Environmental heat exposure and implications on renal health of pediatric communities in the dry climatic zone of Sri Lanka: An approach with urinary biomarkers

• Published in: Environmental research Vol. 222; p. 115399
• Main Authors: Gunasekara, T.D.K.S.C., De Silva, P. Mangala C.S., Chandana, E.P.S., Jayasinghe, Sudheera, Herath, Chula, Siribaddana, Sisira, Jayasundara, Nishad
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.04.2023
• Subjects: Biomarkers; Climate change; Heat stress; Kidney injury; Pediatric kidney health; Thermal comfort; Biomarkers; Climate change; Thermal comfort; Heat stress; Kidney injury; Pediatric kidney health
• ISSN: 0013-9351; 1096-0953
• DOI: 10.1016/j.envres.2023.115399

Prolonged heat exposure during outdoor physical exertion can result in adverse renal health outcomes, and it is also supposed to be a driver of chronic kidney disease of uncertain etiology (CKDu) in tropical regions. School students are more likely to experience high heat exposure during outdoor sports practices, and the current knowledge on potential renal health outcomes associated with heat exposure carries many knowledge gaps. Hence, the present study aimed to perform biomarker-based assessment of the likelihood of pediatric renal injury focusing the communities in the dry climatic zone in Sri Lanka, where it prevails relatively harsh climate and high prevalence of CKDu. School students who engaged in regular outdoor sports practices (high-heat exposure), and an age-matched control of students who did not engage in sports practices (low-heat exposure) from four educational zones: Padavi Sripura (N = 159) and Medirigiriya (N = 171), Uhana (N = 165) and Thanamalwila (N = 169) participated in this cross-sectional study representing CKDu endemic and non-endemic regions. Effective temperature (ET), wet-bulb globe temperature (WBGT), heat index (HI) and humidex were used for comparison of thermal comfort in the environment. The intensity of environmental heat measured by thermal comfort indices showed no significant difference (p > 0.05) among the study regions. Urinary kidney injury molecule (KIM-1) and albumin-creatinine ratio (ACR) in participants with high heat exposure did not differ significantly from those in the control groups in the four study zones, where urinary neutrophil gelatinase-associated lipocalin showed substantial differences in some groups. Irrespective of heat exposure, increased KIM-1 excretion was observed (p < 0.01) in participants of CKDu endemic regions compared to those in non-endemic areas. Within the context of our findings, there is no plausibly strong evidence to establish potential association of heat exposure with the likelihood of developing renal injury or abnormal renal outcomes in dry zone school students in Sri Lanka. [Display omitted] •Heat exposure is supposed as a potential risk factor of kidney injury in tropical regions.•School students are likely to experience high heat exposure during outdoor activities.•This is the first pediatric study in SL that investigates impacts of heat exposure on renal health.•No significant increase of urinary renal injury biomarkers in students with high heat exposure.•We found no plausibly strong evidence of heat exposure as a risk factor of pediatric kidney injury.