Epidemiology, mechanisms and clinical implications of heat-related kidney disease.

Heat exposure is an emerging threat to kidney health, although the mechanisms and magnitude of the problem are incompletely understood. Epidemiological data consistently link hot temperatures with increased kidney morbidity, and heat-stress kidney injury is associated with chronic kidney disease (CKD) in some occupational and agricultural studies. However, the extent to which increasing ambient temperatures will contribute to greater incidence, prevalence and progression of CKD in broader populations is not well characterized. As global temperatures and heatwave frequency increase, people with existing CKD might face dual threats of acute morbidity during heat events and the possibility of accelerated decline in kidney function. Structural determinants, such as housing quality, occupational exposure and access to cooling, compound background physiological vulnerability due to age and comorbidities. Despite this risk, evidence guiding individualized mitigation of heat risk for people with CKD is extrapolated from what is known about how healthy volunteers respond to heat stress. Preventing the growing burden of heat-related kidney injury demands urgent climate action alongside a coordinated kidney health response, with global research collaboration and integration of clinical and societal strategies targeting patient education, context-specific clinical guidance and strong policy responses addressing health inequities and climate resilience.