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Heatwaves are not considered a new phenomenon, however, given global warming, their frequency and intensity has increased, and México is not the exception. In the third heatwave in June of 2023, Mexico had 1,077 cases reported of heat stroke, of which 49.3% were from the state of Nuevo León (northeast Mexico) where our hospital is located.
Heat strokes occur when there is a change from a compensate to a non-compensate state of thermoregulation. A non-compensate state is when the heat a patient receives is greater than the heat it is capable to lose, consequently presenting an imbalance in the body temperature self-regulation systems, leading to central nervous system dysfunction and multiorgan failure.
Acute kidney injury is known to be one of the most common complications, becoming an independent factor for increasing morbidity, mortality, and the cost of care.
Retrospective observational study from the 15th to 30th of June 2023 (third annual heatwave in México) was done, demographics statistics were made and presented in frequency and percentages.
Sociodemographic and paraclinical data of admitted patients during the heatwave are shown in table 1.
Table 1.
Variables
n=13 (%)
Sex
Male
10 (76.92)
Age
61.3
Initial body temperature
39.93°
Initial CPK
459.36
CrS
1.72
BUN
24.76
pH
7.26
Lactate
3.58
Developement of AKI
8 (61.53)
Stage of AKI
1
2
3
Not classifiable
5
6
Renal recovery
Total recovery
Partial recovery
Non-recovery
4
Use of mechanical ventilation
6 (46.15)
In-hospital days
9
Requirement of RRT
Death
4 (30)
According to the epidemiological national record, there were 103 deaths associated with heat stroke between the 24th and 25th week of 2023 (period of the third annual heatwave).
Heat waves are considered the leading cause of death related to natural phenomena, surpassing hurricanes, and tornadoes.
The kidney, followed by the central nervous system, is the most affected organ. This occurs secondary to high exposures to heat, given its preventive role against dehydration and water and electrolyte balance, the kidney injury when present, is characterized for being mostly hemodynamic.
The patients who develop AKI tended to have a worst prognosis, also,
In the patients with AKI (classified initially as KDIGO 1) evolve to KDIGO 3 in the next 24 hrs., tended to have a worst prognosis, longer in hospital days, and the dead.
As pointed out in the Rizo, et al. in the article “Acute kidney injury risk assessment and the nephrology rapid response team, the age, need of mechanical ventilation and creatinine, had the worst prognosis and are the patient that will benefit from a rapid intervention.
Therefore, it`s important to recognize the impact that humans have on the environment as well as its consequences, and implications for the human health.