Inclement Weather and Risk of Missing Scheduled Hemodialysis Appointments among Patients with Kidney Failure

Richard V Remigio; Hyeonjin Song; Jochen G Raimann; Peter Kotanko; Frank W Maddux; Rachel A Lasky; Xin He; Amir Sapkota

doi:10.2215/CJN.0000000000000174

Inclement Weather and Risk of Missing Scheduled Hemodialysis Appointments among Patients with Kidney Failure

Clin J Am Soc Nephrol. 2023 Apr 18;18(7):904-912. doi: 10.2215/CJN.0000000000000174. Online ahead of print.

Authors

Richard V Remigio¹, Hyeonjin Song^{1

2}, Jochen G Raimann³, Peter Kotanko^{3

4}, Frank W Maddux⁵, Rachel A Lasky⁵, Xin He², Amir Sapkota²

Affiliations

¹ Maryland Institute for Applied Environmental Health, University of Maryland, School of Public Health, College Park, Maryland.
² Department of Epidemiology and Biostatistics, University of Maryland, School of Public Health, College Park, Maryland.
³ Research Division, Renal Research Institute, New York, New York.
⁴ Icahn School of Medicine at Mount Sinai, New York, New York.
⁵ Fresenius Medical Care North America, Waltham, Massachusetts.

PMID: 37071662
PMCID: PMC10356145 (available on 2024-07-01)
DOI: 10.2215/CJN.0000000000000174

Abstract

Background: Nonadherence to hemodialysis appointments could potentially result in health complications that can influence morbidity and mortality. We examined the association between different types of inclement weather and hemodialysis appointment adherence.

Methods: We analyzed health records of 60,135 patients with kidney failure who received in-center hemodialysis treatment at Fresenius Kidney Care clinics across the Northeastern US counties during 2001-2019. County-level daily meteorological data on rainfall, hurricane and tropical storm events, snowfall, snow depth, and wind speed were extracted using National Oceanic and Atmosphere Agency data sources. A time-stratified case-crossover study design with conditional Poisson regression was used to estimate the effect of inclement weather exposures within the Northeastern US region. We applied a distributed lag nonlinear model framework to evaluate the delayed effect of inclement weather for up to 1 week.

Results: We observed positive associations between inclement weather and missed appointment (rainfall, hurricane and tropical storm, snowfall, snow depth, and wind advisory) when compared with noninclement weather days. The risk of missed appointments was most pronounced during the day of inclement weather (lag 0) for rainfall (incidence rate ratio [RR], 1.03 per 10-mm rainfall; 95% confidence interval [CI], 1.02 to 1.03) and snowfall (RR, 1.02; 95% CI, 1.01 to 1.02). Over 7 days (lag 0-6), hurricane and tropical storm exposures were associated with a 55% higher risk of missed appointments (RR, 1.55; 95% CI, 1.22 to 1.98). Similarly, 7-day cumulative exposure to sustained wind advisories was associated with 29% higher risk (RR, 1.29; 95% CI, 1.25 to 1.31), while wind gusts advisories showed a 34% higher risk (RR, 1.34; 95% CI, 1.29 to 1.39) of missed appointment.

Conclusions: Inclement weather was associated with higher risk of missed hemodialysis appointments within the Northeastern United States. Furthermore, the association between inclement weather and missed hemodialysis appointments persisted for several days, depending on the inclement weather type.