This is the first Mediterranean study assessing occupation as a risk factor for kidney disease. Occupational heat exposure is associated with dialysis, compared to controls with normal kidneys. Heat exposure should be considered as a risk for kidney disease of unknown etiology. We call for preventive strategies in high-risk professions.

regards to outcome (p <0.001). Incidence of hypokalemia, leucopenia and thrombocytopenia were 51.3%, 52.6% and 47.4% respectively, though not statistically significant. Comparison of the pre and post plasmapheresis LFTs were found to be significant to outcome (p-0.001) [Total Bilirubin (12.4mg/dl, 6.8mg/dl), SGOT (1126 IU/L, 108 IU/L), SGPT (876 IU/L, 116 IU/L), PT (51.1s, 18.4s), INR (4.6, 1.5), APTT (48s, 30.2s)]. Median Delta MELD was found to be 12.08 in survivors, whereas it was 8.7 in non survivors, and was found to be statistically significant with regards to outcome (p-0.001). The total number of plasmapheresis sessions conducted also correlated with outcome (p-0.001). The Median Survival Time in non-survivors was 199.585 hours (95% Confidence Interval).Conclusions: Plasmapheresis can be a therapeutic option for the treatment for acute liver failure due to rat killer paste poisoning. This is supported by the fact that there is a significant improvement in the liver functions and the coagulation parameters post plasmapheresis. Delta MELD may be used as a prognostic indicator of outcome.