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. 2019 Mar;61(3):239-250.
doi: 10.1097/JOM.0000000000001529.

Risk Factors and Mechanisms Underlying Cross-Shift Decline in Kidney Function in Guatemalan Sugarcane Workers

Cecilia J Sorensen  1 , Jaime Butler-Dawson, Miranda Dally, Lyndsay Krisher, Benjamin R Griffin, Richard J Johnson, Jay Lemery, Claudia Asensio, Liliana Tenney, Lee S Newman
Affiliations

Risk Factors and Mechanisms Underlying Cross-Shift Decline in Kidney Function in Guatemalan Sugarcane Workers

Cecilia J Sorensen et al. J Occup Environ Med. 2019 Mar.

Abstract

Objective: Identify early biomarkers and mechanisms of acute kidney injury in workers at risk of developing chronic kidney disease of unknown origin (CKDu).

Methods: We assessed cross-shift changes in kidney function and biomarkers of injury in 105 healthy sugarcane workers. We obtained pre-harvest clinical data as well as daily environmental, clinical, and productivity data for each worker.

Results: The average percent decline in cross-shift estimated glomerular filtration rate (eGFR) was 21.8% (standard deviation [SD] 13.6%). Increasing wet bulb globe temperature (WBGT), high uric acid, decreased urine pH, urinary leukocyte esterase, and serum hyperosmolality were risk factors for decline in kidney function.

Conclusions: Sugarcane workers with normal kidney function experience recurrent subclinical kidney injury, associated with elevations in biomarkers of injury that suggest exposure to high temperatures and extreme physical demands.

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Figures

FIGURE 1
FIGURE 1
Mechanisms by which recurrent exposure to high ambient temperature and high physical workloads, in synergy with other exposures and risk factors, may lead to CKDu. CKDu, chronic kidney disease of unknown origin.
FIGURE 2
FIGURE 2
A: Pre-shift urine specific gravity among study participants, averaged across February, March, and April, 2017. B: Post-shift urine specific gravity among study participants, averaged across February, March, and April, 2017.
FIGURE 3
FIGURE 3
Comparison between pre- and post-shift eGFR during 3 study months (left) and cross-shift percent change in eGFR (right). eGFR, estimated glomerular filtration rate.
See this image and copyright information in PMC

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