ArticleClinical kidney journal2026
Heat-related acute kidney injury risk in England: a nationwide case-crossover analysis of 947 342 AKI alerts.
Article in Clinical kidney journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Acute kidney injury (AKI) incidence is rising and while heat-AKI associations are established, the demographic and clinical groups most vulnerable remain unclear. Identifying these groups is essential for kidney-specific heatwave guidance. Methods: A total of 947 342 AKI alerts in England from April to September 2017-21, from UK Renal Registry data, were linked to HadUK-Grid dataset and hospital admission data. We utilized a time-stratified, bidirectional case-crossover design with distributed lag models estimated odds ratios (ORs) for AKI associated with temperatures above 25°C, stratified by demographic characteristics and admission diagnosis. Results: Heat exposure was associated with AKI [OR 1.038; 95% confidence interval (CI) 1.036-1.040 per 1°C rise above 25°C] with highest odds for stage 3 AKI (OR 1.047; 95% CI 1.039-1.055). Associations were more marked in males (OR 1.041; 95% CI 1.037-1.044) than females (OR 1.035; 95% CI 1.032-1.039); odds doubled in those aged ≥85 years (OR 1.054; 95% CI 1.049-1.060) compared with the 45-64 years age group (OR 1.027; 95% CI 1.021-1.032). Ethnic risks varied between Chinese (OR 1.054, 95% CI: 1.012-1.098), White (OR 1.041; 95% CI 1.038-1.044), Indian (OR 1.033; 95% CI 1.019-1.047), Pakistani/Bangladeshi (OR 1.027; 95% CI 1.011-1.044), Caribbean (OR 1.024; 95% CI 1.005-1.042) and African (OR 1.001; 95% CI 0.982-1.021), with differences partly explained by younger age distribution in ethnic minority groups. Heat-related AKI was more marked for admissions of patients with delirium (OR 1.061; 95% CI 1.029-1.094) and with respiratory diseases (OR 1.044; 95% CI 1.037-1.052). Conclusions: There was effect modification by age for heat-related AKI risk, with especially high risks amongst older individuals; those admitted with delirium or respiratory illness and some ethnic groups. These findings support the development of targeted kidney-specific hot weather guidance to protect the vulnerable populations identified.
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