Acute Kidney Failure among Brazilian Agricultural Workers: A Death-Certificate Case-Control Study

Abstract

Recent evidence suggests that pesticides may play a role in chronic kidney disease. However, little is known about associations with acute kidney failure (AKF). We investigated trends in AKF and pesticide expenditures and associations with agricultural work in two Brazilian regions with intense use of pesticides, in the south and midwest. Using death certificate data, we investigated trends in AKF mortality (1980–2014). We used joinpoint regression to calculate annual percent changes in AKF mortality rates by urban/rural status and, in rural municipalities, by tertiles of per capita pesticide expenditures. We then compared AKF mortality in farmers and population controls from 2006 to 2014 using logistic regression to estimate odds ratios and 95% confidence intervals adjusted by age, sex, region, education, and race. AKF mortality increased in both regions regardless of urban/rural status; trends were steeper from the mid-1990s to 2000s, and in rural municipalities, they were higher by tertiles of pesticide expenditures. Agricultural workers were more likely to die from AKF than from other causes, especially at younger ages, among females, and in the southern municipalities. We observed increasing AKF mortality in rural areas with greater pesticide expenditures and an association of AKF mortality with agricultural work, especially among younger workers.

Riscos ocupacionais associados à doença renal crônica de origem não tradicional (DRCnt) no Brasil: é hora de nos aprofundarmos em um problema negligenciado

“…Poucos estudos abordaram os efeitos renais da exposição ocupacional a agrotóxicos no Brasil. Um estudo recente mostra que a mortalidade por insuficiência renal aguda (IRA) está aumentando em regiões urbanas e rurais, principalmente entre trabalhadores agrícolas de áreas rurais com maior consumo de agrotóxicos, trabalhadores mais jovens, mulheres e moradores do sul do Brasil 51 . Outro estudo com agricultores brasileiros observou a falta de uso de equipamento de proteção individual (EPI) e pouca capacitação ocupacional, e constatou que trabalhadores com mais de 5 anos de exposição a agrotóxicos apresentaram maior risco relativo de alteração da TFG (RR 1,59) 52 .…”

Occupational risks associated with chronic kidney disease of non-traditional origin (CKDnt) in Brazil: it is time to dig deeper into a neglected problem

“…Few studies addressed kidney effects of occupational pesticide exposure in Brazil. A recent study shows that acute kidney failure (AKF) mortality is increasing in urban and rural regions, especially among agricultural workers from rural areas with greater pesticide consumption, younger workers, females, and those living in southern Brazil 51 . Another study with Brazilian farmers observed a lack of personal protective equipment (PPE) use and little occupational training, and found that workers with more than 5 years of pesticide exposure had higher relative risk of GFR alteration (RR 1.59) 52 .…”