Risk Factors for Declines in Kidney Function in Sugarcane Workers in Guatemala

Butler-Dawson, Jaime; Krisher, Lyndsay; Asensio, Claudia Mariana; Cruz, Alex; Tenney, Liliana; Weitzenkamp, David; Dally, Miranda; Asturias, Edwin J.; Newman, Lee S.

doi:10.1097/jom.0000000000001284

Cited by 50 publications

(76 citation statements)

References 34 publications

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“…All four of these exposures were nearly ubiquitous (present in .80% of patients with tubulointerstitial kidney disease), and they point us in the direction of environment and lifestyle rather than genetics alone (because although a positive family history was more prevalent in patients with tubulointerstitial kidney disease, it was reported in only about one third of patients). The same correlates, with the exception of well water use, were observed in a recent study evaluating risk factors for postharvest eGFR decline in Guatemala (30). In contrast to patients with Mesoamerican nephropathy who seem to have clearly defined tasks on the sugarcane farm and may experience differential task-dependent risks for kidney disease (31,32), patients with tubulointerstitial kidney disease in Sri Lanka were essentially running the whole farm.…”

Section: Discussionsupporting

confidence: 65%

Prospective Biopsy-Based Study of CKD of Unknown Etiology in Sri Lanka

Anand¹,

Montez‐Rath²,

Adasooriya

et al. 2019

CJASN

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Background and objectives A kidney disease of unknown cause is common in Sri Lanka's lowland (dry) region. Detailed clinical characterizations of patients with biopsy-proven disease are limited, and there is no current consensus on criteria for a noninvasive diagnosis. Design, setting, participants, & measurements We designed a prospective study in a major Sri Lankan hospital servicing endemic areas to ascertain pathologic and clinical characteristics of and assess risk factors for primary tubulointerstitial kidney disease. We used logistic regression to determine whether common clinical characteristics could be used to predict the presence of primary tubulointerstitial kidney disease on kidney biopsy. Results From 600 new patients presenting to a tertiary nephrology clinic over the course of 1 year, 87 underwent kidney biopsy, and 43 (49%) had a biopsy diagnosis of primary tubulointerstitial kidney disease. On detailed biopsy review, 13 (30%) had evidence of moderate to severe active kidney disease, and six (15%) had evidence of moderate to severe chronic tubulointerstitial kidney disease. Patients with tubulointerstitial kidney disease were exclusively born in endemic provinces; 91% spent a majority of their lifespan there. They were more likely men and farmers (risk ratio, 2.0; 95% confidence interval, 1.2 to 2.9), and they were more likely to have used tobacco (risk ratio, 1.7; 95% confidence interval, 1.0 to 2.3) and well water (risk ratio, 1.5; 95% confidence interval, 1.1 to 2.0). Three clinical characteristics-age, urine dipstick for protein, and serum albumin-could predict likelihood of tubulointerstitial kidney disease on biopsy (model sensitivity of 79% and specificity of 84%). Patients referred for kidney biopsy despite comorbid diabetes or hypertension did not experience lower odds of tubulointerstitial kidney disease. Conclusions A primary tubulointerstitial kidney disease occurs commonly in specific regions of Sri Lanka with characteristic environmental and lifestyle exposures.

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Section: Discussionsupporting

confidence: 65%

Prospective Biopsy-Based Study of CKD of Unknown Etiology in Sri Lanka

Anand¹,

Montez‐Rath²,

Adasooriya

et al. 2019

CJASN

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“…In this study, cross-shift changes at the start of the harvest predicted the longitudinal kidney function decline (47). In Guatemala, 6% of young male cutters and other field workers had a cross-harvest eGFR decline >20% of baseline (53). In a retrospective cohort analysis, 19% of cane cutters, who have the highest physical workload, developed kidney injury at end of harvest, compared to less than 6% of other field workers, and no kidney injury among pesticide applicators or irrigation workers (54).…”

Section: Analytical Epidemiologic Studies Highlight Occupational Heatmentioning

confidence: 76%

“…Several of the above-mentioned cross-shift and cross-harvest studies on heat stress simultaneously addressed pesticide exposures. Except for an isolated association between low pre-shift eGFR and self-reported use of carbamate insecticides in El Salvador (46,63), none of these studies found associations with pesticide use; interactions were not examined (48,51,53,55,58,63). However, the relative difficulty of measuring environmental exposures to toxicants (such as pesticides) or heat stress could obscure their potential role, when compared to potential genetic determinants which typically have less measurement error (67).…”

Section: Pesticides and Metalsmentioning

confidence: 99%

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

Wesseling

Glaser²,

Rodríguez-Guzmán

et al. 2020

Revista Panamericana De Salud Pública

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The death toll of the epidemic of chronic kidney disease of nontraditional origin (CKDnt) in Mesoamerica runs into the tens of thousands, affecting mostly young men. There is no consensus on the etiology. Anecdotal evidence from the 1990s pointed to work in sugarcane; pesticides and heat stress were suspected. Subsequent population-based surveys supported an occupational origin with overall high male-female ratios in high-risk lowlands, but small sex differences within occupational categories, and low prevalence in non-workers. CKDnt was reported in sugarcane and other high-intensity agriculture, and in non-agricultural occupations with heavy manual labor in hot environments, but not among subsistence farmers. Recent studies with stronger designs have shown cross-shift changes in kidney function and hydration biomarkers and cross-harvest kidney function declines related to heat and workload. The implementation of a water-rest-shade intervention midharvest in El Salvador appeared to halt declining kidney function among cane cutters. In Nicaragua a water-rest-shade program appeared sufficient to prevent kidney damage among cane workers with low-moderate workload but not among cutters with heaviest workload. Studies on pesticides and infectious risk factors have been largely negative. Non-occupational risk factors do not explain the observed epidemiologic patterns. In conclusion, work is the main driver of the CKDnt epidemic in Mesoamerica, with occupational heat stress being the single uniting factor shown to lead to kidney dysfunction in affected populations. Sugarcane cutters with extreme heat stress could be viewed as a sentinel occupational population. Occupational heat stress prevention is critical, even more so in view of climate change.

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“…Each year, prior to the start of the 6-month sugarcane harvest, the agribusiness conducts a pre-employment screening which includes a medical exam (blood pressure, heart rate, height, and weight), questionnaire (demographic, lifestyle, medical, and occupational history questions), and venipuncture for measurement of serum creatinine of each individual seeking employment as a sugarcane harvester. Full details on recruitment and preemployment screening are published elsewhere [20]. Subjects for our analysis were retrospectively selected from workers seeking employment as sugarcane harvesters between November 2012 and November 2015 at the agribusiness.…”

Section: Cohortmentioning

confidence: 99%

“…Because these data were collected for hiring purposes, we were limited in our ability to examine additional hypothesized risk factors such as heat exposure [6,11], use of pesticides [36,37], and exposure to heavy metals [34,38]. Due to the structure of our data, we were unable to assess the differences in recurrent dehydration [11], NSAID use [20], and other factors previously implicated in the development of the disease between the two identified groups. There is a possibility of nondifferential misclassification of survey variables including smoking status and alcohol intake.…”

Section: Limitationsmentioning

confidence: 99%

Longitudinal trends in renal function among first time sugarcane harvesters in Guatemala

et al. 2020

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Introduction Chronic kidney disease of unknown origin (CKDu) is an epidemic concentrated in agricultural communities in Central and South America, including young, male sugarcane harvesters. The purpose of this analysis is to understand early changes in kidney function among a cohort of first-time sugarcane harvesters and to determine risk factors for kidney function decline. Methods Joint latent class mixed models were used to model sub-population kidney function trajectory over the course of 4 years (2012-2016). Probability weighted logistic regression was used to determine personal health, community, and individual behavior risk factors associated with sub-population assignment. Data analysis occurred in 2019. Results Of 181 new workers median age 19 years old (IQR: 4), 39 (22%) were identified as having non-stable kidney function with an annual age-adjusted decline of estimated glomerular filtration rate (eGFR) of-1.0 ml/min per 1.73 m 2 (95% CI:-3.4, 1.3). Kidney function (OR: 0.96; 95% CI: 0.93, 0.98), mild hypertension (OR: 5.21; 95% CI: 2.14, 13.94), and having a local home of residence (OR: 7.12; 95% CI: 2.41, 26.02) prior to employment in sugarcane were associated with non-stable eGFR sub-population assignment.

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Risk Factors for Declines in Kidney Function in Sugarcane Workers in Guatemala

Cited by 50 publications

References 34 publications

Prospective Biopsy-Based Study of CKD of Unknown Etiology in Sri Lanka

Prospective Biopsy-Based Study of CKD of Unknown Etiology in Sri Lanka

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

Longitudinal trends in renal function among first time sugarcane harvesters in Guatemala

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