Heat stress, dehydration, and kidney function in sugarcane cutters in El Salvador – A cross-shift study of workers at risk of Mesoamerican nephropathy

Abstract

The high prevalence of reduced eGFR, and the cross-shift changes are consistent with recurrent dehydration from strenuous work in a hot and humid environment as an important causal factor. The pathophysiology may include decreased renal blood flow, high demands on tubular reabsorption, and increased levels of uric acid.

Intervention to diminish dehydration and kidney damage among sugarcane workers

“…Previous studies among sugarcane cutters in Brazil, El Salvador and Nicaragua have also observed similar changes in hydration and kidney function biomarkers that have been attributed to heat stress (8,11,13). Some of the workers in this study met the criteria for AKI over the course of a working day as reported among Brazilian cane cutters (11).…”

“…Briefly, the study includes two cane cutting groups working in relatively distinct climates -inland (~450 m altitude, cooler climate) and coastland (sea level, hotter climate) -chosen because other studies have demonstrated higher prevalence of kidney dysfunction in hotter environments at sea level (8,27,28). Both groups participated in a previous project (8) and the workers and their leaders were willing to participate again.…”

“…Both groups participated in a previous project (8) and the workers and their leaders were willing to participate again. All the inland group of cutters were invited to participate (N=60).…”

“…Several studies suggest a causal association between MeN and chronic heat stress and dehydration (8)(9)(10)(11)(12)(13) and experimental data have shown that repeated dehydration can induce CKD in mice (14,15). Heat exposure, strenuous exercise and dehydration pose a significant challenge to the cardiovascular system, and the transport of oxygen to exercising muscles and vital organs, such as the kidney (16).…”

Climate Change and the Emergent Epidemic of CKD from Heat Stress in Rural Communities: The Case for Heat Stress Nephropathy

“…Clinically, the subjects are usually discovered with an asymptomatic rise in serum creatinine, in association with low grade or absent proteinuria, occasionally with microhematuria (36,37). Mild anemia, hypokalemia, and hyperuricemia are common (41)(42)(43). Renal biopsies show interstitial fibrosis, low grade inflammation, tubular atrophy, and extensive glomerulosclerosis with signs of glomerular ischemia but only mild vascular lesions (42,44).…”