Sugarcane Workweek Study: Risk Factors for Daily Changes in Creatinine

Abstract

Introduction: Agricultural workers laboring in thermally stressful environments are at increased risk for kidney injury and chronic kidney disease of unknown origin (CKDu), and their environmental and occupational exposures have been considered to be important risk factors. This study examined the effects of repeated kidney stress from the simultaneous strain of work and other factors experienced by workers in Guatemala during a typical workweek.Methods: We collected data from 107 sugarcane workers across 7 consecutive work shifts. Data included information on daily occupational, meteorological, environmental, and lifestyle factors. We used multivariable linear mixed models to evaluate associations of these factors with percent change in creatinine. Results:We observed that increasing wet bulb globe temperature (b ¼ 2.5%, 95% confidence interval [CI] ¼ 0.3%, 4.7%) and increasing diastolic blood pressure (b ¼ 6.2%, 95% CI ¼ 0.9%, 11.6%) were associated with increases in creatinine across the shift, whereas consumption of water from chlorinated dormitory tanks as compared to artesian well water (b ¼ À17.5%, 95% CI ¼ À29.6%, À5.4%) and increasing number of rest breaks (b ¼ À5.8%, 95% CI ¼ À9.0%, À2.6%) were found to be protective against increases in creatinine. Workers reporting drinking tank water had lower concentrations of urine creatinineÀcorrected arsenic, lead, uranium, and glyphosate compared to workers reporting the use of well water or municipal water. Conclusion:These results reinforce the need to focus on preventive actions that reduce kidney injury among this worker population, including strategies to reduce heat stress, managing blood pressure, and examining water sources of workers for nephrotoxic contaminants.

Chronic kidney disease with unknown cause across the global spectrum

“…Patients typically present with CKD stage 3 or 4, although an acute presentation has been reported with fever, vomiting, and headaches [15,18,19]. In Central America, transiently increased blood pressure with an elevated serum creatinine level during active farm work has been associated with subsequent kidney functional decline and CKDu [20]. In Indian CKDu patients, hypertension was seen in 53.9%, although cardiovascular complications were found in only 18% [7 & ].…”

“…In Mexico, agrochemicals have been potentially associated with impaired kidney function and proteinuria [29]. Drinking from clean tank vs. municipal or well water lowers urinary arsenic, lead, uranium, and glyphosate concentrations and protects against increased serum creatinine [20]. High urine cadmium and arsenic negatively associate with estimated glomerular filtration rate (eGFR) ( r = −4.23 and −4.36, respectively) while cadmium is positively associated with urinary NGAL (r=2.92) [30].…”

Impact of Heat Stress on Renal Function: A Systematic Literature Review Focusing on Workplace Heat

“…In 18 studies, wet bulb globe temperature (WBGT) index was calculated [12-14, 17, 18, 21, 22, 24, 25, 30-38]; 15 of these articles used the WBGT meter [12,14,17,18,21,22,25,[30][31][32][33][35][36][37][38]. In two of these studies, the index values were obtained from the safety engineering department [13,24], and in another study, the temperature and relative humidity were measured using a digital weather meter [34].…”

“…The median and IQR of postpre shift difference of eGFR among non-AKI and AKI workers was -14.60 (-18.60, -8.25) and -43.10 (-52.30, -34.88), respectively [39]. An investigation across seven consecutive work shifts found that increased WBGT was associated with increased SCr across the shift on all seven workdays (regression coefficient= 2.5%, p-value= 0.02) [14].…”

“…HS can lead to high body temperature and dehydration with subsequent volume depletion, which may cause kidney damage [12,13]. Heat-exposed workers such as miners and industrial and agricultural workers are prone to HS and subsequently develop CKDnt, because of manual work in hot environments, short breaks, and inadequate fluid intake [10,14]. Timely and appropriate screening can be used to prevent kidney damage in high-risk populations such as workers exposed to occupational heat.…”