Burnt sugarcane harvesting is associated with acute renal dysfunction

Abstract

Sugarcane harvesting has been associated with an epidemic of chronic kidney disease in Central America mainly affecting previously healthy young workers. Repeated episodes of acute kidney dysfunction are hypothesized to be one of the possible mechanisms for this phenomenon. Therefore, this exploratory study aimed to assess the acute effects of burnt sugarcane harvesting on renal function among 28 healthy non-African Brazilian workers. Urine and blood samples were collected at the beginning and at the end of the harvesting season and before and at the end of a harvesting workday. All individuals decreased their estimated glomerular filtration rate by ∼20% at the end of the daily shift, and 18.5% presented with serum creatinine increases consistent with acute kidney injury. Those changes were associated with increased serum creatine phosphokinase (a known marker for exertional rhabdomyolysis) and oxidative stress-associated malondialdehyde levels, increased peripheral blood white cell counts, decreased urinary and serum sodium, decreased calculated fractional sodium excretion, and increased urine density. Thus, burnt sugarcane harvesting caused acute renal dysfunction in previously healthy workers. This was associated with a combination of dehydration, systemic inflammation, oxidative stress, and rhabdomyolysis.

Intervention to diminish dehydration and kidney damage among sugarcane workers

“…Previous studies among sugarcane cutters in Brazil, El Salvador and Nicaragua have also observed similar changes in hydration and kidney function biomarkers that have been attributed to heat stress (8,11,13). Some of the workers in this study met the criteria for AKI over the course of a working day as reported among Brazilian cane cutters (11).…”

“…Some of the workers in this study met the criteria for AKI over the course of a working day as reported among Brazilian cane cutters (11). In this study, these negative changes were related to the individual's production, a finding not previously reported.…”

“…Cross-shift increases in S-CPK were within normal ranges indicating that S-CPK increases were caused by muscle breakdown from strenuous labor rather than severe acute rhabdomyolysis. In Brazil, cane cutters had a higher increase in S-CPK during a workday (11). This study also showed a significant change in eGFR over the course of the harvest.…”

“…They found higher S-creatinine and lower eGFR at the end of the observation period (10, 13). In the above-mentioned Brazilian study, no increase in S-creatinine was observed over the harvest, but these cutters had worked an average of only three harvests and the population was very small (11). In the present study, decreasing eGFR appeared to halt after the introduction of the intervention (See figure 1).…”

“…Several studies suggest a causal association between MeN and chronic heat stress and dehydration (8)(9)(10)(11)(12)(13) and experimental data have shown that repeated dehydration can induce CKD in mice (14,15). Heat exposure, strenuous exercise and dehydration pose a significant challenge to the cardiovascular system, and the transport of oxygen to exercising muscles and vital organs, such as the kidney (16).…”