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. 2019 Oct;92(7):977-990.
doi: 10.1007/s00420-019-01426-3. Epub 2019 Apr 17.

Evaluation of heat stress and cumulative incidence of acute kidney injury in sugarcane workers in Guatemala

Jaime Butler-Dawson  1   2   3 , Lyndsay Krisher  4   5 , Hillary Yoder  6 , Miranda Dally  4   5   7 , Cecilia Sorensen  5   8 , Richard J Johnson  5   9 , Claudia Asensio  10 , Alex Cruz  10 , Evan C Johnson  6 , Elizabeth J Carlton  5   7 , Liliana Tenney  4   5   7 , Edwin J Asturias  11   12   13 , Lee S Newman  4   5   7   14
Affiliations

Evaluation of heat stress and cumulative incidence of acute kidney injury in sugarcane workers in Guatemala

Jaime Butler-Dawson et al. Int Arch Occup Environ Health. 2019 Oct.

Abstract

Objective: Agricultural workers worldwide exposed to heat stress could be at the risk of kidney injury, which could lead to chronic kidney disease of an unknown origin (CKDu). Hydration has been promoted as a key measure to reduce kidney injury. In the presence of a hydration intervention, the incidence of acute kidney injury (AKI) was calculated in a sugarcane worker population in Guatemala and several risk factors were evaluated.

Methods: We measured kidney function at the beginning and end of the work shift at three time points in 517 sugarcane workers. We defined AKI as an increase in serum creatinine of 26.5 µmol/L or 50% or more from the pre-shift value. Associations between AKI and risk factors were examined, including interactions with hydration status.

Results: The prevalence of dehydration post-shift (> 1.020 specific gravity) was 11% in February, 9% in March, and 6% in April. Cumulative incidence of AKI was 53% in February, 54% in March, and 51% in April. AKI was associated with increasing post-shift specific gravity, a dehydration marker, (OR 1.24, 95% CI 1.02-1.52) and with lower electrolyte solution intake (OR 0.94, 95% CI 0.89-0.99).

Conclusions: Dehydration and insufficient electrolyte consumption are risk factors for AKI. However even well-hydrated sugarcane workers routinely experience AKI. While hydration is important and protective, there is a need to understand other contributors to risk of AKI and identify prevention strategies with these workers.

Keywords: Agricultural workers; Hydration; Kidney injury.

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Conflict of interest statement

Pantaleon and the University of Colorado have a memorandum of understanding and a contract for consulting on Total Worker Health programs. It supports part of the salaries for the Center for Health, Work, & Environment authors (JBD, LK, MD, LT, and LN). University of Colorado and Pantaleon are separate, independent organizations. University of Colorado employed appropriate research methods in keeping with principles of academic freedom, based conclusions on critical analysis of the evidence, and reported findings fully and objectively. The terms of this arrangement have been reviewed and approved by the University of Colorado Denver in accordance with its conflict of interest policies. Authors: HY, CS, RJ, CA, AC, EJ, EC, and EA have no conflict of interest to report.

Figures

Fig. 1
Fig. 1
Flowchart of pre-employment screening and study recruitment
See this image and copyright information in PMC

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