Climate Change Will Kill Our Kidneys

Feb 27, 2024 | Catch the Green Tea, Young, Gifted & Green Blog Series | 0 comments

There is a very high chance climate change is going to take a lethal toll on our kidneys in the United States (and globally) if we do not decrease the impact of global warming and  pollution. Chronic kidney disease is swiftly becoming another climate induced public health issue in an already fragile state of healthcare in the U.S.  For many people, the thought of kidney disease is scary. It is not uncommon for people to jump right to dialysis which comes with a significant burden and extreme dependence on dialysis treatment just to stay alive. Because of systemic racism, Black people are less likely to have access to healthcare specialists such as nephrologists to determine potential alternatives prior to initiating dialysis treatments, and it turn, are more at risk of having unsuccessful results after receiving dialysis treatment. As it relates to environmental racism, African Americans are 75% more likely than White people to live in “fence-line” communities (1), making Black people among the most at-risk for a myriad of chronic health concerns. According to the Centers for Disease Control and Prevention, 1 in 7 Americans or 35.5 million  people have chronic kidney disease. With diabetes and high blood pressure being the most common causes, almost 1 in 3 people with diabetes and 1 in 5 people with high blood pressure  have kidney disease. Black Americans are 4 times more likely develop end-stage renal disease (ESRD) which requires dialysis treatment. And unfortunately, Black Americans are also dying at faster rates from chronic kidney disease than White Americans, with a 23% increase compared  to a 9% increase between 2019 and 2020. (2) In addition to the physical burden that dialysis causes to individuals, dialysis centers are significant contributors to our global carbon footprint. Studies have revealed that dialysis facilities use a significant amount of water, electricity, and waste generation in addition to substantial carbon emissions. Based on a study conducted in Northeast Ohio published in the Journal of the American Society of Nephrology (3), researchers evaluated a total of 209,481 dialysis centers in 2020 from 15 participating facilities and determined that the annual emissions per facility averaged 769,374 kg carbon dioxide equivalents (CO2-eq), which is noted to be equivalent to the average annual emissions from 93 (residential) homes. Additionally, researchers found that emissions per treatment were 58.9 kg CO2-eq which is the same as driving an average automobile for 149 miles. Between increased carbon emissions, toxic environmental exposures and co-morbidities such as diabetes and hypertension, we are facing an uphill battle when it comes to overall kidney health and management.

So why is kidney disease at risk because of climate change?

Simple answer is everything can impact your kidneys when it comes to climate change and toxic environmental exposures. The kidneys are a powerhouse that filters the blood to help remove toxins but it’s ability to do its  job and do it well depends on the amount of waste material in the blood, the quality of fluid hydration in the body, and how well the kidneys function. As kidney disease develops and kidney function decreases, those with severe kidney disease need dialysis treatment in order to  maintain a better level of kidney function.  The kidneys remove waste and what we breathe, eat, and drink eventually make their way to the kidneys through particles and molecules being absorbed into the blood. Particulate  Matter (PM2.5) in the air, lead in your water, and arsenic and cadmium in your food from contaminated soil can cause kidney  injury. Often, developing kidney disease is multifactorial with genetics, lifestyle, trauma, chronic medical problems, and other causes influencing kidney health. 

We are constantly exposed to many unhealthy things and often do not have as much control as we would like. So the idea that air, food, and fluids all contribute to our kidney function can be overwhelming when we think of the amount of pollution and contamination lingering in so many facets of our lives. For example, increased air quality index values from temporary wildfires or long  term industrial plants will have an impact on your kidney health. The Bisphenol A (BPA)  (sometimes found in plastic bottles) and Per- and polyfluoroalkyl substances (PFAS) (sometimes found in common beauty and personal hygiene products) we consume through our daily products and food will also have an impact on kidney health. Air pollution and toxic environmental exposures can worsen kidney function especially in individuals who already have decreased kidney function and chronic kidney disease.  

There is a growing realization that heat waves negatively impact kidney health which is partially due to the influence of water content and hydration. Studies have shown that there is an increased risk of acute kidney injury, urinary tract infections, and kidney stones after a significant increase in temperature. More specifically, a study showed that in New York, there was an increase in emergency room visits for kidney problems days after a heat wave. (4, 5) Heat related illness and deaths are increasing and are likely worse than documented due to poor reporting. Urban heat islands see the worst outcomes with 81% of  heat related deaths occurring in places with dense concentrations of pavement, buildings, and  other surfaces that absorb heat. (3) Figure 1 (6) below demonstrates the connections between climate change and kidney disease.

Figure 1 (6)

Environmental justice communities are disproportionally at risk for chronic diseases due to increased risk of air pollution, water contamination, vector borne diseases, and extreme events related to climate change. Kidney disease is only one medical  problem influenced by climate and environment. It is vital that policies and regulations around carbon emission mitigation and decreasing environmental pollution and contamination are  focused on clean energy and extreme pollution reduction efforts.  

Vulnerable populations that reside in urban heat islands, fence-line communities, and under-resourced areas are more susceptible to environmental injustice, chronic illnesses, and even death. The health disparities and inequities surrounding kidney disease are compounded at the intersection of climate and environmental injustices.

What should you do if you fear you’re at risk of kidney disease?

While we can’t solve the climate crisis overnight, if you suspect you may be at risk of developing chronic kidney disease, talk to your doctor about kidney function tests which can inform you about your glomerular filtration rate (GFR) which determines how quickly your kidneys are clearing waste from your body. (7) If any of the following descriptions align with your current physical attributes or those of your immediate family members (such as your parents or grandparents), you may find regular kidney health screenings to be valuable (8):

  • 60 years old and up
  • Individuals born at a low birth weight
  • Individuals with cardiovascular disease (or family history)
  • Individuals with hypertension (or family history)
  • Individuals with obesity
  • Individuals from heavily polluted communities (with air, soil, water, etc.)

How Can Effective Policies Save Our Kidneys?

The American Kidney Fund has several progressive legislative recommendations at the local, state and federal levels as it relates to climate change and kidney disease prevention: (9):

  • Federal efforts to work collaboratively with state, tribal, local, and territorial governments, community-based organizations, business and industry, and other stakeholders to address the health impacts of climate change.
  • The development of strategies, programs and actions plans for federal and local agencies to prepare for and respond to the public health effects of climate change.
  • Providing adequate resources to respond to the health impacts of climate change.
  • Promoting and elevating the patient voice as stakeholders work to address the impact of climate change on people’s health.

References 

(1) Tucker, J. What’s behind racial disparities in kidney disease?. (2021, February 27). What’s behind racial disparities in kidney disease?. https://www.health.harvard.edu/blog/whats-behind-racial-disparities-in-kidney-disease-2021020321842

(2) Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States,  2023. Atlanta, GA: US Department of Health and Human Services, Centers for Disease  Control and Prevention; 2023. https://www.cdc.gov/kidneydisease/publications-resources/ ckd-national-facts.html 

(3) Keenan, J. Hemodialysis treatment creates ‘substantial’ carbon footprint, 2022. Nephrology News & Issues: https://www.healio.com/news/nephrology/20220707/hemodialysis-treatment-creates-substantial-carbon-footprint.

(4) Qu Y, Zhang W, Boutelle A-Y, et al. Associations between ambient extreme heat exposure  and emergency department visits related to kidney disease. Am J Kidney Dis. 2023;81(5):  507-516. https://doi.org/10.1053/j.ajkd.2022.09.005  

(5) Fowler DR, Mitchell CS, Brown A, Pollock T, Bratka LA, Paulson J, Noller AC, Mauskapf  R, Oscanyan K, Radcliffe R, Vaidyanathan A, Wolkin A, Taylor EV. Heat-related deaths after  an extreme heat event — four states, 2012 and United States, 1999–2009. Morbidity and  Mortality Weekly Report. 2013:62(22):433–436.

(6) Yeo, S.C., Ooi, X.Y. & Tan, T.S.M. Sustainable kidney care delivery and climate change – a call to action. Global Health 18, 75 (2022). https://doi.org/10.1186/s12992-022-00867-9

(7) Stang, D. (2018, September 17). Kidney Function Tests. Healthline. https://www.healthline.com/health/kidney-function-tests.

(8) Goldman, L. (2023, February 15). 8 Ways to Keep Your Kidneys Healthy. Healthline. https://www.healthline.com/health/kidney-health

(9) Our 2023 Policy Priorities. (2023, June 20). American Kidney Fund. https://www.kidneyfund.org/government-affairs-advocacy/policy-priorities

About the Author

Dr. Aisha Harris is a Flint Native, and engineer turned Board Certified Family Medicine Physician. Dr. Harris owns her own practice–Harris Family Health and also serves as Young, Gifted & Green’s Climate & Environmental Health Director. Follow Harris Family Health on Social Media: Instagram | Facebook | YouTube | LinkedIn | TikTok.

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