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Claim: Climate change may bring more kidney stones – but the Tasian et al. paper lacks proper controls

kidney_stonesFrom the Children’s Hospital of Philadelphia  Something that I consider to be more than a stretch, and possibly conflated junk science, especially since I’ve suffered kidney stones myself and live in a place with summer temperatures that average well over 50°F. See my comments and citations of other papers at the end.


CHOP-led research finds link between hotter days, kidney stones in US adults and children

As daily temperatures increase, so does the number of patients seeking treatment for kidney stones. In a study that may both reflect and foretell a warming planet’s impact on human health, a research team found a link between hot days and kidney stones in 60,000 patients in several U.S. cities with varying climates.

“We found that as daily temperatures rise, there is a rapid increase in the probability of patients presenting over the next 20 days with kidney stones,” said study leader Gregory E. Tasian, M.D., M.Sc., M.S.C.E., a pediatric urologist and epidemiologist at The Children’s Hospital of Philadelphia (CHOP), who is on the staff of the Hospital’s Kidney Stone Center as well as the Hospital’s Center for Pediatric Clinical Effectiveness (CPCE).

Tasian, senior author Ron Keren, M.D., MPH, also of CHOP and CPCE, and colleagues from other centers published their results today in Environmental Health Perspectives, the journal of the National Institute of Environmental Health Sciences. The Urologic Diseases in America Project, supported by the National Institute of Diabetes and Digestive and Kidney Diseases, sponsored the study.

The study team analyzed medical records of more than 60,000 adults and children with kidney stones between 2005 and 2011 in Atlanta, Chicago, Dallas, Los Angeles and Philadelphia, in connection with weather data. Tasian and colleagues described the risk of stone presentation for the full range of temperatures in each city. As mean daily temperatures rose above 50 F (10 C), the risk of kidney stone presentation increased in all the cities except Los Angeles. The delay between high daily temperatures and kidney stone presentation was short, peaking within three days of exposure to hot days.

“These findings point to potential public health effects associated with global climate change,” said Tasian. “However,” cautions Tasian, “although 11 percent of the U.S. population has had kidney stones, most people have not. It is likely that higher temperatures increase the risk of kidney stones in those people predisposed to stone formation.” Higher temperatures contribute to dehydration, which leads to a higher concentration of calcium and other minerals in the urine that promote the growth of kidney stones.

A painful condition that brings half a million patients a year to U.S. emergency rooms, kidney stones have increased markedly over the world in the past three decades. While stones remain more common in adults, the numbers of children developing kidney stones have climbed at a dramatically high rate over the last 25 years. The factors causing the increase in kidney stones are currently unknown, but may be influenced by changes in diet and fluid intake. When stones do not pass on their own, surgery may be necessary.

The study team also found that very low outdoor temperatures increased the risk of kidney stones in three cities: Atlanta, Chicago and Philadelphia. The authors suggest that as frigid weather keeps people indoors more, higher indoor temperatures, changes in diet and decreased physical activity may raise their risk of kidney stones.

The researchers argue that the number of hot days in a given year may better predict kidney stone risk than the mean annual temperature. Atlanta and Los Angeles share the same annual temperature (63 F, or 17 C), but Atlanta has far more hot days than Los Angeles, along with nearly twice the prevalence of kidney stones.

Tasian added that while the five U.S. cities have climates representative of those found throughout the world, future studies should explore how generalizable the current findings are. Other studies should analyze how risk patterns vary in different populations, including among children, represented by a small sample size in the current study.

The study’s broader context is in patterns of global warming. The authors note that other scientists have reported that overall global temperatures between 2000 and 2009 were higher than 82 percent of temperatures over the past 11,300 years. Furthermore, increases in greenhouse gas emissions are projected to raise earth’s average temperatures by 2 to 8 F (1 to 4.5 C) by 2100. “Kidney stone prevalence has already been on the rise over the last 30 years, and we can expect this trend to continue, both in greater numbers and over a broader geographic area, as daily temperatures increase,” concluded Tasian. “With some experts predicting that extreme temperatures will become the norm in 30 years, children will bear the brunt of climate change.”

###

The paper:

Daily Mean Temperature and Clinical Kidney Stone Presentation in Five U.S. Metropolitan Areas: A Time-Series Analysis

Abstract

Background: High ambient temperatures are a risk factor for nephrolithiasis, but the precise relationship between temperature and kidney stone presentation is unknown.

Objectives: Our objective was to estimate associations between mean daily temperature and kidney stone presentation according to lag time and temperatures.

Methods: Using a time series design and distributed lag non-linear models, we estimated the relative risk (RR) of kidney stone presentation associated with mean daily temperatures, including cumulative RR for a 20-day period, and RR for individual daily lags through 20 days. Our analysis used MarketScan data for 60,433 patients who presented for evaluation or treatment of kidney stones from 2005–2011 in Atlanta, Chicago, Dallas, Los Angeles, and Philadelphia.

Results: Associations between mean daily temperature and kidney stone presentation were not monotonic, and there was variation in the exposure-response curve shapes and the strength of associations at different temperatures. However, in most cases RRs increased for temperatures above the reference value of 10°C. The cumulative RR for a daily mean temperature of 30°C versus 10°C was 1.38 in Atlanta (95% CI: 1.07, 1.79), 1.37 in Chicago (95% CI: 1.07, 1.76), 1.36 in Dallas (95% CI: 1.10, 1.69), 1.11 in Los Angeles (95% CI: 0.73, 1.68), and 1.47 in Philadelphia (95% CI: 1.00, 2.17). Kidney stone presentations also were positively associated with temperatures < 2°C in Atlanta, and < 10°C in Chicago and Philadelphia. In 4 cities, the strongest association between kidney stone presentation and a daily mean temperature of 30 versus 10°C was estimated for lags ≤ 3 days.

Conclusions: In general, kidney stone presentations increased with higher daily mean temperatures, with the strongest associations estimated for lags of only a few days. These findings further support an adverse effect of high temperatures on nephrolithiasis.

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First I’ll give them high marks for not putting it behind a paywall. The full paper is available here: http://ehp.niehs.nih.gov/1307703/

Accessible PDF icon PDF Version (1.4 MB) | Accessible PDF icon Supplemental Material (249 KB)

Figure S1 from the Supplemental Material immediately caught my eye:

Figure S1. Overall relative risk of kidney stone presentation cumulated over 30 day lag period associated with mean daily temperature (°C) relative to 10°C in Atlanta (A), Chicago (B), Dallas (C), Los Angeles (D), and Philadelphia (E) from 2005-2011. The estimated relative risk of kidney stone presentation associated with mean daily temperature cumulated over a 30 day lag period using distributed lag non-linear models are shown. Two spline knots were placed at equal intervals over the range of temperatures for each city. Locations of temperature knots were: Atlanta (6.7 °C , 18.9°C), Chicago (-8.9°C, 6.1°C), Dallas (6.5°C, 21.4°C), Los Angeles (13.0°C, 20.6°C), Philadelphia (3.7°C, 18.4°C). Four spline knots were placed at equal intervals in the natural log scale of lags (2, 3, 5, and 10 days) to increase sensitivity for shorter lags. The solid line is the point estimate at each temperature and the surrounding grey area represents the 95% CI.

Figure S1. Overall relative risk of kidney stone presentation cumulated over 30 day lag period associated with mean daily temperature (°C) relative to 10°C in Atlanta (A), Chicago (B), Dallas (C), Los Angeles (D), and Philadelphia (E) from 2005-2011. The estimated relative risk of kidney stone presentation associated with mean daily temperature cumulated over a 30 day lag period using distributed lag non-linear models are shown. Two spline knots were placed at equal intervals over the range of temperatures for each city. Locations of temperature knots were: Atlanta (6.7 °C , 18.9°C), Chicago (-8.9°C, 6.1°C), Dallas (6.5°C, 21.4°C), Los Angeles (13.0°C, 20.6°C), Philadelphia (3.7°C, 18.4°C). Four spline knots were placed at equal intervals in the natural log scale of lags (2, 3, 5, and 10 days) to increase sensitivity for shorter lags. The solid line is the point estimate at each temperature and the surrounding grey area represents the 95% CI.

What immediately struck me was what I dubbed the “Philly Cheesesteak effect”. Look at how sharp the curve is above 20°C for Philadelphia. Similarly, Chicago. Now what strikes me as odd is that both of these cities have average annual mean temperatures that are below the others.

From my perspective, regional diets and obesity might explain this. I have been to every one of these U.S. cities, and I think I have a pretty good handle on the tendencies of the local cuisines.

I back that up with this list. Philadelphia is of course on it. In fact Philadelphia appears on several lists of this kind. Here’s another:

fattest_cities

Note that every city in the Tasian et al. study appears on that list, but not on this one:

fittest_cities

Those lists are based on CDC data. One wonders if Tasian et al. ran the same study on sone of the most fit cities if the relationship they claim would hold. I’ll bet it wouldn’t. It is almost as if they pre-screened for use of the most obese cities.

So, to me, reading the paper, it seems that Tasian et al. didn’t control for diet, obesity, and other health factors. Further, by limiting it to 5 cities, all with high obesity rates, it seems guaranteed to produce a result, especially when you look at this study:


 

Obesity, Weight Gain, and the Risk of Kidney Stones

Taylor et al. Journal of American Medical Association, 2005.

http://jama.jamanetwork.com/article.aspx?articleid=200248

Context Larger body size may result in increased urinary excretion of calcium, oxalate, and uric acid, thereby increasing the risk for calcium-containing kidney stones. It is unclear if obesity increases the risk of stone formation, and it is not known if weight gain influences risk.

Objective To determine if weight, weight gain, body mass index (BMI), and waist circumference are associated with kidney stone formation.

Design, Setting, and Participants A prospective study of 3 large cohorts: the Health Professionals Follow-up Study (N = 45 988 men; age range at baseline, 40-75 years), the Nurses’ Health Study I (N = 93 758 older women; age range at baseline, 34-59 years), and the Nurses’ Health Study II (N = 101 877 younger women; age range at baseline, 27-44 years).

Main Outcome Measures Incidence of symptomatic kidney stones.

Results We documented 4827 incident kidney stones over a combined 46 years of follow-up. After adjusting for age, dietary factors, fluid intake, and thiazide use, the relative risk (RR) for stone formation in men weighing more than 220 lb (100.0 kg) vs men less than 150 lb (68.2 kg) was 1.44 (95% confidence interval [CI], 1.11-1.86; P = .002 for trend). In older and younger women, RRs for these weight categories were 1.89 (95% CI, 1.52-2.36; P<.001 for trend) and 1.92 (95% CI, 1.59-2.31; P<.001 for trend), respectively. The RR in men who gained more than 35 lb (15.9 kg) since age 21 years vs men whose weight did not change was 1.39 (95% CI, 1.14-1.70; P = .001 for trend). Corresponding RRs for the same categories of weight gain since age 18 years in older and younger women were 1.70 (95% CI, 1.40-2.05; P<.001 for trend) and 1.82 (95% CI, 1.50-2.21; P<.001 for trend). Body mass index was associated with the risk of kidney stone formation: the RR for men with a BMI of 30 or greater vs those with a BMI of 21 to 22.9 was 1.33 (95% CI, 1.08-1.63; P<.001 for trend). Corresponding RRs for the same categories of BMI in older and younger women were 1.90 (95% CI, 1.61-2.25; P<.001 for trend) and 2.09 (95% CI, 1.77-2.48; P<.001 for trend). Waist circumference was also positively associated with risk in men (P = .002 for trend) and in older and younger women (P<.001 for trend for both).

Conclusions Obesity and weight gain increase the risk of kidney stone formation. The magnitude of the increased risk may be greater in women than in men.


The Taylor et al. study from JAMA is not listed as a reference in the Tasian et al. study claiming that global warming is linked to kidney stones, but this horrid paper is:

Marcott SA, Shakun JD, Clark PU, Mix AC. 2013. A reconstruction of regional and global temperature for the past 11,300 years. Science 339:1198 -1201.

Further, this study:

Kidney Stones: A Global Picture of Prevalence, Incidence, and Associated Risk Factors, Romero et al. 2010, published in Reviews in Urology http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931286/

says:

In the United States, overall stone prevalence has doubled since the 1964–1972 time period, and appears to have stabilized since the early 1980s.13 Other countries with documented increases in prevalence include Germany, Spain, and Italy.47 Regional reports from Milan, Italy, also document an increased prevalence. 8 Only Scotland had a slight decrease in prevalence from 3.83% in 1977 to 3.5% in 19879,10 (Table 1 and Table 2).

They do cite Romero et al in the paper, but they seemed to have missed that part. Here is the portion of Table 1 covering the USA:

kidney_stone_prevalence

So if global warming was to blame, and since there are regular claims that we’ve seen most of the global warming since about that same time, what caused the stabilization of kidney stone prevalence since the early 1980s in the United States?

Maybe diet, especially greasy fast foods is the cause for the jump since the early 1960’s? There seems to be quite a jump since 1961.

Where+America+Eats+2[1]

Source article here, which adds:

The data comes from USDA figures; fast food expenditures were not tracked before 1929.  There are a few things to note here:

  1. 93 percent of food was consumed at home in 1889, and most of that was homemade from scratch.  
  2. In 2009, barely half (51%) of food was consumed at home, the rest was consumed in either full-service or fast food restaurants. Probably a high proportion of what was consumed at home was actually processed food. 
  3. Fast food was not a significant expenditure before 1960, after which it rapidly gained in popularity.  Today, fast food accounts for 18 percent of total food expenditures. 

It would seem to me that obese people, who are already at risk from kidney stones might sweat more (hyperhidrosis) and thus consume more fluid to make up for the imbalance than non obese people during hot days, and that would increase the chances of flushing out a kidney stone or two, which could account for the increase in reported incidents that the Tasian et al. study uses as the basis for its claims.

I think Tasian and friends have their p-values all out of whack, and the Tasian et al. paper is nothing but junk science designed to produce a result due to the pre-selection of some of the most obese cities in America, creating a small biased sample set, with no control done on cities that aren’t part of that group.

Is there a doctor in the house that can write a challenge this paper?

 

 

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68 thoughts on “Claim: Climate change may bring more kidney stones – but the Tasian et al. paper lacks proper controls

  1. As daily temperatures increase, so does the number of patients seeking treatment for kidney stones.
    =========
    proof positive that kidney stones are causing global warming. Or maybe global warming is caused by seeking treatment for kidney stones.

  2. stone prevalence has doubled since the 1964–1972 time period, and appears to have stabilized since the early 1980s
    ==========
    just about the time global warming took off, kidney stones stabilized. thus, global warming is helping stabilize kidney stones. on the other hand, kidney stones appear to have increased during the global cooling scare on the 60’s and 70’s. proving that kidney stones cause global cooling scares.

  3. agenda driven science at its finest. look for a correlation between temperature and some other factor. ignore the role of chance and natural variability. whatever you find is proof temperate is either causing or caused by whatever correlation you find.

  4. From the paper:

    Conclusions: In general, kidney stone presentations increased with higher daily mean temperatures, with the strongest associations estimated for lags of only a few days. These findings further support an adverse effect of high temperatures on nephrolithiasis.

    Or people are less likely to go to the Doctor for a chronic complaint when it is raining.

  5. Stuff like this makes me wonder that there is no Inspector General to audit the efficacy (sanity?) of studies such as these. Maybe it was better when we didn’t read about these efforts, but on the other hand, if there is to be an effective reaction, we do need to know about them.

    As many of us have written, we immediately doubt any statement beginning with “Scientists report; Experts say, Boffins have discovered.” And maybe that is a good result.

  6. Ridiculous BS. I’ve had my share of kidney stones. And I did notice when I drank too much water (like on a hot day) or booze (like at a christmas party) kidney stones could be triggered. But the stones take years to form and were there to begin with. Genetics has a lot to do with kidney stone formation. Heat does not.

    Even if it were getting hotter and extreme heat frequency were longer, the total amount of kidney stones flushed over the long term would be exactly the same.

    How can such a stupid amateur error as confusing the cause and the trigger make it into publication?

  7. Could this be another example of global warming research funds ambulance chasing? Check the funding? Meanwhile my hunch is that this AGW fad is leaving other unrelated-to-climate but more serious medical and mental conditions in need of investigation and research funds sitting on the shelf.

  8. I’ve had a kidney stone but guarantee you it had zero to do with the climate. What are these people smoking? How ludicrous.

  9. It is like that study that correlates ice-cream sales with murder rates.

    Anyway, If I had a child with a kidney stone problem, I would not take my child to that hospital.

  10. I think climate change doesn’t produce more kidney stones, climate change produces more papers on kidney stones.

  11. “…what caused the stabilization of kidney stone prevalence since the early 1980s in the United States?

    It’s hiding in the deep oceans….

  12. As a physician who has lived and worked in the Middle East I can confirm that symptomatic kidney stones do become more frequent during very hot periods of the year and the most likely mechanism is relative dehydration with consequent concentration of urine which makes stone formation more likely in those genetically predisposed. The solution is to ensure adequate hydration and to increase fluid intake during hot weather. I can’t see how this observation does anything to support the faulty models that predict dangerous future warming , and which have failed in almost every other prediction/projection/scenario description of future (and in many cases past) climate.

  13. For the graphs that go to low enough temps, there also seems to be elevated incident levels around -10 degrees. You can see it in every graph except LA because the LA data doesn’t go that low. By not addressing elevated levels at -10, they’re just cherry picking points on a graph at the high end instead of looking at the big picture.

  14. I was under the impression that most kidney stones are usually a calcium or magnesium oxalate precipitate. Oxalates are found in green beans and chocolate among other foods. It’s diet and hydration level.

  15. The delay between high daily temperatures and kidney stone presentation was short, peaking within three days of exposure to hot days.

    Since stones take much longer than 3 days to form, there clearly must be some other relationship. One thing that does increase with temperature is fluid intake. Could it just be that on warmer days, people tend to drink more, and possibly dislodge already formed stones, thereby blocking a duct and causing all the kerfuffle?

    I have regular stones, at any time of year, so not sure I’ve noticed the correlation myself.

  16. But even if it were true, it wouldn’t mean what the warm-mongers want it to mean for public policy. I mean, even if a study controlled for obesity and whatever else, I could believe that the correlation would hold—when it’s hotter people are more likely to get dehydrated, and if they’re dehydrated they’re more likely to get stones—but in that case wouldn’t just telling people to drink more water be a vastly cheaper solution than, say, wrecking the global economy in the pursuit of lower carbon emissions?

    “For people who’re already marginal in their fluid intake, and who don’t adjust it upwards on hotter days, it’s highly likely their risk of suffering from kidney stones is going to increase! It’s not exactly rocket science!”

    Exactly!

    “. . . proving that kidney stones cause global cooling scares.”

    Ha ha

  17. I’ve had bouts of kidney stones since the early 90s, the last one was in May or 2009. I’ve always drank a lot of colas, mostly Coke, Diet Coke, and the like. Since May 2009, the most severe bout, I’ve cut out all (or as much as possible) drinks with Phosphoric Acid, and so far have not had ANY indications of pain from stones. So I’m having my own “pause”. Must be Climate Change.

  18. This is derivative copy-cat study. The same faux study was done about 7 years ago by some con-artist posing as a medical researcher. No explanation about how water quality, education about hydration, how people in much hotter climates survive, plays a role. Just more climate obsessed clap trap dressed up as science.

  19. Is there a doctor in the house that can write a challenge this paper?

    Normally I’d say this is a job for the Science-Based Medicine folks, but they’re so entrenched in the AGW scare, there’s no way.

  20. I get the things now and then.
    Drink water. Dehydration seems to be a cause, and for a fact higher temperatures Do cause you to sweat more, therefore you’ll need to drink more to offset the losses.
    Watch your diet. I have to be careful about bananas– I love them, but they do seem to cause kidney stones for me. Oranges seem to cause trouble, too.
    I never thought– before now– to blame climate change. It just gets hot in Chicago in summer. Who knew?

    If I watch my water intake and my diet, I have far less trouble with kidney stones than I did when I didn’t pay attention to such things.

  21. This sounds a lot like the EPA asthma research and story line. This would make a nice plan B for EPA science policy staff when they get back from CIA missions and other sabbaticals.

  22. Um, I think hot weather and dehydration may be correlated, and dehydration is positively correlated with kidney stones, right?

  23. “a research team found a link between hot days and kidney stones in 60,000 patients in several U.S. cities “?
    This couldn’t possibly be related to a separate factor unaccounted for in the data-mining part of the study, could it? Something like ‘underhydration’, which was the cause of my daughter’s kidney stones some years ago, until we retrained her to drink more fluids?
    Naah. They couldn’t have been that short-sighted, could they?

  24. If I do not keep my urine at the colour of ‘fine old fino’ as an Army medic put it when I was diagnosed, I am at risk of kidney stones. The problem first surfaced when I was serving in Northern Ireland…

  25. “Is there a doctor in the house that can write a challenge this paper?”
    ————————————————————————————————————————-
    I am not a doctor but I did stay at a Holiday Inn Express recently.
    My solution: drink more water and stay away from McDonald’s.
    (Of course that is good advice at any time.)

  26. Since kidney stones don’t develop in a matter of weeks, it’s hardly likely that a recent increase in temperature has anything to do with more people developing problems with kidney stones.
    More likely it’s the increased level of physical activity as weather warms that is causing the problem.

  27. I have to admit, it is studiesd like this – where you approach a topic with preconceived ideas, hook it to the gravy train in some way, and when you publish, you open the door to new grants for equally targeted studies – that has turned the concept of scientific study into alchemical pursuits. This is the same technique used to prove AND disprove religion. No wonder it is polarizing, and no wonder people view science as mumbo jumbo now. First we took away basic educational tools from the masses and now present them with whatever seems profitable at the moment, and wonder why science has lost its respect. Sad.

  28. Hmmm. . . if they really wanted to do a study forecasting what global warming could do to public health. . . let them investigate just how much global warming might affect the incidence of multiple sclerosis. It is well known that there is a strong association between multiple sclerosis and latitude — to the point that the incidence of MS in the northern US is about five times that in the southern US. (http://www.invw.org/article/a-map-of-multiple-scleros-1329)

    So what could we make of this other than. . . .global warming should bring about a decrease in the incidence of multiple sclerosis, right. . . . . . ????

    Yeah, bet I couldn’t get much funding for that type of paper. . . .

  29. One more for the list! Has it reached 100 yet?

    Way past that, I think. Global Warming is the environmental Wom-Pom: There is nothing that it cannot do.

  30. As my long passed country doctor told me: All things in moderation. A beer or two helps the kidneys, too many triggers gout. At 67, and the longest lived of my siblings, it has worked nicely for me. No kidney stones, but my love of shellfish punishes me with gout if I overdo.

  31. I’m still waiting for the study on the correlation between “climate change” and hangnails.

  32. This ought to go in “Ridleys believe it or not” …
    Quite extensive and answers almost everything.

    http://en.wikipedia.org/wiki/Kidney_stone

    How about better foods like fruit, more exercise, remove fluoride and calcites from water etc. etc.

    Anyone who links a bodily complaint to climate complaint has a brain complaint. The body’s internal temperature is regulated to the nth degree, regardless what the outside is.

  33. With stupid studies like this coming out, I wonder how long before someone comes out with a study linking increased CO2 to our favorite TV shows being canceled.

  34. mjmsprt40 says:
    July 11, 2014 at 8:03 am

    “Watch your diet. I have to be careful about bananas– I love them, but they do seem to cause kidney stones for me.”

    It is true kidney stone are somewhat linked to heat and dehydratation, but climate change… LOL!!!

    The most predominant factor is the lack of anti-crystallization factors (possibly genetic), presence of bacteria and pH of urine.

    Bananas is one of the most potent urine alkalinizer food (high pH). An alkaline urine is a favorable medium for urea reducing bacteria, and those bacteria, by their action, will cause a more alkaline urine level to help themself. Alkaline urine invite the fast growing struvite stone. These stones are sometimes called “infection stones”. The end result is a mix of struvite, amorphous phosphate, and oxalate compounds.

    I’ve done intensive studies on the topic since a couples of year, and there is one thing I’m quite sure of: appart dehydratation (frequent among elderly), climate change has no direct link to kidney calculus.

  35. And nothing to do with the fact that the average person does not drink enough water and too much soda / Red Bull / whatever “energy drink” / booze (and this problem gets worse every year).

  36. I’d thought squirrels in the park was a stretch. But, kidney stones? Some folks know no shame.

  37. Don’t forget the last time WUWT covered this, back in 2008. http://wattsupwiththat.com/2008/05/16/global-warming-may-increase-prevalence-of-kidney-stones-disease/ which says, in part:

    From the Thaindian News and here it is on Science Daily so no, I’m not making this up.

    Washington, May 15 (ANI): Global warming may lead to an increase in kidney stones disease, says a new study.

    Using published data to determine the temperature-dependence of stone disease, researchers applied predictions of temperature increase to determine the impact of global warming on the incidence and cost of stone disease in the United States.

    The Intergovernmental Panel on Climate Change indicates a 1-20 C increase in temperature by 2050 for much of the United States. These findings place a greater significance on the harmful effects of global warming, an ongoing economic and political issue.

    BTW, the 1-20C is bogus, I think it should have read 1-2°C. Probably an OCR glitch.

  38. I liked this line:
    “The study team also found that very low outdoor temperatures increased the risk of kidney stones in three cities: Atlanta, Chicago and Philadelphia. The authors suggest that as frigid weather keeps people indoors more, higher indoor temperatures, changes in diet and decreased physical activity may raise their risk of kidney stones.”

    The authors are clearly confused. We no longer have frigid weather in the continental U.S., because of the weirding, so there are no longer low outdoor temperatures. Therefore, kidney stones that develop in Atlanta, Chicago, or Philly are indeed directly caused by CAGW (p=0.001).

  39. Jeff Alberts says:
    July 11, 2014 at 7:34 am

    I’ve had bouts of kidney stones since the early 90s, the last one was in May or 2009. I’ve always drank a lot of colas, mostly Coke, Diet Coke, and the like. Since May 2009, the most severe bout, I’ve cut out all (or as much as possible) drinks with Phosphoric Acid, and so far have not had ANY indications of pain from stones. So I’m having my own “pause”. Must be Climate Change.

    This us a good point.
    Many people drink beer and soft drinks because they ‘refresh’ as the ads tell us.
    However beer has a natural diuretic in it, namely alcohol, and soft drinks contain another diuretic, caffeine.
    Consequently the more one drinks of these the more chance of dehydration compared to drinking water itself, particularly when physically working or in hot conditions.
    In cats and dogs high phosphorous diets and lower urinary tract infections are linked to stone formation in the lower urinary tract, not the kidneys, as stones happen to rarely build up there.
    Urinary infections are in turn linked to obesity in bitches, in that they ‘auto inoculate’, i.e.when they defaecate they contaminate the vulva making urinary tract infection more probable.
    Also dehydration from any cause contributes to more concentrated urine, so the solutes are more likely to precipitate out as stones when normal kidneys concentrate urine as a longer control of dehydration.
    I sometimes wonder, in humans, if some do not have diminished thirst reflex anyway, so they do not drink enough when needed.
    This reflex could be lowered by being in air conditioning on a hot day watching TV, blogging and smoking dope, taking any of the prescription anti anxiety meds and responding to beer and soft drink ads.
    This could be looked at in the studied US cities.
    Back in the 80’s Lower Urinary Tract Disease [LUTD] in cats was the focus of research in the veterinary world.
    That was because lots of research money was available for cancer research, and cats were seen as a good animal model for LUTD and links to cancer of the bladder.
    They are not the best model because they are desert adapted and can concentrate urine to a high degree.
    In cold weather cats tend to sleep indoors curled up comfortably and stop drinking.
    After about three days of this, on a dry diet, male cats may block their LUT with crystals,small stones, and become very ill.
    So in that animal world, cold is the problem.
    Just as in the 80’s money was available for cancer research, now its ‘climate research’.
    From animal models,dare I use that term here,the behaviour and the response of the animal to the temperature change, their diet, quality of food,medications, obesity and amount of exercise are all factors in stone formation in the LUT.
    Unless the researchers control for these things,the conclusions may not be validated.
    Well may we say,’more research funding is needed’.

  40. One might expect then that India is very high in occurrence rate of kidney stones whilst Norway is very low.
    Long term researchers in Antarctica never.

  41. That means when we all stop using our cars and build more windturbines kidney stones go away? That’s wonderful news! Advertise it everythere! This will help trust in science enormously!

  42. Oh, and stop heating your home. And try to reduce your body temperature. 37 deg C must cause an awful lot of kidney stones. Dying might help. As dead people are colder than living people they get less kidney stones. QED.

  43. Well, I can’t say that I’ve experienced any sort of ill health due to CAGW, let alone kidney stones.

    I can state that the proposed remedies for CAGW (more taxes, less freedom, sky-high energy costs) always make me sick.

  44. [Erk! Tongue way out in cheek]
    Based on this study we must all remember that any particular kidney stone cannot be attributed to AGW, but that there will be more of them and more severe as well. You know… like hurricanes and droughts and winter storms and tornados and inch worms (which will be an inch and a half) long and …

  45. In a study that may both reflect and foretell a warming planet’s impact on human health, a research team found a link between hot days and kidney stones in 60,000 patients in several U.S. cities with varying climates.
    Similar correlations found here:- http://tylervigen.com/
    You’ll be surprised at what, apparently, causes what!

  46. It appears to me that the increasing incidence of kidney stones is mainly from recent trends of lifestyles becoming increasingly unhealthy since, perhaps sometime in the 1950s. On average, people have reduced their physical activity for many reasons, including increased access to cars, lower-cost telephone service, TV, home computers, Internet, home video recording and playback, video games, and smartphones, and employment moving towards jobs of sedentary type.

    Also, calorie intake by Americans increased greatly from the 1950s to the past decade, and only slighty decreased since (and maintained ability of most overweight people to gain weight.) The trend of increasing calorie intake maintained itself through all peaks of both the low-fat and the low-carb popularity peaks. Meanwhile, Americans on-average reduced their consumption of fiber, beverages lacking diuretic drugs (such as plain water, which lacks caffeine and alcohol), and exercise. And, as cities got hotter, in part from reasons other than increase of CO2, people perspirated away more water. Kidneys need good water level in the body to work their best.

    Another thing: Some people can eat more calories than necessary to sustain their lifestyles, and avoid gaining weight past a minimally overweight condition. The downside is that this burning of excess calories is often accompanied by increased pulse rate (depriving the heart from rest) and increased resting blood pressure, which makes the kidney’s job harder.

    Also in the past ~60 years, Americans had on-average increasing sodium intake. This increases strain on the kidneys. Even when blood concentration of sodium does not increase, the kidneys are strained by deciding (or being forced by alcohol) to pass-through something that they were designed by inland-mammal evolution to conserve.

    Both aerobic and strength-building / musclebuilding exercise are good. The former is largely healthy in many ways, including improving blood cholesterol profile and calorie-burning, and muscles get more attractive when they get improvement of their aerobic-type fibers – even though that does not do much for muscle bulk. The latter (maybe to a smaller extent also the former) stimulates production of hormones that contribute to healing of injuries and effects of aging.

  47. Gibby says:
    July 11, 2014 at 8:36 am

    I want to say that the link is between the drinking of soda to hydrate instead of water which results in a higher rate of kidney stones. http://www.ncbi.nlm.nih.gov/pubmed/23676355
    ============
    thanks! that was my first thought on reading this idiocy as well, people arent drinking as much water, but a hell of a lot of soda muck.

  48. There is a very large body of medical literature on the relationship between geography, temperature, and kidney stones. However, these are for the most part epidemiological studies looking at prevalence (the proportion of the population that has ever had the condition). The first thing to realize about this publication is that it is a time series analysis, looking at incidence. It compares temperatures with acute presentation of kidney stones on a day-by-day basis. It is a technique used mostly in economic forecasting. Economic forecasting, like climate science, is one of the few areas where statistical safeguards against data screening are not routinely practiced. But, that is getting away from the point.

    The giveaway for me is the finding that, “The delay between high daily temperatures and kidney stone presentation was short, peaking within three days of exposure to hot days.”

    Nobody goes from not having a kidney stone to having a symptomatic kidney stone in 3 days. What this tells me is that when the weather gets hot, people who may habitually not drink enough water become motivated to drink more water, which pushes pre-existing stones into the ureter or urethra, where they become acutely symptomatic. This is primarily a “flushing” effect. Military personnel deployed to the desert are known to have an increased incidence of kidney stones that peaks about 90 days after deployment. I would consider that the minimum time to form symptomatic stones.

    The proof of the “flushing” phenomenon is in figure S2. Note that the peak around 3 days is followed by a dip a few days later, corresponding to a decreased risk of acute renal colic, now that there are fewer remaining stones.

    It is no accident that all of the cities are high on the obesity list. Obesity is a known risk factor for kidney stones. Kidney stones also increase in the United States from lowest in the NW to highest in the SE, independently of obesity, which is highest in the SE. Since tests for statistical significance depend most fundamentally on sample size, the likelihood of a statistically significant result is much higher where the sample size is large, and does not indicate that the effect is necessarily absent in places where the incidence is lower, but just harder to see.

    The best and simplest way to prevent kidney stones, and a host of other medical problems, is to drink enough water.

  49. I agree with much of what the author of this post has said, though I’m not sure the data support (or refute) what is said in the paragraph on the “flushing effect” above.

    Here’s a copy of the medical study being discussed: http://ehp.niehs.nih.gov/wp-content/uploads/advpub/2014/7/ehp.1307703.pdf

    Clearly, they have not adequately controlled for confounding variables.

    Here’s my medical commentary:

    The major causes of kidney stones are inadequate fluid intake, obesity, and poor diet.

    By poor diet, I mean high carb & protein, high oxalate, high salt, and high caffeine. Here is one reference: http://www.ncbi.nlm.nih.gov/pubmed/24519664.

    Gout patients also form uric acid stones, and gout is worsened by obesity, high-purine diets, alcohol consumption, and lack of dairy product intake. Diets too high or too low in calcium may also increase stone formation. Low citric acid intake increases risk.

    Here is a PubMed search for more info for the curious: http://www.ncbi.nlm.nih.gov/pubmed?term=(kidney%20stones)%20AND%20diet.

    Healthy diet is protective (fiber, fruit, and vegetables): http://www.ncbi.nlm.nih.gov/pubmed/24859445.

    Back to the original study. Seriously, who funds research like this? This is the military-industrial complex as it applied to climate change research funding.

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