Diuretic-associated admissions to the emergency department – too hot to handle? Results from the ADRED-study
Abstract
Background: Rising ambient temperatures and increasing thermal stress are major public health challenges, associated with increased emergency department (ED) visits in Europe. Frequently prescribed diuretics may exacerbate heat-related risks through mechanisms such as dehydration and electrolyte imbalance. Although many studies have shown a connection between temperature and mortality, the effect of cumulative ambient temperature on diuretic-associated adverse drug reactions (ADRs) remains underexplored. This study investigates whether higher temperatures are associated with an increase in diuretic-related ADRs in ED admissions.
Methods: Data from a prospective, observational study on ADRs leading to ED admission (ADRED-study) with a standardized causality assessment of documented drugs were analyzed. Linear, polynomial, and segmented regression were applied to quantify the relationship between 5-day mean temperature and the ratio of suspected diuretic-related ADRs to all diuretic uses.
Results: A significant relationship between higher 5-day mean temperatures and more diuretic-associated ADRs was found in linear regression analysis (β = 0·0035, 95%CI: 0·0015 − 0·0054, R²=0·188). A segmented regression model identified a critical threshold of ~ 15·7 °C (adjusted R ² = 0·382). After the threshold at higher temperatures, the slope for diuretic-associated ADRs increased significantly (β = 0·0201, 95%CI: 0·0068–0·0333). The spline model similarly showed a high statistical fit (adjusted R ² = 0·399), indicating a non-linear, accelerating increase in ADRs at higher temperatures.
Conclusions: Diuretic-associated ADRs increase non-linearly with ambient temperature, with a breakpoint at approximately 15·7 °C. Especially diuretic-medicated individuals may be vulnerable to cumulative thermal stress.
Trial registration: The ADRED-study was registered in the German Clinical Trials Register under DRKS00008979.
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BibTeX
@article{sommer2026diureticassociated,
title = {{Diuretic-associated admissions to the emergency department – too hot to handle? Results from the ADRED-study}},
author = {Jakob Sommer and Justyna Wozniak and David Wißmann and Judith Berres and Verena Graeff and Andrea Kriegisch-Stumpf and Anja Knüppel-Ruppert and Harald Dormann and Julia C Stingl and Katja S Just},
journal = {BMC Medicine},
year = {2026},
month = nov,
doi = {10.1186/s12916-026-05370-1},
url = {https://link.springer.com/article/10.1186/s12916-026-05370-1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Diuretic-associated admissions to the emergency department – too hot to handle? Results from the ADRED-study
AU - Jakob Sommer
AU - Justyna Wozniak
AU - David Wißmann
AU - Judith Berres
AU - Verena Graeff
AU - Andrea Kriegisch-Stumpf
AU - Anja Knüppel-Ruppert
AU - Harald Dormann
AU - Julia C Stingl
AU - Katja S Just
PY - 2026
DA - 2026/11/07
JO - BMC Medicine
DO - 10.1186/s12916-026-05370-1
UR - https://link.springer.com/article/10.1186/s12916-026-05370-1
AB - Background: Rising ambient temperatures and increasing thermal stress are major public health challenges, associated with increased emergency department (ED) visits in Europe. Frequently prescribed diuretics may exacerbate heat-related risks through mechanisms such as dehydration and electrolyte imbalance. Although many studies have shown a connection between temperature and mortality, the effect of cumulative ambient temperature on diuretic-associated adverse drug reactions (ADRs) remains underexplored. This study investigates whether higher temperatures are associated with an increase in diuretic-related ADRs in ED admissions. Methods: Data from a prospective, observational study on ADRs leading to ED admission (ADRED-study) with a standardized causality assessment of documented drugs were analyzed. Linear, polynomial, and segmented regression were applied to quantify the relationship between 5-day mean temperature and the ratio of suspected diuretic-related ADRs to all diuretic uses. Results: A significant relationship between higher 5-day mean temperatures and more diuretic-associated ADRs was found in linear regression analysis (β = 0·0035, 95%CI: 0·0015 − 0·0054, R²=0·188). A segmented regression model identified a critical threshold of ~ 15·7 °C (adjusted R ² = 0·382). After the threshold at higher temperatures, the slope for diuretic-associated ADRs increased significantly (β = 0·0201, 95%CI: 0·0068–0·0333). The spline model similarly showed a high statistical fit (adjusted R ² = 0·399), indicating a non-linear, accelerating increase in ADRs at higher temperatures. Conclusions: Diuretic-associated ADRs increase non-linearly with ambient temperature, with a breakpoint at approximately 15·7 °C. Especially diuretic-medicated individuals may be vulnerable to cumulative thermal stress. Trial registration: The ADRED-study was registered in the German Clinical Trials Register under DRKS00008979.
SN - 1741-7015
ER -