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Delgado IS, Outterson A, Ramesh V, Amador Sanchez AG, Boza AC, Lopez-Pilarte D, Amador Velázquez JJ, Friedman DJ, Brooks DR, Scammell MK, Wang C. Ethical considerations for genetic research in low-income countries: perceptions of informed consent, data sharing, and expectations in Nicaragua. Eur J Hum Genet 2023:10.1038/s41431-023-01505-7. [PMID: 38052907 DOI: 10.1038/s41431-023-01505-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/18/2023] [Accepted: 11/15/2023] [Indexed: 12/07/2023] Open
Abstract
Genetic research presents numerous ethical, legal, and social implications (ELSI), particularly when the research involves collaborations between investigators in high and low-income countries. Some ELSI issues are universal, and others are specific to context and culture. This study investigates perceptions of genetic research in Nicaragua, Central America, where local and U.S. based researchers have collaborated for over a decade. A total of 43 residents from northwestern Nicaragua, a region with high mortality rates attributed to chronic kidney disease of non-traditional causes (CKDnt), were interviewed, including research participants in ongoing studies (n = 36), health professionals (n = 3), labor leaders (n = 2), and family members of research participants (n = 2). Questions focused on informed consent, data-sharing, and post-study expectations. Audio recordings of interviews conducted in Spanish were transcribed and translated into English. English transcripts were coded and analyzed using NVivo 12 software. The lack of familiarity with terms in the consent form presented a barrier to participant comprehension of key elements of the genetic research study, raising concerns about the validity of informed consent. Research participants often viewed their participation as access to health care. Health professionals emphasized the importance of long-term partnerships between foreign-based researchers and local health institutions. Leaders and family members recommended that they be informed of research studies and allowed the opportunity to consent, as they felt the benefits and risks of research also apply to them. Our findings identified genetic research practices to be improved upon in order to be more responsive to the contextual realities of collaborators living in low-resource settings.
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Affiliation(s)
- Iris S Delgado
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA.
| | - Abigail Outterson
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Vaishnavi Ramesh
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | | | - Alfonso César Boza
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Damaris Lopez-Pilarte
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Juan José Amador Velázquez
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - David J Friedman
- Renal Division, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Daniel R Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Madeleine K Scammell
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Catharine Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
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2
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Chicas RC, Wang Y, Jennifer Weil E, Elon L, Xiuhtecutli N, C Houser M, Jones DP, M Sands J, Hertzberg V, McCauley L, Liang D. The impact of heat exposures on biomarkers of AKI and plasma metabolome among agricultural and non-agricultural workers. ENVIRONMENT INTERNATIONAL 2023; 180:108206. [PMID: 37734144 PMCID: PMC10637212 DOI: 10.1016/j.envint.2023.108206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/22/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Agricultural workers are consistently exposed to elevated heat exposures and vulnerable to acute kidney injury. The underlying pathophysiology and detailed molecular mechanisms of AKI among agricultural workers, and the disproportionate burden of HRI and heat stress exposure are not well understood, especially at the level of cellular metabolism. OBJECTIVE The aim of this study was to examine the impact of heat exposures on renal biomarkers and on the human metabolome via untargeted high-resolution metabolomics among agricultural and non-agricultural workers. METHODS Blood and urine samples were collected pre- and post-work shift from 63 agricultural workers and 27 non- agricultural workers. We evaluated pre- and post-work shift renal biomarkers and completed untargeted metabolomics using high-resolution mass spectrometry with liquid chromatography. Metabolome-wide association studies (MWAS) models identified the metabolic features differentially expressed between agricultural workers and non-agricultural workers. RESULTS Median values of pre-shift creatinine and osteopontin (p < 0.05) were higher for agricultural workers than non-agricultural workers. Metabolic pathway enrichment analyses revealed 27 diverse pathways differed between agricultural workers and non-agricultural workers (p < 0.05) including TCA cycle and urea cycle, carbohydrate metabolism, histidine metabolism and evidence for altered microbiome shikimate pathway. CONCLUSION This is the first investigation on the metabolic pathways that are affected among agricultural workers who are exposed to heat compared to non-heat exposed workers. This study shows extensive responses of central metabolic systems to heat exposures that impact human health.
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Affiliation(s)
- Roxana C Chicas
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
| | - Yilin Wang
- Rollins School of Public Health, Gangarosa Department of Environmental Health, Emory University, Atlanta, GA, USA.
| | - E Jennifer Weil
- Division of Renal Medicine, Department of Medicine, Emory University, Atlanta, GA, USA.
| | - Lisa Elon
- Rollins School of Public Health, Gangarosa Department of Environmental Health, Emory University, Atlanta, GA, USA.
| | - Nezahualcoyotl Xiuhtecutli
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA; Farmworker Association of Florida, Apopka, FL, USA.
| | - Madelyn C Houser
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
| | - Dean P Jones
- Department of Medicine, Emory University, Atlanta, GA, USA.
| | - Jeff M Sands
- Division of Renal Medicine, Department of Medicine, Emory University, Atlanta, GA, USA.
| | - Vicki Hertzberg
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
| | - Linda McCauley
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
| | - Donghai Liang
- Rollins School of Public Health, Gangarosa Department of Environmental Health, Emory University, Atlanta, GA, USA.
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Petropoulos ZE, Keogh SA, Jarquín E, López-Pilarte D, Amador Velázquez JJ, García-Trabanino R, Amador Sánchez MR, Guevara R, Gruener A, Allen DR, Leibler JH, Delgado IS, McClean MD, Friedman DJ, Brooks DR, Scammell MK. Heat stress and heat strain among outdoor workers in El Salvador and Nicaragua. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2023; 33:622-630. [PMID: 37041408 PMCID: PMC10403352 DOI: 10.1038/s41370-023-00537-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/02/2023] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND There is growing attention on occupational heat stress in Central America, as workers in this region are affected by a unique form of chronic kidney disease. Previous studies have examined wet bulb globe temperatures and estimated metabolic rates to assess heat stress, but there are limited data characterizing heat strain among these workers. OBJECTIVE The aims were to characterize heat stress and heat strain and examine whether job task, break duration, hydration practices, and kidney function were associated with heat strain. METHODS We used data from the MesoAmerican Nephropathy Occupational Study, a cohort of 569 outdoor workers in El Salvador and Nicaragua who underwent workplace exposure monitoring, including continuous measurement of core body temperature (Tc), heart rate (HR), physical activity, and wet bulb globe temperature (WBGT), over the course of three days in January 2018 - May 2018. Participants represented five industries: sugarcane, corn, plantain, brickmaking, and construction. RESULTS Median WBGTs were relatively high (>27 °C) at most sites, particularly when work shifts spanned the afternoon hours (e.g., 29.2 °C among plantain workers). Sugarcane workers, especially cane cutters in both countries and Nicaraguan agrichemical applicators, had the highest estimated metabolic rates (medians: 299-318 kcal/hr). Most workers spent little time on break (<10% of the shift), as determined by physical activity data. Overall, sugarcane workers-particularly those in Nicaragua-experienced the highest Tc and HR values. However, a few workers in other industries reached high Tc (>39 °C) as well. Impaired kidney function (estimated glomerular filtration rate <90 mL/min/1.73 m2) was associated with higher Tc and HR values, even after adjustment. SIGNIFICANCE This is the largest study to-date examining heat stress and strain among outdoor workers in Central America. Workers at sugar companies regularly experienced Tc > 38°C (76.9% of monitored person-days at Nicaraguan companies; 46.5% at Salvadoran companies). Workers with impaired kidney function had higher measures of Tc and HR. IMPACT STATEMENT This study examined levels of occupational heat stress and heat strain experienced among outdoor workers in five industries in El Salvador and Nicaragua. We characterized heat stress using wet bulb globe temperatures and estimated metabolic rate and heat strain using core body temperature and heart rate. Sugarcane workers, particularly cane cutters and Nicaraguan agrichemical applicators, performed more strenuous work and experienced greater levels of heat strain. Impaired kidney function was associated with higher heart rates and core body temperatures.
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Affiliation(s)
- Zoe E Petropoulos
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA.
| | - Sinead A Keogh
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Emmanuel Jarquín
- Agencia para el Desarrollo y la Salud Agropecuaria (AGDYSA), San Salvador, El Salvador
| | - Damaris López-Pilarte
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | | | - Ramón García-Trabanino
- Agencia para el Desarrollo y la Salud Agropecuaria (AGDYSA), San Salvador, El Salvador
- Centro de Hemodiálisis, San Salvador, El Salvador
- Emergency Social Fund for Health, Tierra Blanca, El Salvador
| | | | - Raúl Guevara
- Agencia para el Desarrollo y la Salud Agropecuaria (AGDYSA), San Salvador, El Salvador
| | - Alexa Gruener
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Dustin R Allen
- Department of Health Sciences, Boston University College of Health and Rehabilitation Sciences, Boston, MA, USA
| | - Jessica H Leibler
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Iris S Delgado
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Michael D McClean
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - David J Friedman
- Division of Nephrology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Daniel R Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Madeleine K Scammell
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
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4
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Raines NH, Leone DA, O’Callaghan-Gordo C, Ramirez-Rubio O, Amador JJ, Lopez Pilarte D, Delgado IS, Leibler JH, Embade N, Gil-Redondo R, Bruzzone C, Bizkarguenaga M, Scammell MK, Parikh SM, Millet O, Brooks DR, Friedman DJ. Metabolic Features of Increased Gut Permeability, Inflammation, and Altered Energy Metabolism Distinguish Agricultural Workers at Risk for Mesoamerican Nephropathy. Metabolites 2023; 13:325. [PMID: 36984765 PMCID: PMC10058628 DOI: 10.3390/metabo13030325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/10/2023] [Accepted: 02/18/2023] [Indexed: 02/24/2023] Open
Abstract
Mesoamerican nephropathy (MeN) is a form of chronic kidney disease found predominantly in young men in Mesoamerica. Strenuous agricultural labor is a consistent risk factor for MeN, but the pathophysiologic mechanism leading to disease is poorly understood. We compared the urine metabolome among men in Nicaragua engaged in sugarcane harvest and seed cutting (n = 117), a group at high risk for MeN, against three referents: Nicaraguans working less strenuous jobs at the same sugarcane plantations (n = 78); Nicaraguans performing non-agricultural work (n = 102); and agricultural workers in Spain (n = 78). Using proton nuclear magnetic resonance, we identified 136 metabolites among participants. Our non-hypothesis-based approach identified distinguishing urine metabolic features in the high-risk group, revealing increased levels of hippurate and other gut-derived metabolites and decreased metabolites related to central energy metabolism when compared to referent groups. Our complementary hypothesis-based approach, focused on nicotinamide adenine dinucleotide (NAD+) related metabolites, and revealed a higher kynurenate/tryptophan ratio in the high-risk group (p = 0.001), consistent with a heightened inflammatory state. Workers in high-risk occupations are distinguishable by urinary metabolic features that suggest increased gut permeability, inflammation, and altered energy metabolism. Further study is needed to explore the pathophysiologic implications of these findings.
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Affiliation(s)
- Nathan H. Raines
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Dominick A. Leone
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Cristina O’Callaghan-Gordo
- Faculty of Health Sciences, Universitat Oberta de Catalunya, 08018 Barcelona, Spain
- ISGlobal, Barcelona Institute for Global Health, 08003 Barcelona, Spain
- Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Oriana Ramirez-Rubio
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
- ISGlobal, Barcelona Institute for Global Health, 08003 Barcelona, Spain
| | - Juan José Amador
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Damaris Lopez Pilarte
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Iris S. Delgado
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Jessica H. Leibler
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA
| | - Nieves Embade
- Precision Medicine and Metabolism Laboratory, CIC bioGUNE, Basque Research and Technology Alliance (BRTA), 48160 Derio, Spain
| | - Rubén Gil-Redondo
- Precision Medicine and Metabolism Laboratory, CIC bioGUNE, Basque Research and Technology Alliance (BRTA), 48160 Derio, Spain
| | - Chiara Bruzzone
- Precision Medicine and Metabolism Laboratory, CIC bioGUNE, Basque Research and Technology Alliance (BRTA), 48160 Derio, Spain
| | - Maider Bizkarguenaga
- Precision Medicine and Metabolism Laboratory, CIC bioGUNE, Basque Research and Technology Alliance (BRTA), 48160 Derio, Spain
| | - Madeleine K. Scammell
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Samir M. Parikh
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical School, Dallas, TX 75390, USA
| | - Oscar Millet
- Precision Medicine and Metabolism Laboratory, CIC bioGUNE, Basque Research and Technology Alliance (BRTA), 48160 Derio, Spain
- CIBERehd, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Daniel R. Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - David J. Friedman
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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5
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Sasai F, Roncal-Jimenez C, Rogers K, Sato Y, Brown JM, Glaser J, Garcia G, Sanchez-Lozada LG, Rodriguez-Iturbe B, Dawson JB, Sorensen C, Hernando AA, Gonzalez-Quiroz M, Lanaspa M, Newman LS, Johnson RJ. Climate change and nephrology. Nephrol Dial Transplant 2023; 38:41-48. [PMID: 34473287 PMCID: PMC9869860 DOI: 10.1093/ndt/gfab258] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Indexed: 01/26/2023] Open
Abstract
Climate change should be of special concern for the nephrologist, as the kidney has a critical role in protecting the host from dehydration, but it is also a favorite target of heat stress and dehydration. Here we discuss how rising temperatures and extreme heat events may affect the kidney. The most severe presentation of heat stress is heat stroke, which can result in severe electrolyte disturbance and both acute and chronic kidney disease (CKD). However, lesser levels of heat stress also have multiple effects, including exacerbating kidney disease and precipitating cardiovascular events in subjects with established kidney disease. Heat stress can also increase the risk for kidney stones, cause multiple electrolyte abnormalities and induce both acute and chronic kidney disease. Recently there have been multiple epidemics of CKD of uncertain etiology in various regions of the world, including Mesoamerica, Sri Lanka, India and Thailand. There is increasing evidence that climate change and heat stress may play a contributory role in these conditions, although other causes, including toxins, could also be involved. As climate change worsens, the nephrologist should prepare for an increase in diseases associated with heat stress and dehydration.
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Affiliation(s)
- Fumihiko Sasai
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Carlos Roncal-Jimenez
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Keegan Rogers
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Yuka Sato
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jared M Brown
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Gabriela Garcia
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Bernardo Rodriguez-Iturbe
- Laboratory of Renal Physiopathology, Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City
- Instituto Nacional de Cencias Médicas y Nutrición "Salvador Zubirán", Department of Nephrology, Mexico City, Mexico
| | - Jaime Butler Dawson
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Cecilia Sorensen
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ana Andres Hernando
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marvin Gonzalez-Quiroz
- Research Centre on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua, León, Nicaragua
- Centre for Nephrology, University College London, London, UK
| | - Miguel Lanaspa
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lee S Newman
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Figueroa-Solis E, Gimeno Ruiz de Porras D, Rojas-Garbanzo M, Whitehead L, Zhang K, Delclos GL. Prevalence and Geographic Distribution of Self-Reported Chronic Kidney Disease and Potential Risk Factors in Central America. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1308. [PMID: 36674063 PMCID: PMC9859154 DOI: 10.3390/ijerph20021308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Cases for chronic kidney disease of unknown etiology (CKDu) are increasing in specific disease hotspots located in rural agricultural communities over Central America. The goal of the study was to estimate the prevalence and geographic distribution of self-reported work-related CKD and associated risk factors for CKDu by industry sector in Central America. METHODS We calculated the prevalence and distribution of self-reported CKD, work-related CKD, and suspected CKDu risk factors among the 9032 workers in the Second Central American Survey of Working Conditions and Health (II ECCTS, 2018). We mapped the distribution of suspected CKDu risk factors to work-related CKDu and weather conditions using average annual temperatures. RESULTS The primary and secondary industry sectors showed the highest proportion of males, suspected CKDu risk factors, and work-related CKD. Age (30-49 years: OR = 2.38, 95% CI 1.03-5.51), ethnicity (mestizo: OR, 7.44, 95% CI: 2.14-25.82), and exposure to high physical work demands (OR = 2.45, 95% CI: 1.18-5.09) were associated with work-related CKD. The majority of work-related CKD were reported in the western parts of Honduras and Nicaragua, in hot temperature regions, and overlapped with those areas with a high density of CKDu risk factors. Finally, some areas clustered CKDu risk factors without any work-related CKD points, mainly in the western part of Guatemala. CONCLUSION Our findings supplement prior CKDu findings regarding a high prevalence of work-related CKD among 30- to 49-year-old mestizo males in the primary and secondary sectors, in hot temperature areas, in the central and western region, and overlapping with persons reporting two or more CKDu risk factors. Moreover, several geographic areas with CKDu risk factor clusters had no reported work-related CKD. These areas represent new industries and sectors to be monitored for possible future increases of CKDu cases.
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Affiliation(s)
- Erika Figueroa-Solis
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
| | - David Gimeno Ruiz de Porras
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in San Antonio, San Antonio, TX 78229, USA
| | - Marianela Rojas-Garbanzo
- Instituto Regional de Estudios en Sustancias Tóxicas (IRET), National University of Costa Rica, Heredia 40101, Costa Rica
| | - Lawrence Whitehead
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
| | - Kai Zhang
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Albany, NY 12144, USA
| | - George L. Delclos
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX 77030, USA
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7
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Cajina-Aguirre CL, Strasma AK, Álvarez-Novoa RJ. Global Dialysis Perspective: Nicaragua. KIDNEY360 2023; 4:110-113. [PMID: 36700913 PMCID: PMC10101595 DOI: 10.34067/kid.0005572022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022]
Affiliation(s)
- Carmen L. Cajina-Aguirre
- Department of Physiological Sciences, Faculty of Medical Sciences, National Autonomous University of Nicaragua, Managua, Nicaragua
| | - Anna K. Strasma
- Division of Nephrology, Duke University School of Medicine, Durham, North Carolina
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8
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Pinkerton LE, Bertke S, Dahm MM, Kubale TL, Siegel MR, Hales TR, Yiin JH, Purdue MP, Beaumont JJ, Daniels RD. End-stage renal disease incidence in a cohort of US firefighters from San Francisco, Chicago, and Philadelphia. Am J Ind Med 2022; 65:975-984. [PMID: 36268894 PMCID: PMC9828160 DOI: 10.1002/ajim.23435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/29/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Firefighters perform strenuous work in hot environments, which may increase their risk of chronic kidney disease. The purpose of this study was to evaluate the risk of end-stage renal disease (ESRD) and types of ESRD among a cohort of US firefighters compared to the US general population, and to examine exposure-response relationships. METHODS ESRD from 1977 through 2014 was identified through linkage with Medicare data. ESRD incidence in the cohort compared to the US population was evaluated using life table analyses. Associations of all ESRD, systemic ESRD, hypertensive ESRD, and diabetic ESRD with exposure surrogates (exposed days, fire runs, and fire hours) were examined in Cox proportional hazards models adjusted for attained age (the time scale), race, birth date, fire department, and employment duration. RESULTS The incidence of all ESRD was less than expected (standardized incidence ratio (SIR) = 0.79; 95% confidence interval = 0.69-0.89, observed = 247). SIRs for ESRD types were not significantly increased. Positive associations of all ESRD, systemic ESRD, and hypertensive ESRD with exposed days were observed: however, 95% confidence intervals included one. CONCLUSIONS We found little evidence of increased risk of ESRD among this cohort of firefighters. Limitations included the inability to evaluate exposure-response relationships for some ESRD types due to small observed numbers, the limitations of the surrogates of exposure, and the lack of information on more sensitive outcome measures for potential kidney effects.
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Affiliation(s)
- Lynne E. Pinkerton
- MaximusMcLeanVirginiaUSA
- Division of Field Studies and EngineeringNational Institute for Occupational Safety and HealthCincinnatiOhioUSA
| | - Stephen Bertke
- Division of Field Studies and EngineeringNational Institute for Occupational Safety and HealthCincinnatiOhioUSA
| | - Matthew M. Dahm
- Division of Field Studies and EngineeringNational Institute for Occupational Safety and HealthCincinnatiOhioUSA
| | - Travis L. Kubale
- World Trade Center Health ProgramNational Institute for Occupational Safety and HealthWashingtonDistrict of ColumbiaUSA
| | - Miriam R. Siegel
- Division of Field Studies and EngineeringNational Institute for Occupational Safety and HealthCincinnatiOhioUSA
| | - Thomas R. Hales
- Division of Safety ResearchNational Institute for Occupational Safety and HealthDenverColoradoUSA
| | - James H. Yiin
- Office of Extramural ProgramsNational Institute for Occupational Safety and HealthAtlantaGeorgiaUSA
| | - Mark P. Purdue
- Division of Cancer Epidemiology and GeneticsNational Cancer InstituteRockvilleMarylandUSA
| | - James J. Beaumont
- Department of Public Health SciencesUniversity of California DavisDavisCaliforniaUSA
| | - Robert D. Daniels
- World Trade Center Health ProgramNational Institute for Occupational Safety and HealthWashingtonDistrict of ColumbiaUSA
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9
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Aoun M, Chelala D. Where do you live and what do you do? Two questions that might impact your kidney health. FRONTIERS IN NEPHROLOGY 2022; 2:1011964. [PMID: 37675017 PMCID: PMC10479685 DOI: 10.3389/fneph.2022.1011964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/13/2022] [Indexed: 09/08/2023]
Abstract
In many cases the social determinants of health need to be assessed through their interaction with environmental factors. This review looks at the impact of physical location and occupation of individuals on their kidney health. It examines the effect of living at high altitude on kidney function and the relationship between extreme cold or hot temperatures and the incidence of kidney injury. It reviews as well the many occupations that have been linked to kidney disease in high-income and low-and-middle-income countries. As a conclusion, this overview proposes preventive recommendations that could be individualized based on weather, altitude, socio-economic level of the country and occupation of the individual.
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Affiliation(s)
- Mabel Aoun
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
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10
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Anastario M, Rodriguez AM, Xiuhtecutli N, Wagner E. Characterization of Lifetime Agrichemical Exposure Sequences Relative to International Migration in Foreign Born Latinx Agricultural Workers Living in South Florida. J Immigr Minor Health 2022; 24:1145-1153. [PMID: 34559343 PMCID: PMC8461595 DOI: 10.1007/s10903-021-01278-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 11/30/2022]
Abstract
There is a limited understanding of how toxic exposures to agrichemicals vary relative to international migration over the life course. A life history calendar (LHC) was piloted to explore sequences of agrichemical exposure relative to international migration. LHCs were administered to 41 foreign born individuals from Mexico and Central America who had agricultural work experience during their lifetime and who were living in South Florida. Social sequence analysis was used to explore occupation-by-agrichemical events relative to migration. A three-cluster solution was used to classify low, moderate, and high lifetime exposure sequences. The odds of any perceived effects of agrichemicals on the body increased with time prior to migration in the moderate and high exposure sequence clusters and continued to increase 20% with each year following migration in the moderate exposure cluster. Workers with high lifetime agrichemical exposures prior to migrating internationally showed lower likelihoods of a perceived effect on the body following migration despite continued exposure. Further research on instrument validity is warranted.
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Affiliation(s)
- Mike Anastario
- Robert Stempel College of Public Health & Social Work, Florida International University, ACH5 11200 SW 8th St, Miami, FL, 33174, USA.
| | - Ana Maria Rodriguez
- Robert Stempel College of Public Health & Social Work, Florida International University, ACH5 11200 SW 8th St, Miami, FL, 33174, USA
| | | | - Eric Wagner
- Robert Stempel College of Public Health & Social Work, Florida International University, ACH5 11200 SW 8th St, Miami, FL, 33174, USA
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11
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Al-Bouwarthan M, AlMulla AA, Yaseen M. The impact of heat on kidney health: A PRISMA-compliant bibliometric analysis. Medicine (Baltimore) 2022; 101:e30328. [PMID: 36086778 PMCID: PMC10980493 DOI: 10.1097/md.0000000000030328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 07/19/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Exposure to excessive heat can impact kidney health. Climate change is projected to aggravate this impact. An analysis of articles published between 1958 and 2021 was conducted to explore the progress of the research on this issue. METHODS This study included a bibliometric analysis wherein Web of Science was used to generate a list of all published articles related to the impact of heat on kidney health. Basic information about the articles, such as titles, authors' names, keywords, and citations, were recorded and analyzed. RESULTS A total of 226 published articles related to the impact of heat on kidney health were identified as of November 20, 2021. Most of these articles (93%) were published within the last decade. The United States was the most prominent country in terms of research productivity and collaboration. Researchers from the United States were well represented among the top 20 contributors of published articles on the study issue. The productivity of the top 20 authors varied between 6 and 32 articles each. A total of 25 common words used by the authors were identified. The most frequently used keywords were chronic kidney disease, heat stress, acute kidney injury, Mesoamerican nephropathy, and climate change. Keyword analysis revealed 3 distinct major research clusters in the existing scientific research on the impact of heat on kidney health: chronic kidney disease of unknown etiology, heat stress and renal physiology, and the effect of climate change on kidney health. CONCLUSIONS Research on heat-related kidney injury has witnessed rapid development in recent decades, motivated by the emergence of chronic kidney disease of unknown etiology and climate change. Developing countries in hot regions must increase their productivity in this research area through international collaboration and partnerships.
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Affiliation(s)
- Mohammed Al-Bouwarthan
- Department of Environmental Health, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulaziz A. AlMulla
- Department of Environmental Health, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Muhammad Yaseen
- Faculty of Sciences, Department of Mathematics and Statistics, University of Agriculture, Faisalabad, Pakistan
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12
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Keogh SA, Leibler JH, Sennett Decker CM, Amador Velázquez JJ, Jarquin ER, Lopez-Pilarte D, Garcia-Trabanino R, Delgado IS, Petropoulos ZE, Friedman DJ, Amador Sánchez MR, Guevara R, McClean MD, Brooks DR, Scammell MK. High prevalence of chronic kidney disease of unknown etiology among workers in the Mesoamerican Nephropathy Occupational Study. BMC Nephrol 2022; 23:238. [PMID: 35794550 PMCID: PMC9261054 DOI: 10.1186/s12882-022-02861-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 06/20/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Mortality from chronic kidney disease of unknown etiology (CKDu) is extremely high along the Pacific coast of Central America, particularly among sugarcane workers. The Mesoamerican Nephropathy Occupational Study (MANOS) is a prospective cohort study of CKDu among agricultural and non-agricultural workers in El Salvador and Nicaragua. The objective of this manuscript is to describe the MANOS cohort recruitment, baseline data collection, and CKDu prevalence after two rounds. METHODS Workers with no known diabetes, hypertension, or CKD were recruited from sugarcane, corn, plantain, brickmaking, and road construction industries (n = 569). Investigators administered questionnaires, collected biological samples, and observed workers for three consecutive workdays at the worksite. Serum specimens were analyzed for kidney function parameters, and used to calculate estimated glomerular filtration rate (eGFR). At six months, serum was collected again prior to the work shift. CKD at baseline is defined as eGFR ≤ 60 ml/min/1.73m2 at both timepoints. Age-standardized prevalence was calculated by industry, country, and demographic measures. Kidney function parameters were compared by CKD status. RESULTS Prevalence of CKD at baseline was 7.4% (n = 42). Age-standardized prevalence was highest in Salvadoran sugarcane (14.1%), followed by Salvadoran corn (11.6%), and Nicaraguan brickmaking (8.1%). Nicaraguan sugarcane had the lowest prevalence, likely due to kidney function screenings prior to employment. CONCLUSION Despite efforts to enroll participants without CKD, our identification of prevalent CKD among agricultural and non-agricultural workers in the MANOS cohort indicates notable kidney disease in the region, particularly among sugarcane workers.
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Affiliation(s)
- Sinead A Keogh
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St. T4W, Boston, MA, 02118, USA
| | - Jessica H Leibler
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St. T4W, Boston, MA, 02118, USA
| | - Caryn M Sennett Decker
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St. T4W, Boston, MA, 02118, USA
| | - Juan Jose Amador Velázquez
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St. T4W, Boston, MA, 02118, USA
- Department of Epidemiology, Boston University School of Public Health, 715 Albany St. T3E, Boston, MA, USA
| | - Emmanuel R Jarquin
- Agencia para el Desarrollo y la Salud Agropecuaria (AGDYSA), San Salvador, El Salvador
| | - Damaris Lopez-Pilarte
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St. T4W, Boston, MA, 02118, USA
- Department of Epidemiology, Boston University School of Public Health, 715 Albany St. T3E, Boston, MA, USA
| | - Ramon Garcia-Trabanino
- Agencia para el Desarrollo y la Salud Agropecuaria (AGDYSA), San Salvador, El Salvador
- Centro de Hemodiálisis, San Salvador, El Salvador
- Emergency Social Fund for Health, Tierra Blanca, El Salvador
| | - Iris S Delgado
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St. T4W, Boston, MA, 02118, USA
- Department of Epidemiology, Boston University School of Public Health, 715 Albany St. T3E, Boston, MA, USA
| | - Zoe E Petropoulos
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St. T4W, Boston, MA, 02118, USA
| | - David J Friedman
- Division of Nephrology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Magaly Rosario Amador Sánchez
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St. T4W, Boston, MA, 02118, USA
- Department of Epidemiology, Boston University School of Public Health, 715 Albany St. T3E, Boston, MA, USA
| | - Raul Guevara
- Agencia para el Desarrollo y la Salud Agropecuaria (AGDYSA), San Salvador, El Salvador
| | - Michael D McClean
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St. T4W, Boston, MA, 02118, USA
| | - Daniel R Brooks
- Department of Epidemiology, Boston University School of Public Health, 715 Albany St. T3E, Boston, MA, USA
| | - Madeleine K Scammell
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St. T4W, Boston, MA, 02118, USA.
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Sasai F, Rogers K, Orlicky DJ, Stem A, Schaeffer J, Garcia G, Fox J, Ray MS, Butler-Dawson J, Gonzalez-Quiroz M, Leiva R, Taduri G, Anutrakulchai S, Venugopal V, Madero M, Glaser J, Wijkstrom J, Wernerson A, Brown J, Roncal-Jimenez CA, Johnson RJ. Inhaled Silica Nanoparticles Causes Chronic Kidney Disease in Rats. Am J Physiol Renal Physiol 2022; 323:F48-F58. [PMID: 35635324 DOI: 10.1152/ajprenal.00021.2022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Silica nanoparticles (SiNPs) released during the burning of sugarcane have been postulated to have a role in chronic kidney disease of unknown etiology. We tested the hypothesis that pristine SiNPs of the size present in sugarcane might cause chronic kidney injury when administered through the lung in rats. METHODS We administered 200 nm or 300 nm amorphous SiNPs twice weekly (4 mg/dose) or vehicle by oropharyngeal aspiration for 13 weeks to rats followed by sacrifice after an additional 13 weeks (26 weeks total). Tissues were evaluated for presence of SiNPs and evidence of histologic injury. RESULTS Both sizes of SiNPs caused kidney damage, with early tubular injury and inflammation (at week 13) that continued to inflammation and chronic fibrosis at week 26 despite discontinuing the SiNP administration. Both sizes of SiNPs caused local inflammation in the lung and kidney and were detected in the serum and urine at week 13, and the 200 nm particles also localized to the kidney with no evidence of retention of the 300 nm particles. At week 26 there was some clearance of the 200 nm silica from the kidneys, and urinary levels of SiNPs were reduced but still significant in both the 200 and 300 nm exposed rats. CONCLUSIONS Inhaled SiNPs causes chronic kidney injury that progresses despite stopping the SiNP administration. These findings are consistent with the hypothesis that human exposure to amorphous silica nanoparticles found in burned sugarcane fields could have a participatory role in chronic kidney disease of unknown etiology.
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Affiliation(s)
- Fumihiko Sasai
- Division of Renal Disease, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Keegan Rogers
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - David J Orlicky
- Department of Pathology, University of Colorado School of Medicine, Denver, Colorado, United States
| | - Arthur Stem
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Joshua Schaeffer
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States.,Center for Health, Work and Environment, Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | - Gabriela Garcia
- Division of Renal Disease, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Jacob Fox
- Division of Renal Disease, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Matthew S Ray
- Division of Renal Disease, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Jaime Butler-Dawson
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
| | - Marvin Gonzalez-Quiroz
- Research Centre on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua, León, Nicaragua
| | - Ricardo Leiva
- Division of Kidney Diseases, Hospital Rosales, San Salvador, El Salvador
| | | | | | - Vidhya Venugopal
- School of Public Health, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Magdalena Madero
- Division of Kidney Diseases, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | | | - Julia Wijkstrom
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Annika Wernerson
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Jared Brown
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Carlos A Roncal-Jimenez
- Division of Renal Disease, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Richard J Johnson
- Division of Renal Disease, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
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14
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Crowe J, Rojas-Valverde D, Rojas-Garbanzo M, Gutiérrez-Vargas R, Ugalde-Ramírez JA, Ledezma-Rojas JP, Cabrera-Alpizar W, Salazar-Salazar M, Mauricio-La Torre R, Valera-Amador L, van Wendel de Joode B. Kidney Function in Rice Workers Exposed to Heat and Dehydration in Costa Rica. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19094962. [PMID: 35564355 PMCID: PMC9100597 DOI: 10.3390/ijerph19094962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 12/04/2022]
Abstract
The aim of this study was to evaluate heat exposure, dehydration, and kidney function in rice workers over the course of three months, in Guanacaste, Costa Rica. We collected biological and questionnaire data across a three-month-period in male field (n = 27) and other (n = 45) workers from a rice company where chronic kidney disease of unknown origin (CKDu) is endemic. We used stepwise forward regression to determine variables associated with estimated glomerular filtration rate eGFR at enrollment and/or change in eGFR, and Poisson regression to assess associations with incident kidney injury (IKI) over the course of three months. Participants were 20−62 years old (median = 40 in both groups). Dehydration was common (≥37%) in both groups, particularly among other workers at enrollment, but field workers were more exposed to heat and had higher workloads. Low eGFR (<60 mL/min/1.73 m2) was more prevalent in field workers at enrollment (19% vs. 4%) and follow-up (26% vs. 7%). Field workers experienced incident kidney injury (IKI) more frequently than other workers: 26% versus 2%, respectively. Age (β = −0.71, 95%CI: −1.1, −0.4), current position as a field worker (β = −2.75, 95%CI: −6.49, 0.99) and past work in construction (β = 3.8, 95%CI: −0.1, 7.6) were included in the multivariate regression model to explain eGFR at enrollment. The multivariate regression model for decreased in eGFR over three month included current field worker (β = −3.9, 95%CI: −8.2, 0.4), current smoking (β= −6.2, 95%CI: −13.7−1.3), dehydration (USG ≥ 1.025) at both visits (β= −3.19, 95%CI: −7.6, 1.2) and pain medication at follow-up (β= −3.2, 95%CI: −8.2, 1.95). Current fieldwork [IR (incidence rate) = 2.2, 95%CI 1.1, 5.8) and being diabetic (IR = 1.8, 95%CI 0.9, 3.6) were associated with IKI. Low eGFR was common in field workers from a rice company in Guanacaste, and being a field worker was a risk factor for IKI, consistent with the hypothesis that occupational heat exposure is a critical risk factor for CKDu in Mesoamerica.
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Affiliation(s)
- Jennifer Crowe
- Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia 40101, Costa Rica; (M.R.-G.); (B.v.W.d.J.)
- Correspondence:
| | - Daniel Rojas-Valverde
- Centro de Investigación y Diagnóstico en Salud y Deporte (CIDISAD), Escuela de Ciencias del Movimiento Humano y Calidad de Vida (CIEMHCAVI), Universidad Nacional, Heredia 40101, Costa Rica; (D.R.-V.); (R.G.-V.); (J.A.U.-R.); (W.C.-A.)
| | - Marianela Rojas-Garbanzo
- Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia 40101, Costa Rica; (M.R.-G.); (B.v.W.d.J.)
| | - Randall Gutiérrez-Vargas
- Centro de Investigación y Diagnóstico en Salud y Deporte (CIDISAD), Escuela de Ciencias del Movimiento Humano y Calidad de Vida (CIEMHCAVI), Universidad Nacional, Heredia 40101, Costa Rica; (D.R.-V.); (R.G.-V.); (J.A.U.-R.); (W.C.-A.)
| | - José Alexis Ugalde-Ramírez
- Centro de Investigación y Diagnóstico en Salud y Deporte (CIDISAD), Escuela de Ciencias del Movimiento Humano y Calidad de Vida (CIEMHCAVI), Universidad Nacional, Heredia 40101, Costa Rica; (D.R.-V.); (R.G.-V.); (J.A.U.-R.); (W.C.-A.)
| | - José Pablo Ledezma-Rojas
- Masters Program in Occupational Health, Universidad Nacional-Instituto Tecnológico de Costa Rica, Heredia 40101, Costa Rica;
| | - William Cabrera-Alpizar
- Centro de Investigación y Diagnóstico en Salud y Deporte (CIDISAD), Escuela de Ciencias del Movimiento Humano y Calidad de Vida (CIEMHCAVI), Universidad Nacional, Heredia 40101, Costa Rica; (D.R.-V.); (R.G.-V.); (J.A.U.-R.); (W.C.-A.)
| | | | | | | | - Berna van Wendel de Joode
- Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia 40101, Costa Rica; (M.R.-G.); (B.v.W.d.J.)
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Glaser J, Wegman DH, Arias-Monge E, Pacheco-Zenteno F, Prince H, Chavarria D, Martinez-Cuadra WJ, Jakobsson K, Hansson E, Lucas RAI, Weiss I, Wesseling C. Workplace Intervention for Heat Stress: Essential Elements of Design, Implementation, and Assessment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073779. [PMID: 35409463 PMCID: PMC8998134 DOI: 10.3390/ijerph19073779] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/24/2022] [Accepted: 03/14/2022] [Indexed: 11/16/2022]
Abstract
Heat stress is associated with numerous health effects that potentially harm workers, especially in a warming world. This investigation occurred in a setting where laborers are confronted with occupational heat stress from physically demanding work in high environmental temperatures. Collaboration with a major Nicaraguan sugarcane producer offered the opportunity to study interventions to prevent occupational heat-stress-related kidney disease. Two aims for this study of a rest-shade-water intervention program were: (1) describe the evolving intervention, summarize findings that motivated proposed improvements, assess impact of those improvements, and identify challenges to successful implementation and (2) extract primary lessons learned about intervention research that have both general relevance to investigations of work-related disease prevention and specific relevance to this setting. The learning curve for the various stakeholders as well as the barriers to success demonstrate that effectiveness of an intervention cannot be adequately assessed without considerations of implementation. Designing, effectively implementing, and assessing both health impacts and implementation quality is a resource-intensive endeavor requiring a transdisciplinary approach. Both general and specific lessons learned are presented for decisions on study design and study elements, implementation assessment, and management engagement in understanding how productivity and health can be successfully balanced and for building effective communication between investigators and all levels of management.
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Affiliation(s)
- Jason Glaser
- La Isla Network, 2219 California Ave NW, #52, Washington, DC 20008, USA; (E.A.-M.); (W.J.M.-C.); (K.J.); (E.H.); (R.A.I.L.); (I.W.); (C.W.)
- Correspondence: (J.G.); (D.H.W.); Tel.: +1-(347)-585-7465 (J.G.); +1-(617)-921-1506 (D.H.W.)
| | - David H. Wegman
- La Isla Network, 2219 California Ave NW, #52, Washington, DC 20008, USA; (E.A.-M.); (W.J.M.-C.); (K.J.); (E.H.); (R.A.I.L.); (I.W.); (C.W.)
- University of Massachusetts Lowell, Lowell, MA 01854, USA
- Correspondence: (J.G.); (D.H.W.); Tel.: +1-(347)-585-7465 (J.G.); +1-(617)-921-1506 (D.H.W.)
| | - Esteban Arias-Monge
- La Isla Network, 2219 California Ave NW, #52, Washington, DC 20008, USA; (E.A.-M.); (W.J.M.-C.); (K.J.); (E.H.); (R.A.I.L.); (I.W.); (C.W.)
- Unidad de Gestión Ambiental y Seguridad Laboral, Instituto Tecnológico de Costa Rica, 15th Street, 14th Avenue, Cartago 159-7050, Costa Rica
| | - Felipe Pacheco-Zenteno
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Göteborg, Sweden;
| | - Heath Prince
- Ray Marshall Center, LBJ School of Public Affairs, University of Texas at Austin, 3001 Lake Austin Blvd., Ste. 3.200, Austin, TX 78703, USA;
| | - Denis Chavarria
- Occupational Health, Ingenio San Antonio, Chinandega 26100, Nicaragua;
| | - William Jose Martinez-Cuadra
- La Isla Network, 2219 California Ave NW, #52, Washington, DC 20008, USA; (E.A.-M.); (W.J.M.-C.); (K.J.); (E.H.); (R.A.I.L.); (I.W.); (C.W.)
| | - Kristina Jakobsson
- La Isla Network, 2219 California Ave NW, #52, Washington, DC 20008, USA; (E.A.-M.); (W.J.M.-C.); (K.J.); (E.H.); (R.A.I.L.); (I.W.); (C.W.)
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Göteborg, Sweden;
- Occupational and Environmental Medicine, Sahlgrenska University Hospital, 405 30 Göteborg, Sweden
| | - Erik Hansson
- La Isla Network, 2219 California Ave NW, #52, Washington, DC 20008, USA; (E.A.-M.); (W.J.M.-C.); (K.J.); (E.H.); (R.A.I.L.); (I.W.); (C.W.)
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, 405 30 Göteborg, Sweden;
| | - Rebekah A. I. Lucas
- La Isla Network, 2219 California Ave NW, #52, Washington, DC 20008, USA; (E.A.-M.); (W.J.M.-C.); (K.J.); (E.H.); (R.A.I.L.); (I.W.); (C.W.)
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Ilana Weiss
- La Isla Network, 2219 California Ave NW, #52, Washington, DC 20008, USA; (E.A.-M.); (W.J.M.-C.); (K.J.); (E.H.); (R.A.I.L.); (I.W.); (C.W.)
| | - Catharina Wesseling
- La Isla Network, 2219 California Ave NW, #52, Washington, DC 20008, USA; (E.A.-M.); (W.J.M.-C.); (K.J.); (E.H.); (R.A.I.L.); (I.W.); (C.W.)
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Solnavägen 4, 113 65 Stockholm, Sweden
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16
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Doueihy C, Chelala D, Ossaili H, Hachem GE, Zeidan S, Ghoul BE, Aoun M. Occupational Heat Exposure as a Risk Factor for End-Stage Kidney Disease: A Case-Control Study. J Occup Environ Med 2022; 64:e103-e108. [PMID: 34879029 DOI: 10.1097/jom.0000000000002458] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE More patients are reaching end-stage kidney disease without evident cause. This study aims to explore occupational risk factors associated with hemodialysis. METHODS A multicenter matched case-control study included dialysis patients and age, sex, and diabetes-matched controls (normal kidney function). Conditional logistic regression analysis assessed occupational factors associated with dialysis. RESULTS Two hundred thirty eight hemodialysis patients and 238 controls were included. History of occupational heat exposure (odds ratio [OR] = 1.93; 95% confidence interval [CI]: 1.24 to 3.00), working as a cook (OR = 12; 95% CI: 1.56 to 92.29), as construction worker (OR = 10; 95% CI: 1.28 to 78.12) were associated with higher risk of dialysis. These results were significant in men and in those with kidney disease of unknown etiology. CONCLUSIONS Occupational heat exposure was found to be associated with hemodialysis. This is an important step for future development of preventive strategies in high-risk professions.
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Affiliation(s)
- Celina Doueihy
- Saint-Joseph University of Beirut (Dr Doueihy, Dr Chelala, Dr Ossaili, Dr Hachem, Dr Aoun), Hotel-Dieu de France Hospital (Dr Chelala), Beirut; Centre Hospitalier du Nord, Mazraat Jnaid (Dr Zeidan, Dr Ghoul); Saint-George Hospital Ajaltoun, Ajaltoun (Dr Aoun), Lebanon
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17
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Jolly AM, Thomas J. Chronic kidney disease of unknown etiology in India: a comparative study with Mesoamerican and Sri Lankan nephropathy. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:15303-15317. [PMID: 34984612 DOI: 10.1007/s11356-021-16548-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/11/2021] [Indexed: 06/14/2023]
Abstract
Chronic kidney disease of unknown etiology [CKDu] is a condition characterized by decline in kidney function and is not associated with diabetic nephropathy or hypertensive nephropathy. In this review, we have done a detailed literature analysis on CKDu in India, and then had a comparison with that of Mesoamerica and Sri Lanka. In India, CKDu became the second most common type of CKD after diabetic nephropathy. Silica was seen in the groundwater of both India and Sri Lanka, whereas in Mesoamerica silica exposure through particulate matter was seen among CKDu communities. DDE is a common agrochemical seen in both India and Sri Lanka. The risk factors vary from region to region and it is important to categorize CKDu population based on the risk factors to avoid misinterpretation of the condition as non-CKDu category and to evade further complications. More studies have to be conducted to reveal the detailed pathophysiological mechanisms and its relation with irrational exploitation of environmental resources.
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Affiliation(s)
- Aleeta Maria Jolly
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Ponekkara, Kerala, India
| | - Jaya Thomas
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Ponekkara, Kerala, India.
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18
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López-Gálvez N, Wagoner R, Canales RA, Ernst K, Burgess JL, de Zapien J, Rosales C, Beamer P. Longitudinal assessment of kidney function in migrant farm workers. ENVIRONMENTAL RESEARCH 2021; 202:111686. [PMID: 34273367 PMCID: PMC8578352 DOI: 10.1016/j.envres.2021.111686] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 05/30/2023]
Abstract
Chronic kidney disease of unknown etiology (CKDu) is an epidemic that affects young agricultural workers in several warm regions of the world. However, there is a lack of monitoring of kidney issues in regions with extremely warm environments such as the Northwest of Mexico, a semi-arid region with a growing agricultural industry, where migrant and seasonal farm workers (MSFWs) travel to work in the fields. The objective of this study was to longitudinally assess kidney functioning of MSFWs in relation to pesticide exposure, heat stress and dehydration in a large-scale farm in Mexico. We enrolled 101 MSFWs, of whom 50 were randomly selected to work in an organic certified area and 51 were randomly selected to work in a conventional area. We also enrolled 50 office workers within the same region as a reference group. We collected urine and blood samples from all workers in addition to demographic, behavioral, and occupational characteristics. The physiological strain index (PSI) was used to estimate workers' heat strain. Sampling was conducted at pre-harvest (March) and late in the harvest (July). Linear mixed models were built with the estimated glomerular filtration rate (eGFR) as the dependent variable. We found a significant decrease in kidney function in MSFWs compared to office workers. By the late harvest, one MSFW developed kidney disease, two MSFWs suffered a kidney injury, and 14 MSFWs were at risk of a kidney injury. We found that the eGFR in MSFWs decreased significantly from pre-harvest (125 ± 13.0 mL/min/1.73 m2) to late harvest (109 ± 13.6 mL/min/1.73 m2) (p < 0.001), while no significant change was observed in office workers. The eGFR was significantly lower in MSFWs who worked in the conventional field (101.2 ± 19.4 mL/min/1.73 m2) vs the organic field (110.9 ± 13.6 mL/min/1.73 m2) (p = 0.002). In our final model, we found that dehydration was associated with the decrease of eGFR. We also found an interaction between heat strain and job category, as a significant decline in eGFR by job category (conventional/organic MSFWs and office workers) was related to an increase in heat strain. This suggests that pesticide exposure needs to be considered in combination with heat stress and dehydration. This study provides valuable information on kidney function in MSFWs, and it shows the importance of early long-term monitoring in farm workers in other regions where CKDu has not been evaluated yet.
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Affiliation(s)
- Nicolás López-Gálvez
- San Diego State University Research Foundation, San Diego State University, 5250 Campanile Dr, San Diego, CA, 92182, USA; Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave, PO 245210, Tucson, AZ, 85724, USA.
| | - Rietta Wagoner
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave, PO 245210, Tucson, AZ, 85724, USA
| | - Robert A Canales
- Interdisciplinary Program in Applied Mathematics, University of Arizona, 617 N. Santa Rita Ave, PO Box 210089, Tucson, AZ, 85721, USA
| | - Kacey Ernst
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave, PO 245210, Tucson, AZ, 85724, USA
| | - Jefferey L Burgess
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave, PO 245210, Tucson, AZ, 85724, USA
| | - Jill de Zapien
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave, PO 245210, Tucson, AZ, 85724, USA
| | - Cecilia Rosales
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave, PO 245210, Tucson, AZ, 85724, USA
| | - Paloma Beamer
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave, PO 245210, Tucson, AZ, 85724, USA
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19
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Pett J, Mohamed F, Knight J, Linhart C, Osborne NJ, Taylor R. Two decades of chronic kidney disease of unknown aetiology (CKDu) research: Existing evidence and persistent gaps from epidemiological studies in Sri Lanka. Nephrology (Carlton) 2021; 27:238-247. [PMID: 34704321 PMCID: PMC9298898 DOI: 10.1111/nep.13989] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/29/2021] [Accepted: 10/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chronic Kidney Disease of unknown origin (CKDu) excludes known primary renal conditions or systemic disease (such as diabetes mellitus or hypertension). Prominence of CKDu has been noted for some decades in Sri Lanka, especially among men in particular rural areas, prompting many studies directed towards environmental causation. This article critically reviews relevant primary studies. METHODS Articles for this literature review (n = 86) were found by searching Medline, Embase, Global Health and ProQuest databases over 2000-2020 utilizing a standard algorithm. Articles were critiqued according to criteria for diagnosis of CKDu, aetiological agents investigated, analytic methods employed and findings. RESULTS Criteria for diagnosis of CKDu varied significantly, including pre-selection by proteinuria, eGFR and biopsy proven interstitial nephritis. Prevalence studies have been largely conducted in the North Central Province, with recent studies demonstrating the presence of CKDu in other regions. Aetiological factors investigated in primary studies included water source, use of agrochemicals, agricultural work, heavy metals, snake bites, ayurvedic medication, heat stress, infectious diseases and usage of tobacco and betel leaf. There is no conclusive evidence for any one aetiological agent despite consistent evidence of distal factors such as male sex, rural residence and farming. CONCLUSIONS The current body of evidence for any aetiological agent as the cause of CKDu in Sri Lanka is limited. Further research with stronger study designs is necessary to increase knowledge of aetiology of CKDu in Sri Lanka to identify and eliminate exposure to possible causative agent(s) prior to concluding that the disease is multifactorial.
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Affiliation(s)
- Jennifer Pett
- School of Population Health, University of New South Wales, Sydney, NSW, Australia.,The George Institute for Global Health, Sydney, NSW, Australia
| | - Fahim Mohamed
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine University of Peradeniya, Kandy, Sri Lanka.,Department of Pharmacy, Faculty of Allied Health, University of Peradeniya, Peradeniya, Sri Lanka.,Australian Kidney Biomarker Reference Laboratory, Department of Nephrology, Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia.,Faculty of Medicine and Health, Discipline of Biomedical Informatics and Digital Health, Clinical Pharmacology and Toxicology Research Group, The University of Sydney, Sydney, NSW, Australia
| | - John Knight
- School of Population Health, University of New South Wales, Sydney, NSW, Australia.,The George Institute for Global Health, Sydney, NSW, Australia
| | - Christine Linhart
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Nicholas J Osborne
- School of Population Health, University of New South Wales, Sydney, NSW, Australia.,School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Richard Taylor
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
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20
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Butler-Dawson J, Barnoya J, Brindley S, Krisher L, Fan W, Asensio C, Newman LS. Cross-sectional study examining the accuracy of self-reported smoking status as compared to urinary cotinine levels among workers at risk for chronic kidney disease of unknown origin in Guatemala. BMJ Open 2021; 11:e050374. [PMID: 34697113 PMCID: PMC8547360 DOI: 10.1136/bmjopen-2021-050374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 10/06/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES There is a lack of information on cotinine levels in rural populations in low-income and middle-income countries like Guatemala. Therefore, there is a need to explore smoking status and biomarkers of tobacco use in epidemiological research in rural, low-income populations, in particular those at-risk for chronic kidney disease of unknown origin (CKDu). DESIGN We evaluated self-reported smoking status against urinary cotinine levels, the gold standard biomarker of tobacco smoke exposure, among agricultural workers at four separate cross-sectional time points. SETTING Guatemala. PARTICIPANTS 283 sugarcane workers. PRIMARY OUTCOME MEASURES Compared self-reported smoking status and urinary cotinine levels in two agricultural worker studies. RESULTS Self-reported smoking prevalence was 12% among workers. According to cotinine levels (≥50 ng/mL), the smoking prevalence was 34%. Self-reported smoking status had 28% sensitivity and 96% specificity. Urinary cotinine levels show that smoking prevalence is underestimated in this worker population. CONCLUSIONS According to our findings, smoking status should be objectively measured with biomarkers rather than self-reported in CKDu epidemiological research. Self-reported smoking status is likely an underestimate of the true smoking prevalence among agricultural workers. Research on the CKDu epidemic in Central America and other parts of the world might be underestimating tobacco exposure as a potential contributor to the development of CKDu.
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Affiliation(s)
- Jaime Butler-Dawson
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Joaquin Barnoya
- Integra Cancer Institute, Guatemala City, Guatemala
- Unit for Cardiovascular Surgery, Unidad de Cirugía Cardiovascular de Guatemala, UNICAR, Guatemala City, Guatemala
| | - Stephen Brindley
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Lyndsay Krisher
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Wenyi Fan
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | | | - Lee S Newman
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, School of Medicine, and Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
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21
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Petropoulos ZE, Ramirez-Rubio O, Scammell MK, Laws RL, Lopez-Pilarte D, Amador JJ, Ballester J, O’Callaghan-Gordo C, Brooks DR. Climate Trends at a Hotspot of Chronic Kidney Disease of Unknown Causes in Nicaragua, 1973-2014. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5418. [PMID: 34069421 PMCID: PMC8159092 DOI: 10.3390/ijerph18105418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/17/2022]
Abstract
An ongoing epidemic of chronic kidney disease of uncertain etiology (CKDu) afflicts large parts of Central America and is hypothesized to be linked to heat stress at work. Mortality rates from CKDu appear to have increased dramatically since the 1970s. To explore this relationship, we assessed trends in maximum and minimum temperatures during harvest months between 1973 and 2014 as well as in the number of days during the harvest season for which the maximum temperature surpassed 35 °C. Data were collected at a weather station at a Nicaraguan sugar company where large numbers of workers have been affected by CKDu. Monthly averages of the daily maximum temperatures between 1996 and 2014 were also compared to concurrent weather data from eight Automated Surface Observing System Network weather stations across Nicaragua. Our objectives were to assess changes in temperature across harvest seasons, estimate the number of days that workers were at risk of heat-related illness and compare daily maximum temperatures across various sites in Nicaragua. The monthly average daily maximum temperature during the harvest season increased by 0.7 °C per decade between 1973 and 1990. The number of days per harvest season with a maximum temperature over 35 °C increased by approximately five days per year between 1974 and 1990, from 32 days to 114 days. Between 1991 and 2013, the number of harvest days with a maximum temperature over 35 °C decreased by two days per year, and the monthly average daily maximum temperature decreased by 0.3 °C per decade. Comparisons with weather stations across Nicaragua demonstrate that this company is located in one of the consistently hottest regions of the country.
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Affiliation(s)
- Zoe E. Petropoulos
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (M.K.S.); (R.L.L.)
| | - Oriana Ramirez-Rubio
- ISGlobal, 08003 Barcelona, Spain; (O.R.-R.); (J.B.); (C.O.-G.)
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA; (D.L.-P.); (J.J.A.); (D.R.B.)
| | - Madeleine K. Scammell
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (M.K.S.); (R.L.L.)
| | - Rebecca L. Laws
- Department of Environmental Health, Boston University School of Public Health, Boston, MA 02118, USA; (M.K.S.); (R.L.L.)
| | - Damaris Lopez-Pilarte
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA; (D.L.-P.); (J.J.A.); (D.R.B.)
| | - Juan José Amador
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA; (D.L.-P.); (J.J.A.); (D.R.B.)
| | - Joan Ballester
- ISGlobal, 08003 Barcelona, Spain; (O.R.-R.); (J.B.); (C.O.-G.)
| | - Cristina O’Callaghan-Gordo
- ISGlobal, 08003 Barcelona, Spain; (O.R.-R.); (J.B.); (C.O.-G.)
- Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain
- Faculty of Health Sciences, Universitat Oberta de Catalunya, 08018 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Daniel R. Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA; (D.L.-P.); (J.J.A.); (D.R.B.)
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22
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Hansson E, Mansourian A, Farnaghi M, Petzold M, Jakobsson K. An ecological study of chronic kidney disease in five Mesoamerican countries: associations with crop and heat. BMC Public Health 2021; 21:840. [PMID: 33933045 PMCID: PMC8088703 DOI: 10.1186/s12889-021-10822-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 04/12/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Mesoamerica is severely affected by an epidemic of Chronic Kidney Disease of non-traditional origin (CKDnt), an epidemic with a marked variation within countries. We sought to describe the spatial distribution of CKDnt in Mesoamerica and examine area-level crop and climate risk factors. METHODS CKD mortality or hospital admissions data was available for five countries: Mexico, Guatemala, El Salvador, Nicaragua and Costa Rica and linked to demographic, crop and climate data. Maps were developed using Bayesian spatial regression models. Regression models were used to analyze the association between area-level CKD burden and heat and cultivation of four crops: sugarcane, banana, rice and coffee. RESULTS There are regions within each of the five countries with elevated CKD burden. Municipalities in hot areas and much sugarcane cultivation had higher CKD burden, both compared to equally hot municipalities with lower intensity of sugarcane cultivation and to less hot areas with equally intense sugarcane cultivation, but associations with other crops at different intensity and heat levels were not consistent across countries. CONCLUSION Mapping routinely collected, already available data could be a first step to identify areas with high CKD burden. The finding of higher CKD burden in hot regions with intense sugarcane cultivation which was repeated in all five countries agree with individual-level studies identifying heavy physical labor in heat as a key CKDnt risk factor. In contrast, no associations between CKD burden and other crops were observed.
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Affiliation(s)
- Erik Hansson
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden. .,La Isla Network, Washington, D.C., USA.
| | - Ali Mansourian
- GIS Centre, Department of Physical Geography and Ecosystem Science, Lund University, Lund, Sweden
| | - Mahdi Farnaghi
- GIS Centre, Department of Physical Geography and Ecosystem Science, Lund University, Lund, Sweden
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Kristina Jakobsson
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,La Isla Network, Washington, D.C., USA.,Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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23
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Figueroa-Solis E, Gimeno Ruiz de Porras D, Delclos GL. Pilot study determining the feasibility of implementing the Disadvantaged Populations eGFR Epidemiology Study (DEGREE) protocol, point-of-care field measurements and a new module on risk factors for chronic kidney disease of unknown origin in Hispanic outdoor workers. BMC Nephrol 2021; 22:88. [PMID: 33711949 PMCID: PMC7953681 DOI: 10.1186/s12882-021-02288-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 03/02/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To field test the Disadvantaged Populations eGFR Epidemiology (DEGREE) protocol, outdoor point-of-care (POC) testing for serum creatinine, and a new risk factor module on chronic kidney disease of undetermined origin (CKDu) in U.S. outdoor Hispanic workers. METHODS Fifty workers were interviewed in Houston (TX). DEGREE and CKDu questionnaires were completed indoors. Anthropometrics and paired blood samples for POC and laboratory assay were completed outdoors over two periods (November-December 2017, April-May 2018). RESULTS Administration of DEGREE and CKDu questionnaires averaged 10 and 5 min, respectively, with all questions easily understood. We observed high correlations between POC and IDMS creatinine (r = 0.919) and BUN (r = 0.974). The POC device would disable testing when outdoor temperatures were above 85 °F or below 65 °F; this was adjustable. CONCLUSIONS Implementation of DEGREE and the new CKDu module was straightforward and well understood. The POC device performed well in the field, with some adjustment in methods when temperature readings were out of range.
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Affiliation(s)
- Erika Figueroa-Solis
- Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, USA.
| | - David Gimeno Ruiz de Porras
- grid.267309.90000 0001 0629 5880Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in San Antonio, San Antonio, TX USA ,grid.5612.00000 0001 2172 2676Center for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain ,grid.413448.e0000 0000 9314 1427CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - George L. Delclos
- grid.267308.80000 0000 9206 2401Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX USA ,grid.5612.00000 0001 2172 2676Center for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain ,grid.413448.e0000 0000 9314 1427CIBER Epidemiología y Salud Pública, Madrid, Spain
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Miller AC, Tuiz E, Shaw L, Flood D, Garcia P, Dhaenens E, Thomson DR, Barnoya J, Montano CM, Rohloff P. Population Estimates of GFR and Risk Factors for CKD in Guatemala. Kidney Int Rep 2021; 6:796-805. [PMID: 33732994 PMCID: PMC7938058 DOI: 10.1016/j.ekir.2020.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/15/2020] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) is an emerging public health priority in Central America. However, data on the prevalence of CKD in Guatemala, Central America's most populous country, are limited, especially for rural communities. METHODS We conducted a population-representative survey of 2 rural agricultural municipalities in Guatemala. We collected anthropometric data, blood pressure, serum and urine creatinine, glycosylated hemoglobin, and urine albumin. Sociodemographic, health, and exposure data were self-reported. RESULTS We enrolled 807 individuals (63% of all eligible, 35% male, mean age 39.5 years). An estimated 4.0% (95% confidence interval [CI] 2.4-6.6) had CKD, defined as an estimated glomerular filtration rate (eGFR) less than 60 ml/min per 1.73 m2. Most individuals with an eGFR below 60 ml/min per 1.73 m2 had diabetes or hypertension. In multivariable analysis, the important factors associated with risk for an eGFR less than 60 ml/min per 1.73 m2 included a history of diabetes or hypertension (adjusted odds ratio [aOR] 11.21; 95% CI 3.28-38.24), underweight (body mass index [BMI] <18.5) (aOR 21.09; 95% CI 2.05-217.0), and an interaction between sugar cane agriculture and poverty (aOR 1.10; 95% CI 1.01-1.19). CONCLUSIONS In this population-based survey, most observed CKD was associated with diabetes and hypertension. These results emphasize the urgent public health need to address the emerging epidemic of diabetes, hypertension, and CKD in rural Guatemala. In addition, the association between CKD and sugar cane in individuals living in poverty provides some circumstantial evidence for existence of CKD of unknown etiology in the study communities, which requires further investigation.
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Affiliation(s)
- Ann C. Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Eva Tuiz
- Centro de Investigación en la Salud Indígena, Wuqu’ Kawoq, Tecpán, Guatemala
| | - Leah Shaw
- Centro de Investigación en la Salud Indígena, Wuqu’ Kawoq, Tecpán, Guatemala
| | - David Flood
- Centro de Investigación en la Salud Indígena, Wuqu’ Kawoq, Tecpán, Guatemala
| | - Pablo Garcia
- Centro de Investigación en la Salud Indígena, Wuqu’ Kawoq, Tecpán, Guatemala
| | - Eloin Dhaenens
- Centro de Investigación en la Salud Indígena, Wuqu’ Kawoq, Tecpán, Guatemala
| | - Dana R. Thomson
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
| | | | | | - Peter Rohloff
- Centro de Investigación en la Salud Indígena, Wuqu’ Kawoq, Tecpán, Guatemala
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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25
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Redmon JH, Levine KE, Lebov J, Harrington J, Kondash AJ. A comparative review: Chronic Kidney Disease of unknown etiology (CKDu) research conducted in Latin America versus Asia. ENVIRONMENTAL RESEARCH 2021; 192:110270. [PMID: 33035557 DOI: 10.1016/j.envres.2020.110270] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/19/2020] [Accepted: 09/19/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The incidence of chronic kidney disease of unknown or uncertain etiology (CKDu) is recognized as a global non-communicable health crisis. The goal of this work is to compare the types of research studies in Latin America and Asia, two regions with increasing CKDu incidence. METHODS A comparative literature review was conducted to evaluate the CKDu research design for peer-reviewed articles published from 2015 to 2019. Full texts were reviewed to identify study location, study type, study design, risk factors evaluated, and if applicable, sample type and number. RESULTS In Asia and Latin America, 82 and 65 articles were identified in total, respectively, with 55 field studies in Asia versus 34 in Latin America. In Asia, research was focused on drinking water (34), heavy metals (20), and agrochemical product usage (19) as potential risk factors. In Latin America, research focused mostly on heat stress/dehydration (36) and agrochemical product usage (18) as potential CKDu risk factors. Biological samples were collected more frequently than environmental samples, especially in Latin America. DISCUSSION Research to pinpoint the risk factors associated with CKDu to date is not standardized and typically limited in geographical scope. The emphasis of CKDu research varies by geographic region, with a greater priority placed on water quality and chemical exposure in Asia, versus dehydration and heat stress in Latin America. Using a harmonized approach to CKDu research would yield improved understanding of the risk factors associated with CKDu and how they compare across affected regions.
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Affiliation(s)
| | | | - Jill Lebov
- RTI International, Research Triangle Park, NC, USA
| | | | - A J Kondash
- RTI International, Research Triangle Park, NC, USA
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26
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Sanchez Polo V, Garcia-Trabanino R, Rodriguez G, Madero M. Mesoamerican Nephropathy (MeN): What We Know so Far. Int J Nephrol Renovasc Dis 2020; 13:261-272. [PMID: 33116757 PMCID: PMC7588276 DOI: 10.2147/ijnrd.s270709] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/25/2020] [Indexed: 11/23/2022] Open
Abstract
In 2002, a report from El Salvador described a high incidence of chronic kidney disease (CKD) of unknown cause, mostly in young males from specific coastal areas. Similar situations were observed along the Pacific Ocean coastline of other Central American countries and southern Mexico (Mesoamerica). This new form of CKD has been denominated Mesoamerican endemic nephropathy (MeN). The typical presentation of MeN is a young male from an endemic area with a family history of CKD, low eGFR, high serum creatinine, low level of albuminuria, hypokalemia, hyperuricemia, and urine urate crystals. Kidney biopsy demonstrating tubulointerstitial nephritis remains the gold standard for diagnosis but is available only for a minority. Commonly proposed causes include thermal stress/dehydration and/or exposure to environmental pollutants. However, likely, a third factor, which could be genetic or epigenetic, could contribute to the cause and development of the disease, along with social determinants. Currently, preventive measures focus on minimizing workers exposure to thermal stress/dehydration. There are many research opportunities and priorities should include clinical trials to evaluate the efficacy and safety of the current treatment protocols, along with etiological and genetic studies, and the development of kidney disease data systems. Although there is scant and controversial literature with regard s to the etiology, diagnosis and management of the disease, our aim is to provide the reader a vision of the disease based on our experience.
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Affiliation(s)
| | - Ramon Garcia-Trabanino
- Centro de Hemodiálisis, San Salvador, El Salvador
- Fondo Social de Emergencia Para la Salud, Tierra Blanca, El Salvador
| | - Guillermo Rodriguez
- Service of Nephrology, Hospital Dr. R.A. Calderón Guardia, Caja Costarricense de Seguro Social, San José, Costa Rica
| | - Magdalena Madero
- Division of Nephrology, Instituto Nacional de Cardiología Ignacio Chávez, México, México
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27
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Hansson E, Glaser J, Jakobsson K, Weiss I, Wesseling C, Lucas RAI, Wei JLK, Ekström U, Wijkström J, Bodin T, Johnson RJ, Wegman DH. Pathophysiological Mechanisms by which Heat Stress Potentially Induces Kidney Inflammation and Chronic Kidney Disease in Sugarcane Workers. Nutrients 2020; 12:E1639. [PMID: 32498242 PMCID: PMC7352879 DOI: 10.3390/nu12061639] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/22/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic kidney disease of non-traditional origin (CKDnt) is common among Mesoamerican sugarcane workers. Recurrent heat stress and dehydration is a leading hypothesis. Evidence indicate a key role of inflammation. METHODS Starting in sports and heat pathophysiology literature, we develop a theoretical framework of how strenuous work in heat could induce kidney inflammation. We describe the release of pro-inflammatory substances from a leaky gut and/or injured muscle, alone or in combination with tubular fructose and uric acid, aggravation by reduced renal blood flow and increased tubular metabolic demands. Then, we analyze longitudinal data from >800 sugarcane cutters followed across harvest and review the CKDnt literature to assess empirical support of the theoretical framework. RESULTS Inflammation (CRP elevation and fever) and hyperuricemia was tightly linked to kidney injury. Rehydrating with sugary liquids and NSAID intake increased the risk of kidney injury, whereas electrolyte solution consumption was protective. Hypokalemia and hypomagnesemia were associated with kidney injury. DISCUSSION Heat stress, muscle injury, reduced renal blood flow and fructose metabolism may induce kidney inflammation, the successful resolution of which may be impaired by daily repeating pro-inflammatory triggers. We outline further descriptive, experimental and intervention studies addressing the factors identified in this study.
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Affiliation(s)
- Erik Hansson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, 405 30 Gothenburg, Sweden;
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
| | - Jason Glaser
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Kristina Jakobsson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, 405 30 Gothenburg, Sweden;
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- Occupational and Environmental Medicine, Sahlgrenska University Hospital, Box 414, 405 30 Gothenburg, Sweden
| | - Ilana Weiss
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
| | - Catarina Wesseling
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 171 65 Solna, Sweden;
| | - Rebekah A. I. Lucas
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, 142 Edgbaston Park Rd, Birmingham B15 2TT, UK
| | - Jason Lee Kai Wei
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, 2 Medical Drive, MD9, National University of Singapore, Singapore 117593, Singapore;
- Global Asia Institute, National University of Singapore, 10 Lower Kent Ridge Rd, Singapore 119076, Singapore
- N.1 Institute for Health, National University of Singapore, 28 Medical Dr, Singapore 117456, Singapore
| | - Ulf Ekström
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lund University, 221 85 Lund, Sweden
| | - Julia Wijkström
- Division of Renal Medicine, Department of Clinical Science Intervention and Technology, Karolinska Institutet, 141 86 Stockholm, Sweden;
| | - Theo Bodin
- Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 171 65 Solna, Sweden;
| | - Richard J. Johnson
- Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Aurora, CO 80045, USA;
| | - David H. Wegman
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- Department of Work Environment, University of Massachusetts Lowell, Lowell, MA 01845, USA
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Ferguson R, Leatherman S, Fiore M, Minnings K, Mosco M, Kaufman J, Kerns E, Amador JJ, Brooks DR, Fiore M, Parekh RS, Fiore L. Prevalence and Risk Factors for CKD in the General Population of Southwestern Nicaragua. J Am Soc Nephrol 2020; 31:1585-1593. [PMID: 32471819 DOI: 10.1681/asn.2019050521] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 03/24/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Studies have described Mesoamerican nephropathy among agricultural workers of El Salvador and northwestern Nicaragua. Data on prevalence and risk factors for CKD beyond agricultural workers and in other regions in Nicaragua are sparse. METHODS We recruited participants from 32 randomly selected communities in the Department of Rivas's ten municipalities in two phases. In phase 1, we screened participants using a field-based capillary creatinine measuring system and collected self-reported information on lifestyle and occupational, exposure, and health histories. Two years later, in phase 2, we enrolled 222 new participants, performing serum creatinine testing in these participants and confirmatory serum creatinine testing in phase 1 participants. RESULTS We enrolled 1242 of 1397 adults (89%) living in 533 households (median age 41 years; 43% male). We confirmed CKD (eGFR<60 ml/min per 1.73 m2) in 53 of 1227 (4.3%) evaluable participants. In multivariable testing, risk factors for prevalent CKD included age (odds ratio [OR], 1.92; 95% confidence interval [95% CI], 1.89 to 1.96) and self-reported history of hypertension (OR, 1.95; 95% CI, 1.04 to 3.64), diabetes (OR, 2.88; 95% CI, 1.40 to 5.93), or current or past work in the sugarcane industry (OR 2.92; 95% CI, 1.36 to 6.27). CONCLUSIONS Adjusted CKD prevalence was about 5% with repeat confirmatory testing in southwest Nicaragua, lower than in the northwest region. Risk factors included diabetes, hypertension, and current or prior work in the sugarcane industry but not in other forms of agricultural work. Formal CKD surveillance programs in Nicaragua are needed to assess the overall burden of CKD nationally, with a focus on agricultural workers.
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Affiliation(s)
- Ryan Ferguson
- Boston University, School of Public Health, Boston, Massachusetts
| | - Sarah Leatherman
- Boston Cooperative Studies Program Coordinating Center, Veterans Affairs, Boston Healthcare System, Boston, Massachusetts
| | - Madeline Fiore
- University of Massachusetts, School of Medicine, Worcester, Massachusetts
| | - Kailey Minnings
- University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada
| | - Martha Mosco
- New York Presbyterian Hospital, Weill Cornell, New York, New York
| | - James Kaufman
- Division of Nephrology, Veterans Affairs New York Harbor Healthcare System and New York University School of Medicine, New York, New York
| | - Eric Kerns
- Division of Nephrology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Juan Jose Amador
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Daniel R Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | | | - Rulan S Parekh
- University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada.,Division of Nephrology, Department of Pediatrics and Medicine, Hospital for Sick Children, University Health Network, Toronto, Ontario, Canada
| | - Louis Fiore
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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29
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Al-Bouwarthan M, Quinn MM, Kriebel D, Wegman DH. Risk of Kidney Injury among Construction Workers Exposed to Heat Stress: A Longitudinal Study from Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113775. [PMID: 32466510 PMCID: PMC7312975 DOI: 10.3390/ijerph17113775] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/15/2020] [Accepted: 05/24/2020] [Indexed: 12/13/2022]
Abstract
Saudi Arabia (SA) is one of the hottest countries in the world. This study was conducted to assess the impact of summer heat stress in Southeastern SA on short-term kidney injury (KI) among building construction workers and to identify relevant risk factors. Measurements of urinary albumin-creatinine ratio (ACR), height, weight, hydration, symptoms, daily work and behavioral factors were collected in June and September of 2016 from a cohort of construction workers (n = 65) in Al-Ahsa Province, SA. KI was defined as ACR ≥ 30 mg/g. Multivariate linear regression analysis was used to assess factors related to cross-summer changes in ACR. A significant increase in ACR occurred among most workers over the study period; incidence of KI was 18%. Risk factors associated with an increased ACR included dehydration, short sleep, and obesity. The findings suggest that exposure to summer heat may lead to the development of KI among construction workers in this region. Adequate hydration and promotion of healthy habits among workers may help reduce the risk of KI. A reduction in work hours may be the most effective intervention because this action can reduce heat exposure and improve sleep quality.
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Affiliation(s)
- Mohammed Al-Bouwarthan
- Department of Public Health, College of Health Sciences, University of Massachusetts Lowell, 61 Wilder Street, Lowell, MA 01854, USA; (M.M.Q.); (D.K.); (D.H.W.)
- Department of Environmental Health, College of Public Health, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
- Correspondence:
| | - Margaret M. Quinn
- Department of Public Health, College of Health Sciences, University of Massachusetts Lowell, 61 Wilder Street, Lowell, MA 01854, USA; (M.M.Q.); (D.K.); (D.H.W.)
| | - David Kriebel
- Department of Public Health, College of Health Sciences, University of Massachusetts Lowell, 61 Wilder Street, Lowell, MA 01854, USA; (M.M.Q.); (D.K.); (D.H.W.)
| | - David H. Wegman
- Department of Public Health, College of Health Sciences, University of Massachusetts Lowell, 61 Wilder Street, Lowell, MA 01854, USA; (M.M.Q.); (D.K.); (D.H.W.)
- La Isla Network, P.O. Box 816, Ada, MI 49301, USA
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30
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Scammell MK. Trust, Conflict, and Engagement in Occupational Health: North American Epidemiologists Conduct Occupational Study in Communities Affected by Chronic Kidney Disease of Unknown Origin (CKDu). Curr Environ Health Rep 2020; 6:247-255. [PMID: 31630378 DOI: 10.1007/s40572-019-00244-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW Science has been used as a tool of colonialism, and aspects of science privilege researchers in the global North (USA and Europe). The environmental justice and worker health movements in the USA and globally have influenced aspects of how occupational and environmental health research is conceived and conducted so that it is more equitable. This review provides a case example of research in the area of chronic kidney disease of unknown origin (CKDu). RECENT FINDINGS In the present work, the author describes aspects of community-based participatory research and anti-colonial research that influence a current occupational epidemiology study of CKDu in Mesoamerica among workers in agriculture and non-agricultural industries. The research includes investigators from numerous countries in the global North and South and funding from the US government and corporations. The role of industry in science and the misuse of science by corporate interests remain substantial threats to research integrity. The ability of researchers to navigate potentially conflicting interests with industry and workers, and establish trust within and outside the scientific community, is essential for sustained engagement in longitudinal studies. Trust is about human relationships. It takes time and effort to build and is essential for creating equitable, empowering research relationships.
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Affiliation(s)
- Madeleine K Scammell
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St., T442 West, Boston, MA, 02118, USA.
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31
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Wesseling C, Glaser J, Rodríguez-Guzmán J, Weiss I, Lucas R, Peraza S, da Silva AS, Hansson E, Johnson RJ, Hogstedt C, Wegman DH, Jakobsson K. Chronic kidney disease of non-traditional origin in Mesoamerica: a disease primarily driven by occupational heat stress. Rev Panam Salud Publica 2020; 44:e15. [PMID: 31998376 PMCID: PMC6984407 DOI: 10.26633/rpsp.2020.15] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/09/2020] [Indexed: 12/30/2022] Open
Abstract
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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Affiliation(s)
- Catharina Wesseling
- La Isla NetworkLa Isla NetworkWashington DCUnited States of AmericaLa Isla Network, Washington DC, United States of America.
- Karolinska InstitutetKarolinska InstitutetStockholmSwedenKarolinska Institutet, Stockholm, Sweden
| | - Jason Glaser
- La Isla NetworkLa Isla NetworkWashington DCUnited States of AmericaLa Isla Network, Washington DC, United States of America.
| | - Julieta Rodríguez-Guzmán
- Pan-American Health OrganizationPan-American Health OrganizationWashington DCUnited States of AmericaPan-American Health Organization, Washington DC, United States of America
| | - Ilana Weiss
- La Isla NetworkLa Isla NetworkWashington DCUnited States of AmericaLa Isla Network, Washington DC, United States of America.
| | - Rebekah Lucas
- University of BirminghamUniversity of BirminghamBirminghamUnited KingdomUniversity of Birmingham, Birmingham, United Kingdom
| | - Sandra Peraza
- University of El SalvadorUniversity of El SalvadorSan SalvadorEl SalvadorUniversity of El Salvador, San Salvador, El Salvador
| | - Agnes Soares da Silva
- Pan-American Health OrganizationPan-American Health OrganizationWashington DCUnited States of AmericaPan-American Health Organization, Washington DC, United States of America
| | - Erik Hansson
- University of GothenburgUniversity of GothenburgGothenburgSwedenUniversity of Gothenburg, Gothenburg, Sweden
| | - Richard J. Johnson
- University of Colorado at DenverUniversity of Colorado at DenverAuroraUnited States of AmericaUniversity of Colorado at Denver, Aurora, United States of America
| | - Christer Hogstedt
- Karolinska InstitutetKarolinska InstitutetStockholmSwedenKarolinska Institutet, Stockholm, Sweden
| | - David H. Wegman
- University of Massachusetts LowellUniversity of Massachusetts LowellLowellUnited States of AmericaUniversity of Massachusetts Lowell, Lowell, United States of America
| | - Kristina Jakobsson
- University of GothenburgUniversity of GothenburgGothenburgSwedenUniversity of Gothenburg, Gothenburg, Sweden
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