Evaluation of heat stress and cumulative incidence of acute kidney injury in sugarcane workers in Guatemala

doi:10.1007/s00420-019-01426-3

. 2019 Oct;92(7):977-990.

doi: 10.1007/s00420-019-01426-3. Epub 2019 Apr 17.

Evaluation of heat stress and cumulative incidence of acute kidney injury in sugarcane workers in Guatemala

Jaime Butler-Dawson^{1

2

3}, Lyndsay Krisher^{4

5}, Hillary Yoder⁶, Miranda Dally^{4

5

7}, Cecilia Sorensen^{5

8}, Richard J Johnson^{5

9}, Claudia Asensio¹⁰, Alex Cruz¹⁰, Evan C Johnson⁶, Elizabeth J Carlton^{5

7}, Liliana Tenney^{4

5

7}, Edwin J Asturias^{11

12

13}, Lee S Newman^{4

5

7

14}

Affiliations

¹ Department of Environmental and Occupational Health, Center for Health, Work, and Environment Colorado School of Public Health, University of Colorado, Anschutz Medical Campus 13001 E. 17th Pl., Ste. W3111, Aurora, CO, 80045, USA. jaime.butler-dawson@ucdenver.edu.
² Colorado Consortium on Climate Change and Human Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA. jaime.butler-dawson@ucdenver.edu.
³ Department of Environmental and Occupational Health, School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA. jaime.butler-dawson@ucdenver.edu.
⁴ Department of Environmental and Occupational Health, Center for Health, Work, and Environment Colorado School of Public Health, University of Colorado, Anschutz Medical Campus 13001 E. 17th Pl., Ste. W3111, Aurora, CO, 80045, USA.
⁵ Colorado Consortium on Climate Change and Human Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
⁶ Department Kinesiology and Health, University of Wyoming, Laramie, WY, USA.
⁷ Department of Environmental and Occupational Health, School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
⁸ Department of Emergency Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.
⁹ Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
¹⁰ Pantaleon, Guatemala City, GT, USA.
¹¹ Division of Pediatric Infectious Diseases, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
¹² Center for Global Health, Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, USA.
¹³ Department of Epidemiology, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
¹⁴ Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.

PMID: 30997573
PMCID: PMC6768910
DOI: 10.1007/s00420-019-01426-3

Evaluation of heat stress and cumulative incidence of acute kidney injury in sugarcane workers in Guatemala

Jaime Butler-Dawson et al. Int Arch Occup Environ Health. 2019 Oct.

. 2019 Oct;92(7):977-990.

doi: 10.1007/s00420-019-01426-3. Epub 2019 Apr 17.

Authors

Affiliations

¹ Department of Environmental and Occupational Health, Center for Health, Work, and Environment Colorado School of Public Health, University of Colorado, Anschutz Medical Campus 13001 E. 17th Pl., Ste. W3111, Aurora, CO, 80045, USA. jaime.butler-dawson@ucdenver.edu.
² Colorado Consortium on Climate Change and Human Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA. jaime.butler-dawson@ucdenver.edu.
³ Department of Environmental and Occupational Health, School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA. jaime.butler-dawson@ucdenver.edu.
⁴ Department of Environmental and Occupational Health, Center for Health, Work, and Environment Colorado School of Public Health, University of Colorado, Anschutz Medical Campus 13001 E. 17th Pl., Ste. W3111, Aurora, CO, 80045, USA.
⁵ Colorado Consortium on Climate Change and Human Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
⁶ Department Kinesiology and Health, University of Wyoming, Laramie, WY, USA.
⁷ Department of Environmental and Occupational Health, School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
⁸ Department of Emergency Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.
⁹ Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
¹⁰ Pantaleon, Guatemala City, GT, USA.
¹¹ Division of Pediatric Infectious Diseases, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
¹² Center for Global Health, Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, USA.
¹³ Department of Epidemiology, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
¹⁴ Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.

PMID: 30997573
PMCID: PMC6768910
DOI: 10.1007/s00420-019-01426-3

Abstract

Objective: Agricultural workers worldwide exposed to heat stress could be at the risk of kidney injury, which could lead to chronic kidney disease of an unknown origin (CKDu). Hydration has been promoted as a key measure to reduce kidney injury. In the presence of a hydration intervention, the incidence of acute kidney injury (AKI) was calculated in a sugarcane worker population in Guatemala and several risk factors were evaluated.

Methods: We measured kidney function at the beginning and end of the work shift at three time points in 517 sugarcane workers. We defined AKI as an increase in serum creatinine of 26.5 µmol/L or 50% or more from the pre-shift value. Associations between AKI and risk factors were examined, including interactions with hydration status.

Results: The prevalence of dehydration post-shift (> 1.020 specific gravity) was 11% in February, 9% in March, and 6% in April. Cumulative incidence of AKI was 53% in February, 54% in March, and 51% in April. AKI was associated with increasing post-shift specific gravity, a dehydration marker, (OR 1.24, 95% CI 1.02-1.52) and with lower electrolyte solution intake (OR 0.94, 95% CI 0.89-0.99).

Conclusions: Dehydration and insufficient electrolyte consumption are risk factors for AKI. However even well-hydrated sugarcane workers routinely experience AKI. While hydration is important and protective, there is a need to understand other contributors to risk of AKI and identify prevention strategies with these workers.

Keywords: Agricultural workers; Hydration; Kidney injury.

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Conflict of interest statement

Pantaleon and the University of Colorado have a memorandum of understanding and a contract for consulting on Total Worker Health programs. It supports part of the salaries for the Center for Health, Work, & Environment authors (JBD, LK, MD, LT, and LN). University of Colorado and Pantaleon are separate, independent organizations. University of Colorado employed appropriate research methods in keeping with principles of academic freedom, based conclusions on critical analysis of the evidence, and reported findings fully and objectively. The terms of this arrangement have been reviewed and approved by the University of Colorado Denver in accordance with its conflict of interest policies. Authors: HY, CS, RJ, CA, AC, EJ, EC, and EA have no conflict of interest to report.

Figures

**Fig. 1**
Flowchart of pre-employment screening and study recruitment

See this image and copyright information in PMC

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References

1. Bodin T, Garcia-Trabanino R, Weiss I, Jarquin E, Glaser J, Jakobsson K, et al. Intervention to reduce heat stress and improve efficiency among sugarcane workers in El Salvador: Phase 1. Occup Environ Med. 2016;73(6):409–416. - PMC - PubMed
1. Butler-Dawson J, Krisher L, Asensio C, Cruz A, Tenney L, Weitzenkamp D, et al. Risk factors for declines in kidney function in sugarcane workers in Guatemala. J Occup Environ Med. 2018;60(6):548–558. - PMC - PubMed
1. Clarkson PM, Kearns AK, Rouzier P, Rubin R, Thompson PD. Serum creatine kinase levels and renal function measures in exertional muscle damage. Med Sci Sports Exerc. 2006;38(4):623–627. - PubMed
1. Correa-Rotter R, Wesseling C, Johnson RJ. CKD of unknown origin in central america: the case for a mesoamerican nephropathy. Am J Kidney Dis. 2014;63(3):506–520. - PMC - PubMed
1. Crowe J, Wesseling C, Solano BR, Umana MP, Ramirez AR, Kjellstrom T, et al. Heat exposure in sugarcane harvesters in Costa Rica. Am J Ind Med. 2013;56(10):1157–1164. - PubMed

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[1] Bodin T, Garcia-Trabanino R, Weiss I, Jarquin E, Glaser J, Jakobsson K, et al. Intervention to reduce heat stress and improve efficiency among sugarcane workers in El Salvador: Phase 1. Occup Environ Med. 2016;73(6):409–416. - PMC - PubMed

[2] Bodin T, Garcia-Trabanino R, Weiss I, Jarquin E, Glaser J, Jakobsson K, et al. Intervention to reduce heat stress and improve efficiency among sugarcane workers in El Salvador: Phase 1. Occup Environ Med. 2016;73(6):409–416. - PMC - PubMed

[3] Butler-Dawson J, Krisher L, Asensio C, Cruz A, Tenney L, Weitzenkamp D, et al. Risk factors for declines in kidney function in sugarcane workers in Guatemala. J Occup Environ Med. 2018;60(6):548–558. - PMC - PubMed

[4] Butler-Dawson J, Krisher L, Asensio C, Cruz A, Tenney L, Weitzenkamp D, et al. Risk factors for declines in kidney function in sugarcane workers in Guatemala. J Occup Environ Med. 2018;60(6):548–558. - PMC - PubMed

[5] Clarkson PM, Kearns AK, Rouzier P, Rubin R, Thompson PD. Serum creatine kinase levels and renal function measures in exertional muscle damage. Med Sci Sports Exerc. 2006;38(4):623–627. - PubMed

[6] Clarkson PM, Kearns AK, Rouzier P, Rubin R, Thompson PD. Serum creatine kinase levels and renal function measures in exertional muscle damage. Med Sci Sports Exerc. 2006;38(4):623–627. - PubMed

[7] Correa-Rotter R, Wesseling C, Johnson RJ. CKD of unknown origin in central america: the case for a mesoamerican nephropathy. Am J Kidney Dis. 2014;63(3):506–520. - PMC - PubMed

[8] Correa-Rotter R, Wesseling C, Johnson RJ. CKD of unknown origin in central america: the case for a mesoamerican nephropathy. Am J Kidney Dis. 2014;63(3):506–520. - PMC - PubMed

[9] Crowe J, Wesseling C, Solano BR, Umana MP, Ramirez AR, Kjellstrom T, et al. Heat exposure in sugarcane harvesters in Costa Rica. Am J Ind Med. 2013;56(10):1157–1164. - PubMed

[10] Crowe J, Wesseling C, Solano BR, Umana MP, Ramirez AR, Kjellstrom T, et al. Heat exposure in sugarcane harvesters in Costa Rica. Am J Ind Med. 2013;56(10):1157–1164. - PubMed

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Evaluation of heat stress and cumulative incidence of acute kidney injury in sugarcane workers in Guatemala

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Evaluation of heat stress and cumulative incidence of acute kidney injury in sugarcane workers in Guatemala

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