What climate change means for dialysis patients

The ideas and innovators shaping health care

Sep 04, 2024 View in browser   By Gregory Svirnovskiy, Ruth Reader, Carmen Paun, Daniel Payne and Erin Schumaker DANGER ZONE Dr. Suzanne Watnick | Courtesy of American Society of Nephrology Hotter temperatures and extreme weather are increasing, and doctors are worried about what that could mean for the more than half million Americans on dialysis. Climate change is linked to kidney disease, and storms that cut off power threaten access to care. Without treatment, a dialysis patient might survive just days to weeks. Dr. Suzanne Watnick, a professor at the University of Washington and health policy scholar at the American Society of Nephrology, spoke with Gregory about the problem. The interview has been edited for length and clarity.  How does climate change contribute to kidney disease? We know that there are conditions where the combination of heat, and probably toxins, have contributed to kidney diseases, particularly for those at risk, such as people with high blood pressure and diabetes. And people with renal conditions also face climate-related risks during treatment?  You have situations where patients who need access to life-saving therapies, that is dialysis — kidney replacement therapy — can’t get access. We’ve seen this happen again and again. During more frequent storms with power outages, dialysis facilities may shut down if they don’t have backup generators. Even people who do dialysis at home have trouble. In the Pacific Northwest last winter, there was a terrible storm where power was out for three days. I have a neighbor who’s on peritoneal dialysis in her home. She forgot how to do what we call manual exchanges. So we had to figure out how to get her to a facility that had emergency backup power. The health care industry contributes to climate change. Is it grappling with that? One dialysis patient on a hemodialysis machine uses over 20,000 liters of water a year, just in their machine alone. It actually is about 60,000 liters of water if you think about how much has to be used to get clean water into the machine. And if you do the math, you’re talking worldwide, like 150-plus billion liters of water. Can that be reduced? Just decreasing the amount of water flow for the dialysate, the fluid that cleans the blood, can result in large improvements. Encouraging home dialysis may afford more opportunities to use fewer resources. WELCOME TO FUTURE PULSE Cohasset, Mass. | Shawn Zeller/POLITICO This is where we explore the ideas and innovators shaping health care. Humans developed bigger brains than chimpanzees millions of years ago but that came with a trade-off, a new study suggests: our gray matter ages faster. Share any thoughts, news, tips and feedback with Carmen Paun at cpaun@politico.com, Daniel Payne at dpayne@politico.com, Ruth Reader at rreader@politico.com, or Erin Schumaker at eschumaker@politico.com. Send tips securely through SecureDrop, Signal, Telegram or WhatsApp.  AROUND THE NATION Despite a unanimous Assembly vote, California isn't going to pass a law fining social media companies that harm kids. | Getty A California bill that attempted to penalize social media companies for harming children is not going to become law this year, the sponsor of the measure confirmed to our Jeremy B. White. Concerned that online platforms exacerbate youth addiction and mental health issues, Democratic Assemblymember Josh Lowenthal sought to threaten fines of up to $1 million per child if a court found they’d negligently allowed kids to be harmed. But Lowenthal pulled the bill last week, arguing Senate amendments had undermined his intent. Why it matters: The bill was the first in the nation of such scope and had earned unusual bipartisan support as its proponents echoed warnings from Gov. Gavin Newsom and his wife, Jennifer Siebel Newsom, about the potential perils of social media. The Assembly passed it unanimously in May. But state Senate amendments imposed a tougher legal standard to penalize the companies, requiring that they “knowingly or willfully” failed to protect children. “Poison pill amendments inserted into the bill in the Senate Appropriations Committee mean the bill doesn’t do what it’s intended to — provide justice for kids harmed by social media,” Lowenthal said. Tech’s clout: Those amendments largely reflected Facebook owner Meta’s wishes, per an email seen by POLITICO. A Meta representative declined to comment. An industry group of which Meta is a member argued in committee hearings that the bill would violate the First Amendment. Industry lobbying has repeatedly thwarted California lawmakers’ attempts to regulate the social media industry. Senate appropriators shelved a bill allowing lawsuits against tech companies that harm kids in 2022, and NetChoice, an advocacy group for the tech giants, has convinced two federal courts to block a two-year-old law requiring website operators to stop using design features that allegedly harm kids. THE REGULATORS The FDA says it can't release all the data it has on AI tools. | Sarah Silbiger/Getty Images The FDA is firing back at critics who say it’s lax in regulating artificial intelligence tools in health care. Yesterday, Future Pulse reported on a study that found forty-two percent of FDA-authorized AI medical devices lacked published clinical validation data. The study authors, researchers from the University of North Carolina at Chapel Hill and other institutions, argued that this lack of transparency makes it hard for health systems, doctors, and patients to understand what AI they should be using. FDA director of digital health Troy Tazbaz said there’s a difference between the data the agency reviews and what gets published. “Much of the testing that is performed to support a marketing authorization decision by the FDA is considered confidential commercial information,” he said in a statement. “Therefore, the agency cannot make that information available to the public as a matter of federal law unless the manufacturer gives their permission, which typically they do not." Even so: Tazbaz said the agency understands that transparency into these devices will ultimately lead to safer and more effective use. To that end, the agency is working with regulators in Canada and the U.K. on establishing guiding principles that could help the industry be more transparent — if it wants to.   Follow us on Twitter Carmen Paun @carmenpaun Daniel Payne @_daniel_payne Ruth Reader @RuthReader Erin Schumaker @erinlschumaker   Follow us

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