Kidney Health in a Changing Climate: Emerging Disease Patterns and Driving Mechanisms.

Abstract

Climate change has reshaped global health in unprecedented ways, with CKD increasingly recognized as a major climate-sensitive condition. Kidney diseases affect an estimated 850 million people worldwide, and countries with the highest incidence are often facing rapid social and economic vulnerability alongside sustained rises in annual temperatures. A growing body of evidence has demonstrated that recurrent heat exposure, failures in heat dissipation, and associated environmental stressors markedly increase the risk of acute kidney injury and accelerate its progression to CKD. On the other hand, epidemiological indicators reinforce this relationship, showing approximately a 30% increase in kidney disease morbidity in regions exposed to high heat, as well as heat-associated CKD epidemics in Central America, Mexico, India, and Sri Lanka, even in the absence of traditional risk factors. These patterns suggested that chronic heat stress and repeated dehydration during manual labor may act as catalysts that unmask metabolic vulnerabilities or enhance susceptibility to nephrotoxic exposures. In this review, we integrated robust population-level data with mechanistic biological insights to explain how these climatic trends disproportionately affect vulnerable populations. We examined historical and contemporary temperature trajectories, identified countries with the greatest climatic and epidemiological burden, and presented key indicators such as incidence, mortality, and clinically relevant population metrics. At the molecular level, we connected these findings to heat-sensitive pathways involving dehydration, mitochondrial dysfunction, tubular injury, inflammation, renal hypoperfusion, and uric acid stone formation. Finally, we situated these processes within the ecological and evolutionary context of human thermoregulation, highlighting a growing adaptation lag between accelerating global warming and the limits of human physiological resilience. Thus, we argued that a comprehensive understanding of these multilevel interactions, from environmental conditions to cellular metabolism, is crucial for shaping effective prevention efforts, early diagnostic strategies, and evidence-based policies capable of mitigating the global rise of heat-associated kidney disease.