PDF(Pubmed)
Abstract：
The incidence and prevalence of dialysis in Taiwan are high compared to other regions. Consequently, mitigating chronic kidney disease (CKD) and the worsening of kidney function have emerged as critical healthcare priorities in Taiwan. Heat stress is known to be a significant risk factor for CKD and kidney function impairment. However, differences in the impact of heat stress between males and females remains unexplored. We conducted this retrospective cross-sectional analysis using data from the Taiwan Biobank (TWB), incorporating records of the wet bulb globe temperature (WBGT) during midday (11 AM-2 PM) and working hours (8 AM-5 PM) periods based on the participants\' residential address. Average 1-, 3-, and 5-year WBGT values prior to the survey year were calculated and analyzed using a geospatial artificial intelligence-based ensemble mixed spatial model, covering the period from 2010 to 2020. A total of 114,483 participants from the TWB were included in this study, of whom 35.9% were male and 1053 had impaired kidney function (defined as estimated glomerular filtration rate < 60 ml/min/1.73 m2). Multivariable analysis revealed that in the male participants, during the midday period, the 1-, 3-, and 5-year average WBGT values per 1 ℃ increase were significantly positively associated with eGFR < 60 ml/min/1.73 m2 (odds ratio [OR], 1.096, 95% confidence interval [CI] = 1.002-1.199, p = 0.044 for 1 year; OR, 1.093, 95% CI = 1.000-1.196, p = 0.005 for 3 years; OR, 1.094, 95% CI = 1.002-1.195, p = 0.045 for 5 years). However, significant associations were not found for the working hours period. In the female participants, during the midday period, the 1-, 3-, and 5-year average WBGT values per 1 ℃ increase were significantly negatively associated with eGFR < 60 ml/min/1.73 m2 (OR, 0.872, 95% CI = 0.778-0.976, p = 0.018 for 1 year; OR, 0.874, 95% CI = 0.780-0.978, p = 0.019 for 3 years; OR, 0.875, 95% CI = 0.784-0.977, p = 0.018 for 5 years). In addition, during the working hours period, the 1-, 3-, and 5-year average WBGT values per 1 ℃ increase were also significantly negatively associated with eGFR < 60 ml/min/1.73 m2 (OR, 0.856, 95% CI = 0.774-0.946, p = 0.002 for 1 year; OR, 0.856, 95% CI = 0.774-0.948, p = 0.003 for 3 years; OR, 0.853, 95% CI = 0.772-0.943, p = 0.002 for 5 years). In conclusion, our results revealed that increased WBGT was associated with impaired kidney function in males, whereas increased WBGT was associated with a protective effect against impaired kidney function in females. Further studies are needed to elucidate the exact mechanisms underlying these sex-specific differences.
摘要：
与其他地区相比，台湾的透析发病率和患病率较高。因此,在台湾,减轻慢性肾脏病(CKD)和肾功能恶化已成为重要的医疗优先事项.已知热应激是CKD和肾功能损害的重要危险因素。然而,男性和女性之间热应激影响的差异仍未被探索。我们使用台湾生物库(TWB)的数据进行了回顾性横断面分析，根据参与者的住址，纳入中午(上午11点至下午2点)和工作时间(上午8点至下午5点)期间的湿球温度(WBGT)记录。平均1-，3-,并使用基于地理空间人工智能的集成混合空间模型计算和分析了调查年之前的5年WBGT值，涵盖2010年至2020年期间。共有114,483名来自TWB的参与者参加了这项研究。其中35.9%为男性，1053例肾功能受损（定义为估计肾小球滤过率<60ml/min/1.73m2）。多变量分析表明，在男性参与者中，在中午期间，1-,3-,和5年平均每增加1℃的WBGT值与eGFR<60ml/min/1.73m2（比值比[OR]，1.096，95%置信区间[CI]=1.002-1.199，1年p=0.044；OR，1.093，95%CI=1.000-1.196，3年p=0.005；OR，1.094，95%CI=1.002-1.195，5年p=0.045）。然而,在工作时间期间没有发现显著的关联.在女性参与者中，在中午期间，1-,3-,5年平均WBGT值每增加1℃与eGFR<60ml/min/1.73m2（OR，0.872，95%CI=0.778-0.976，1年p=0.018；OR，0.874，95%CI=0.780-0.978，3年p=0.019；OR，0.875，95%CI=0.784-0.977，5年p=0.018）。此外,在工作时间期间，1-,3-,5年平均WBGT值每增加1℃也与eGFR<60ml/min/1.73m2（OR，0.856，95%CI=0.774-0.946，1年p=0.002；OR，0.856，95%CI=0.774-0.948，3年p=0.003；OR，0.853，95%CI=0.772-0.943，5年p=0.002）。总之,我们的结果显示，男性WBGT增加与肾功能受损有关，而增加的WBGT与女性肾功能受损的保护作用相关。需要进一步的研究来阐明这些性别特异性差异的确切机制。
