Short-term heat exposure has been linked with increased risks of AKI and CKD, but the effect on the incidence or prevalence of CKD is unknown. This study examines the association of high temperatures with CKD prevalence and ESKD incidence at county level in the United States (US). County-level diagnosed CKD prevalence data (2005-2019) among Medicare enrollees aged ≥65 years from the US Kidney Disease Surveillance System and ESKD incidence data (2010-2019) from the United States Renal Data System were analyzed. County-specific heat exposure measurements included annual average temperature (AAT) and annual heat wave days from nClimGrid-Daily dataset (US National Centers for Environmental Information). We used a linear mixed model to assess associations between heat exposure and diagnosed CKD prevalence as well as ESKD incidence, while geographically weighted regression assessed spatial variations, adjusting for time-trend, county-specific factors and demographics. Stratified analysis compared associations across socioeconomic subgroups. AAT had significantly positive associations with diagnosed CKD prevalence and ESKD incidence. Each 1°C increase in AAT was associated with a 0.23 (95% confidence interval, 0.20 to 0.27) percentage point increase in the prevalence of diagnosed CKD. Similarly, each 1°C increase in AAT was associated with an additional 1.37 (95% confidence interval, 1.08 to 1.65) ESKD cases/100,000 population. Heat wave days were positively associated with both kidney outcomes, and the strength of these associations increased with higher temperature thresholds and longer duration. Stronger associations between heat exposure and both kidney outcomes were observed in high poverty and nonmetropolitan counties ( P < 0.05). The strength of associations was greater in counties in southern and northwestern regions. The associations between ambient temperature and kidney health, with socioeconomic and regional differences, may have implications for interventions aimed at reducing the potential effects of high temperatures on kidney health, particularly in vulnerable populations.

Heat waves are increasingly recognized as an environmental determinant of chronic kidney disease (CKD). However, the CKD burden attributable to heat waves and associated healthcare inequalities, particularly under future climate change, remains insufficiently characterized. Based on two nationally representative cross-sectional surveys in China, we established climate region-specific exposure-response functions between heat waves and CKD. Then, we conducted 1-km grid-level health impact assessments integrating the most up-to-date nationally representative CKD prevalence data, temperature projections, population estimates, and socioeconomic indicators. The analyses focused on stages 4–5 CKD (advanced CKD), given its progressive nature and requirements for continuous medical treatment. Heat wave-attributable CKD burden was quantified as attributable cases (ACs), attributable fractions (AFs), and population attributable fractions (PAFs). Projections for 2030–2090 were generated under multiple Shared Socioeconomic Pathways (SSPs). Hospital accessibility was evaluated using AC-weighted driving times and accessibility scores, with inequality assessed via Gini indices and Lorenz curves. In 2020, an estimated 491,362 (227,772–694,191) stages 4–5 CKD cases (about 30.06

Short-term heat exposure has been linked with increased risks of AKI and CKD, but the effect on the incidence or prevalence of CKD is unknown. This study examines the association of high temperatures with CKD prevalence and ESKD incidence at county level in the United States (US). County-level diagnosed CKD prevalence data (2005–2019) among Medicare enrollees aged ≥65 years from the US Kidney Disease Surveillance System and ESKD incidence data (2010–2019) from the United States Renal Data System were analyzed. County-specific heat exposure measurements included annual average temperature (AAT) and annual heat wave days from nClimGrid-Daily dataset (US National Centers for Environmental Information). We used a linear mixed model to assess associations between heat exposure and diagnosed CKD prevalence as well as ESKD incidence, while geographically weighted regression assessed spatial variations, adjusting for time-trend, county-specific factors and demographics. Stratified analysis compared associations across socioeconomic subgroups. AAT had significantly positive associations with diagnosed CKD prevalence and ESKD incidence. Each 1°C increase in AAT was associated with a 0.23 (95% confidence interval, 0.20 to 0.27) percentage point increase in the prevalence of diagnosed CKD. Similarly, each 1°C increase in AAT was associated with an additional 1.37 (95% confidence interval, 1.08 to 1.65) ESKD cases/100,000 population. Heat wave days were positively associated with both kidney outcomes, and the strength of these associations increased with higher temperature thresholds and longer duration. Stronger associations between heat exposure and both kidney outcomes were observed in high poverty and nonmetropolitan counties ( P < 0.05). The strength of associations was greater in counties in southern and northwestern regions. The associations between ambient temperature and kidney health, with socioeconomic and regional differences, may have implications for interventions aimed at reducing the potential effects of high temperatures on kidney health, particularly in vulnerable populations.

The exposure-response associations of ambient heavy metals and persistent organic pollutants (POPs) with mortality in the general population remain unclear. This cohort study aimed to explore the long-term effect of exposure to four air pollutants, including lead (Pb), cadmium (Cd), mercury (Hg), and benzo(a)pyrene [B(a)P] on all-cause and cause-specific mortality. This study involved 497,056 participants from the UK Biobank cohort. We used the Cox proportional hazards model to calculate associations. Effects of joint exposure to heavy metals were estimated using quantile g-computation. Shape of the exposure-response association was examined by fitting penalty splines, in both the total population and subpopulations stratified by age, sex, smoking status, and genetic factors. Modifying effects of age, sex, smoking status, and genetic factors were also examined. Over a median follow-up of 13.7 years, we identified 39,530 (8.0%) deaths. Exposure to mixtures of Pb, Cd, and Hg was associated with 1.040-1.154 times increased risk of all-cause cancer, cardiovascular disease (CVD), stroke, and respiratory disease mortality. Of the specific causes of mortality, Pb and Cd were most strongly associated with respiratory diseases, including chronic obstructive pulmonary disease, followed by ischemic heart disease, CVD, and cancer. Hg and B(a)P seemed to exhibit lower toxicity compared with Pb and Cd. Exposure-response curves demonstrated monotonically increased risk for most mortality outcomes, though Hg was found to be nonlinearly associated with all-cause and stroke mortality. Age, smoking status, and genetic factors were found to modify the susceptibility to heavy metals. Our findings suggested that long-term exposure to heavy metals and B(a)P was monotonically associated with elevated risk of multiple mortality outcomes, indicating there may be no safe threshold for these chemicals. Substantial benefits to public health could be achieved through stringent environmental regulations and clean air initiatives.

Background Despite the majority of patients with chronic kidney disease (CKD) live in low-and middle-income countries, most evidence on screening strategies is derived from high-income countries, where the contexts differ significantly. This study aims to assess the cost-effectiveness of population-based CKD screening strategies in both the general population and adults with diabetes in China. Methods A validated microsimulation model of CKD was developed to evaluate the costs and health consequences of population-based CKD screening strategies from a societal perspective. A cohort of the population aged 45 years in China was simulated over their lifetime. Model parameters were estimated based on the existing literature and various data sources in China. Main outcomes included the averted number of cases with cardiovascular disease (CVD) and kidney failure with replacement therapy (KFRT) under the population-based screening strategy compared with usual care, and the incremental cost-effectiveness ratios (ICERs). CKD screening with different frequencies and for different age groups in both the general population and adults with diabetes were considered. One-way sensitivity analyses were performed to assess the robustness of the results. Findings The ICER of annual screening starting at 45 years of age was $10,588 per quality-adjusted life year (QALY) for the general population and $9184 per QALY for adults with diabetes. Other screening strategies were also costeffective compared to usual care, with ICERs less than three times the per-capita gross domestic product of China ($35,501). The most prominent absolute decrease in lifetime incidence of KFRT and CVD were also observed with the annual screening strategy in both the general population and in adults with diabetes. Specifically, the decreases were 1.88 and 8.55 per 1000 individuals for KFRT, and 35.07 and 19.92 per 1000 individuals for CVD, respectively. Interpretation CKD screening in both the general population and adults with diabetes is cost-effective and could avert substantial numbers of KFRT and CVD cases in China. Copyright (c) 2025 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Previous studies investigating the health benefits of green space primarily focused on its quantity, while individual accessibility has been insufficiently considered. This study aimed to investigate the associations between green space within accessible isochrones and mortality and the effect modification by regional urbanicity. Using a nationally representative survey of 47,086 participants with prospective death records according to ICD-10 codes (up to December 2017) and high spatial-resolution remote sensing data, this cohort study investigated the associations of green space (characterized using green land cover proportion and the Normalized Difference Vegetation Index [NDVI]) within 15-min walking and cycling isochrones with all-cause and cause-specific (cardiovascular disease, respiratory disease, and cancer) mortality. We also explored the associations across regions with different levels of urbanicity-related built environment factors using interaction models. Green space within 15-min walking and cycling isochrones was associated with lower risks of mortality. For instance, a 10 % increase in green land cover proportion within 15-min isochrones was associated with 5 % (hazard ratio [HR] = 0.95, 95 % CI: 0.90, 1.00 for walking) and 12 % (HR = 0.88, 95 % CI: 0.81, 0.96 for cycling) reductions in all-cause mortality risk. Stronger protective effects of green space on mortality were found in areas with higher nighttime light index (NLI), population density, road density, and impervious land cover proportion (P for interaction <0.05). Similar effect modification by urbanicity-related built environment factors was also found for associations of green space with cardiovascular disease mortality. Accessible green space within 15-min walking and cycling regions was associated with lower mortality risks, especially in regions with higher urbanicity levels. The findings underscore the importance of considering both the accessibility of green space and regional urbanicity in land planning to maximize the health benefits of green space.

The city built environment plays a crucial role in influencing population vulnerability to temperature extremes, yet population-based evidence has been limited. We included 21,494 urban residents from a nationally representative cohort study. Temperature extremes were defined using residential address-specific thresholds lasting for ≥ 3 days. Street view images within participants’ residences (500-m radius) were evaluated using semantic segmentation by DeepLabV3 Plus-ResNet101 pretrained by the Cityscapes dataset. Cox proportional hazard models and interaction models were applied to explore the moderating effects of street view-derived built environments on the effects of temperature extremes on mortality. Each additional day of heatwave (95th) and coldspell (5th) duration per year was associated with a 6

Limited studies have examined associations of gaseous air pollutants exposure with chronic kidney disease (CKD) in Europe. This study aimed to calculate the relationships between long-term exposure to ambient sulfur dioxide (SO _2 ), carbon monoxide (CO), ozone (O _3 ), and benzene and CKD in the UK. We included 502 369 participants from the UK biobank cohort. Associations of SO _2 , CO, O _3 , and benzene with CKD were estimated using Co x proportional hazards model. The shape of the exposure-response association between each air pollutant and CKD was then depicted using the shape constrained health impact function. We finally estimated the incidence of CKD attributable to each air pollutant by linking the constructed exposure-response association to the 2019 Global Burden of Disease data. Our results suggested SO _2 , high O _3 days (daily max 8 hr O _3 concentration > 120 µ g m ^−3 ), CO, and benzene were positively associated with the risk of incident CKD. The hazard ratios (HRs) of CKD for SO _2 , CO, and benzene were 1.058 (95% CI: 1.039–1.078), 1.003 (95% CI: 1.001–1.005), and 1.619 (1.433–1.829) for every 1 μ g m ^−3 increase in the concentration, respectively. For high O _3 days, the HR of CKD was 1.044 (95% CI: 1.032–1.056) for every 1 d increase, but correlation to O _3 concentration did not reach the statistical significance in the time-varying model. The risk of CKD increased non-linearly with increasing SO _2 , high O _3 days, and CO, and linearly with increasing benzene. We estimated that 7.9%, 16.0%, 8.0% of incident CKD cases in the UK in 2021 could be attributed to exposure to SO _2 , O _3 , and benzene, respectively. We concluded that exposure to SO _2 , CO, O _3 , and benzene were all positively associated with increased CKD risk. Our findings highlight the importance of considering air pollution while making strategies targeting on CKD management.

Importance: Climate change mitigation policies aimed at limiting greenhouse gas (GHG) emissions would bring substantial health co-benefits by directly alleviating climate change or indirectly reducing air pollution. As one of the largest developing countries and GHG emitter globally, China’s carbon-peaking and carbon neutrality goals would lead to substantial co-benefits on global environment and therefore on human health. This review summarized the key findings and gaps in studies on the impact of China’s carbon mitigation strategies on human health. Highlights: There is a wide consensus that limiting the temperature rise well below 2 °C would markedly reduce the climate-related health impacts compared with high emission scenario, although heat-related mortalities, labor productivity reduction rates, and infectious disease morbidities would continue increasing over time as temperature rises. Further, hundreds of thousands of air pollutant-related mortalities (mainly due to PM2.5 and O3) could be avoided per year compared with the reference scenario without climate policy. Carbon reduction policies can also alleviate morbidities due to acute exposure to PM2.5. Further research with respect to morbidities attributed to nonoptimal temperature and air pollution, and health impacts attributed to precipitation and extreme weather events under current carbon policy in China or its equivalent in other developing countries is needed to improve our understanding of the disease burden in the coming decades. Conclusions: This review provides up-to-date evidence of potential health co-benefits under Chinese carbon policies and highlights the importance of considering these co-benefits into future climate policy development in both China and other nations endeavoring carbon reductions.

Chronic kidney disease (CKD) is a global public health concern, and accumulating evidence has indicated that air pollution increases the odds of CKD. However, a limited number of studies have examined the long-term effects of ambient fine particulate matter (PM2.5) components on the risk of CKD among general population; thus, major knowledge gaps remain. Using data from a nationwide representative cross-sectional survey in China and a validated PM2.5 composition dataset, we established generalized linear models to quantify the association between five major components of PM2.5 and CKD prevalence. There were significant associations between long-term exposure to three PM2.5 components [including black carbon (BC), sulfate (SO42−), organic matter (OM)] and increased odds of CKD prevalence. Along with an interquartile range (IQR) increment in BC (3.3 μg/m3), SO42− (9.7 μg/m3), and OM (16.2 μg/m3) at a 4-year moving average, the odds ratios (ORs) for CKD prevalence were 1.28 (95

The population disease burden caused by extreme temperature events has been increasing. However, research on the long-term effects of extreme temperature events on chronic kidney disease (CKD), as well as the combined effects with individual behaviors and metabolic factors is still lacking. Based on 176,874 participants from the most recent nationally representative surveillance on CKD and validated high spatial resolution (0.1 degrees) remotesensing products, this study investigated the associations between extreme temperature events in the preceding five years before investigation and CKD (defined by reduced renal function or albuminuria) prevalence. We also investigated the associations between "Life's Essential 8", a recognized scale to evaluate overall cardiovascular health (CVH) based on individual behaviors and metabolic indicators and CKD prevalence, as well as its combined effects with extreme temperature events. One additional day of heat waves and cold spells per year was associated with increased ORs of CKD [1.10 (95 % CI: 1.08, 1.11) and 1.07 (95 % CI: 1.05, 1.09), respectively]. Meanwhile, per standard deviation (SD) increment in health behavior score (SD = 16.1), health factor score (SD = 18.4), and overall CVH score (SD = 12.4) were associated with decreased ORs of CKD [0.92 (95 % CI: 0.90, 0.93), 0.60 (95 % CI: 0.59, 0.61), and 0.64 (95 % CI: 0.63, 0.65, respectively]. Relative to higher heat wave & lower CVH score group, the ORs of CKD were 0.87 (95 % CI: 0.84, 0.90), 0.51 (95 % CI: 0.48, 0.53), and 0.42 (95 % CI: 0.40, 0.44) in lower & lower, higher & higher, and lower & higher group, respectively. Our findings underscore the importance of considering the synergistic effects of individual behavioral and metabolic factors for strategies to mitigate the impacts of climate change on CKD.

Particulate of diameter <= 1 mu m (PM1) presents a novel risk factor of adverse health effects. Nevertheless, the association of PM1 with the risk of chronic kidney disease (CKD) in the general population is not well understood, particularly in regions with high PM1 levels like China. Based on a nationwide representative survey involving 47,204 adults and multi-source ambient air pollution inversion data, the present study evaluated the association of PM1 with CKD prevalence in China. The two-year average PM1, particulate of diameter <= 2.5 mu m (PM2.5), and PM1-2.5 values were accessed using a satellite-based random forest approach. CKD was defined as estimated glomerular filtration rate < 60 ml/min/1.73 m(2) or albuminuria. The results suggested that a 10 mu g/m(3) rise in PM1 was related to a higher CKD risk (odds ratio [OR], 1.13; 95% confidence interval [CI] 1.08-1.18) and albuminuria (OR, 1.11; 95% CI, 1.05-1.17). The association between PM1 and CKD was more evident among urban populations, older adults, and those without comorbidities such as diabetes or hypertension. Every 1% increase in the PM1/PM2.5 ratio was related to the prevalence of CKD (OR, 1.03; 95% CI, 1.03-1.04), but no significant relationship was found for PM1-2.5. In conclusion, the present study demonstrated long-term exposure to PM1 was associated with an increased risk of CKD in the general population and PM1 might play a leading role in the observed relationship of PM2.5 with the risk of CKD. These findings provide crucial evidence for developing air pollution control strategies to reduce the burden of CKD.

Chronic kidney disease (CKD) is a complex disease caused by both genetic and non-genetic factors, but little is known about the role of their interplay in incident CKD. This study aimed to evaluate associations of a combination of non-genetic factors related to lifestyle, socio-economics, and environment with incident CKD and whether genetic factors influence these associations.

Epidemiological evidence concerning whether exposure to fine particulate matter (PM2.5) and its components was linked to an elevated risk of hospitalizations for chronic kidney disease (CKD) remains insufficient. Moreover, it remains unclear whether ambient temperatures have potential modification effects on PM2.5's impacts. In the current study, we collected a nationwide sample of 2,259,240 hospitalization records for CKD in 260 Chinese cities. The associations between air pollutants and CKD hospitalizations were determined by the space-time-stratified case-crossover design. We further assessed the effects of PM2.5 and its components in three temperature strata [i.e., lowest (<25th), medium (25-75th), and highest (>75th)]. The findings demonstrated the significant and monotonic associations between risk of CKD hospitalizations and exposure to PM2.5, black carbon (BC), sulfate (SO42-), nitrate (NO3-), ammonium (NH4+), and organic matter (OM). For instance, along with an interquartile range increment in PM2.5 (29.47 mu g/m(3)), the relative risks (RR) were 1.016 (95 % confidence interval [CI]:1.012-1.019) at lag 0-4 days. Higher ambient temperature significantly exacerbated the estimated impact of PM2.5 and its components on CKD hospitalizations, while significantly stronger associations were also observed at lower temperature for SO42- and NO3-. The modification effects of non-optimum temperatures varied among different etiologies of CKD and geographic regions. This study provides insights into the joint kidney health effects of climate change and air pollution. These findings highlight the necessity of protection measures against high concentration of PM2.5 and non-optimum temperatures for the vulnerable populations. (c) 2024 The Authors. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

The increasing frequency of heat waves under the global urbanization and climate change background poses elevating risks of chronic kidney disease (CKD). Nevertheless, there has been no evidence on associations between long-term exposures to heat waves and CKD as well as the modifying effects of land cover patterns. Based on a national representative population-based survey on CKD covering 47,086 adults and high spatial resolution datasets on temperature and land cover data, we found that annual days of exposure to heat waves were associated with increased odds of CKD prevalence. For one day/year increases in HW_975_4d (above 97.5 % of annual maximum temperature and lasting for at least 4 consecutive days), the odds ratio (OR) of CKD was 1.14 (95 %CI: 1.12, 1.15). Meanwhile, stronger associations were observed in regions with lower urbanicity [rural: 1.14 (95 %CI: 1.12, 1.16) vs urban: 1.07 (95 %CI: 1.03, 1.11), Pinteraction < 0.001], lower water body coverage [lower: 1.14 (95 %CI: 1.12, 1.16) vs higher: 1.02 (95 %CI: 0.98, 1.05), Pinteraction < 0.001], and lower impervious area coverage [lower: 1.16 (95 %CI: 1.14, 1.18) vs higher: 1.06 (95 %CI: 1.03, 1.10), Pinteraction = 0.008]. In addition, this study found disparities in modifying effects of water bodies and impervious areas in rural and urban settings. In rural regions, the associations between heat waves and CKD prevalence showed a consistent decreasing trend with increases in both proportions of water bodies and impervious areas (Pinteraction < 0.05). Nevertheless, in urban regions, we observed significant effect modification by water bodies, but not by impervious areas. Our study indicates the need for targeted land planning as part of adapting to the kidney impacts of heat waves, with a focus on urbanization in rural regions, as well as water body construction and utilization in both rural and urban regions.