ObjectivesTo examine the association between workload and kidney injury in a fieldworker cohort with different levels of physically demanding work over a sugarcane harvest, and to assess whether the existing heat prevention efforts at a leading occupational safety and health programme are sufficient to mitigate kidney injury.MethodsBiological and questionnaire data were collected before (n=545) and at the end (n=427) of harvest among field support staff (low workload), drip irrigation workers (moderate), seed cutters (high) and burned sugarcane cutters (very high). Dropouts were contacted (87%) and reported the reason for leaving work. Cross-harvest incident kidney injury (IKI) was defined as serum creatinine increase ≥0.30 mg/dL or ≥1.5 times the baseline value, or among dropouts reporting kidney injury leading to leaving work.ResultsMean cross-harvest estimated glomerular filtration rate change was significantly associated with workload, increasing from 0 mL/min/1.73 m2 in the low-moderate category to −5 mL/min/1.73 m2 in the high and −9 mL/min/1.73 m2 in the very high workload group. A similar pattern occurred with IKI, where low-moderate workload had 2% compared with 27% in the very high workload category. A healthy worker selection effect was detected, with 32% of dropouts reporting kidney injury. Fever and C reactive protein elevation were associated with kidney injury.ConclusionsWorkers considered to have the highest workload had more cross-harvest kidney damage than workers with less workload. Work practices preventing heat stress should be strengthened and their role in preventing kidney damage examined further. Future occupational studies on chronic kidney disease of unknown aetiology should account for a healthy worker effect by pursuing those lost to follow-up.

ObjectivesTo assess if improvement of working conditions related to heat stress was associated with improved kidney health outcomes among sugarcane harvest workers in Chichigalpa, Nicaragua, a region heavily affected by the epidemic of chronic kidney disease of non-traditional origin.MethodsBased on our findings during the 2017–2018 harvest (harvest 1), recommendations that enhanced the rest schedule and improved access to hydration and shade were given before the 2018–2019 harvest (harvest 2). Actual work conditions during harvest 2 were then observed. Serum creatinine (SCr) was measured before and at end-harvest, and cross-harvest changes in estimated glomerular filtration rate (eGFR) and incident kidney injury (IKI, ie, SCr increase by ≥0.30 mg/dL or ≥1.5 times the baseline value) were compared between harvest 1 and harvest 2 for three jobs with different physical workloads using regression modelling. Workers who left during harvest were contacted at home, to address the healthy worker selection effect.ResultsIn burned cane cutters, mean cross-harvest eGFR decreased 6 mL/min/1.73 m2 (95% CI 2 to 9 mL/min/1.73 m2) less and IKI was 70% (95% CI 90% to 50%) lower in harvest 2 as compared with harvest 1 data. No such improvements were seen among seed cutters groups with less successful intervention implementation.ConclusionKidney injury risk was again elevated in workers with strenuous jobs. The results support further efforts to prevent kidney injury among sugarcane workers, and other heat-stressed workers, by improving access to water, rest and shade. The distinction between design and implementation of such interventions should be recognised.

Strenuous work in hot environments is associated with negative impacts on biomarkers of kidney function over the workday and over five months. Appropriate access to water, rest and shade during work offers relief from high levels of heat stress and reduces effects on kidney function.Affiliation: University of Massachusetts Lowell, 7 Camden Place, Cambridge, MA 02138, USA. david_wegman@uml.eduThe following article refers to this text: 2018;44(1):1-2

The ratio between proteases and their inhibitors is unbalanced in cancer. The cysteine protease inhibitor cystatin C is internalized by some cancer cells, which affects cellular properties. Here we aimed to investigate if uptake of cystatin C and the related inhibitor cystatin E/M occur in melanoma cell lines and to evaluate to what extent the uptake affects the legumain activity that is typically increased in melanoma. First we studied the basic expression, secretion, and intracellular content of all type 2 cystatins as well as expression and activity of their possible target enzymes legumain and cathepsin B in MDA-MB-435S, A375, and C8161 melanoma cells. Legumain activity was measureable in all cell lines, and of the potential legumain inhibitors, cystatin C, E/M, and F, cystatin C was the one mainly produced. All cells internalized cystatin C added to culture media, leading to increased intracellular cystatin C levels by 120-200%. Cystatin E/M was internalized as well but at a modest rate. The effects on intracellular legumain activity were nevertheless pronounced, probably because the cells lacked this inhibitor, and its affinity for legumain is 100-fold higher than that of cystatin C. Likewise, the low-degree uptake resulted in reduced migration and invasion of A375 cells in Matrigel to an extent comparable with the W106F variant of cystatin C with optimal uptake properties and resulting in much higher intracellular levels. Thus, cystatin E/M appears to be a good candidate to efficiently down-regulate the increased legumain activity, possibly important for the malignant phenotype of melanoma cells.

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Our study population consisted of 31 733 individuals receiving a disability benefit from the Dutch Social Security Agency (SSA). Data were collected from the databases of the SSA. Disorders were assessed by an insurance physician at application. We tested for differences in socio-demographics, main diagnoses and comorbidity for those entering and leaving disability benefits.Mental disorders were most often registered as the main diagnosis for work disability. Diagnoses differed between age groups and educational level categories. For younger and higher educated individuals mental disorders was the main diagnosis for work disability, and for older and lower educated individuals physical disorders (mainly musculoskeletal, cardiovascular and cancer). Five years after approval, 82% still received disability benefits. Outflow was lowest for individuals with (multiple) mental disorders and individuals with comorbidity of mental and physical disorders, and highest for individuals with (multiple) physical disorders.

Background The Central American kidney disease epidemic persists despite efforts to identify cause(s) and introduce clear, evidence-based interventions to protect workers. Evidence suggests that chronic dehydration during heavy work in hot environments contributes to morbidity. An intervention was introduced to determine if risk could be reduced in sugarcane workers. Objective To assess efforts to implement a Water.Rest.Shade intervention in one setting where sugarcane cutting was believed to increase CKDu in the workforce. Methods The intervention was introduced mid-way through the harvest in one of two work groups. The intervention group received water throughout the day with scheduled rest breaks in shaded settings. Health data (anthropometric and questionnaires), blood and urine were collected four times over a-six-month harvest. Daily wet bulb globe temperatures (WBGT) were recorded. Results There were significant changes in biomarkers acrossshift and across-harvest that reduced the markers of dehydration (changes of urine osmolality and serum albumin) and reduced rate of loss in estimated glomerular filtration rate (eGFR). Cross-shift change in eGFR was reduced in the group receiving the intervention. Significant decreased eGFR over the harvest appeared to stop after the intervention in those receiving the Water.Rest.Shade program. Conclusion Preliminary evidence indicates a Water.Rest.Shade intervention program reduces the impact of heat stress on acute and over-harvest biomarkers of kidney function. Potential long-term benefits of such an intervention need to be confirmed in long-term follow-up and in other settings. Further research is needed to determine whether biomarker changes predict reduced risk of CKDu in this type of work.