Mechanisms by Which Dehydration May Lead to Chronic Kidney Disease

Roncal-Jiménez, Carlos A.; Lanaspa, Miguel A.; Jensen, Thomas; Sánchez-Lozada, Laura G.; Johnson, Richard J.

doi:10.1159/000381239

Cited by 507 publications

(104 citation statements)

References 21 publications

(26 reference statements)

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“…Thus, our results show that not all agricultural workers are at increased risk for CKD, as is commonly stated, but rather workers in certain types of agriculture and other jobs in the heat such as work in the construction industry. The absence of reduced kidney function among subsistence farmers is consistent with a study in a MeN epidemic area in El Salvador, where subsistence farmers without a history of plantation work had a significantly lower prevalence of abnormal SCr than men who had worked on sugar or cotton plantations (15% vs 33%) 20. Reduced kidney function was accompanied by a higher frequency of anaemia among sugarcane cutters (36% vs 4–9% in the other groups).…”

Section: Discussionsupporting

confidence: 86%

Heat stress, hydration and uric acid: a cross-sectional study in workers of three occupations in a hotspot of Mesoamerican nephropathy in Nicaragua

et al. 2016

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ObjectivesTo study Mesoamerican nephropathy (MeN) and its risk factors in three hot occupations.DesignCross-sectional.SettingChinandega and León municipalities, a MeN hotspot on the Nicaraguan Pacific coast, January–February 2013.Participants194 male workers aged 17–39 years: 86 sugarcane cutters, 56 construction workers, 52 small-scale farmers.Outcome measures(1) Differences between the three occupational groups in prevalences/levels of socioeconomic, occupational, lifestyle and health risk factors for chronic kidney disease (CKD) and in biomarkers of kidney function and hydration; (2) differences in prevalences/levels of CKD risk factors between workers with reduced estimated glomerular filtration rate (eGFRCKD-EPI <80 mL/min/1.73 m2) and workers with normal kidney function (eGFRCKD-EPI ≥80 mL/min/1.73 m2).ResultsSugarcane cutters were more exposed to heat and consumed more fluid on workdays and had less obesity, lower blood sugar, lower blood pressure and a better lipid profile. Reduced eGFR occurred in 16%, 9% and 2% of sugarcane cutters, construction workers and farmers, respectively (trend cane > construction > farming, p=0.003). Significant trends (cane > construction > farming) were also observed for high serum urea nitrogen (blood urea nitrogen (BUN) >20 mg/dL), high serum creatinine (SCr >1.2 mg/dL), low urinary pH (≤5.5) and high BUN/SCr ratio (>20) but not for high urinary specific gravity (≥1.030). Sugarcane cutters also more often had proteinuria and blood and leucocytes in the urine. Workers with eGFR <80 mL/min/1.73 m2 reported a higher intake of water and lower intake of sugary beverages. Serum uric acid levels related strongly and inversely to eGFR levels (adj β −10.4 mL/min/1.73 m2, 95% CI −12.2 to −8.5, p<0.001). No associations were observed for other metabolic risk factors, pesticides, non-steroidal anti-inflammatory drugs or alcohol. Among cane cutters, consumption of electrolyte hydration solution appeared preventive (adj β 8.1 mL/min/1.73 m2, p=0.09).ConclusionsHeat stress, dehydration and kidney dysfunction were most common among sugarcane cutters. Kidney dysfunction also occurred to a lesser extent among construction workers, but hardly at all among small-scale farmers. High serum uric acid was associated with reduced kidney function.

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Section: Discussionsupporting

confidence: 86%

Heat stress, hydration and uric acid: a cross-sectional study in workers of three occupations in a hotspot of Mesoamerican nephropathy in Nicaragua

et al. 2016

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“…Volume depletion has been posited as a mechanism for AKI and potentially further damage 55–57. Recent research suggests that chronic volume depletion leads to sustained release of vasopressin and increased uric acid levels, which may precipitate long-term damage to the kidneys 58 59. Our findings suggest that heat strain, not volume depletion, may be a more concerning risk factor in this population.…”

Section: Discussionmentioning

confidence: 56%

Heat strain, volume depletion and kidney function in California agricultural workers

et al. 2017

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Background Agricultural work can expose workers to increased risk of heat strain and volume depletion due to repeated exposures to high ambient temperatures, arduous physical exertion and limited rehydration. These risk factors may result in acute kidney injury (AKI). Methods We estimated AKI cumulative incidence in a convenience sample of 283 agricultural workers based on elevations of serum creatinine between preshift and postshift blood samples. Heat strain was assessed based on changes in core body temperature and heart rate. Volume depletion was assessed using changes in body mass over the work shift. Logistic regression models were used to estimate the associations of AKI with traditional risk factors (age, diabetes, hypertension and history of kidney disease) as well as with occupational risk factors (years in farm work, method of payment and farm task). Results 35 participants were characterised with incident AKI over the course of a work shift (12.3%). Workers who experienced heat strain had increased adjusted odds of AKI (1.34, 95% CI 1.04 to 1.74). Piece rate work was associated with 4.24 odds of AKI (95% CI 1.56 to 11.52). Females paid by the piece had 102.81 adjusted odds of AKI (95% CI 7.32 to 1443.20). Discussion Heat strain and piece rate work are associated with incident AKI after a single shift of agricultural work, though gender differences exist. Modifications to payment structures may help prevent AKI.

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“…While sorbitol is initially protective of renal medulla cells during a hyperosmolar state, it can also lead to oxidative damage and inflammation [8]. This is primarily due to fructokinase, which is involved in the metabolism of sorbitol [50,51] and ultimately leads to increased serum uric acid [5].…”

Section: Discussion/conclusionmentioning

confidence: 99%

Hyperosmolality, High Blood Pressure, and Decreased Estimated Glomerular Filtration Rate in US Adolescents, National Health and Nutrition Examination Survey 1999–2012

Chmielewski

Khalsa

Carmody

2019

Nephron

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Background: Experimental evidence suggests that hyperosmolality may be a causative factor in the development of both salt-sensitive hypertension and chronic kidney disease (CKD). There are no population-wide studies in young persons to assess the relationships among these factors. Objective: To determine the association of serum osmolality and serum sodium with high systolic blood pressure (SBP) and decreased estimated glomerular filtration rate (eGFR) among a nationally representative population of adolescents. Method: Relevant data among participants ages 12–14 were obtained from the National Health and Nutrition Examination Survey cycles 1999–2012. Serum osmolality was calculated using the Worthley equation. eGFR was calculated using the Counahan-Barratt equation, and values < 90 mL/min/1.73 m² were considered decreased. High SBP was defined as SBP ≥95th percentile for age, height, and sex. Results: A total of 4,168 adolescents were analyzed (representative population: 10,464,592). Adolescents with serum osmolality ≥290 mOsm/kg and/or serum sodium ≥143 mmol/L had increased odds for both high SBP (serum osmolality ≥290 mOsm/kg: OR 2.04; 95% CI 1.03–4.02; sodium ≥143 mmol/L: OR 4.36; 95% CI 1.58–12.04) and decreased eGFR (serum osmolality ≥290 mOsm/kg: OR 1.61; 95% CI 1.18–2.21; sodium ≥143 mmol/L: OR 3.27; 95% CI 1.77–6.03) when compared to participants with values below these thresholds. These thresholds remained significant even after multivariable adjustment. Conclusion: Among adolescents in a nationally representative survey, hypernatremia and hyperosmolality were associated with high SBP and decreased eGFR. These findings may support the hypothesis that an imbalance of salt and water contribute to hypertension and CKD.

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Mechanisms by Which Dehydration May Lead to Chronic Kidney Disease

Cited by 507 publications

References 21 publications

Heat stress, hydration and uric acid: a cross-sectional study in workers of three occupations in a hotspot of Mesoamerican nephropathy in Nicaragua

Heat stress, hydration and uric acid: a cross-sectional study in workers of three occupations in a hotspot of Mesoamerican nephropathy in Nicaragua

Heat strain, volume depletion and kidney function in California agricultural workers

Hyperosmolality, High Blood Pressure, and Decreased Estimated Glomerular Filtration Rate in US Adolescents, National Health and Nutrition Examination Survey 1999–2012

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