title: The Combined Effect of High Ambient Temperature and Antihypertensive Treatment on Renal Function in Hospitalized Elderly Patients.
abstract: BACKGROUND
  The aging kidney manifests structural, functional as well as pharmacological changes, rendering elderly patients more susceptible to adverse environmental influences on their health, dehydration in particular.
  
  
  OBJECTIVE
  Higher temperature is associated with renal function impairment in patients 65 years and older who routinely take thiazide and/or ACE-inhibitors/ARBs.
  
  
  METHODS
  We obtained health data of patients older than 65 who were admitted to a large tertiary center during the years 2006-2011, with a previous diagnosis of hypertension, and treated with thiazide, ACE-inhibitors/ARBs or both. We collected environmental data of daily temperature, available from collaborative public and governmental institutions. In order to estimate the effect of daily temperature on renal function we performed linear mixed models, separately for each treatment group and creatinine change during hospital admission.
  
  
  RESULTS
  We identified 26,286 admissions for 14, 268 patients with a mean age of 75.6 (±6.9) years, of whom 53.6% were men. Increment in daily temperature on admission of 5°C had significant effect on creatinine increase in the no treatment (baseline creatinine adjusted 0.824 mg/dL, % change 1.212, % change 95% C.I 0.082-2.354) and dual treatment groups (baseline creatinine adjusted 1.032mg/dL, % change 3.440, % change 95% C.I 1.227-5.700). Sub-analysis stratified by advanced age, chronic kidney disease and primary diagnosis on hospital admission, revealed a significant association within patients admitted due to acute infection and treated with dual therapy.
  
  
  CONCLUSIONS
  Whereas previous studies analyzed sporadic climate effects during heat waves and/or excluded older population taking anti-hypertensive medications, the present study is novel by showing a durable association of temperature and decreased renal function specifically in elderly patients taking anti-hypertensive medications.
authors.affiliation: Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.|Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel.|Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Iftach
authors.initials: I
authors.lastname: Sagy
authors.affiliation: Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.|Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Alina
authors.initials: A
authors.lastname: Vodonos
authors.affiliation: Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.|Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel.|Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Victor
authors.initials: V
authors.lastname: Novack
authors.affiliation: Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel.|Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.|Department of Nephrology, Soroka University Medical Center, Beer-Sheva, Israel.
authors.forename: Boris
authors.initials: B
authors.lastname: Rogachev
authors.affiliation: Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel.|Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.|Department of Nephrology, Soroka University Medical Center, Beer-Sheva, Israel.
authors.forename: Yosef S
authors.initials: YS
authors.lastname: Haviv
authors.affiliation: Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel.|Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Leonid
authors.initials: L
authors.lastname: Barski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D003404:Creatinine / Q000097:blood; D005260:Female; D006760:Hospitalization; D006358:Hot Temperature; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D049993:Sodium Chloride Symporter Inhibitors / Q000008:administration & dosage*; D062606:Tertiary Care Centers
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D049993:Sodium Chloride Symporter Inhibitors; D003404:Creatinine