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Lucas RAI, Hansson E, Skinner BD, Arias-Monge E, Wesseling C, Ekström U, Weiss I, Castellón ZE, Poveda S, Cerda-Granados FI, Martinez-Cuadra WJ, Glaser J, Wegman DH, Jakobsson K. The work-recovery cycle of kidney strain and inflammation in sugarcane workers following repeat heat exposure at work and at home. Eur J Appl Physiol 2024:10.1007/s00421-024-05610-3. [PMID: 39369140 DOI: 10.1007/s00421-024-05610-3] [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: 11/01/2023] [Accepted: 08/24/2024] [Indexed: 10/07/2024]
Abstract
PURPOSE To examine heat exposure at work and home and the work-recovery cycle and temporal variation of kidney strain, muscle injury and inflammation biomarkers in sugarcane workers. METHODS 20 male sugarcane workers (age: 33 ± 7 years) with a workplace Rest.Shade.Hydration (RSH) intervention were observed over 4 days, at the end (18 h post-shift recovery) and beginning of a work week (42 h post-shift recovery). Measures included work intensity (heart rate), gastro-intestinal temperature, estimated body core temperature (using heart rate), fluid consumption, pre- and post-work blood and urine samples, physical activity (accelerometery) away from work, plus ambient heat exposure at work and home. RESULTS On workdays, workers awakened at approx. 02:40 after 5 h sleep in ~ 30 °C. Across work shifts, daily average WBGT ranged from 26 to 29 °C (cooler than normal) and average workload intensity ranged from 55 to 58%HRmax. Workers reported consuming ~ 8 L of water and ~ 4 × 300 mL bags of electrolyte fluid each day. Serum creatinine, cystatin C and creatine phosphokinase markedly increased post-work and decreased during recovery; serum potassium did the opposite (all p < 0.01). Biomarker concentration changes were similar between recovery periods (18 h vs. 42 h; all p > 0.27). C-reactive protein was the highest at the end of the work week (p = 0.01). CONCLUSION Despite RSH intervention, cross-shift kidney strain was marked (recovering overnight) and systemic inflammation increased over the work week. Thus, biomonitoring of kidney function in occupational populations should be performed before a work shift at any point in the work week. This is essential knowledge for field studies and surveillance.
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Affiliation(s)
- Rebekah A I Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
- La Isla Network, Washington, DC, USA.
| | - Erik Hansson
- La Isla Network, Washington, DC, USA
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bethany D Skinner
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- La Isla Network, Washington, DC, USA
| | | | - Catharina Wesseling
- La Isla Network, Washington, DC, USA
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ulf Ekström
- La Isla Network, Washington, DC, USA
- Department of Laboratory Medicine, Lund University, Lund, Sweden
| | | | | | | | | | | | | | - David H Wegman
- La Isla Network, Washington, DC, USA
- University of Massachusetts Lowell, Lowell, MA, USA
| | - Kristina Jakobsson
- La Isla Network, Washington, DC, USA
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Chicas RC, Elon L, Xiuhtecutli N, Liang D, Houser MC, Mwarumba T, Berra L, Hertzberg V, Sands JM, McCauley L. Longitudinal Renal Function Degradation Among Florida Agricultural Workers. J Occup Environ Med 2024; 66:694-705. [PMID: 38748403 PMCID: PMC11371535 DOI: 10.1097/jom.0000000000003142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
OBJECTIVE This longitudinal study evaluated renal function and acute kidney injury (AKI) over time in US agricultural workers. METHODS We followed Florida agricultural workers from January 2020 to August 2022, collecting blood and urine preworkday and postworkday during five visits. RESULTS Preworkday estimated glomerular filtration rate function in all participants was lower in summers but relatively consistent over time. In participants who worked almost exclusively in fernery operations (piece-rate compensation), we observed a high incidence of postworkday AKI in 2020 (21%) that increased to 43% by the end of the study. In comparison, 11% of nursery workers (hourly compensation) had AKI, and this rate was fairly stable. CONCLUSION AKI risk over time differs according to the type of agricultural work. Piece rate workers who are incentivized to forgo rest breaks and hydration to earn higher wages demonstrate steadily increasing rates of AKI.
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Affiliation(s)
- Roxana C Chicas
- From the Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia (R.C.C., N.X., M.C.H., V.H., L.M.C.); Rollins School of Public Health, Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia (L.E.); Farmworker Association of Florida, Apopka, Florida (N.X.); Rollins School of Public Health, Emory University, Atlanta, Georgia (D.L., L.B.); Department of Medicine, Emory University, Atlanta, Georgia (T.M.); and Division of Renal Medicine, Department of Medicine, Emory University, Atlanta, Georgia (J.M.S.)
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Yu Y, Zhang M, Tang Y, Zhai C, Hu W, Yu G, Sun H, Xu Y, Zong Q, Liu Y, Gong X, Wang F, Zou Y. Global disease burden attributable to kidney dysfunction, 1990-2019: A health inequality and trend analysis based on the global burden of disease study. Diabetes Res Clin Pract 2024; 215:111801. [PMID: 39094741 DOI: 10.1016/j.diabres.2024.111801] [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: 05/04/2024] [Revised: 07/16/2024] [Accepted: 07/29/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE This study aimed to evaluate the burden of kidney dysfunction (KD), assess socioeconomic inequalities, and project trends in the future. METHODS Data on deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) were from Global Burden of Disease Study 2019. The Joinpoint regression model was utilized to analyze the temporal trend by the annual percentage change (APC). The slope index and concentration index were employed to evaluate cross-country disparities. The future trend was predicted using an age-period-cohort analysis. RESULTS In the past three decades, the death numbers of KD increased from 1,571,720 to 3,161,552, DALYs from 42,090,331 to 76,486,945, YLDs from 5,003,267 to 11,282,484, and YLLs from 37,087,065 to 65,204,461, respectively. The age-standardized rate (ASR) of deaths, DALYs, and YLLs exhibited a declining trend. The ASR of YLDs increased until 2017, then decreased. The slope index and concentration index for DALYs increased from 248.1 to 351.9 and from 40.70 to 57.8. In the future, the ASR of deaths, DALYs, YLDs, and YLLs will remain stable, while their numbers will continue to rise, except for YLLs. CONCLUSIONS The disease burden of KD remained serious. Tailored interventions should be developed based on national contexts.
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Affiliation(s)
- Yingying Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Mingyi Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yuqin Tang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Chunxia Zhai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Wanqin Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Guanghui Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Hongyu Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Ying Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Qiqun Zong
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yuqi Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Xingyu Gong
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Fang Wang
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yanfeng Zou
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
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Hess HW, Baker TB, Tarr ML, Zoh RS, Johnson BD, Hostler D, Schlader ZJ. Creatinine clearance is maintained in a range of wet-bulb globe temperatures and work-rest ratios during simulated occupational heat stress. Am J Physiol Renal Physiol 2024; 327:F224-F234. [PMID: 38867674 PMCID: PMC11460332 DOI: 10.1152/ajprenal.00089.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/07/2024] [Accepted: 06/06/2024] [Indexed: 06/14/2024] Open
Abstract
We tested the hypothesis that compliance with the National Institute for Occupational Safety and Health (NIOSH) heat stress recommendations will prevent reductions in glomerular filtration rate (GFR) across a range of wet-bulb globe temperatures (WBGTs) and work-rest ratios at a fixed work intensity. We also tested the hypothesis that noncompliance would result in a reduction in GFR compared with a work-rest matched compliant trial. Twelve healthy adults completed five trials (four NIOSH compliant and one noncompliant) that consisted of 4 h of exposure to a range of WBGTs. Subjects walked on a treadmill (heat production: approximately 430 W) and work-rest ratios (work/h: 60, 45, 30, and 15 min) were prescribed as a function of WBGT (24°C, 26.5°C, 28.5°C, 30°C, and 36°C), and subjects drank a sport drink ad libitum. Peak core temperature (TC) and percentage change in body weight (%ΔBW) were measured. Creatinine clearance measured pre- and postexposure provided a primary marker of GFR. Peak TC did not differ among NIOSH-compliant trials (P = 0.065) but differed between compliant versus noncompliant trials (P < 0.001). %ΔBW did not differ among NIOSH-compliant trials (P = 0.131) or between compliant versus noncompliant trials (P = 0.185). Creatinine clearance did not change or differ among compliant trials (P ≥ 0.079). Creatinine clearance did not change or differ between compliant versus noncompliant trials (P ≥ 0.661). Compliance with the NIOSH recommendations maintained GFR. Surprisingly, despite a greater heat strain in a noncompliant trial, GFR was maintained highlighting the potential relative importance of hydration.NEW & NOTEWORTHY We highlight that glomerular filtration rate (GFR) is maintained during simulated occupational heat stress across a range of total work, work-rest ratios, and wet-bulb globe temperatures with ad libitum consumption of an electrolyte and sugar-containing sports drink. Compared with a work-rest matched compliant trial, noncompliance resulted in augmented heat strain but did not induce a reduction in GFR likely due to an increased relative fluid intake and robust fluid conservatory responses.
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Affiliation(s)
- Hayden W Hess
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana, United States
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York, United States
| | - Tyler B Baker
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana, United States
| | - Macie L Tarr
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana, United States
| | - Roger S Zoh
- Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana, United States
| | - Blair D Johnson
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana, United States
| | - David Hostler
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York, United States
| | - Zachary J Schlader
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana, United States
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Venugopal V, Damavarapu N, Shanmugam R, Latha PK. Occupational heat exposure and its impact on kidney health among cashew workers. J Nephrol 2024:10.1007/s40620-024-02022-6. [PMID: 39068375 DOI: 10.1007/s40620-024-02022-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 06/30/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Rising temperatures increase workers' risk of heat-related illnesses due to heat stress (HS). Chronic Kidney Disease of unknown etiology (CKDu) is rising in non-agricultural workers in hot climates. Dehydration, heat stress, and physical exertion can damage cashew workers' kidney health. METHODS In 2020-2021, 262 cashew workers in Cuddalore, Tamil Nadu were assessed for Wet Bulb Globe Temperature (WBGT), and job-specific American Conference of Governmental Industrial Hygienists standard was used to evaluate workload. "High heat-exposed" meant heat stress exceeded the Threshold Limit Value for safe manual work (27.5 °C for heavy and 28 °C for moderate physical activity). Heat Strain Indicators (HSIs) such as Tympanic Temperature (Ttemp), Sweat Rate (SwR), Urine Specific Gravity (USG), and urine dipstick parameters were measured in all workers, however serum creatinine was measured only in 100 workers. Glomerular Filtration Rate (eGFR) was calculated using the CKD-EPI equation. A standardized questionnaire assessed heat-related health symptoms. RESULTS Over 65% of workers experienced wet bulb globe temperature exposures exceeding the threshold limit value (Avg.- wet bulb globe temperature 30.4 °C ± 1.8 °C). Ninety-five percent of heat-exposed workers experienced at least one of the physiological heat strain indicators. The risk of urogenital symptoms was 7.7 times greater among high-heat-exposed workers (95% CI 3.4-17.1), which corroborates well with the measured post shift urine specific gravity (37%). Despite controlling for relevant confounders (age & gender), high-heat-exposed workers had 3.5-fold higher odds of eGFR < 90 ml/min/1.73 m2 compared to less-exposed workers (95% CI 1.1-10.6). CONCLUSION Persistent heat stress promotes heat-related disorders in cashew workers and lowers eGFR. This needs further investigation to determine its longer term effects on kidney function. Workplace cooling solutions that reduce heat stress are critically needed to protect the kidneys and ensure occupational health.
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Affiliation(s)
- Vidhya Venugopal
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, No: 1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu, 600116, India.
| | - Nikitha Damavarapu
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, No: 1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu, 600116, India
| | - Rekha Shanmugam
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, No: 1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu, 600116, India
| | - Perumal Kamalakkannan Latha
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, No: 1, Ramachandra Nagar, Porur, Chennai, Tamil Nadu, 600116, India
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Hansson E, Jakobsson K, Glaser JR, Wesseling C, Chavarria D, Lucas RAI, Prince H, Wegman DH. Response to: Letter to the Editor-Productivity as an efficacy measure in rest-shade-hydration interventions: the need for a more complete dissemination and implementation science approach by Dally M and Newman LS. Ann Work Expo Health 2024; 68:668-671. [PMID: 38829828 DOI: 10.1093/annweh/wxae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Indexed: 06/05/2024] Open
Affiliation(s)
- Erik Hansson
- La Isla Network, 2219 California NW Unit 52, 20008 Washington, District of Columbia, United States
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, 40530 Gothenburg, Sweden
| | - Kristina Jakobsson
- La Isla Network, 2219 California NW Unit 52, 20008 Washington, District of Columbia, United States
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, 40530 Gothenburg, Sweden
- Occupational and Environmental Medicine, Sahlgrenska University Hospital, Box 414, 40530 Gothenburg, Sweden
| | - Jason R Glaser
- La Isla Network, 2219 California NW Unit 52, 20008 Washington, District of Columbia, United States
| | - Catharina Wesseling
- La Isla Network, 2219 California NW Unit 52, 20008 Washington, District of Columbia, United States
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institute, Box 210, 171 77 Stockholm, Sweden
| | - Denis Chavarria
- Occupational Health Management, Ingenio San Antonio/Nicaragua Sugar Estates Limited, Km. 119 Carretera León-Chinandega, Chichigalpa, Nicaragua
| | - Rebekah A I Lucas
- La Isla Network, 2219 California NW Unit 52, 20008 Washington, District of Columbia, United States
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Heath Prince
- La Isla Network, 2219 California NW Unit 52, 20008 Washington, District of Columbia, United States
- LBJ School of Public Affairs, University of Texas at Austin, 2315 Red River St, Austin, TX 78712, United States
| | - David H Wegman
- La Isla Network, 2219 California NW Unit 52, 20008 Washington, District of Columbia, United States
- University of Massachusetts Lowell, 1 University Avenue, Lowell, MA 01854, United States
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Raines NH, Leone DA, Amador JJ, Lopez-Pilarte D, Ramírez-Rubio O, Delgado IS, Francey LJ, Leibler JH, Asara JM, Scammell MK, Parikh SM, Brooks DR, Friedman DJ. Derangement in Nicotinamide Adenine Dinucleotide Metabolism is Observed During Acute Kidney Injury Among Male Agricultural Workers at Risk for Mesoamerican Nephropathy. Kidney Int Rep 2024; 9:2250-2259. [PMID: 39081728 PMCID: PMC11284402 DOI: 10.1016/j.ekir.2024.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/08/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction Mesoamerican nephropathy (MeN) is a chronic kidney disease (CKD) which may be caused by recurrent acute kidney injury (AKI). We investigated urinary quinolinate-to-tryptophan ratio (Q/T), a validated marker of nicotinamide adenine dinucleotide (NAD+) biosynthesis that is elevated during ischemic and inflammatory AKI, in a sugarcane worker population in Nicaragua with high rates of MeN. Methods Among 693 male sugarcane workers studied, we identified 45 who developed AKI during the harvest season. We matched them 1:1 based on age and job category with 2 comparison groups: (i) "no kidney injury," active sugarcane workers with serum creatinine (sCr) <1.1 mg/dl; and (ii) "CKD," individuals no longer working in sugarcane due to their CKD, who had additional 1:1 matching for sCr. We measured urine metabolites using liquid chromatography coupled tandem mass spectrometry (LC-MS/MS) and compared Q/T and other metabolic features between the AKI and comparison groups. Results Urine Q/T was significantly higher in workers with AKI than in those with no kidney injury (median interquartile Range [IQR]: 0.104 [0.074-0.167] vs. 0.060 [0.045-0.091], P < 0.0001) and marginally higher than in workers with CKD (0.086 [0.063-0.142], P = 0.059). Urine levels of the NAD+ precursor nicotinamide were lower in the AKI group than in comparison groups. Conclusion Workers at risk for MeN who develop AKI demonstrate features of impaired NAD+ biosynthesis, thereby providing new insights into the metabolic mechanisms of injury in this population. Therapeutic use of oral nicotinamide, which may ameliorate NAD+ biosynthetic derangement and fortify against kidney injury, should be investigated to prevent AKI in this setting.
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Affiliation(s)
- Nathan H. Raines
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Dominic A. Leone
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Juan Jose Amador
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Damaris Lopez-Pilarte
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Oriana Ramírez-Rubio
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
| | - Iris S. Delgado
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Lauren J. Francey
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jessica H. Leibler
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - John M. Asara
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Signal Transduction, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Madeleine K. Scammell
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Samir M. Parikh
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Daniel R. Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - David J. Friedman
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Hansson E, Jakobsson K, Glaser J, Wesseling C, Chavarria D, Lucas RAI, Prince H, Wegman DH. Impact of heat and a rest-shade-hydration intervention program on productivity of piece-paid industrial agricultural workers at risk of chronic kidney disease of nontraditional origin. Ann Work Expo Health 2024; 68:366-375. [PMID: 38367206 PMCID: PMC11033565 DOI: 10.1093/annweh/wxae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/06/2024] [Indexed: 02/19/2024] Open
Abstract
OBJECTIVES Assess the impact of environmental heat and a rest-shade-hydration (RSH) intervention against heat stress on productivity of piece-paid Mesoamerican sugarcane cutters. These workers are at a high risk of chronic kidney disease of non-traditional origin (CKDnt), from the severe heat stress they experience due to heavy work under hot conditions. RSH interventions in these populations improve kidney health outcomes, but their impact on productivity has yet to be examined. METHODS We accessed routine productivity data from seed (SC, N = 749) and burned (BCC, N = 535) sugarcane cutters observed over five harvest seasons with increasing RSH intervention at a large Nicaraguan sugarcane mill. Hourly field-site wet-bulb globe temperature (WBGT) was recorded by mill staff and summarized as a daily mean. Mixed linear regression was used to model daily productivity, adjusting for age (18-29, 30-44, and >45 years), sex, WBGT (<28, 28-29, 29-30, 30-31, and >31 °C) on the same and preceding day, harvest season (2017-18 to 2021-22), month, and acclimatization status (<1, 1-2, and >2 weeks). RESULTS There was an inverse dose-response relationship between SC productivity and WBGT on the same and preceding days, decreasing by approximately 3%/°C WBGT. Productivity increased during the study period, i.e. coinciding with RSH scale-up, by approximately 19% in SC and 9% in BCC. CONCLUSION Agricultural worker productivity was expected lower on hotter days, strengthening the interest in all stakeholders to mitigate increasing global temperatures and their impact. Despite decreasing the total time allocated for work each day, an RSH intervention appears to result in increased productivity and no apparent loss in productivity.
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Affiliation(s)
- Erik Hansson
- La Isla Network, 2219 California NW Unit 52, 20008 Washington, District of Columbia, United States
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, 413 90 Gothenburg, Sweden
| | - Kristina Jakobsson
- La Isla Network, 2219 California NW Unit 52, 20008 Washington, District of Columbia, United States
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, 413 90 Gothenburg, Sweden
- Occupational and Environmental Medicine, Sahlgrenska University Hospital, Box 414, 413 90 Gothenburg, Sweden
| | - Jason Glaser
- La Isla Network, 2219 California NW Unit 52, 20008 Washington, District of Columbia, United States
| | - Catharina Wesseling
- La Isla Network, 2219 California NW Unit 52, 20008 Washington, District of Columbia, United States
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institute, Box 210, 171 77 Stockholm, Sweden
| | - Denis Chavarria
- Occupational Health Management, Ingenio San Antonio/Nicaragua Sugar Estates Limited, Km. 119 Carretera León-Chinandega, Chichigalpa, Nicaragua
| | - Rebekah A I Lucas
- La Isla Network, 2219 California NW Unit 52, 20008 Washington, District of Columbia, United States
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, United Kingdom
| | - Heath Prince
- La Isla Network, 2219 California NW Unit 52, 20008 Washington, District of Columbia, United States
- LBJ School of Public Affairs, University of Texas at Austin, 2315 Red River St, Austin, TX 78712,United States
| | - David H Wegman
- La Isla Network, 2219 California NW Unit 52, 20008 Washington, District of Columbia, United States
- University of Massachusetts Lowell, 1 University Avenue, Lowell, 01854 MA, United States
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Zhang Z, Heerspink HJL, Chertow GM, Correa-Rotter R, Gasparrini A, Jongs N, Langkilde AM, McMurray JJV, Mistry MN, Rossing P, Toto RD, Vart P, Nitsch D, Wheeler DC, Caplin B. Ambient heat exposure and kidney function in patients with chronic kidney disease: a post-hoc analysis of the DAPA-CKD trial. Lancet Planet Health 2024; 8:e225-e233. [PMID: 38580424 DOI: 10.1016/s2542-5196(24)00026-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Higher temperatures are associated with higher rates of hospital admissions for nephrolithiasis and acute kidney injury. Occupational heat stress is also a risk factor for kidney dysfunction in resource-poor settings. It is unclear whether ambient heat exposure is associated with loss of kidney function in patients with established chronic kidney disease. We assessed the association between heat index and change in estimated glomerular filtration rate (eGFR) in participants from the DAPA-CKD trial in a post-hoc analysis. METHODS DAPA-CKD was a randomised controlled trial of oral dapagliflozin 10 mg once daily or placebo that enrolled participants aged 18 years or older, with or without type 2 diabetes, with a urinary albumin-to-creatinine ratio of 200-5000 mg/g, and an eGFR of 25-75 mL/min per 1·73 m2. In this post-hoc analysis, we explored the association between time-varying daily centre-level heat index (ERA5 dataset) and individual-level change in eGFR in trial participants using linear mixed effect models and case-time series. The DAPA-CKD trial is registered with ClinicalTrials.gov, NCT03036150. FINDINGS Climate and eGFR data were available for 4017 (93·3%) of 4304 participants in 21 countries (mean age: 61·9 years; mean eGFR: 43·3 mL per 1·73 m2; median 28 months follow-up). Across centres, a heat index of more than 30°C occurred on a median of 0·6% of days. In adjusted linear mixed effect models, within each 120-day window, each 30 days' heat index of more than 30°C was associated with a -0·6% (95% CI -0·9% to -0·3%) change in eGFR. Similar estimates were obtained using case-time series. Additional analyses over longer time-windows showed associations consistent with haemodynamic or seasonal variability, or both, but overall estimates corresponded to an additional 3·7 mL per 1·73 m2 (95% CI 0·1 to 7·0) loss of eGFR per year in a patient with an eGFR of 45 mL per 1·73 m2 located in a very hot versus a temperate environment. INTERPRETATION Higher ambient heat exposure is associated with more rapid eGFR decline in those with established chronic kidney disease. Efforts to mitigate heat exposure should be tested as part of strategies to attenuate chronic kidney disease progression. FUNDING None.
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Affiliation(s)
- Zhiyan Zhang
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, Netherlands; The George Institute for Global Health, Sydney, NSW, Australia
| | - Glenn M Chertow
- Department of Medicine, Department of Epidemiology and Population Health, and Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Ricardo Correa-Rotter
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Antonio Gasparrini
- Environment & Health Modelling Lab, Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Niels Jongs
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, Netherlands
| | | | - John J V McMurray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Malcolm N Mistry
- Environment & Health Modelling Lab, Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK; Department of Economics, Ca' Foscari University of Venice, Venice, Italy
| | - Peter Rossing
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Robert D Toto
- Department of Internal Medicine, UT Southwestern Medical Centre, Dallas, TX, USA
| | - Priya Vart
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, Netherlands
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - David C Wheeler
- Department of Renal Medicine, University College London, London, UK
| | - Ben Caplin
- Department of Renal Medicine, University College London, London, UK.
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Hansson E, Jakobsson K, Glaser JR, Wesseling C, Chavarría D, Lucas RAI, Wegman DH. Association Between Acute Kidney Injury Hospital Visits and Environmental Heat Stress at a Nicaraguan Sugarcane Plantation. Workplace Health Saf 2024; 72:131-142. [PMID: 38591368 PMCID: PMC11055406 DOI: 10.1177/21650799241235410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
BACKGROUND Mesoamerican sugarcane cutters are at a high risk of chronic kidney disease of non-traditional origin, a disease likely linked to heat-related acute kidney injury (AKI). Studies in general populations have described a positive association between high environmental temperatures and clinically assessed kidney outcomes, but there are no studies in occupational settings. METHOD We accessed routine records of clinically diagnosed AKI (AKI-CD) and wet bulb globe temperatures (WBGT) at a large Nicaraguan sugarcane plantation and modeled the relationship between these using negative binomial regression. A rest-shade-hydration intervention was gradually enhanced during the study period, and efforts were made to increase the referral of workers with suspected AKI to healthcare. RESULTS Each 1°C WBGT was associated with an 18% (95% confidence interval [CI]: [4, 33%]) higher AKI-CD rate on the same day and a 14% (95% CI [-5, 37%]) higher rate over a week. AKI-CD rates and severity, and time between symptoms onset and diagnosis decreased during the study period, that is, with increasing rest-shade-hydration intervention. Symptoms and biochemical signs of systemic inflammation were common among AKI-CD cases. DISCUSSION Occupational heat stress, resulting from heavy work in environmental heat, was associated with a higher rate of clinically diagnosed AKI in a population at risk of CKDnt. Promoting rest-shade-hydration may have contributed to reducing AKI rates during the study period. Occupational health and safety personnel have key roles to play in enforcing rest, shade, and hydration practices, referring workers with suspected AKI to healthcare as well as collecting and analyzing the data needed to support workplace heat stress interventions.
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Affiliation(s)
- Erik Hansson
- La Isla Network, Washington, District of Columbia, USA
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristina Jakobsson
- La Isla Network, Washington, District of Columbia, USA
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Catharina Wesseling
- La Isla Network, Washington, District of Columbia, USA
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Denis Chavarría
- Occupational Health Management, Ingenio San Antonio/Nicaragua Sugar Estates Limited, Chichigalpa, Nicaragua
| | - Rebekah A. I. Lucas
- La Isla Network, Washington, District of Columbia, USA
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - David H. Wegman
- La Isla Network, Washington, District of Columbia, USA
- University of Massachusetts Lowell, Lowell, Massachusetts, USA
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11
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Chang CJ, Chi CY, Yang HY. Heat exposure and chronic kidney disease: a temporal link in a Taiwanese agricultural county. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:1511-1524. [PMID: 37319425 DOI: 10.1080/09603123.2023.2223514] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/02/2023] [Indexed: 06/17/2023]
Abstract
Heat stress-related kidney injury has drawn public health attention. This study explored the temporal relationships between impaired kidney function and preceding outdoor heat exposure Taiwan. Data of participants collected through a health screening program was used to assess the association between chronic kidney disease (CKD) and average ambient temperature with various time lag structures. A total of 1,243 CKD cases and 38,831 non-CKD participants were included in the study. After adjusting for demographic, socioeconomic, lifestyle factors, and comorbidities, CKD was positively associated with the ambient temperature within 1-9 months. The 9-month average ambient temperature yielded the highest odds ratio of CKD (OR = 1.22; 95% CI = 1.09-1.37). Furthermore, females and farmers were found to be more vulnerable to CKD risk after outdoor heat exposure. These findings suggest that the prevention of heat stress-related kidney injury should consider relevant time frames and focus on vulnerable populations.
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Affiliation(s)
- Che-Jui Chang
- Institute of Occupational and Environmental Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan
- Department of Family Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Chun-Yi Chi
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan
| | - Hsiao-Yu Yang
- Institute of Occupational and Environmental Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan
- Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Population Health and Welfare Research Center, National Taiwan University College of Public Health, Taipei, Taiwan
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12
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Gonzalez-Quiroz M, Heggeseth B, Camacho A, Oomatia A, Al-Rashed AM, Zhang Y, McCreight A, Jewell N, Aragon A, Nitsch D, Pearce N, Caplin B. Population-level detection of early loss of kidney function: 7-year follow-up of a young adult cohort at risk of Mesoamerican nephropathy. Int J Epidemiol 2024; 53:dyad151. [PMID: 37930052 PMCID: PMC10859140 DOI: 10.1093/ije/dyad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Mesoamerican nephropathy is a leading contributor to premature mortality in Central America. Efforts to identify the cause are hampered by difficulties in distinguishing associations with potential initiating factors from common exposures thought to exacerbate the progression of all forms of established chronic kidney disease (CKD). We explored evidence of disease onset or departure from the healthy estimated glomerular filtration rate distribution [departure from ∼eGFR(healthy)] in an at-risk population. METHODS Two community-based cohorts (adults aged 18-30 years, n = 351 and 420) from 11 rural communities in Northwest Nicaragua were followed up over 7 and 3 years respectively. We examined associations with both (i) incident CKD and (ii) the time point of departure from ∼eGFR(healthy), using a hidden Markov model. RESULTS CKD occurred in men only (male incidence rate: 0.7%/year). Fifty-three (out of 1878 visits, 2.7%) and 8 (out of 1067 visits, 0.8%) episodes of probable departure from ∼eGFR(healthy) occurred in men and women, respectively. Cumulative time in sugarcane work and symptoms of excess occupational sun exposure were associated with incident CKD. The same exposures were associated with probability of departure from ∼eGFR(healthy) in time-updated analyses along with measured and self-reported weight loss, nausea, vomiting and cramps, as well as non-steroidal anti-inflammatory drug use. CONCLUSIONS CKD burden in this population is high and risk factors for established disease are occupational. Additionally, a syndrome suggesting an alternative exposure is associated with evidence of disease onset supporting a possible separate unknown initiating factor for which further investigation is needed. Interventions to reduce the impact of occupational risks should be pursued meanwhile.
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Affiliation(s)
- Marvin Gonzalez-Quiroz
- Department of Renal Medicine, University College London, London, UK
- Wuqu’ Kawoq Maya Health Alliance, Chimaltenango, Guatemala
| | - Brianna Heggeseth
- Department of Mathematics, Statistics, and Computer Science, Macalester College, St Paul, MN, USA
| | - Armando Camacho
- Research Centre on Health, Work and Environment, National Autonomous University of Nicaragua, León (UNAN-Leon), León, Nicaragua
| | - Amin Oomatia
- Department of Renal Medicine, University College London, London, UK
| | - Ali M Al-Rashed
- Department of Renal Medicine, University College London, London, UK
| | - Yixuan Zhang
- Department of Mathematics, Statistics, and Computer Science, Macalester College, St Paul, MN, USA
| | - Alexander McCreight
- Department of Mathematics, Statistics, and Computer Science, Macalester College, St Paul, MN, USA
| | - Nicholas Jewell
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Aurora Aragon
- Wuqu’ Kawoq Maya Health Alliance, Chimaltenango, Guatemala
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Ben Caplin
- Department of Renal Medicine, University College London, London, UK
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13
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Albu I, Elon L, Xiuhtecutli N, McCauley L, Chicas R. Retention of Agricultural Workers Participating in a Renal Longitudinal Study. J Agromedicine 2024; 29:26-33. [PMID: 37574800 PMCID: PMC10841276 DOI: 10.1080/1059924x.2023.2246966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
OBJECTIVES The relationship between heat stress, chronic kidney diseases and acute kidney injury has been documented in cross-sectional studies with agricultural workers. However, only a few international studies have assessed renal function in agricultural workers longitudinally. Our research study, Occupational Heat Exposure and Renal Dysfunction (OHEaRD) is the first longitudinal study in the U.S. that monitored renal function in agricultural workers five times over the course of 32-months. The main objectives of this study were to evaluate the rate of retention and identify predictors associated with retention in a longitudinal study with agricultural workers. METHODS In January 2020, we enrolled 119 Florida agricultural workers to observe on 5 workdays over 32 months. Retention was defined by the number of follow-up visits that a participant attended, the consistency of visit attendance, and attendance at the last visit. Participants were provided hemoglobin A1C, lipid panel, creatinine measurement, glomerular filtration rate (eGFR), blood pressure, and body mass index results and an incentive gift card were handed out to participants at each visit. RESULTS Four enrollees did not participate on any workday, thus analysis concentrated on the remaining 115 participants. The majority of participants (64%) completed the 32-month study, 78% completed at least 4 visits, and 55% completed all 5 visits. The statistically significant predictors of higher retention among this study were being older in age (p=0.02), Mexican nationality (p=0.004), working in ferneries (p=0.009), more years working in agriculture (p=0.02), and higher total cholesterol (p=0.02). Appreciation for the health tests was associated with greater participation at the final visit (p=0.01). CONCLUSION Retention in longitudinal studies is crucial to better understand kidney disease among agricultural workers, an understudied population. Participants reported valuing the access to health results, indicating that implementing point-of-care health screenings and providing the health results to each participant is a good retention strategy. There was some evidence that a participant living with or being related to a fellow co-participant could impact retention as they either showed up or missed visits together, suggesting recruiting from the same household may reduce retention.
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Affiliation(s)
- Ioana Albu
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Lisa Elon
- Rollins School of Public Health, Department of Biostatistics and Bioinformatics, 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
| | - Linda McCauley
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Roxana Chicas
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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14
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Lan R, Qin Y, Chen X, Hu J, Luo W, Shen Y, Li X, Mao L, Ye H, Wang Z. Risky working conditions and chronic kidney disease. J Occup Med Toxicol 2023; 18:26. [PMID: 37964292 PMCID: PMC10644450 DOI: 10.1186/s12995-023-00393-3] [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: 08/30/2023] [Accepted: 11/06/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Individuals in the workplace are exposed to various environments, tasks, and schedules. Previous studies have indicated a link between occupational exposures and an increased risk of chronic kidney disease (CKD). However, the social conditions of the work environment may also be a crucial contributing factor to CKD. Furthermore, individuals may encounter multiple occupational-related risk factors simultaneously, underscoring the importance of investigating the joint risk of different working conditions on CKD. METHODS A prospective analysis of 65,069 UK Biobank participants aged 40 to 69 years without CKD at baseline (2006-2010) was performed. A self-administered questionnaire assessed working conditions and a working conditions risk score were developed. Participants who answered "sometimes" or "often" exposure to occupational heat or occupational secondhand cigarette smoke; involved in shift work or heavy workloads ("usually" or "always"), were grouped as high-risk working conditions. Each working condition was scored as 1 if grouped as high-risk, and 0 if not. The working conditions risk score was equal to the sum of these four working conditions. Cox proportional hazard regression models were used to estimate the associations between working conditions and CKD incidence. RESULTS The mean follow-up time was 6.7 years. After adjusting for demographic, lifestyle, and working time factors, the hazard ratios for the development of CKD for heavy workloads, shift work, occupational secondhand cigarette smoke exposure, and occupational heat exposure were 1.24 (95%CI = 1.03, 1.51), 1.33 (95%CI = 1.10, 1.62), 1.13 (95%CI = 1.01, 1.26), 1.11 (95%CI = 0.99, 1.24), respectively. The risk of CKD was found to be significantly associated with an increasing working conditions risk score. Individuals with a working conditions risk score of 4 had an 88.0% (95% CI = 1.05, 3.35) higher risk of developing CKD when compared to those with a working conditions risk score of 0. CONCLUSIONS Adverse working conditions, particularly when considered in combination, can significantly elevate the risk of chronic kidney disease (CKD). These results provide a reference for implementing measures to prevent CKD.
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Affiliation(s)
- Rui Lan
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Street, Yuzhong District, Chongqing, 400016, China
| | - Yao Qin
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Street, Yuzhong District, Chongqing, 400016, China
| | - Xiangjun Chen
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Street, Yuzhong District, Chongqing, 400016, China
| | - Jinbo Hu
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Street, Yuzhong District, Chongqing, 400016, China
| | - Wenjin Luo
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Street, Yuzhong District, Chongqing, 400016, China
| | - Yan Shen
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Street, Yuzhong District, Chongqing, 400016, China
| | - Xue Li
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Street, Yuzhong District, Chongqing, 400016, China
| | - Lina Mao
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Street, Yuzhong District, Chongqing, 400016, China
| | - Hanwen Ye
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Street, Yuzhong District, Chongqing, 400016, China
| | - Zhihong Wang
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Street, Yuzhong District, Chongqing, 400016, China.
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15
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Shanmugam R, Latha PK, Venugopal V. Comparison of women's heat risk profiles among those working in indoor and outdoor sectors. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2023; 78:357-368. [PMID: 37881951 DOI: 10.1080/19338244.2023.2272733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023]
Abstract
Rising temperatures and heat events may affect workers, especially women, by increasing the risk of Heat Related Illnesses (HRIs). We conducted a cross-sectional study among 903 women in outdoor and indoor sectors. We measured Wet Bulb Globe Temperature (WBGT) and physiological Heat Strain Indicators (HSI), as well as self-reported symptoms of HRIs using a HOTHAPS questionnaire. Multivariate Logistic Regression models were used to compare the heat risks. WBGT exposures were high in both the outdoor (Avg. WBGT = 28.8 °C ± 2.4 °C) and indoor (Avg. WBGT = 28.7 °C ± 3.5 °C) sectors. Outdoor Women Workers (OWW) reported higher HRI symptoms (94%vs.81%), and heat exposures were positively correlated with HRIs (AOR: 3.7; 95%CI: 2.4-6.1). OWW showed a 1.5-fold higher risk of measured HSI above safe limits (95%CI: 1.1-2.1) and a 2.1-fold higher risk of urogenital issues (95%CI: 2.1-3.8) than Indoor Women Workers (IWW). Due to direct sun exposure, intensive labor, and a lack of welfare facilities, OWW has a higher HRI risk.
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Affiliation(s)
- Rekha Shanmugam
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - P K Latha
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Vidhya Venugopal
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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16
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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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17
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H Hathaway M, L Patil C, Odhiambo A, Onyango D, Dorevitch S. Prevalence and predictors of chronic kidney disease of undetermined causes (CKDu) in Western Kenya's "sugar belt": a cross-sectional study. BMC Nephrol 2023; 24:157. [PMID: 37280533 DOI: 10.1186/s12882-023-03213-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/22/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Epidemics of chronic kidney disease of undetermined causes (CKDu) among young male agricultural workers have been observed in many tropical regions. Western Kenya has similar climatic and occupational characteristics as many of those areas. The study objectives were to characterize prevalence and predictors of CKDu, such as, HIV, a known cause of CKD, in a sugarcane growing region of Kenya; and to estimate prevalence of CKDu across occupational categories and evaluate if physically demanding work or sugarcane work are associated with reduced eGFR. METHODS The Disadvantaged Populations eGFR Epidemiology Study (DEGREE) protocol was followed in a cross-sectional study conducted in Kisumu County, Western Kenya. Multivariate logistic regression was performed to identify predictors of reduced eGFR. RESULTS Among 782 adults the prevalence of eGFR < 90 was 9.85%. Among the 612 participants without diabetes, hypertension, and heavy proteinuria the prevalence of eGFR < 90 was 8.99% (95%CI 6.8%, 11.5%) and 0.33% (95%CI 0.04%, 1.2%) had eGFR < 60. Among the 508 participants without known risk factors for reduced eGFR (including HIV), the prevalence of eGFR < 90 was 5.12% (95%CI 3.4%, 7.4%); none had eGFR < 60. Significant risk factors for reduced eGFR were sublocation, age, body mass index, and HIV. No association was found between reduced eGFR and work in the sugarcane industry, as a cane cutter, or in physically demanding occupations. CONCLUSION CKDu is not a common public health problem in this population, and possibly this region. We recommend that future studies should consider HIV to be a known cause of reduced eGFR. Factors other than equatorial climate and work in agriculture may be important determinants of CKDu epidemics.
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Affiliation(s)
- Michelle H Hathaway
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, 1603 W. Taylor St., Chicago, IL, 60612, USA.
| | - Crystal L Patil
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, 845 S. Damen Ave., MC 802, Chicago, IL, 60612, USA
| | - Aloyce Odhiambo
- Safe Water and AIDS Project, Behind Royal City Garden Hotel, Milimani Estate, Off Aga Khan Road, P.O. Box, Kisumu, 3323-40100, Kenya
| | - Dickens Onyango
- County Department of Health, County Government of Kisumu, Kisumu, Kenya
| | - Samuel Dorevitch
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois Chicago, 1603 W. Taylor St., Chicago, IL, 60612, USA
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18
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Alahmad B, Al-Hemoud A, Al-Bouwarthan M, Khraishah H, Kamel M, Akrouf Q, Wegman DH, Bernstein AS, Koutrakis P. Extreme heat and work injuries in Kuwait's hot summers. Occup Environ Med 2023; 80:347-352. [PMID: 37068948 DOI: 10.1136/oemed-2022-108697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/27/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Hot, desert Gulf countries are host to millions of migrant workers doing outdoor jobs such as construction and hospitality. The Gulf countries apply a summertime ban on midday work to protect workers from extreme heat, although without clear evidence of effectiveness. We assessed the risk of occupational injuries associated with extreme hot temperatures during the summertime ban on midday work in Kuwait. METHODS We collected daily occupational injuries in the summer months that are reported to the Ministry of Health's Occupational Health Department for 5 years from 2015 to 2019. We fitted generalised additive models with a quasi-Poisson distribution in a time series design. A 7-day moving average of daily temperature was modelled with penalised splines adjusted for relative humidity, time trend and day of the week. RESULTS During the summertime ban, the daily average temperature was 39.4°C (±1.8°C). There were 7.2, 7.6 and 9.4 reported injuries per day in the summer months of June, July and August, respectively. Compared with the 10th percentile of summer temperatures in Kuwait (37.0°C), the average day with a temperature of 39.4°C increased the relative risk of injury to 1.44 (95% CI 1.34 to 1.53). Similarly, temperatures of 40°C and 41°C were associated with relative risks of 1.48 (95% CI 1.39 to 1.59) and 1.44 (95% CI 1.27 to 1.63), respectively. At the 90th percentile (42°C), the risks levelled off (relative risk 1.21; 95% CI 0.93 to 1.57). CONCLUSION We found substantial increases in the risk of occupational injury from extremely hot temperatures despite the ban on midday work policy in Kuwait. 'Calendar-based' regulations may be inadequate to provide occupational heat protections, especially for migrant workers.
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Affiliation(s)
- Barrak Alahmad
- Environmental Health Department, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Department of Environmental and Occupational Health, College of Public Health, Kuwait University, Kuwait City, Kuwait
- Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Ali Al-Hemoud
- Environment and Life Sciences Research Center, Kuwait Institute for Scientific Research, Safat, Kuwait
| | - Mohammed Al-Bouwarthan
- Department of Environmental Health, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Haitham Khraishah
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Mohamed Kamel
- Occupational Health Administration, Ministry of Health, Kuwait City, Kuwait
| | - Qassem Akrouf
- Occupational Health Administration, Ministry of Health, Kuwait City, Kuwait
| | - David H Wegman
- Environmental Health Department, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Department of Public Health, College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, USA
- La Isla Network, District of Columbia, Washington, DC, USA
| | - Aaron S Bernstein
- Center for Climate, Health and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard University, Cambridge, Massachusetts, USA
| | - Petros Koutrakis
- Environmental Health Department, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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19
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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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20
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Hansson E, Broberg K, Wijkström J, Glaser J, Gonzalez-Quiroz M, Ekström U, Abrahamson M, Jakobsson K. An explorative study of inflammation-related proteins associated with kidney injury in male heat-stressed workers. J Therm Biol 2023; 112:103433. [PMID: 36796890 DOI: 10.1016/j.jtherbio.2022.103433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 11/12/2022] [Accepted: 12/15/2022] [Indexed: 01/22/2023]
Abstract
Chronic kidney disease of non-traditional origin (CKDnt) and acute kidney injury (AKI) often affect heat-stressed Mesoamerican manual workers. Inflammation occurs concurrently with AKI in this population, but its role remains unknown. To explore links between inflammation and kidney injury in heat stress, we compared levels of inflammation-related proteins in cutters with and without increasing serum creatinine levels during sugarcane harvest. These sugarcane cutters have previously been identified to be repeatedly exposed to severe heat stress during the five month harvest season. A nested case-control study was conducted among male Nicaraguan sugarcane cutters in a CKDnt hotspot. Cases (n = 30) were defined as having an increase in creatinine of ≥0.3 mg/dL across the five-month harvest. Controls (n = 57) had stable creatinine levels. Ninety-two inflammation-related proteins in serum were measured before and after harvest using Proximity Extension Assays. Mixed linear regression was used to identify differences in protein concentrations between cases and controls before harvest, differential trends during harvest, and association between protein concentrations and the urine kidney injury markers Kidney Injury Molecule (KIM)-1, Monocyte Chemoattractant Protein (MCP)-1 and albumin. One protein, chemokine (C-C motif) ligand 23 (CCL23), was elevated among cases at pre-harvest. Changes in seven inflammation-related proteins (CCL19, CCL23, colony-stimulating factor 1 [CSF1], hepatocyte and fibroblast growth factors [HGF and FGF23], and tumor necrosis factor beta [TNFB] and TNF-related activation-induced cytokine [TRANCE]) were associated with case status and at least two out of three urine kidney injury markers (KIM-1, MCP-1 and albumin). Several of these have been implicated in myofibroblast activation, which likely is an important step in kidney interstitial fibrotic disease such as CKDnt. This study provides an initial exploration of immune system determinants of, and activation during, kidney injury experienced during prolonged heat stress.
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Affiliation(s)
- Erik Hansson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; La Isla Network, Washington, D.C., USA.
| | - Karin Broberg
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Julia Wijkström
- Division of Renal Medicine, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | | | - Marvin Gonzalez-Quiroz
- Department of Renal Medicine, University College London, London, United Kingdom; School of Medicine, Universidad Nacional de Chimborazo, Riobamba, Ecuador
| | - Ulf Ekström
- La Isla Network, Washington, D.C., USA; Division of Clinical Chemistry and Pharmacology, Department of Laboratory Medicine, Lund University, Sweden
| | - Magnus Abrahamson
- Division of Clinical Chemistry and Pharmacology, Department of Laboratory Medicine, Lund University, Sweden
| | - Kristina Jakobsson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; La Isla Network, Washington, D.C., USA
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21
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Lucas RAI, Skinner BD, Arias-Monge E, Jakobsson K, Wesseling C, Weiss I, Poveda S, Cerda-Granados FI, Glaser J, Hansson E, Wegman DH. Targeting workload to ameliorate risk of heat stress in industrial sugarcane workers. Scand J Work Environ Health 2023; 49:43-52. [PMID: 36209512 PMCID: PMC10549916 DOI: 10.5271/sjweh.4057] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The aim of this study was to quantify the physiological workload of manual laborers in industrial sugarcane and assess the effect of receiving a rest, shade, and hydration intervention to reduce heat stress exposure risk. METHODS In an observational study, physiological workload was evaluated for burned cane cutters (BCC), seed cutters (SC) and drip irrigation repair workers (DIRW) using heart rate (HR) recorded continuously (Polar®) across a work shift. Workers' percentage of maximal HR (%HRmax), time spent in different HR zones, and estimated core temperature (ECTemp) were calculated. The effect of increasing rest across two harvests was evaluated for BCC and SC. RESULTS A total of 162 workers participated in this study [52 BCC (all male), 71 SC (13 female) and 39 DIRW (16 female)]. Average %HRmax across a work shift was similar between BCC and SC (BCC: 58%, SC: 59%), but lower in DIRW (51%). BCC and SC spent similar proportions of work shifts at hard/very hard intensities (BCC: 13%, SC: 15%), versus DIRW who worked mostly at light (46%) or light-moderate (39%) intensities. SC maximum ECTemp reached 38.2°C, BCC 38.1°C; while DIRW only reached 37.7°C. Females performed at a higher %HRmax than males across work shifts (SC 64% versus 58%; DIRW 55% versus 49%). An additional rest period was associated with a lower average %HRmax across a work shift in BCC. CONCLUSION In this setting, BCC and SC both undertake very physiologically demanding work. Females maintained a higher workload than male co-workers. Regulated rest periods each hour, with water and shade access, appears to reduce physiological workload/strain.
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Affiliation(s)
- Rebekah A I Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
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22
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Hansson E, Wesseling C, Wegman D, Ekström U, Chavarria D, Glaser J, Jakobsson K. Point-of-care biomarkers for prediction of kidney function trajectory among sugarcane cutters: a comparative test accuracy study. BMJ Open 2022; 12:e060364. [PMID: 36400724 PMCID: PMC9677021 DOI: 10.1136/bmjopen-2021-060364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Heat-stressed Mesoamerican workers, such as sugarcane cutters, suffer from high rates of chronic kidney disease of non-traditional origin (CKDnt). We aimed to identify easily available early markers of rapid kidney function decline in a population at high risk of CKDnt. DESIGN The accuracy of different biomarkers measured during harvest for prediction of cross-harvest kidney function decline were assessed in an exploratory study group, and the performance of the most promising biomarker was then assessed in an independent confirmation group. SETTING Male sugarcane cutters in El Salvador and Nicaragua. PARTICIPANTS 39 male Salvadoran sugarcane cutters sampled fortnightly at ≤9 occasions before and after work shift during harvest. 371 male Nicaraguan sugarcane cutters were sampled as part of routine monitoring during two harvests. Cutters worked at high physical intensity at wet-bulb globe temperatures mostly above 29°C for 6-8 hours per day 6 days a week during the 5-6 months harvest season. PRIMARY OUTCOMES Change in estimated glomerular filtration rate (CKD Epidemiology Collaboration) across the harvest season (ΔeGFRcross-harvest). RESULTS Dipstick leukocyturia after work shift in the El Salvadoran group was the most promising marker, explaining >25% of ΔeGFRcross-harvest variance at 8/9 occasions during harvest. Leukocyturia was associated with experiencing fever, little or dark urine, cramps, headache, dizziness and abdominal pain in the preceding 2-week period. Decreasing blood haemoglobin (Hb) and eGFR during harvest were also predictive of ΔeGFRcross-harvest. In the Nicaraguan confirmation dataset, those having ≥++ leukocyturia at any sampling during harvest had a 13 mL/min/1.73 m2 (95% CI 10 to 16 mL/min/1.73 m2) worse ΔeGFRcross-harvest than those without recorded leukocyturia. CONCLUSION Leukocyturia and Hb, both measurable with point-of-care methods, may be early indicators for kidney injury and risk for eGFR decline among heat-stressed male workers, thereby facilitating individual-level prevention and research aiming to understand the causes of CKDnt.
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Affiliation(s)
- Erik Hansson
- La Isla Network, Washington, District of Columbia, USA
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Catharina Wesseling
- La Isla Network, Washington, District of Columbia, USA
- Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institute, Stockholm, Sweden
| | - David Wegman
- La Isla Network, Washington, District of Columbia, USA
- University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Ulf Ekström
- La Isla Network, Washington, District of Columbia, USA
- Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Denis Chavarria
- Occupational Health Management, Ingenio San Antonio/Nicaragua Sugar Estates Limited, Chichigalpa, Nicaragua
| | - Jason Glaser
- La Isla Network, Washington, District of Columbia, USA
| | - Kristina Jakobsson
- La Isla Network, Washington, District of Columbia, USA
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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23
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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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24
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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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25
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Yan T, Yang S, Zhou X, Zhang C, Zhu X, Ma W, Tang S, Li J. Chronic kidney disease among greenhouse workers and field workers in China. CHEMOSPHERE 2022; 302:134905. [PMID: 35561762 DOI: 10.1016/j.chemosphere.2022.134905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/07/2022] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Agricultural workers are at increased risk of developing chronic kidney disease of non-traditional etiology (CKDnt). The environment in solar greenhouse has high-intensity agricultural hazard factors. However, the association between solar greenhouse work and CKDnt remains unknown. OBJECTIVES We aimed to evaluate the relationship among solar greenhouse work, field work, and CKDnt risk, and to explore gender differences in CKDnt risk among solar greenhouse workers. METHODS Solar greenhouse workers and field workers were selected as the greenhouse worker and field worker groups in a cross-sectional study. Individuals with an estimated glomerular filtration rate (eGFR) of <60 ml/min per 1.73 m2 were defined as CKDnt patients. Binary logistic regression and generalized linear regression models were used to estimate the association among solar greenhouse workers, field workers and CKDnt. Furthermore, gender differences in CKDnt were also analyzed. RESULTS A total of 638 solar greenhouse workers and 231 field workers were included. The prevalence of CKDnt was 2.8% in the solar greenhouse workers and 0.4% in the field workers, and the prevalence of CKDnt was higher in female solar greenhouse workers than in males. The eGFR reduced by 20.0% (19.74 ml/min per 1.73 m2) in the greenhouse worker group compared with that in the field worker group (p < 0.05). Generalized linear analysis showed that the level of eGFR was lower in women than that in men after adjusting for parameters (β = -10.99 [-12.79, -9.10]). CONCLUSION Solar greenhouse workers may be at an increased risk of CKDnt, and women are more vulnerable.
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Affiliation(s)
- Tenglong Yan
- Beijing Institute of Occupational Disease Prevention and Treatment, Beijing 100093, China
| | - Siwen Yang
- National Center for Occupational Safety and Health, National Health Commission of the People's Republic of China, Beijing 102308, China
| | - Xingfan Zhou
- Beijing Key Laboratory of Occupational Safety and Health, Institute of Urban Safety and Environmental Science, Beijing Academy of Science and Technology, Beijing 100054, China
| | - Chuyi Zhang
- Beijing Key Laboratory of Occupational Safety and Health, Institute of Urban Safety and Environmental Science, Beijing Academy of Science and Technology, Beijing 100054, China
| | - Xiaojun Zhu
- National Center for Occupational Safety and Health, National Health Commission of the People's Republic of China, Beijing 102308, China.
| | - Wenjun Ma
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, China
| | - Shichuan Tang
- Beijing Key Laboratory of Occupational Safety and Health, Institute of Urban Safety and Environmental Science, Beijing Academy of Science and Technology, Beijing 100054, China
| | - Jue Li
- Beijing Institute of Occupational Disease Prevention and Treatment, Beijing 100093, China
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26
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Hansson E, Wegman DH, Wesseling C, Glaser J, Schlader ZJ, Wijkström J, Jakobsson K. Markers of kidney tubular and interstitial injury and function among sugarcane workers with cross-harvest serum creatinine elevation. Occup Environ Med 2022; 79:396-402. [PMID: 34972693 PMCID: PMC9120403 DOI: 10.1136/oemed-2021-107989] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/08/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Serum creatinine (SCr) is a routine marker of kidney injury but also increases with dehydration and muscular work. This study was to elucidate whether increase in SCr is associated with more specific markers of kidney tubular and interstitial injury and function, during prolonged heat stress among workers at high risk of chronic kidney disease of non-traditional origin (CKDnt). METHODS Urine monocyte chemoattractant protein-1 (MCP-1), kidney injury molecule-1 (KIM-1), calbindin, glutathione S-transferase-π (GST-π), clusterin, interleukin 18 and albumin, fractional excretion of potassium (FEK), blood haemoglobin, serum potassium, ferritin and erythropoietin were measured before and after harvest in a sample of 30 workers with a ≥0.3 mg/dL SCr increase across harvest (cases), and 53 workers with stable SCr (controls). RESULTS Urine MCP-1 (p for differential cross-harvest trend <0.001), KIM-1 (p=0.002), calbindin (p=0.02), GST-π (p=0.04), albumin (p=0.001) and FEK (p<0.001) increased in cases, whereas blood haemoglobin (p<0.001) and serum erythropoietin (p<0.001) decreased. CONCLUSION Several markers of tubular and interstitial injury and function changed as SCr increased across a harvest season, supporting the use of SCr as an indicator of kidney injury in physically active workers regularly exposed to heat stress. Repeated injury similar to that described here, and continued work under strenuous and hot conditions with similarly elevated injury markers is likely to worsen and possibly initiate CKDnt.
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Affiliation(s)
- Erik Hansson
- La Isla Network, Washington, DC, USA
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
| | - David H Wegman
- La Isla Network, Washington, DC, USA
- University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Catharina Wesseling
- La Isla Network, Washington, DC, USA
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Zachary J Schlader
- Department of Kinesiology, Indiana University Bloomington School of Public Health, Bloomington, Indiana, USA
| | - Julia Wijkström
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Jakobsson
- La Isla Network, Washington, DC, USA
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
- Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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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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Alayyannur PA, Ramdhan DH. Relationship of heat stress with acute kidney disease and chronic kidney disease: A literature review. J Public Health Res 2022. [DOI: 10.1177/22799036221104149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Heat stress is a physical hazard and a potential health risk which can result in various conditions ranging from discomfort, headaches, psychological disorders, heat stroke and even death in extreme cases. Factors which cause heat stress include high ambient temperature, limited air movement, strenuous physical work and direct exposure to the heat of the engine/ sun. Continuous heat stress, exacerbated by dehydration, can lead to kidney disease. This study is a literature review conducted to explore factors that influence heat stress and the relationship of heat stress with acute kidney disease and chronic kidney disease. Methods: Literature search was conducted in September 2021. Research sources were taken from several databases, namely Science Direct, ProQuest, PubMed, and Google Scholar. From the databases, 23,316 articles were from Science Direct, 140,319 articles were from ProQuest, 670 articles were from PubMed, and 288,000 articles were from Google Scholars. Out of the total database only 24 articles met the inclusion criteria. The variables in this study were heat stress, acute kidney disease, and chronic kidney disease. Results: This literature review shows that several factors which can affect heat stress are heat exposure, workload, rehydration, and rest period arrangements. Heat stress experienced by workers can cause decreased kidney function and chronic kidney disease. Heat stress conditions that are continuously experienced by workers can cause chronic kidney disease. Conclusion: Heat stress can be experienced by workers due to heat exposure, heavy workload, poor rehydration, and poor rest period arrangements. Heat stress can cause acute kidney disease and chronic kidney disease.
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Affiliation(s)
- Putri Ayuni Alayyannur
- Student of Doctoral Program, Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
- Department of Occupational Health and Safety, Faculty of Public Health, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Doni Hikmat Ramdhan
- Department of Occupational Health and Safety, Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
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Andersson A, Hansson E, Ekström U, Grubb A, Abrahamson M, Jakobsson K, Xu Y. Large difference but high correlation between creatinine and cystatin C estimated glomerular filtration rate in Mesoamerican sugarcane cutters. Occup Environ Med 2022; 79:497-502. [PMID: 35354651 PMCID: PMC9209661 DOI: 10.1136/oemed-2021-107990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 03/06/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To explore the relationship between creatinine and cystatin C based estimated glomerular filtration rate (eGFR) in actively working sugarcane cutters. METHODS This cohort study included 458 sugarcane cutters from Nicaragua and El Salvador. Serum samples were taken before and at end of harvest seasons and analysed for creatinine and cystatin C. Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas were used to calculate eGFRs based on creatinine (eGFRcr), cystatin C (eGFRcys) and both creatinine and cystatin C (eGFRcrcys) at each time point. Bland-Altman plots and paired t-tests were used to compare the difference between eGFRcr and eGFRcys, and the difference in eGFRs between before and at end of the harvest seasons. RESULTS The mean eGFRcr was higher than eGFRcys in both cohorts; absolute difference 22 mL/min/1.73 m2 (95% CI 21 to 23) in Nicaragua and 13 mL/min/1.73 m2 (95% CI 11 to 15) in El Salvador. Correlations between eGFRcr and eGFRcys were high, with r=0.69, 0.77 and 0.67 in Nicaragua at pre-harvest, end-harvest and cross-harvest, and r=0.89, 0.89 and 0.49 in El Salvador. CONCLUSIONS Creatinine increases among heat-stressed workers reflect reduced glomerular filtration as estimated using eGFRcys, a marker independent of muscle mass and metabolism. The discrepancy between eGFRcr and eGFRcys may indicate reduced glomerular filtration of larger molecules and/or systemic bias in CKD-EPI performance in this population.
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Affiliation(s)
- Axel Andersson
- School of Public Health and Community Medicine, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden .,La Isla Network, Washington, District of Columbia, USA
| | - Erik Hansson
- School of Public Health and Community Medicine, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden.,La Isla Network, Washington, District of Columbia, USA
| | - Ulf Ekström
- La Isla Network, Washington, District of Columbia, USA.,Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Anders Grubb
- Department of Laboratory Medicine, Lund University, Lund, Sweden
| | | | - Kristina Jakobsson
- School of Public Health and Community Medicine, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden.,Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Yiyi Xu
- School of Public Health and Community Medicine, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
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30
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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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El Khayat M, Halwani DA, Hneiny L, Alameddine I, Haidar MA, Habib RR. Impacts of Climate Change and Heat Stress on Farmworkers' Health: A Scoping Review. Front Public Health 2022; 10:782811. [PMID: 35211437 PMCID: PMC8861180 DOI: 10.3389/fpubh.2022.782811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 01/10/2022] [Indexed: 01/27/2023] Open
Abstract
Due to the continuous rise of global temperatures and heatwaves worldwide as a result of climate change, concerns for the health and safety of working populations have increased. Workers in the food production chain, particularly farmworkers, are especially vulnerable to heat stress due to the strenuous nature of their work, which is performed primarily outdoors under poor working conditions. At the cross-section of climate change and farmworkers' health, a scoping review was undertaken to summarize the existing knowledge regarding the health impacts associated with climate change and heat stress, guide future research toward better understanding current and future climate change risks, and inform policies to protect the health and safety of agricultural workers. A systematic search of 5 electronic databases and gray literature websites was conducted to identify relevant literature published up until December 2021. A total of 9045 records were retrieved from the searches, of which 92 articles were included in the final review. The majority of the reviewed articles focused on heat-related illnesses (n = 57) and kidney diseases (n = 28). The risk factors identified in the reviewed studies included gender, dehydration, heat strain, wearing inappropriate clothing, workload, piece-rate payment, job decision latitude, and hot environmental conditions. On the other hand, various protective and preventive factors were identified including drinking water, changing work hours and schedule of activities, wearing appropriate clothing, reducing soda consumption, taking breaks in shaded or air-conditioned areas, and increasing electrolyte consumption in addition to improving access to medical care. This review also identified various factors that are unique to vulnerable agricultural populations, including migrant and child farmworkers. Our findings call for an urgent need to expand future research on vulnerable agricultural communities including migrant workers so as to develop effective policies and interventions that can protect these communities from the effects of heat stress.
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Affiliation(s)
- Moussa El Khayat
- Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Dana A. Halwani
- Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Layal Hneiny
- Saab Medical Library, American University of Beirut, Beirut, Lebanon
| | - Ibrahim Alameddine
- Department of Civil and Environmental Engineering, Maroun Semaan Faculty of Engineering and Architecture, American University of Beirut, Beirut, Lebanon
| | - Mustapha A. Haidar
- Department of Agriculture, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Rima R. Habib
- Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Body Composition, Anemia, and Kidney Function among Guatemalan Sugarcane Workers. Nutrients 2021; 13:nu13113928. [PMID: 34836182 PMCID: PMC8621317 DOI: 10.3390/nu13113928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/23/2021] [Accepted: 10/24/2021] [Indexed: 01/01/2023] Open
Abstract
Rates of anemia among agricultural workers, who are also at risk for kidney injury and chronic kidney disease of unknown cause (CKDu), are unknown. We evaluated body composition through the sum of three skinfolds among 203 male sugarcane cutters and assessed the relationship of variables related to nutrition, anemia (hemoglobin < 13 g/dL), and elevated hemoglobin A1c (HbA1c ≥ 5.7%) with estimated glomerular filtration rate (eGFR) using linear regression. Eleven percent of workers were at the level of essential body fat (2-5%). Anemia was present among 13% of workers, 70% of which were normochromic normocytic, a type of anemia suggesting potential underlying chronic disease. Anemia was more common among those with lower BMI and fat free mass. The prevalence of elevated HbA1c was 21%. A moderate negative correlation was found between hemoglobin and HbA1c (Pearson's r = -0.32, p <0.01) which suggests that HbA1c values should be interpreted with caution in populations that have high rates of anemia. Twelve percent of workers had reduced kidney function with an eGFR < 90 mL/min/1.73 m2. On average, the eGFR was 18 mL/min per 1.73 m2 lower [(95% CI:-24, -12), p <0.01)] for those with anemia than those without, and 8 mL/min per 1.73 m2 lower among those with elevated HbA1c [(95% CI: -13, -2), p < 0.01]. Results will inform future studies examining the role of anemia in the evaluation of CKDu and interventions to improve nutrition for workers in low-resource settings.
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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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Pacheco-Zenteno F, Glaser J, Jakobsson K, Weiss I, Arias-Monge E, Gyllensten K. The Prevention of Occupational Heat Stress in Sugarcane Workers in Nicaragua-An Interpretative Phenomenological Analysis. Front Public Health 2021; 9:713711. [PMID: 34712636 PMCID: PMC8545795 DOI: 10.3389/fpubh.2021.713711] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/09/2021] [Indexed: 02/03/2023] Open
Abstract
Background: Chronic kidney disease of non-traditional origin (CKDnt) is an ongoing epidemic that has taken the lives of tens of thousands of people in Mesoamerica, also affecting other tropical geographies. Occupational heat stress, which will increase worldwide as climate change persists, has been identified as a primary trigger of kidney injury and reduced renal function. At Nicaragua's largest sugarcane mill, the water, rest, and shade (WRS) intervention has proven to reduce the risk of heat stress and kidney injury effectively as assessed by the research and policy NGO La Isla Network (LIN) and their academic partners, who have worked with the sugar mill to improve the design of their intervention system. However, discrepancies between intervention design and implementation have been found. This study explores the perceptions of the WRS intervention in the company from the perspective of positions responsible for the workers' environment and heat stress prevention implementation. Methods: A qualitative design was used in the study. Twenty-one key informants of low and middle management, field assistants, and two members from LIN took part in the study. Semi-structured interviews were used to collect the data. Interviews' transcriptions were analyzed using interpretative phenomenological analysis (IPA). Results: Four main themes were developed in the analysis of the data: “A worthwhile struggle,” “Culture of care”, “Traditional production culture Vs. Culture of care,” and “The importance of the formalization of care.” Each theme contained sub-themes, all of which were further discussed in the light of organizational psychology. Conclusion and Implications: Discretionary differences resulting in low and middle management prioritizing production over health protection appeared to relate to a fair part of the implementation challenges and indicate that more efforts are needed to align operations' production and health goals. Education enhancement might be necessary, while further focus on health metrics for performance assessment might offer an opportunity to level perceived incentives and value of health and production.
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Affiliation(s)
- Felipe Pacheco-Zenteno
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Jason Glaser
- La Isla Network, Washington, DC, United States.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kristina Jakobsson
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,La Isla Network, Washington, DC, United States.,Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ilana Weiss
- La Isla Network, Washington, DC, United States
| | - Esteban Arias-Monge
- La Isla Network, Washington, DC, United States.,Departamento de Gestión Ambiental y Seguridad Laboral, Instituto Tecnológico de Costa Rica, Cartago, Costa Rica
| | - Kristina Gyllensten
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Wijkström J, Gonzalez-Quiroz M, Leiva R, Trujillo ZC, Elinder CG, Wernerson A. Mesoamerican Nephropathy and Kidney Disease Progression: A Case Series of Individuals With Kidney Biopsies From Nicaragua and El Salvador. Kidney Med 2021; 3:871-873. [PMID: 34693268 PMCID: PMC8515091 DOI: 10.1016/j.xkme.2021.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Julia Wijkström
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Renal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Marvin Gonzalez-Quiroz
- Research Centre on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua, León (UNAN-León), León, Nicaragua.,Department of Renal Medicine, University College London, London, United Kingdom
| | - Ricardo Leiva
- Department of Nephrology, Hospital Nacional Rosales, San Salvador, El Salvador
| | - Zulma Cruz Trujillo
- Department of Nephrology, Hospital Nacional Rosales, San Salvador, El Salvador
| | - Carl-Gustaf Elinder
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Annika Wernerson
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Tonelli M, Tiv S, Anand S, Mohan D, Garcia Garcia G, Gutiérrez Padilla JA, Klarenbach S, Navarro Blackaller G, Seck S, Wang J, Zhang L, Muntner P. Diagnostic Yield of Population-Based Screening for Chronic Kidney Disease in Low-Income, Middle-Income, and High-Income Countries. JAMA Netw Open 2021; 4:e2127396. [PMID: 34605917 PMCID: PMC8491102 DOI: 10.1001/jamanetworkopen.2021.27396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Population-based screening for chronic kidney disease (CKD) is sometimes recommended based on the assumption that detecting CKD is associated with beneficial changes in treatment. However, the treatment of CKD is often similar to the treatment of hypertension or diabetes, which commonly coexist with CKD. OBJECTIVE To determine the frequency with which population-based screening for CKD is associated with a change in recommended treatment compared with a strategy of measuring blood pressure and assessing glycemia. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted using data obtained from studies that evaluated CKD in population-based samples from China (2007-2010), India (2010-2014), Mexico (2007-2008), Senegal (2012), and the United States (2009-2014), including a total of 126 242 adults screened for CKD. Data were analyzed from January 2020 to March 2021. MAIN OUTCOMES AND MEASURES The primary definition of CKD was estimated glomerular filtration rate less than 60 mL/min/1.73 m2. For individuals with CKD, the need for a treatment change was defined as not taking an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker or having blood pressure levels of 140/90 mm Hg or greater. For individuals with CKD who also had diabetes, the need for a treatment change was also defined as having hemoglobin A1c levels of 8% or greater or fasting glucose levels of 178.4 mg/dL (9.9 mmol/L) or greater. Case finding was defined as testing for CKD only in adults with hypertension or diabetes. RESULTS Among 126 242 adults screened for CKD, there were 47 204 patients in the China cohort, 9817 patients in the India cohort, 51 137 patients in the Mexico cohort, 2441 patients in the Senegal cohort, and 15 643 patients in the US cohort. The mean age of participants was 49.6 years (95% CI, 49.5-49.7 years) in the China cohort, 42.9 years (95% CI, 42.6-43.2 years) in the India cohort, 51.6 years (95% CI, 51.5-51.7 years) in the Mexico cohort, 48.2 years (95% CI, 47.5-48.9 years) in the Senegal cohort, and 47.3 years (95% CI, 46.6-48.0 years) in the US cohort. The proportion of women was 57.3% (95% CI, 56.9%-57.7%) in the China cohort, 53.4% (95% CI, 52.4%-54.4%) in the India cohort, 68.8% (95% CI, 68.4%-69.2%) in the Mexico cohort, 56.0% (95% CI, 54.0%-58.0%) in the Senegal cohort, and 51.9% (51.0%-52.7%) in the US cohort. The prevalence of CKD was 2.5% (95% CI, 2.4%-2.7%) in the China cohort, 2.3% (95% CI, 2.0%-2.6%) in the India cohort, 10.6% (95% CI, 10.3%-10.9%) in the Mexico cohort, 13.1% (95% CI, 11.7%-14.4%) in the Senegal cohort, and 6.8% (95% CI, 6.2%-7.5%) in the US cohort. Screening for CKD was associated with the identification of additional adults whose treatment would change (beyond those identified by measuring blood pressure and glycemia) per 1000 adults: China: 8 adults (95% CI, 8-9 adults); India: 5 adults (95% CI, 4-7 adults); Mexico: 26 adults (95% CI, 24-27 adults); Senegal: 59 adults (95% CI, 50-69 adults); and the US: 19 adults (95% CI, 16-23 adults). Case finding was associated with the identification of 46.2% (95% CI, 45.1%-47.4%) to 86.4% (95% CI, 85.4%-87.3%) of individuals with CKD depending on the country, an increase in the proportion of individuals requiring a treatment change by as much 89.6% (95% CI, 80.4%-99.3%) in the US, and a decrease in the proportion of individuals needing GFR measurements by as much as 57.8% (95% CI, 56.3%-59.3%) in the US. CONCLUSIONS AND RELEVANCE This study found that most additional individuals with CKD identified by population-based screening programs did not need a change in treatment compared with a strategy of measuring blood pressure and assessing glycemia and that case finding was more efficient than screening for early detection of CKD.
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Affiliation(s)
| | - Sophanny Tiv
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Shuchi Anand
- Division of Nephrology, Department of Medicine, Stanford University, Stanford, California
| | - Deepa Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | - Guillermo Garcia Garcia
- Hospital Civil de Guadalajara Fray Antonio Alcalde, University Center for Health Science, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - José Alfonso Gutiérrez Padilla
- Hospital Civil de Guadalajara Fray Antonio Alcalde, University Center for Health Science, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Scott Klarenbach
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Guillermo Navarro Blackaller
- Hospital Civil de Guadalajara Fray Antonio Alcalde, University Center for Health Science, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Sidy Seck
- Department of Internal Medicine and Nephrology, Gaston Berger University, Saint-Louis, Senegal
| | - Jinwei Wang
- Peking University Institute of Nephrology, Peking University First Hospital, Beijing, China
| | - Luxia Zhang
- Peking University Institute of Nephrology, Peking University First Hospital, Beijing, China
| | - Paul Muntner
- Department of Epidemiology, School of Public Health, University of Alabama, Tuscaloosa
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Butler-Dawson J, Krisher L, Dally M, James KA, Johnson RJ, Jaramillo D, Yoder H, Johnson EC, Pilloni D, Asensio C, Cruz A, Newman LS. Sugarcane Workweek Study: Risk Factors for Daily Changes in Creatinine. Kidney Int Rep 2021; 6:2404-2414. [PMID: 34514201 PMCID: PMC8418948 DOI: 10.1016/j.ekir.2021.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Agricultural workers laboring in thermally stressful environments are at increased risk for kidney injury and chronic kidney disease of unknown origin (CKDu), and their environmental and occupational exposures have been considered to be important risk factors. This study examined the effects of repeated kidney stress from the simultaneous strain of work and other factors experienced by workers in Guatemala during a typical workweek. METHODS We collected data from 107 sugarcane workers across 7 consecutive work shifts. Data included information on daily occupational, meteorological, environmental, and lifestyle factors. We used multivariable linear mixed models to evaluate associations of these factors with percent change in creatinine. RESULTS We observed that increasing wet bulb globe temperature (β = 2.5%, 95% confidence interval [CI] = 0.3%, 4.7%) and increasing diastolic blood pressure (β = 6.2%, 95% CI = 0.9%, 11.6%) were associated with increases in creatinine across the shift, whereas consumption of water from chlorinated dormitory tanks as compared to artesian well water (β = -17.5%, 95% CI = -29.6%, -5.4%) and increasing number of rest breaks (β = -5.8%, 95% CI = -9.0%, -2.6%) were found to be protective against increases in creatinine. Workers reporting drinking tank water had lower concentrations of urine creatinine-corrected arsenic, lead, uranium, and glyphosate compared to workers reporting the use of well water or municipal water. CONCLUSION These results reinforce the need to focus on preventive actions that reduce kidney injury among this worker population, including strategies to reduce heat stress, managing blood pressure, and examining water sources of workers for nephrotoxic contaminants.
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Affiliation(s)
- Jaime Butler-Dawson
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lyndsay Krisher
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Miranda Dally
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Katherine A. James
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Richard J. Johnson
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Diana Jaramillo
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Hillary Yoder
- Department Kinesiology & Health, University of Wyoming, Laramie, Wyoming, USA
| | - Evan C. Johnson
- Department Kinesiology & Health, University of Wyoming, Laramie, Wyoming, USA
| | | | | | - Alex Cruz
- Pantaleon, Guatemala City, Guatemala
| | - Lee S. Newman
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
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Venugopal V, Lennqvist R, Latha PK, S R, Suraya A, Jakobsson K, Kjellstrom T. Challenges in conducting epidemiological field studies evaluating associations between heat stress and renal health among workers in informal sectors: experiences from India. ENVIRONMENTAL RESEARCH 2021; 200:111343. [PMID: 34015298 DOI: 10.1016/j.envres.2021.111343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 04/28/2021] [Accepted: 05/13/2021] [Indexed: 06/12/2023]
Abstract
Well-designed Environmental Epidemiological Studies (EES) play a crucial role in quantifying the influence of environmental exposures and their associated risks on health in the wider population. They provide critical research evidence for identifying and developing interventions to avert adverse health consequences from those exposures. However, uncertainty and variability inherent to any field based EES could hinder the nature and magnitude of association between an exposure and health outcome. This is particularly pronounced in resource limited settings and resource-tight research projects. The present study evaluated the association between occupational heat stress and renal health among informal work sectors in India which had some significant challenges. Informal workers exposed to chronic occupational heat stress had significantly higher adverse renal health outcomes than the unexposed workers. Our field challenges included gaining access and permissions to conduct the study, participant recalls bias and attrition, accurately estimating exposures, confounding from causes of both exposure and disease, and to a large extent tight-funding. Though opportunities are abundant, we must ensure field conditions are optimized to attain study objectives. A keen understanding and sensitivity towards the cultural and work settings is essential for successful project completion. Based on our experiences, we provide strategies to adopt to improve fieldwork and provide recommendations to help overcome the field challenges and achieve better results for future EES studies in developing country settings.
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Affiliation(s)
- Vidhya Venugopal
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India.
| | - Robin Lennqvist
- Occupational and Environmental Medicine, Gothenburg University, Sweden
| | - P K Latha
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India
| | - Rekha S
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India
| | - Anna Suraya
- CIHLMU Center for International Health, University Hospital, LMU Munich, Germany
| | | | - Tord Kjellstrom
- National Center for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia; HEAT-SHIELD Project, Center for Technology Research and Innovation Ltd, (CETRI), Limassol, Cyprus; Health and Environment International Trust, Mapua, New Zealand
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Electrolyte Beverage Intake to Promote Hydration and Maintain Kidney Function in Guatemalan Sugarcane Workers Laboring in Hot Conditions. J Occup Environ Med 2021; 62:e696-e703. [PMID: 33003044 PMCID: PMC7720870 DOI: 10.1097/jom.0000000000002033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To evaluate impact of electrolyte supplementation on hydration status and health outcomes in Guatemalan agricultural workers performing heavy work under hot climatic conditions. METHODS A 3-week pragmatic trial was conducted with a group of 50 workers during the 2017 to 2018 sugarcane harvest. Workers received an electrolyte hydration intervention during 2 of the 3 weeks. Blood and urine samples were collected each week. RESULTS Increased electrolyte intake resulted in less muscle injury. Kidney function was maintained across the intervention period. Workers were adequately hydrated and average electrolyte levels remained in normal ranges. Mild indications of hyponatremia occurred at higher levels of fluid intake. CONCLUSIONS This trial demonstrates the feasibility of maintaining workers' electrolyte levels under extremely hot and humid conditions while mitigating muscle injury. Electrolyte supplementation should be added to standard workplace water, rest, and shade interventions to protect workers.
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Chapman CL, Hess HW, Lucas RAI, Glaser J, Saran R, Bragg-Gresham J, Wegman DH, Hansson E, Minson CT, Schlader ZJ. Occupational heat exposure and the risk of chronic kidney disease of nontraditional origin in the United States. Am J Physiol Regul Integr Comp Physiol 2021; 321:R141-R151. [PMID: 34161738 DOI: 10.1152/ajpregu.00103.2021] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Occupational heat exposure is linked to the development of kidney injury and disease in individuals who frequently perform physically demanding work in the heat. For instance, in Central America, an epidemic of chronic kidney disease of nontraditional origin (CKDnt) is occurring among manual laborers, whereas potentially related epidemics have emerged in India and Sri Lanka. There is growing concern that workers in the United States suffer with CKDnt, but reports are limited. One of the leading hypotheses is that repetitive kidney injury caused by physical work in the heat can progress to CKDnt. Whether heat stress is the primary causal agent or accelerates existing underlying pathology remains contested. However, the current evidence supports that heat stress induces tubular kidney injury, which is worsened by higher core temperatures, dehydration, longer work durations, muscle damaging exercise, and consumption of beverages containing high levels of fructose. The purpose of this narrative review is to identify occupations that may place US workers at greater risk of kidney injury and CKDnt. Specifically, we reviewed the scientific literature to characterize the demographics, environmental conditions, physiological strain (i.e., core temperature increase, dehydration, heart rate), and work durations in sectors typically experiencing occupational heat exposure, including farming, wildland firefighting, landscaping, and utilities. Overall, the surprisingly limited available evidence characterizing occupational heat exposure in US workers supports the need for future investigations to understand this risk of CKDnt.
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Affiliation(s)
| | - Hayden W Hess
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
| | - Rebekah A I Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jason Glaser
- La Isla Network, Washington, D.C.,Responsible Business Center at Birkbeck, University of London, London, United Kingdom
| | - Rajiv Saran
- Division of Nephrology and the Kidney Epidemiology and Cost Center, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Jennifer Bragg-Gresham
- Division of Nephrology and the Kidney Epidemiology and Cost Center, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - David H Wegman
- Department of Epidemiology, University of Massachusetts Lowell, Lowell, Massachusetts
| | - Erik Hansson
- La Isla Network, Washington, D.C.,School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Zachary J Schlader
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, Indiana
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Sanitation access, behavior, and practices and their health and social implications for on-duty female police officials — a perceptional study in South India. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01615-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Chang JCJ, Yang HY. Epidemiology of chronic kidney disease of undetermined aetiology in Taiwanese farmers: a cross-sectional study from Changhua Community-based Integrated Screening programme. Occup Environ Med 2021; 78:849-858. [PMID: 34108255 DOI: 10.1136/oemed-2021-107369] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/09/2021] [Accepted: 05/03/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Chronic kidney disease of undetermined or non-traditional aetiology (CKDu or CKDnT) has been reported in Mesoamerica among farmers under heat stress. Epidemiological evidence was lacking in Asian countries with similar climatic conditions. The objective of this study was to investigate the prevalence of CKDu and possible risk factors. METHODS We used the data from the Changhua Community-based Integrated Screening programme from 2005 to 2014, which is the annual screening for chronic diseases in Taiwan's largest rice-farming county since 2005. Our study population included farmers and non-farmers aged 15-60 years. CKDu was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 at age under 60 years without hypertension, diabetes, proteinuria, haematuria or using Chinese herbal medicine. We estimated the adjusted prevalence OR (POR) of CKDu by farmers, age, sex, education, urbanisation, smoking, body mass index, hyperuricaemia, hyperlipidaemia, heart disease and chronic liver disease. RESULTS 5555 farmers and 35 761 non-farmers were included in this study. CKDu accounted for 48.9% of all CKD cases. The prevalence of CKDu was 2.3% in the farmers and 0.9% in the non-farmers. The crude POR of CKDu in farmers compared with non-farmers was 2.73 (2.13-3.50), and the adjusted POR was 1.45 (1.10-1.90). Dehydration (blood urea nitrogen-to-creatinine ratio >20) was found in 22% of the farmers and 14% of the non-farmers. CONCLUSIONS Farmers in subtropical Asian countries are at increased risk of CKDu. Governments should take the CKDu epidemics seriously and provide farmers with occupational health education programmes on thermal hazards.
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Affiliation(s)
- Jerry Che-Jui Chang
- Institute of Occupational and Environmental Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan.,Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiao-Yu Yang
- Institute of Occupational and Environmental Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan .,Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan.,Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan
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43
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Nunfam VF, Afrifa-Yamoah E, Adusei-Asante K, Van Etten EJ, Frimpong K, Mensah IA, Oosthuizen J. Construct validity and invariance assessment of the social impacts of occupational heat stress scale (SIOHSS) among Ghanaian mining workers. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 771:144911. [PMID: 33736178 DOI: 10.1016/j.scitotenv.2020.144911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/28/2020] [Accepted: 12/28/2020] [Indexed: 06/12/2023]
Abstract
Heat exposure studies over the last decade have shown little attention in assessing and reporting the psychometric properties of the various scales used to measure impacts of occupational heat stress on workers. A descriptive cross-sectional survey including 320 small- and large-scale mining workers was employed to assess the construct validity of the social impacts of occupational heat stress scale (SIOHSS) in the Western Region of Ghana in 2017. A confirmatory factor analysis (CFA) and invariance analysis were carried out using AMOS version 25 and statistical product and service solutions (SPSS) version 26 to examine the model fit and establish consistency correspondingly across multiple groups (gender, age, working hours, type of mining and workplace setting). Empirically, our results depicted that effects on health and safety, behavioural, productivity and social well-being were each found to be reliable, with Cronbach's α of 0.722, 0.807, 0.852 and 0.900 respectively. Though there were issues of insufficient discriminant validity as some average variance extract (AVE) were smaller than the corresponding maximum shared variance (MSV), the CFA showed good model fit indices (CFI = 0.856, GFI = 0.890, TLI = 0.863, SRMR = 0.08, RMSEA = 0.08). Also, the model was variant for all constrained aspects of the structural model indicating a requirement for an adaptation of the instrument across groups. The good to moderate internal consistency and construct validity of the SIOHSS is adequate evidence for the confidence required for its reliability and accuracy in measuring the social impacts of occupational heat stress on workers.
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Affiliation(s)
- Victor Fannam Nunfam
- School of Arts and Humanities, Edith Cowan University, Perth, Western Australia, Australia; Takoradi Technical University, Takoradi, Western Region, Ghana.
| | | | - Kwadwo Adusei-Asante
- School of Arts and Humanities, Edith Cowan University, Perth, Western Australia, Australia.
| | | | - Kwasi Frimpong
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia; Ghana Institute of Management and Public Administration, Accra, Greater Accra Region, Ghana.
| | | | - Jacques Oosthuizen
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia.
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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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45
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Stallings TL, Riefkohl Lisci A, McCray NL, Weiner DE, Kaufman JS, Aschengrau A, Ma Y, LaValley MP, Ramírez-Rubio O, Jose Amador J, López-Pilarte D, Laws RL, Winter M, McSorley VE, Brooks DR, Applebaum KM. Dysuria, heat stress, and muscle injury among Nicaraguan sugarcane workers at risk for Mesoamerican nephropathy. Scand J Work Environ Health 2021; 47:377-386. [PMID: 34003295 PMCID: PMC8259701 DOI: 10.5271/sjweh.3963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objectives: Nicaraguan sugarcane workers, particularly cane cutters, have an elevated prevalence of chronic kidney disease of unknown origin, also referred to as Mesoamerican nephropathy (MeN). The pathogenesis of MeN may include recurrent heat stress, crystalluria, and muscle injury with subsequent kidney injury. Yet, studies examining the frequency of such events in long-term, longitudinal studies are limited. Methods: Using employment and medical data for male workers at a Nicaraguan sugarcane company, we classified months of active work as either work as a cane cutter or other sugarcane job and determined occurrence of dysuria, heat events and muscle events. Work months and events occurred January 1997 to June 2010. Associations between cane cutting and each outcome were analyzed using logistic regression based on generalized estimating equations for repeated events, controlling for age. Results: Among 242 workers with 7257 active work months, 19.5% of person-months were as a cane cutter. There were 160, 21, and 16 episodes of dysuria, heat events, and muscle events, respectively. Compared with work months in other jobs, cane cutting was associated with an elevated odds of dysuria [odds ratio 2.40 (95% confidence interval 1.56–3.68)]. The number of heat and muscle events by cane cutter and other job were limited. Conclusions: Working as a cane cutter compared with other jobs in the sugarcane industry was associated with increased dysuria, supporting the hypothesis that cane cutters are at increased risk of events suspected of inducing or presaging clinically evident kidney injury.
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Affiliation(s)
- Tiffany L Stallings
- The George Washington University, Milken Institute School of Public Health, Department of Environmental and Occupational Health, 950 New Hampshire Ave., NW, Suite 400, Washington, DC 20052, USA.
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46
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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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47
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Rojas-Valverde D, Olcina G, Sánchez-Ureña B, Pino-Ortega J, Martínez-Guardado I, Timón R. Proteinuria and Bilirubinuria as Potential Risk Indicators of Acute Kidney Injury during Running in Outpatient Settings. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:medicina56110562. [PMID: 33120965 PMCID: PMC7692335 DOI: 10.3390/medicina56110562] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023]
Abstract
Background and objectives: The purpose of this study was to explore which urinary markers could indicate acute kidney injury (AKI) during prolonged trail running in outpatient settings. Materials and Methods: Twenty-nine experienced trail runners (age 39.1 ± 8.8 years, weight 71.9 ± 11 kg, height 171.9 ± 8.3 cm) completed a 35 km event (cumulative positive ascend of 1815 m, altitude = 906 to 1178 m.a.s.l.) under a temperature of 25.52 ± 1.98 °C and humidity of 79.25 ± 7.45%). Two participant groups (AKI = 17 and No-AKI = 12) were made according to AKI diagnosis criteria based on pre- and post-race values of serum creatinine (sCr) (an increase of 1.5 times from baseline). Blood and urinalysis were performed immediately pre- and post-race. Results: Pre- vs. post-race differences in sCr and sBUN were found in both AKI and No-AKI groups (p < 0.01). Differences in post-race values were found between groups (p = 0.03). A total of 52% of AKI runners presented significant increases in proteinuria (χ2 = 0.94, p = 0.01) and 47% in bilirubinuria (χ2 = 0.94, p = 0.04). Conversely, No-AKI participants presented no significant increases in urine markers. Conclusions: These study’s findings may suggest the potential use of urinalysis as an accessible alternative in the outpatient setting to early identify transitional AKI until a clinical confirmation is performed.
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Affiliation(s)
- Daniel Rojas-Valverde
- Centro de Investigación y Diagnóstico en Salud y Deporte (CIDISAD), Escuela Ciencias del Movimiento Humano y Calidad de Vida (CIEMHCAVI), Universidad Nacional, Heredia 86-3000, Costa Rica
- Grupo en Avances en el Entrenamiento Deportivo y Acondicionamiento Físico (GAEDAF), Facultad Ciencias del Deporte, Universidad de Extremadura, 10005 Cáceres, Spain;
- Correspondence: (D.R.-V.); (G.O.); (R.T.); Tel.: +506-8825-0219 (D.R.-V.)
| | - Guillermo Olcina
- Grupo en Avances en el Entrenamiento Deportivo y Acondicionamiento Físico (GAEDAF), Facultad Ciencias del Deporte, Universidad de Extremadura, 10005 Cáceres, Spain;
- Correspondence: (D.R.-V.); (G.O.); (R.T.); Tel.: +506-8825-0219 (D.R.-V.)
| | - Braulio Sánchez-Ureña
- Programa Ciencias del Ejercicio y la Salud (PROCESA), Escuela Ciencias del Movimiento Humano y Calidad de Vida (CIEMHCAVI), Universidad Nacional, Heredia 86-3000, Costa Rica;
| | - José Pino-Ortega
- Departmento de Actividad Física y Deporte, Facultad Ciencias del Deporte, 30720 Murcia, Spain;
| | - Ismael Martínez-Guardado
- Grupo en Avances en el Entrenamiento Deportivo y Acondicionamiento Físico (GAEDAF), Facultad Ciencias del Deporte, Universidad de Extremadura, 10005 Cáceres, Spain;
| | - Rafael Timón
- Grupo en Avances en el Entrenamiento Deportivo y Acondicionamiento Físico (GAEDAF), Facultad Ciencias del Deporte, Universidad de Extremadura, 10005 Cáceres, Spain;
- Correspondence: (D.R.-V.); (G.O.); (R.T.); Tel.: +506-8825-0219 (D.R.-V.)
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48
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Pundee R, Kongtip P, Nankongnab N, Anutrakulchai S, Robson MG, Woskie S. Cross-shift change of acute kidney injury biomarkers in sugarcane farmers and cutters. HUMAN AND ECOLOGICAL RISK ASSESSMENT : HERA 2020; 27:1170-1187. [PMID: 34290492 PMCID: PMC8291722 DOI: 10.1080/10807039.2020.1812049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/14/2020] [Accepted: 08/16/2020] [Indexed: 06/04/2023]
Abstract
Sugarcane farmers and cutters have been reported to be at high risk of acute kidney injury. This cross-sectional study aimed to assess acute kidney injury biomarkers, and cross-shift change among 150 sugarcane cutters and 98 sugarcane farmers in Thailand. Physical health examination, environmental measurements, and measured urinary neutrophil gelatinase-associated lipocalin (NGAL) were assessed. Cross-shift change of urine creatinine (uCr), albumin creatinine ratio (ACR), and NGAL between sugarcane farmers and cutters was compared. Factors influencing abnormal post-shift ACR and NGAL were analyzed by binary logistic regression adjusted with covariates. Sugarcane cutters were significantly more likely to take nonsteroidal anti-inflammatory drugs (NSAID) and herbs to relieve pain than sugarcane farmers. Males were more likely to be current smokers and drinkers although 62% of cutters and 56% of farmers were female. Sugarcane farmers and cutters had similar post-shift estimated glomerular filtration rate (eGFR) and ACR levels. Cross-shift measurements showed that both sugarcane cutters and sugarcane farmers had significantly higher post-shift geometric mean (GM) urinary NGAL, but that the cross-shift changes of NGAL were significantly higher for sugarcane cutters (182%) vs. sugarcane farmers (112%). Water intake less than recommendation of subjects was a significant predictor of a higher risk for an abnormal post-shift ACR after controlling for covariates, while being a sugarcane cutter was a predictor of a lower risk of an abnormal risk of a post-shift NGAL after controlling for covariates. Measurements of heat stress (WBGT plus workload) found that sugarcane cutters exceeded recommended exposures while sugarcane farmers were compliance to the TLV. These findings suggest that to protect sugarcane farmers and cutters, preventative measures are needed.
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Affiliation(s)
- Ritthirong Pundee
- Mahidol University Faculty of Public Health, Department of Occupational Health and Safety, Bangkok, Thailand
| | - Pornpimol Kongtip
- Mahidol University Faculty of Public Health, Department of Occupational Health and Safety, Bangkok, Thailand
- Center of Excellence on Environmental Health and Toxicology, Bangkok, Thailand
| | - Noppanun Nankongnab
- Mahidol University Faculty of Public Health, Department of Occupational Health and Safety, Bangkok, Thailand
| | - Sirirat Anutrakulchai
- Khon Kaen University Faculty of Medicine, Department of Medicine, Khon Kaen, Thailand
| | - Mark Gregory Robson
- Rutgers, School of Environmental and Biological Sciences, New Brunswick, USA
| | - Susan Woskie
- Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Department of Public Health, Lowell, USA
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49
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Boonruksa P, Maturachon T, Kongtip P, Woskie S. Heat Stress, Physiological Response, and Heat-Related Symptoms among Thai Sugarcane Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6363. [PMID: 32882881 PMCID: PMC7503547 DOI: 10.3390/ijerph17176363] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 12/11/2022]
Abstract
Prolonged or intense exposure to heat can lead to a range of health effects. This study investigated heat exposure and heat-related symptoms which sugarcane workers (90 sugarcane cutters and 93 factory workers) experienced during a harvesting season in Thailand. During the hottest month of harvesting season, wet bulb globe temperature was collected in the work environment, and workloads observed, to assess heat stress. Urine samples for dehydration test, blood pressure, heart rate, and body temperature were measured pre- and post-shift to measure heat strain. Fluid intake and heat-related symptoms which subjects had experienced during the harvesting season were gathered via interviews at the end of the season. From the results, sugarcane cutters showed high risk for heat stress and strain, unlike factory workers who had low risk based on the American Conference of Governmental Industrial Hygiene (ACGIH) threshold limit values (TLVs) for heat stress. Dehydration was observed among sugarcane cutters and significant physiological changes including heart rate, body temperature, and systolic blood pressure occurred across the work shift. Significantly more sugarcane cutters reported experiencing heat-related symptoms including weakness/fatigue, heavy sweating, headache, rash, muscle cramp, dry mouth, dizziness, fever, dry/cracking skin, and swelling, compared to sugarcane factory workers. We conclude that the heat stress experienced by sugarcane cutters working in extremely hot environments, with high workloads, is associated with acute health effects. Preventive and control measures for heat stress are needed to reduce the risk of heat strain.
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Affiliation(s)
- Pongsit Boonruksa
- School of Occupational Health and Safety, Institute of Public Health, Suranaree University of Technology, 111 University Ave., Muang, Nakhon Ratchasima 30000, Thailand
| | - Thatkhwan Maturachon
- School of Community Health Nursing, Institute of Nursing, Suranaree University of Technology, 111 University Ave., Muang, Nakhon Ratchasima 30000, Thailand;
| | - Pornpimol Kongtip
- Department of Occupational Health and Safety, Faculty of Public Health, Mahidol University, 420/1 Rajvithi Road, Bangkok 10400, Thailand;
- Center of Excellence on Environmental Health and Toxicology, EHT, Bangkok 10400, Thailand
| | - Susan Woskie
- Department of Public Health, University of Massachusetts Lowell, One University Ave, Lowell, MA 01854-2867, USA;
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50
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Madero M. Is an Environmental Nephrotoxin the Primary Cause of CKDu (Mesoamerican Nephropathy)? Commentary. KIDNEY360 2020; 1:602-603. [PMID: 35378017 PMCID: PMC8815559 DOI: 10.34067/kid.0003412020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 06/14/2023]
Affiliation(s)
- Magdalena Madero
- Division of Nephrology, Instituto Nacional de Cardiologia, Mexico City, Mexico
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