Preventing kidney injury among sugarcane workers: promising evidence from enhanced workplace interventions

Occup Environ Med. 2020 Aug;77(8):527-534. doi: 10.1136/oemed-2020-106406. Epub 2020 May 13.


Objectives: To assess if improvement of working conditions related to heat stress was associated with improved kidney health outcomes among sugarcane harvest workers in Chichigalpa, Nicaragua, a region heavily affected by the epidemic of chronic kidney disease of non-traditional origin.

Methods: Based on our findings during the 2017-2018 harvest (harvest 1), recommendations that enhanced the rest schedule and improved access to hydration and shade were given before the 2018-2019 harvest (harvest 2). Actual work conditions during harvest 2 were then observed. Serum creatinine (SCr) was measured before and at end-harvest, and cross-harvest changes in estimated glomerular filtration rate (eGFR) and incident kidney injury (IKI, ie, SCr increase by ≥0.30 mg/dL or ≥1.5 times the baseline value) were compared between harvest 1 and harvest 2 for three jobs with different physical workloads using regression modelling. Workers who left during harvest were contacted at home, to address the healthy worker selection effect.

Results: In burned cane cutters, mean cross-harvest eGFR decreased 6 mL/min/1.73 m2 (95% CI 2 to 9 mL/min/1.73 m2) less and IKI was 70% (95% CI 90% to 50%) lower in harvest 2 as compared with harvest 1 data. No such improvements were seen among seed cutters groups with less successful intervention implementation.

Conclusion: Kidney injury risk was again elevated in workers with strenuous jobs. The results support further efforts to prevent kidney injury among sugarcane workers, and other heat-stressed workers, by improving access to water, rest and shade. The distinction between design and implementation of such interventions should be recognised.

Keywords: climate; international occupational health; intervention studies; renal; workload.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / prevention & control*
  • Adult
  • Cohort Studies
  • Creatinine / blood
  • Dehydration / prevention & control
  • Farmers*
  • Female
  • Glomerular Filtration Rate
  • Healthy Worker Effect
  • Heat Stress Disorders / prevention & control*
  • Humans
  • Male
  • Nicaragua / epidemiology
  • Occupational Diseases / epidemiology
  • Occupational Diseases / prevention & control*
  • Saccharum


  • Creatinine