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General medicine
Heat-related chronic kidney disease mortality in the young and old: differing mechanisms, potentially similar solutions?
  1. Tomás Ó Flatharta1,
  2. Aidan Flynn2,
  3. Eamon C Mulkerrin3
  1. 1 Department of Geriatric Medicine, University Hospital Galway, Galway, Ireland
  2. 2 Department of Cardiology, Portiuncula University Hospital, Galway, Ireland
  3. 3 Clinical Research Facility, Department of Medicine, National University of Ireland, Galway, Ireland
  1. Correspondence to Dr Tomás Ó Flatharta, Department of Geriatric Medicine, University Hospital Galway, Galway H91 YR71, Ireland; t.oflatharta3{at}

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Global warming is the single biggest threat to the future of the planet according to World Health Organisation.1 Climate change has contributed to higher rates of weather-related disasters over the last 10 years, including exposure to heatwaves.2 An increased prevalence of chronic kidney disease (CKD)-related mortality in young people who do not have the usual risk factors for the same has raised concern. The problem is particularly concentrated in areas such as Central America, India, Sri Lanka and Egypt,3 where young working men are exposed to excessive heat on a regular basis. This is sometimes dubbed Mesoamerican nephropathy or CKD of unknown origin (CKDu). Working indoors, which affects more female workers, including kitchen work with ovens, smelters and steel manufacturing are also implicated.4 Approximately 40% of the world’s population inhabit areas subject to excessive heat throughout the year. Increasing prevalence of early-onset CKD has been noted worldwide, with El Salvador, in particular, recording the highest mortality rates.5

Meanwhile, CKD is emerging as a leading cause of mortality particularly in patients suffering from hypertension, diabetes mellitus and obesity. Worldwide, kidney disease is now reported as the 12th most common cause of death.6 While debate persists regarding the diagnosis and actual prevalence of CKD in those of advanced age, the majority of these patients are derived from the older age groups.7 Moreover, age-related reductions in renal reserve, plasma renin and aldosterone responses, glomerular filtration rate, as well as a predisposition to hyperkalaemia and haemoconcentration with hypernatraemia render older …

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