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Chang CJ, Chi CY, Yang HY. Heat exposure and chronic kidney disease: a temporal link in a Taiwanese agricultural county. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:1511-1524. [PMID: 37319425 DOI: 10.1080/09603123.2023.2223514] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/02/2023] [Indexed: 06/17/2023]
Abstract
Heat stress-related kidney injury has drawn public health attention. This study explored the temporal relationships between impaired kidney function and preceding outdoor heat exposure Taiwan. Data of participants collected through a health screening program was used to assess the association between chronic kidney disease (CKD) and average ambient temperature with various time lag structures. A total of 1,243 CKD cases and 38,831 non-CKD participants were included in the study. After adjusting for demographic, socioeconomic, lifestyle factors, and comorbidities, CKD was positively associated with the ambient temperature within 1-9 months. The 9-month average ambient temperature yielded the highest odds ratio of CKD (OR = 1.22; 95% CI = 1.09-1.37). Furthermore, females and farmers were found to be more vulnerable to CKD risk after outdoor heat exposure. These findings suggest that the prevention of heat stress-related kidney injury should consider relevant time frames and focus on vulnerable populations.
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Affiliation(s)
- Che-Jui Chang
- Institute of Occupational and Environmental Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan
- Department of Family Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Chun-Yi Chi
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan
| | - Hsiao-Yu Yang
- Institute of Occupational and Environmental Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan
- Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Population Health and Welfare Research Center, National Taiwan University College of Public Health, Taipei, Taiwan
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2
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Arroyo G, Soto G, García S, Pérez-Folgar J, Bailón P, Acabal B, Cocón A, Díaz-Moscoso M, Nave F. Prevalence of kidney disease of unknown etiology in agricultural workers, Guatemala. Rev Panam Salud Publica 2023; 47:e84. [PMID: 37266488 PMCID: PMC10231270 DOI: 10.26633/rpsp.2023.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/17/2023] [Indexed: 06/03/2023] Open
Abstract
Objectives To determine the prevalence of kidney disease of unknown etiology in banana, melon, and tomato workers in north-eastern Guatemala, and to evaluate the usefulness of a cystatin C blood test for early detection of renal disease. Methods This was a cross-sectional, farm-based study of 462 agricultural workers conducted from June to September 2021. Epidemiological and demographic characteristics of the workers were collected through a self-administered questionnaire. Blood samples were obtained to determine glucose, creatinine and cystatin C levels. Anthropometric and clinical data were also recorded. Results The prevalence of kidney disease of unknown etiology was 3.03% (95% confidence interval (CI): 1.36-4.70%) based on glomerular filtration rate (GFR-EPI) < 60 mL/min/1.73 m2, with a significantly higher prevalence in banana workers (5.67%; 95% CI: 2.16-9.18%) than melon workers (p = 0.009) and tomato workers (p = 0.044). Ten workers (2.16%) had reduced kidney function (GFR-EPI 60-90 mL/min/1.73 m2). The levels of cystatin C showed less variability (coefficient of variation 46.4%) than those of creatinine (coefficient of variation 67.0%), and cystatin C levels in cases with abnormal and reduced kidney function were significantly different from cases with normal kidney function (p < 0.001). Conclusions Surveillance of the health of active farm workers and improvement of working conditions, such as sun protection, adequate hydration, and sufficient breaks, are recommended. The significant differences in cystatin C levels between cases with abnormal and reduced kidney function and those with normal kidney function suggest that cystatin C could be a useful measure for early detection of renal disease.
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Affiliation(s)
- Gerardo Arroyo
- Universidad de San Carlos de GuatemalaGuatemala CityGuatemalaUniversidad de San Carlos de Guatemala, Guatemala City, Guatemala.
| | - Gabriella Soto
- Universidad de San Carlos de GuatemalaGuatemala CityGuatemalaUniversidad de San Carlos de Guatemala, Guatemala City, Guatemala.
| | - Sofía García
- Universidad de San Carlos de GuatemalaGuatemala CityGuatemalaUniversidad de San Carlos de Guatemala, Guatemala City, Guatemala.
| | - Jorge Pérez-Folgar
- Universidad de San Carlos de GuatemalaGuatemala CityGuatemalaUniversidad de San Carlos de Guatemala, Guatemala City, Guatemala.
| | - Paola Bailón
- Universidad de San Carlos de GuatemalaGuatemala CityGuatemalaUniversidad de San Carlos de Guatemala, Guatemala City, Guatemala.
| | - Brenda Acabal
- Universidad de San Carlos de GuatemalaGuatemala CityGuatemalaUniversidad de San Carlos de Guatemala, Guatemala City, Guatemala.
| | - Anita Cocón
- Universidad de San Carlos de GuatemalaGuatemala CityGuatemalaUniversidad de San Carlos de Guatemala, Guatemala City, Guatemala.
| | - Mario Díaz-Moscoso
- Centro Universitario de Oriente (CUNORI)ChiquimulaGuatemalaCentro Universitario de Oriente (CUNORI), Chiquimula, Guatemala.
| | - Federico Nave
- Universidad de San Carlos de GuatemalaGuatemala CityGuatemalaUniversidad de San Carlos de Guatemala, Guatemala City, Guatemala.
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Cerón A. Environmental and Social Factors Associated with High Chronic Kidney Disease Mortality Rates in Municipalities of Guatemala: An Ecological Study of Municipal-Level Mortality Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085532. [PMID: 37107814 DOI: 10.3390/ijerph20085532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/25/2023] [Accepted: 04/13/2023] [Indexed: 05/11/2023]
Abstract
The purpose of this study was to determine the association between social and environmental indicators and high mortality rates from chronic kidney disease (CKD) in municipalities of Guatemala. An ecological study of municipal-level factors associated with CKD mortality in Guatemala was conducted. Crude mortality rates were calculated for the 2009-2019 period for each of the country's 340 municipalities, by gender and age groups. Municipal-level social and environmental indicators were used as independent variables. Linear regression was used for bivariate and multivariate analysis. A total of 28,723 deaths from CKD were documented for the 2009-2019 period. Average crude mortality rate for all ages for the country's 340 municipalities was 70.66 per 100,000 [0-502.99]. Very highly positive associations with high mortality rates were found in two agrarian territories where land use is mainly for permanent crops (e.g., sugar cane, coffee, rubber, banana, plantain, African palm) and pastures for cattle, with very low percentages of land covered by forests or protected areas. Social factors related to poverty and environmental factors related to agricultural use of land may play a role in the high CKD mortality rates documented in a cluster of municipalities of Guatemala.
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Affiliation(s)
- Alejandro Cerón
- Department of Anthropology, University of Denver, Denver, CO 80208, USA
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Hansson E, Wesseling C, Wegman D, Ekström U, Chavarria D, Glaser J, Jakobsson K. Point-of-care biomarkers for prediction of kidney function trajectory among sugarcane cutters: a comparative test accuracy study. BMJ Open 2022; 12:e060364. [PMID: 36400724 PMCID: PMC9677021 DOI: 10.1136/bmjopen-2021-060364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Heat-stressed Mesoamerican workers, such as sugarcane cutters, suffer from high rates of chronic kidney disease of non-traditional origin (CKDnt). We aimed to identify easily available early markers of rapid kidney function decline in a population at high risk of CKDnt. DESIGN The accuracy of different biomarkers measured during harvest for prediction of cross-harvest kidney function decline were assessed in an exploratory study group, and the performance of the most promising biomarker was then assessed in an independent confirmation group. SETTING Male sugarcane cutters in El Salvador and Nicaragua. PARTICIPANTS 39 male Salvadoran sugarcane cutters sampled fortnightly at ≤9 occasions before and after work shift during harvest. 371 male Nicaraguan sugarcane cutters were sampled as part of routine monitoring during two harvests. Cutters worked at high physical intensity at wet-bulb globe temperatures mostly above 29°C for 6-8 hours per day 6 days a week during the 5-6 months harvest season. PRIMARY OUTCOMES Change in estimated glomerular filtration rate (CKD Epidemiology Collaboration) across the harvest season (ΔeGFRcross-harvest). RESULTS Dipstick leukocyturia after work shift in the El Salvadoran group was the most promising marker, explaining >25% of ΔeGFRcross-harvest variance at 8/9 occasions during harvest. Leukocyturia was associated with experiencing fever, little or dark urine, cramps, headache, dizziness and abdominal pain in the preceding 2-week period. Decreasing blood haemoglobin (Hb) and eGFR during harvest were also predictive of ΔeGFRcross-harvest. In the Nicaraguan confirmation dataset, those having ≥++ leukocyturia at any sampling during harvest had a 13 mL/min/1.73 m2 (95% CI 10 to 16 mL/min/1.73 m2) worse ΔeGFRcross-harvest than those without recorded leukocyturia. CONCLUSION Leukocyturia and Hb, both measurable with point-of-care methods, may be early indicators for kidney injury and risk for eGFR decline among heat-stressed male workers, thereby facilitating individual-level prevention and research aiming to understand the causes of CKDnt.
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Affiliation(s)
- Erik Hansson
- La Isla Network, Washington, District of Columbia, USA
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Catharina Wesseling
- La Isla Network, Washington, District of Columbia, USA
- Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institute, Stockholm, Sweden
| | - David Wegman
- La Isla Network, Washington, District of Columbia, USA
- University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Ulf Ekström
- La Isla Network, Washington, District of Columbia, USA
- Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Denis Chavarria
- Occupational Health Management, Ingenio San Antonio/Nicaragua Sugar Estates Limited, Chichigalpa, Nicaragua
| | - Jason Glaser
- La Isla Network, Washington, District of Columbia, USA
| | - Kristina Jakobsson
- La Isla Network, Washington, District of Columbia, USA
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Kidney Function in Factory Workers Exposed to Heat Stress: A 2-Year Follow-up Study. J Occup Environ Med 2022; 64:e685-e689. [PMID: 35959898 DOI: 10.1097/jom.0000000000002666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aims of the study are to re-evaluate kidney function in workers exposed and not exposed to heat stress after 2 years and to compare kidney function cross-shift using creatinine and cystatin C. METHODS Participants were workers from a metallurgical industry. The clinical and biochemical markers of hydration and kidney function were evaluated before and after a single shift in work. RESULTS We included 14 workers (6 in the heat group and 8 in the control group). The serum creatinine levels did not change during the follow-up period. Cross-shift, creatinine-based eGFR (estimated glomerular filtration rate) decreased, and cystatin C-based eGFR was maintained in the heat and control groups. CONCLUSIONS Workers exposed to heat stress maintained their kidney function after a 2-year follow-up. Cystatin C is a better kidney function marker than creatinine for cross-shift assessments in this setting.
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Malik M, Bhatt P, Singh J, Kaushik RD, Sharma G, Kumar V. Preclinical Safety Assessment of Chemically Cross-Linked Modified Mandua Starch: Acute and Sub-Acute Oral Toxicity Studies in Swiss Albino Mice. ACS OMEGA 2022; 7:35506-35514. [PMID: 36249409 PMCID: PMC9558613 DOI: 10.1021/acsomega.2c01309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/24/2022] [Indexed: 06/16/2023]
Abstract
In the present era, 28 days of repeated-dose-toxicity study following the Organization for Economic Cooperation and Development (OECD) guidelines 407 is compulsory for every drug to go through phase 1 clinical trials. The increasing demand for high-resistant starch containing nutraceuticals and the applicability of modified starch in development of targeted drug delivery inspired us to investigate the toxic profile of mandua starch chemically cross-linked by epichlorohydrin and compare it with alkali-isolated starch in healthy adult Swiss albino mice, which can be the first step for exploring the use of epichlorohydrin-cross-linked mandua starch (ECC-MS) as a pharmaceutical excipient. Histopathological examinations of the kidney and liver did not expose noteworthy abnormalities in the treated mice. There were no clinical and mortality symptoms of toxicity observed during the repeated-dose-toxicity study. The oral consumption of ECC-MS did not pose any harm as it was neither lethal nor had any harmful hematological, biochemical, psychological, anatomical, and behavioral effects. The use of ECC-MS and alkali-isolated mandua starch (AMS) was found safe at a dose of 2000 mg/kg body weight in the acute toxicity study and at doses of 2000, 1500, and 1000 mg/kg body weight in the sub-acute toxicity study as no detrimental effects were observed after oral administration in mice for 14 and 28 days, respectively.
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Affiliation(s)
- Mayank
Kumar Malik
- Department
of Pharmaceutical Sciences, Faculty of Medical Science & Health, Gurukula Kangri (Deemed to be University), Haridwar 249407, Uttrakhand, India
- Department
of Chemistry, Faculty of Sciences, Gurukula
Kangri (Deemed to be University), Haridwar 249407, Uttrakhand, India
| | - Pankaj Bhatt
- Department
of Pharmaceutical Sciences, Faculty of Medical Science & Health, Gurukula Kangri (Deemed to be University), Haridwar 249407, Uttrakhand, India
| | - Jaspal Singh
- Department
of Chemistry, Faculty of Sciences, Gurukula
Kangri (Deemed to be University), Haridwar 249407, Uttrakhand, India
| | - Rajneesh Dutt Kaushik
- Department
of Chemistry, Faculty of Sciences, Gurukula
Kangri (Deemed to be University), Haridwar 249407, Uttrakhand, India
| | - Gaurav Sharma
- Bilwal
Medchem and Research Laboratory Pvt. Ltd., Jaipur 302023, Rajasthan, India
| | - Vipin Kumar
- Department
of Pharmaceutical Sciences, Faculty of Medical Science & Health, Gurukula Kangri (Deemed to be University), Haridwar 249407, Uttrakhand, India
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Dally M, Sorensen CJ, Butler-Dawson J, Griffin BR, Johnson RJ, Krisher L, Jaramillo D, Asensio C, Newman LS. Sugarcane Workweek Study: Mechanisms Underlying Daily Changes in Creatinine. Kidney Int Rep 2021; 6:3083-3086. [PMID: 34901578 PMCID: PMC8640536 DOI: 10.1016/j.ekir.2021.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/09/2021] [Accepted: 08/16/2021] [Indexed: 11/08/2022] Open
Affiliation(s)
- Miranda Dally
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cecilia J Sorensen
- Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jaime Butler-Dawson
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Richard J Johnson
- Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lyndsay Krisher
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Diana Jaramillo
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Lee S Newman
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Division of Pulmonary Sciences and Critical Care Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Comparison of ARIMA, ES, GRNN and ARIMA–GRNN hybrid models to forecast the second wave of COVID-19 in India and the United States. Epidemiol Infect 2021. [PMCID: PMC8632421 DOI: 10.1017/s0950268821002375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
As acute infectious pneumonia, the coronavirus disease-2019 (COVID-19) has created unique challenges for each nation and region. Both India and the United States (US) have experienced a second outbreak, resulting in a severe disease burden. The study aimed to develop optimal models to predict the daily new cases, in order to help to develop public health strategies. The autoregressive integrated moving average (ARIMA) models, generalised regression neural network (GRNN) models, ARIMA–GRNN hybrid model and exponential smoothing (ES) model were used to fit the daily new cases. The performances were evaluated by minimum mean absolute per cent error (MAPE). The predictive value with ARIMA (3, 1, 3) (1, 1, 1)14 model was closest to the actual value in India, while the ARIMA–GRNN presented a better performance in the US. According to the models, the number of daily new COVID-19 cases in India continued to decrease after 27 May 2021. In conclusion, the ARIMA model presented to be the best-fit model in forecasting daily COVID-19 new cases in India, and the ARIMA–GRNN hybrid model had the best prediction performance in the US. The appropriate model should be selected for different regions in predicting daily new cases. The results can shed light on understanding the trends of the outbreak and giving ideas of the epidemiological stage of these regions.
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Body Composition, Anemia, and Kidney Function among Guatemalan Sugarcane Workers. Nutrients 2021; 13:nu13113928. [PMID: 34836182 PMCID: PMC8621317 DOI: 10.3390/nu13113928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/23/2021] [Accepted: 10/24/2021] [Indexed: 01/01/2023] Open
Abstract
Rates of anemia among agricultural workers, who are also at risk for kidney injury and chronic kidney disease of unknown cause (CKDu), are unknown. We evaluated body composition through the sum of three skinfolds among 203 male sugarcane cutters and assessed the relationship of variables related to nutrition, anemia (hemoglobin < 13 g/dL), and elevated hemoglobin A1c (HbA1c ≥ 5.7%) with estimated glomerular filtration rate (eGFR) using linear regression. Eleven percent of workers were at the level of essential body fat (2-5%). Anemia was present among 13% of workers, 70% of which were normochromic normocytic, a type of anemia suggesting potential underlying chronic disease. Anemia was more common among those with lower BMI and fat free mass. The prevalence of elevated HbA1c was 21%. A moderate negative correlation was found between hemoglobin and HbA1c (Pearson's r = -0.32, p <0.01) which suggests that HbA1c values should be interpreted with caution in populations that have high rates of anemia. Twelve percent of workers had reduced kidney function with an eGFR < 90 mL/min/1.73 m2. On average, the eGFR was 18 mL/min per 1.73 m2 lower [(95% CI:-24, -12), p <0.01)] for those with anemia than those without, and 8 mL/min per 1.73 m2 lower among those with elevated HbA1c [(95% CI: -13, -2), p < 0.01]. Results will inform future studies examining the role of anemia in the evaluation of CKDu and interventions to improve nutrition for workers in low-resource settings.
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Valdivia Mazeyra MF, Muñoz Ramos P, Serrano R, Alonso Riaño M, Gil Giraldo Y, Quiroga B. Mesoamerican nephropathy: A not so unknown chronic kidney disease. Nefrologia 2021; 41:612-619. [PMID: 36165150 DOI: 10.1016/j.nefroe.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 03/18/2021] [Indexed: 06/16/2023] Open
Abstract
From 2000, Mesoamerican region has reached an important rate of chronic kidney disease of unknown etiology. Under the name of Meroamerican Nephropathy (MeN) several hypotheses (including dehydration, heat stress, environmental or toxic exposure or even infections) have tried to explain the etiology this new disease. MeN affects young men, agricultural workers exposed to high temperatures. MeN courses with unspecific symptoms as low-grade fever and dysuria and progressive kidney disease with impaired renal function and hydroelectrolyte disturbances. The diagnosis requires kidney biopsy showing tubule-interstitial nephritis (usually at chronic stage). Although MeN conditions a high morbi-mortality in endemic regions, there is a lack of specific treatment and only preventive measures have demonstrated some effect of prognosis (avoid heat stress, constant hydration). In this review we aim to summarize the available information of MeN, illustrating the information in a case report.
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Affiliation(s)
| | | | - Rosario Serrano
- Servicio de Anatomía Patológica, Hospital Universitario de La Princesa, Madrid, Spain
| | - Marina Alonso Riaño
- Servicio de Anatomía Patológica, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Yohana Gil Giraldo
- Servicio de Nefrología, Hospital Universitario de La Princesa, Madrid, Spain
| | - Borja Quiroga
- Servicio de Nefrología, Hospital Universitario de La Princesa, Madrid, Spain.
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Butler-Dawson J, Krisher L, Dally M, James KA, Johnson RJ, Jaramillo D, Yoder H, Johnson EC, Pilloni D, Asensio C, Cruz A, Newman LS. Sugarcane Workweek Study: Risk Factors for Daily Changes in Creatinine. Kidney Int Rep 2021; 6:2404-2414. [PMID: 34514201 PMCID: PMC8418948 DOI: 10.1016/j.ekir.2021.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Agricultural workers laboring in thermally stressful environments are at increased risk for kidney injury and chronic kidney disease of unknown origin (CKDu), and their environmental and occupational exposures have been considered to be important risk factors. This study examined the effects of repeated kidney stress from the simultaneous strain of work and other factors experienced by workers in Guatemala during a typical workweek. METHODS We collected data from 107 sugarcane workers across 7 consecutive work shifts. Data included information on daily occupational, meteorological, environmental, and lifestyle factors. We used multivariable linear mixed models to evaluate associations of these factors with percent change in creatinine. RESULTS We observed that increasing wet bulb globe temperature (β = 2.5%, 95% confidence interval [CI] = 0.3%, 4.7%) and increasing diastolic blood pressure (β = 6.2%, 95% CI = 0.9%, 11.6%) were associated with increases in creatinine across the shift, whereas consumption of water from chlorinated dormitory tanks as compared to artesian well water (β = -17.5%, 95% CI = -29.6%, -5.4%) and increasing number of rest breaks (β = -5.8%, 95% CI = -9.0%, -2.6%) were found to be protective against increases in creatinine. Workers reporting drinking tank water had lower concentrations of urine creatinine-corrected arsenic, lead, uranium, and glyphosate compared to workers reporting the use of well water or municipal water. CONCLUSION These results reinforce the need to focus on preventive actions that reduce kidney injury among this worker population, including strategies to reduce heat stress, managing blood pressure, and examining water sources of workers for nephrotoxic contaminants.
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Affiliation(s)
- Jaime Butler-Dawson
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lyndsay Krisher
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Miranda Dally
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Katherine A. James
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Richard J. Johnson
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Diana Jaramillo
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Hillary Yoder
- Department Kinesiology & Health, University of Wyoming, Laramie, Wyoming, USA
| | - Evan C. Johnson
- Department Kinesiology & Health, University of Wyoming, Laramie, Wyoming, USA
| | | | | | - Alex Cruz
- Pantaleon, Guatemala City, Guatemala
| | - Lee S. Newman
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
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Electrolyte Beverage Intake to Promote Hydration and Maintain Kidney Function in Guatemalan Sugarcane Workers Laboring in Hot Conditions. J Occup Environ Med 2021; 62:e696-e703. [PMID: 33003044 PMCID: PMC7720870 DOI: 10.1097/jom.0000000000002033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To evaluate impact of electrolyte supplementation on hydration status and health outcomes in Guatemalan agricultural workers performing heavy work under hot climatic conditions. METHODS A 3-week pragmatic trial was conducted with a group of 50 workers during the 2017 to 2018 sugarcane harvest. Workers received an electrolyte hydration intervention during 2 of the 3 weeks. Blood and urine samples were collected each week. RESULTS Increased electrolyte intake resulted in less muscle injury. Kidney function was maintained across the intervention period. Workers were adequately hydrated and average electrolyte levels remained in normal ranges. Mild indications of hyponatremia occurred at higher levels of fluid intake. CONCLUSIONS This trial demonstrates the feasibility of maintaining workers' electrolyte levels under extremely hot and humid conditions while mitigating muscle injury. Electrolyte supplementation should be added to standard workplace water, rest, and shade interventions to protect workers.
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Valdivia Mazeyra MF, Muñoz Ramos P, Serrano R, Alonso Riaño M, Gil Giraldo Y, Quiroga B. Mesoamerican nephropathy: A not so unknown chronic kidney disease. Nefrologia 2021; 41:S0211-6995(21)00100-4. [PMID: 34140176 DOI: 10.1016/j.nefro.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022] Open
Abstract
From 2000, Mesoamerican region has reached an important rate of chronic kidney disease of unknown etiology. Under the name of Meroamerican Nephropathy (MeN) several hypotheses (including dehydration, heat stress, environmental or toxic exposure or even infections) have tried to explain the etiology this new disease. MeN affects young men, agricultural workers exposed to high temperatures. MeN courses with unspecific symptoms as low-grade fever and dysuria and progressive kidney disease with impaired renal function and hydroelectrolyte disturbances. The diagnosis requires kidney biopsy showing tubule-interstitial nephritis (usually at chronic stage). Although MeN conditions a high morbi-mortality in endemic regions, there is a lack of specific treatment and only preventive measures have demonstrated some effect of prognosis (avoid heat stress, constant hydration). In this review we aim to summarize the available information of MeN, illustrating the information in a case report.
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Affiliation(s)
| | | | - Rosario Serrano
- Servicio de Anatomía Patológica, Hospital Universitario de La Princesa, Madrid, España
| | - Marina Alonso Riaño
- Servicio de Anatomía Patológica, Hospital Universitario 12 de Octubre, Madrid, España
| | - Yohana Gil Giraldo
- Servicio de Nefrología, Hospital Universitario de La Princesa, Madrid, España
| | - Borja Quiroga
- Servicio de Nefrología, Hospital Universitario de La Princesa, Madrid, España.
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