急诊科（ED）访问之间的关联和AKI的住院。现有研究的关键限制是通过国际疾病分类（ICD）出院诊断编码。代码分类的AKI虽然是特定的不是Aki的敏感标记；它错过了总案件的很高比例。而且，它没有区别从医院获得的AKI获得社区的经验，无法评估AKI的严重性，也不提供信息在病人的情况下。除了这些局限温度的粗略度量（例如，一个或几个监测站点）并未完全捕获重要城市热动态。总体而言，AKI结局和热暴露的错误分类都导致了A 缺乏对室外热量对AKI的真正影响的理解。该项目是由（1）需要的激励改进的结果评估，（2）改进的暴露评估和（3）可识别可热的识别可以通过有针对性干预措施保护的种群。为了满足这些需求，我们将高度分析 2013 - 2021年佐治亚州亚特兰大的150万种电子病历超过150万个电子病历的详细临床数据库链接将作为该项目的一部分开发的高分辨率，最先进的接触产品。为了确定AKI病例，我们将考虑ICD诊断代码 - 反映了热量中使用的内容 AKI文学 - 以及通过评估KDIGO（肾脏疾病改善了全球倡议）的基于基于的系列创建（SCR）定义比较ED“首先测量” SCR与基线值。 Kdigo定义将启用对社区获得的AKI和严重性的特定评估（即阶段）。在AIM 1中，我们将发展一个富人 ED访问数据库，患者居住地址的热暴露指标以及个人和区域级别社会人口统计学和健康风险因素。在目标2和3中，我们将估计短期户外的关联热地暴露和AKI，并将确定个人和面积级别的风险因素，以增加脆弱性室外热有关的AKI。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，并提供定量风险评估和热健康影响经济评估的投入。