Several studies done in South Indian states, where heat wave warnings are issued, have shown proof of increase in kidney disease.
Representational image. (iStock)
India is currently grappling with an unprecedented surge in temperatures, unleashing prolonged heat waves across various regions. While the immediate discomforts of a heat wave, like dehydration and heat exhaustion, are widely known, there exists a less-discussed yet equally critical concern deserving attention: the impact of extreme heat on individuals with kidney-related health issues.
South First spoke to nephrologists who shed light on the multifaceted challenges facing kidney patients during heat waves, offering insights into mitigating these risks.
Kidney patients find themselves particularly vulnerable during heat waves due to their compromised ability to regulate fluid and electrolyte balance.
The kidneys, pivotal in managing water in the body, filtering waste, and maintaining electrolyte levels, face heightened strain under these conditions.
As temperatures soar, the body sheds more fluid through sweat, heightening the risk of dehydration. For kidney patients, maintaining this delicate balance becomes even more challenging, leading to potential exacerbations of their condition.
“Kidney disease emerges as a prominent contributor to heightened morbidity and mortality during heat events,” Dr Arvind Canchi, Consultant Nephrologist and Transplant Physician at Trustwell Hospitals in Bengaluru, tells South First.
Dehydration emerges as a primary concern for kidney patients amid heat waves. It can impede blood flow to the kidneys, exacerbating preexisting conditions such as chronic kidney disease (CKD) or acute kidney injury (AKI).
Complicating matters further, many kidney patients rely on diuretics or other medications that can escalate fluid loss, rendering them more susceptible to dehydration.
Speaking to South First, Dr Sundar Sankaran, Consultant Nephrologist and Program Director at Aster Institute of Renal Transplantation in Bengaluru, also the ex-chairman of the Indian Society of Nephrology, explains that the primary cause of kidney failure or acute kidney injuries during summer can be attributed to conditions such as diarrhoea, vomiting, and gastroenteritis, including cholera.
“This often occurs as individuals seek to quench their thirst with beverages from juice or ice cream vendors, particularly those by the roadside. If these products are not prepared in a hygienic manner, they can lead to gastroenteritis and even cholera, resulting in acute kidney failure. These cases typically resolve with the administration of intravenous (IV) fluids and antibiotics. However, in some instances, a small number of patients may require dialysis for a brief period, ranging from a few days to weeks, until their kidney function is restored,” he explains.
Electrolyte imbalance is another significant risk during heat waves. Electrolytes, such as sodium and potassium, are vital for many bodily functions, including nerve signalling and muscle contraction. Kidney patients often struggle with maintaining proper electrolyte levels due to their condition.
Heat-induced excessive sweating can lead to a rapid loss of these crucial minerals, potentially leading to life-threatening situations like arrhythmias or muscle weakness.
Heat stress, where the body struggles to cool itself effectively, poses particular peril for individuals with kidney disease. The additional strain on the body exacerbates kidney damage, especially among those with compromised kidney function, such as CKD patients.
Dr Sundar referenced a study published in the National Library of Medicine elucidating the nexus between occupational heat stress and kidney health, underscoring the urgency of preventing such conditions, particularly for millions worldwide exposed to intense physical activity in high-temperature environments, intense physical activity, and do not have labour laws to even allow them sufficient rehydration breaks.
The study showed evidence that extreme occupational heat stress combined with chronic dehydration may contribute to the development of CKD and ultimately, kidney failure.
Meanwhile, nephrologists agree that there is more and more literature and anecdotal evidence available about how heat waves, caused due to climate change, is pushing kidney patients to even hospital admissions and emergencies.
Dr Sundar cited another study done in New York between 2005 and 2013 in the American Journal of Kidney Disease, published by the National Kidney Foundation, where researchers found that extreme heat exposure was significantly associated with increased kidney disease-related emergency department visits.
“Given the increasing frequency and intensity of extreme heat in weather patterns due to climate change and the growing prevalence of kidney disease worldwide, it is imperative to unerstand the association between heat exposure and the various subtypes of kidney disease,” stated the study.
Adding to this, Dr Canchi cited a study of seven Indian salt pans in Tamil Nadu, four in Marakkanam and three in Vedharanyam. The study was conducted during the summer (April-July) and winter (October-January) seasons between 2017 and 2020, to capture seasonal changes.
“Even small increases in global temperature, as predicetd by climate change, will have a significant impact on the workforce in India and other tropical countries where workers are already exposed to dangerously high temperatures,” cited the study.
Dr. Canchi informs South First that a multinational meta-analysis revealed a concerning statistic: a mere 1-degree Celsius rise in temperature could escalate the risk of kidney failure by 1.1 per cent, along with an increase in mortality rates from kidney diseases, encompassing kidney failure, urolithiasis, acute kidney injury (AKI), and urinary tract infections (UTI) by 3.1 percent.
Interestingly, research conducted by Indian scholars delved into the connection between heat exposure and chronic kidney disease of unknown etiology (CKDu) in South India’s Andhra Pradesh, particularly in the Uddanam region. They found that extreme heat in this area was a significant contributor to CKDu, exacerbated by factors such as elevated groundwater silica levels.
“CKDu is best described in India, particularly in Andhra Pradesh’s Srikakulam and Uddanam regions — also called Uddanam nephropathy. It’s also recognised in Central America as Mesoamerican nephropathy. However, a multitude of factors, including pesticide usage and silica exposure, may contribute to the prevalence of CKDu,” elaborates Dr Canchi.
Meanwhile, Dr Sundar highlights Ballari in Karnataka as another hotspot witnessing a surge in kidney-related cases. Echoing this sentiment, Dr Ravi R, a nephrologist from Ballari, affirms the uptick in patient admissions during the summer months.
He tells South First, “Yes, the number of patients coming in has increased this summer. Severe dehydration can cause low blood pressure. Low blood pressure will lead to low blood supply to kidneys. This can lead to low kidney function, some even temporarily.”
To safeguard themselves during a heatwave, kidney patients must adopt proactive measures to manage their condition and avert complications. It is imperative that the Union and state governments issue early warnings about impending heatwaves.
While all residents in heavily affected areas are advised to remain indoors during afternoons, kidney patients must exercise extra caution. They should refrain from outdoor activities, maintain cool indoor environments during extreme heat, and ensure proper hydration to prevent dehydration.
Hydration: Ensuring adequate fluid intake is crucial, but kidney patients must balance this with their fluid restrictions. Consulting with healthcare providers to adjust fluid intake during heat waves is advisable.
“Both acute kidney injury and chronic kidney damge occurs due to heat and dehydration. The disease gets worse in hot places with limited access to water,” Dr Sundar adds.
Medication Management: Reviewing medications with healthcare providers is essential, as some may need adjustments during extreme heat to prevent dehydration and electrolyte imbalances.
Cooling Strategies: Employing cooling strategies such as staying in air-conditioned environments, wearing light clothing, and taking cool baths can help manage body temperature.
The Union government’s advisory on heat wave management stressed on “staying covered, wear thin loose, cotton garments preferably light coloured, cover ones head with an umbrella, hat, cap, towel and other traditional headgears during exposure to sunlight, wear shoes or chappals while going out in the sun; stay indoors as much as possible, block direct sunlight and heat waves by keeping windows and curtains closed during the day.”
However, while all this holds good for kidney patients too, nephrologists say that it is important that kidney patients are provided with a separate “Dos and Don’ts” list for summer, especially in heat wave zones.
Dr Ravi insists that kidney patients should be informed about dehydration and heat stress. “They must be asked to observed if they are feeling excessively thirsty, dark-colored urine, dizziness, and fatigue. Then, immediate medical attention should be sought if any concerning symptoms arise,” he says.
Furthermore, being mindful of dietary choices, especially the intake of foods high in electrolytes, can help manage electrolyte balance.
(Edited by Kamna Revanoor)
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