Changes in kidney function among Nicaraguan sugarcane workers

Abstract

Background: There is an epidemic of chronic kidney disease (CKD) of unknown etiology in Central American workers.

Objectives: To investigate changes and job-specific differences in kidney function over a 6-month sugarcane harvest season, explore the potential role of hydration, and measure proteinuria.

Methods: We recruited 284 Nicaraguan sugarcane workers performing seven distinct tasks. We measured urine albumin and serum creatinine and estimated glomerular filtration rate (eGFR).

Results: eGFR varied by job and decreased during the harvest in seed cutters (-8·6 ml/min/1·73 m(2)), irrigators (-7·4 ml/min/1·73 m(2)), and cane cutters (-5·0 ml/min/1·73 m(2)), as compared to factory workers. The number of years employed at the company was negatively associated with eGFR. Fewer than 5% of workers had albumin-to-creatinine ratio (ACR) >30 mg/g.

Conclusions: The decline in kidney function during the harvest and the differences by job category and employment duration provide evidence that one or more risk factors of CKD are occupational.

Keywords: Chronic kidney disease of nontraditional etiology,; Chronic kidney disease,; Estimated glomerular filtration rate,; Mesoamerican Nephropathy,; Serum creatinine,; Tubulointerstitial.

Figure 1

Derivation of study population (n = 284).