Evaluation of heat stress and cumulative incidence of acute kidney injury in sugarcane workers in Guatemala

Abstract

Objective Agricultural workers worldwide exposed to heat stress could be at the risk of kidney injury, which could lead to chronic kidney disease of an unknown origin (CKDu). Hydration has been promoted as a key measure to reduce kidney injury. In the presence of a hydration intervention, the incidence of acute kidney injury (AKI) was calculated in a sugarcane worker population in Guatemala and several risk factors were evaluated. Methods We measured kidney function at the beginning and end of the work shift at three time points in 517 sugarcane workers. We defined AKI as an increase in serum creatinine of 26.5 µmol/L or 50% or more from the pre-shift value. Associations between AKI and risk factors were examined, including interactions with hydration status. Results The prevalence of dehydration post-shift (> 1.020 specific gravity) was 11% in February, 9% in March, and 6% in April. Cumulative incidence of AKI was 53% in February, 54% in March, and 51% in April. AKI was associated with increasing post-shift specific gravity, a dehydration marker, (OR 1.24, 95% CI 1.02-1.52) and with lower electrolyte solution intake (OR 0.94, 95% CI 0.89-0.99). Conclusions Dehydration and insufficient electrolyte consumption are risk factors for AKI. However even well-hydrated sugarcane workers routinely experience AKI. While hydration is important and protective, there is a need to understand other contributors to risk of AKI and identify prevention strategies with these workers.

Chronic kidney disease of non-traditional origin in Mesoamerica: a disease primarily driven by occupational heat stress

“…Hyperuricemia has been associated with kidney dysfunction in cross-sectional studies (30,46,47,71), tentatively as part of the pathophysiological pathway compatible with an occupational heat stress etiology (72). Consumption of NSAIDs, which also can be seen as occupationally related if used because of musculoskeletal pain in hard manual labor, yielded negative results in all studies, except for an interaction with pre-shift dehydrated state for acute kidney injury in a Guatemalan cross-shift study in sugarcane field workers (50), and there are no consistent observations for other nephrotoxic pharmaceuticals. Alcohol, illegal alcohol and tobacco were inconsistently related to low kidney function in prevalence studies.…”

“…Cross-shift evaluations have been conducted in sugarcane cutters in Costa Rica, Nicaragua, El Salvador and Guatemala. Without exception, these studies concluded that cross-shift physiologic and biomarker changes were compatible with recurrent dehydration from strenuous work in hot environments (45)(46)(47)(48)(49)(50). Three studies examining multiple cross-shifts documented repeated dehydration over the day (45,47,48).…”

“…In Guatemala, an ostensibly intense hydration regimen was implemented, but indicators of poor hydration were still associated with kidney function decline and biomarkers of kidney injury during the workday (49). Among these cane cutters, increases in SCr compatible with the KDIGO acute kidney injury definition occurred in 78% at least once during three measurement days (50). Other studies have also reported changes similar in magnitude during the workday (47,48).…”

Association of Copeptin, a Surrogate Marker of Arginine Vasopressin, with Decreased Kidney Function in Sugarcane Workers in Guatemala

“…This research was conducted in a prospective cohort of male sugarcane field workers in Guatemala in 2016-17. The study is de-scribed in detail elsewhere [9,10]. A schematic of the study timeline is provided in the online supplement Figure S1 (for all online suppl.…”

Heat illness and renal injury in mail and package delivery workers

“…Because AKI is a known complication in outdoor workers who are hospitalized with HRIs, it is likely that SIR substantially undercounts work-related AKI cases if they are classified only as "heat exhaustion." 12,21,22 Furthermore, the SIR database excludes HRIs that were not severe enough to require inpatient hospitalization. Our analysis also excluded many smaller, delivery companies that may employ untrained workers who may also be at risk.…”