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Workplace Screening Identifies Clinically Significant and Potentially Reversible Kidney Injury in Heat-Exposed Sugarcane Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228552. [PMID: 33218070 PMCID: PMC7698805 DOI: 10.3390/ijerph17228552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/12/2020] [Accepted: 11/14/2020] [Indexed: 12/14/2022]
Abstract
An epidemic of chronic kidney disease of unknown origin (CKDu) has emerged in the past two decades in agricultural communities, characterized by progressive renal failure with a dearth of early clinical symptoms. The aim of this study is to improve understanding of the natural history of this disease and to evaluate the impact of an educational and behavioral intervention on the trajectories of renal decline among a cohort of Guatemalan sugarcane workers. We identified groups of workers based on their kidney function during a longitudinal parent study conducted among sugarcane workers during the 2016–2017 harvest season. At the study’s first time point in February 2017, workers who developed abnormal kidney function (AKF) (estimated glomerular filtration rate, eGFR, <60 mL/min per 1.73 m2) were placed in the AKF group, workers with reduced kidney function (RKF) (eGFR 60–89) were placed in the RKF group, and workers who maintained normal kidney function (NKF) (eGFR ≥ 90) were placed in the NKF group. As part of the study, a health promotion, behavioral and educational intervention centered on water, electrolytes, rest, and shade (WERS) was provided to all study participants. We then prospectively analyzed renal function at the three study time points in February, March, and April. Additional data collected from previous harvests allowed for retrospective analysis and we compared the rate of change in eGFR over the previous five years (2012 to 2016) for each identified group. Mixed effects linear regression with random intercepts for the workers was used to investigate the difference in rates of change for the three groups and to assess the impact of the intervention study on rate of change of kidney function during the study compared to each group’s prior trajectory, utilizing the retrospective data collected during the five years prior to the study intervention. Between 2012 and 2016, eGFR declined at a rate of 0.18 mL/min per 1.73 m2 per year for the NKF group (95% CI: −0.66, 0.29, p = 0.45), 2.02 per year for the RKF group (95% CI: 1.00, 3.03, p = 0.0001) and 7.52 per year for the AKF group (95% CI: 6.01, 9.04, p < 0.0001). All study groups stabilized or improved their trajectory of decline during the intervention. This study supports the need to institute WERS interventions and to include mid-harvest screening protocols and longitudinal tracking of kidney function among sugarcane workers at high risk of CKDu. Early detection of rapid kidney function decline combined with appropriate interventions hold promise for stopping or slowing progression of renal insufficiency among these workers.
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Butler-Dawson J, Krisher L, Yoder H, Dally M, Sorensen C, Johnson RJ, Asensio C, Cruz A, Johnson EC, Carlton EJ, Tenney L, Asturias EJ, Newman LS. Evaluation of heat stress and cumulative incidence of acute kidney injury in sugarcane workers in Guatemala. Int Arch Occup Environ Health 2019; 92:977-990. [PMID: 30997573 PMCID: PMC6768910 DOI: 10.1007/s00420-019-01426-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 03/19/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Agricultural workers worldwide exposed to heat stress could be at the risk of kidney injury, which could lead to chronic kidney disease of an unknown origin (CKDu). Hydration has been promoted as a key measure to reduce kidney injury. In the presence of a hydration intervention, the incidence of acute kidney injury (AKI) was calculated in a sugarcane worker population in Guatemala and several risk factors were evaluated. METHODS We measured kidney function at the beginning and end of the work shift at three time points in 517 sugarcane workers. We defined AKI as an increase in serum creatinine of 26.5 µmol/L or 50% or more from the pre-shift value. Associations between AKI and risk factors were examined, including interactions with hydration status. RESULTS The prevalence of dehydration post-shift (> 1.020 specific gravity) was 11% in February, 9% in March, and 6% in April. Cumulative incidence of AKI was 53% in February, 54% in March, and 51% in April. AKI was associated with increasing post-shift specific gravity, a dehydration marker, (OR 1.24, 95% CI 1.02-1.52) and with lower electrolyte solution intake (OR 0.94, 95% CI 0.89-0.99). CONCLUSIONS Dehydration and insufficient electrolyte consumption are risk factors for AKI. However even well-hydrated sugarcane workers routinely experience AKI. While hydration is important and protective, there is a need to understand other contributors to risk of AKI and identify prevention strategies with these workers.
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Affiliation(s)
- Jaime Butler-Dawson
- Department of Environmental and Occupational Health, Center for Health, Work, and Environment Colorado School of Public Health, University of Colorado, Anschutz Medical Campus 13001 E. 17th Pl., Ste. W3111, Aurora, CO, 80045, USA.
- Colorado Consortium on Climate Change and Human Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
- Department of Environmental and Occupational Health, School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
| | - Lyndsay Krisher
- Department of Environmental and Occupational Health, Center for Health, Work, and Environment Colorado School of Public Health, University of Colorado, Anschutz Medical Campus 13001 E. 17th Pl., Ste. W3111, Aurora, CO, 80045, USA
- Colorado Consortium on Climate Change and Human Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Hillary Yoder
- Department Kinesiology and Health, University of Wyoming, Laramie, WY, USA
| | - Miranda Dally
- Department of Environmental and Occupational Health, Center for Health, Work, and Environment Colorado School of Public Health, University of Colorado, Anschutz Medical Campus 13001 E. 17th Pl., Ste. W3111, Aurora, CO, 80045, USA
- Colorado Consortium on Climate Change and Human Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
- Department of Environmental and Occupational Health, School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Cecilia Sorensen
- Colorado Consortium on Climate Change and Human Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
- Department of Emergency Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Richard J Johnson
- Colorado Consortium on Climate Change and Human Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
- Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | | | | | - Evan C Johnson
- Department Kinesiology and Health, University of Wyoming, Laramie, WY, USA
| | - Elizabeth J Carlton
- Colorado Consortium on Climate Change and Human Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
- Department of Environmental and Occupational Health, School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Liliana Tenney
- Department of Environmental and Occupational Health, Center for Health, Work, and Environment Colorado School of Public Health, University of Colorado, Anschutz Medical Campus 13001 E. 17th Pl., Ste. W3111, Aurora, CO, 80045, USA
- Colorado Consortium on Climate Change and Human Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
- Department of Environmental and Occupational Health, School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Edwin J Asturias
- Division of Pediatric Infectious Diseases, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
- Center for Global Health, Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Lee S Newman
- Department of Environmental and Occupational Health, Center for Health, Work, and Environment Colorado School of Public Health, University of Colorado, Anschutz Medical Campus 13001 E. 17th Pl., Ste. W3111, Aurora, CO, 80045, USA
- Colorado Consortium on Climate Change and Human Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
- Department of Environmental and Occupational Health, School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
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