Heat stress, dehydration, and kidney function in sugarcane cutters in El Salvador – A cross-shift study of workers at risk of Mesoamerican nephropathy

ObjectivesThere is an epidemic of Mesoamerican nephropathy (MeN) in Central America, where sugarcane production is prominent. Numerous causes are proposed, but to date limited evidence supports any one hypothesis. A nested case–control study using biosamples from a rural, community-based follow-up study of 350 young adults from Northwest Nicaragua at risk of MeN was conducted with the aim of characterising the associations between urinary concentrations of metals, pesticides and mycotoxins from samples collected in the first 6 months and decline in kidney function over 2 years.MethodsUrine samples collected at baseline (pre-sugarcane harvest) and the first 6 month follow-up (post-sugarcane harvest) visit were tested. Twelve metals and metalloids (aluminium, total arsenic, cadmium, chromium, cobalt, copper, lead, manganese, mercury, selenium, silicon and strontium) were analysed by inductively coupled plasma-mass spectrometry. Twelve pesticides or their metabolites (2,4-dichlorophenoxyacetic acid, 3-phenoxybenzoic acid, 4-fluoro-3-phenoxybenzoic acid, chloro-3,3,3-trifluoro-1-propen-1-yl-2,2-dimethylcyclopropanecarboxylic acid, cis/trans 3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid, ethylenethiourea, glyphosate, 4-chloro-2-methylphenoxy acetic acid, 3-hydroxy-pyrimetanil, 5-hydroxytiabendazole, hydroxy-tebuconazole and 3,5,6-trichloro-2-pyridinol) and two mycotoxins (ochratoxin A (OTA) and citrinin (CIT)) were analysed by liquid chromatography coupled-mass spectrometry. Differences in the creatinine-corrected urinary concentrations of the measured exposures between outcome groups (participants with stable vs declining kidney function) were examined.ResultsElevated levels of aluminium and total arsenic as well as metabolites of several pesticides were detected across the population. No differences were identified between the declining and stable groups in the levels of metals or pesticides tested. OTA and CIT were below the limit of detection.ConclusionsThe tested metals, metalloids, pesticides and mycotoxins were not associated with loss of kidney function in participants at-risk of MeN.

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Dysuria, heat stress, and muscle injury among Nicaraguan sugarcane workers at risk for Mesoamerican nephropathy

Scandinavian Journal of Work Environment & Health ◽

10.5271/sjweh.3963 ◽

2021 ◽

Author(s):

Tiffany L Stallings ◽

Alejandro Riefkohl Lisci ◽

Nathan L McCray ◽

Daniel E Weiner ◽

James S Kaufman ◽

...

Keyword(s):

At Risk ◽

Heat Stress ◽

Muscle Injury ◽

Mesoamerican Nephropathy

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Correction: Environmental exposures in young adults with declining kidney function in a population at risk of Mesoamerican nephropathy

Occupational and Environmental Medicine ◽

10.1136/oemed-2019-105772corr1 ◽

2020 ◽

Vol 77 (8) ◽

pp. 586-586

Keyword(s):

At Risk ◽

Young Adults ◽

Kidney Function ◽

Environmental Exposures ◽

Population At Risk ◽

Mesoamerican Nephropathy

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Identification of young adults at risk of an accelerated loss of kidney function in an area affected by Mesoamerican nephropathy

BMC Nephrology ◽

10.1186/s12882-018-1193-x ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 3

Author(s):

Marvin Gonzalez-Quiroz ◽

Evangelia-Theano Smpokou ◽

Neil Pearce ◽

Ben Caplin ◽

Dorothea Nitsch

Keyword(s):

At Risk ◽

Young Adults ◽

Kidney Function ◽

Mesoamerican Nephropathy

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Kidney function in sugarcane cutters in Nicaragua – A longitudinal study of workers at risk of Mesoamerican nephropathy

Environmental Research ◽

10.1016/j.envres.2016.02.002 ◽

2016 ◽

Vol 147 ◽

pp. 125-132 ◽

Cited By ~ 62

Author(s):

Catharina Wesseling ◽

Aurora Aragón ◽

Marvin González ◽

Ilana Weiss ◽

Jason Glaser ◽

...

Keyword(s):

At Risk ◽

Longitudinal Study ◽

Kidney Function ◽

Mesoamerican Nephropathy

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Effect of Pravastatin on Rate of Kidney Function Loss in People With or at Risk for Coronary Disease

Circulation ◽

10.1161/circulationaha.104.517565 ◽

2005 ◽

Vol 112 (2) ◽

pp. 171-178 ◽

Cited By ~ 139

Author(s):

Marcello Tonelli ◽

Chris Isles ◽

Timothy Craven ◽

Andrew Tonkin ◽

Marc A. Pfeffer ◽

...

Keyword(s):

At Risk ◽

Kidney Function ◽

Coronary Disease ◽

Function Loss

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Chronic kidney disease of non-traditional origin in Mesoamerica: a disease primarily driven by occupational heat stress

Revista Panamericana de Salud Pública ◽

10.26633/rpsp.2020.15 ◽

2020 ◽

Vol 44 ◽

pp. 1 ◽

Cited By ~ 9

Author(s):

Catharina Wesseling ◽

Jason Glaser ◽

Julieta Rodríguez-Guzmán ◽

Ilana Weiss ◽

Rebekah Lucas ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Heat Stress ◽

Kidney Disease ◽

Kidney Function ◽

Population Based ◽

Occupational Risk Factors ◽

Infectious Risk ◽

Main Driver ◽

Low Prevalence

The death toll of the epidemic of chronic kidney disease of nontraditional origin (CKDnt) in Mesoamerica runs into the tens of thousands, affecting mostly young men. There is no consensus on the etiology. Anecdotal evidence from the 1990s pointed to work in sugarcane; pesticides and heat stress were suspected. Subsequent population-based surveys supported an occupational origin with overall high male-female ratios in high-risk lowlands, but small sex differences within occupational categories, and low prevalence in non-workers. CKDnt was reported in sugarcane and other high-intensity agriculture, and in non-agricultural occupations with heavy manual labor in hot environments, but not among subsistence farmers. Recent studies with stronger designs have shown cross-shift changes in kidney function and hydration biomarkers and cross-harvest kidney function declines related to heat and workload. The implementation of a water-rest-shade intervention midharvest in El Salvador appeared to halt declining kidney function among cane cutters. In Nicaragua a water-rest-shade program appeared sufficient to prevent kidney damage among cane workers with low-moderate workload but not among cutters with heaviest workload. Studies on pesticides and infectious risk factors have been largely negative. Non-occupational risk factors do not explain the observed epidemiologic patterns. In conclusion, work is the main driver of the CKDnt epidemic in Mesoamerica, with occupational heat stress being the single uniting factor shown to lead to kidney dysfunction in affected populations. Sugarcane cutters with extreme heat stress could be viewed as a sentinel occupational population. Occupational heat stress prevention is critical, even more so in view of climate change.

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Hydration Status and Kidney Health of Factory Workers Exposed to Heat Stress: A Pilot Feasibility Study

Annals of Nutrition and Metabolism ◽

10.1159/000500373 ◽

2019 ◽

Vol 74 (Suppl. 3) ◽

pp. 30-37 ◽

Cited By ~ 1

Author(s):

Fabiana B. Nerbass ◽

Louise Moist ◽

William F. Clark ◽

Marcos A. Vieira ◽

Roberto Pecoits-Filho

Keyword(s):

Heat Stress ◽

Data Collection ◽

Kidney Function ◽

Complete Data ◽

Hydration Status ◽

Blood Collection ◽

Factory Workers ◽

Work Shift ◽

Study Protocols ◽

Before And After

Dehydration associated with heat stress increases the risk of workplace injury or illness, decreases productivity, and may contribute to the chronic kidney disease epidemic identified in outdoor workers from hot climates. There is limited research on the effects of chronic occupational heat stress among indoor workers. We aimed to test the feasibility of measuring markers of hydration and kidney function in foundry factory workers in Southern Brazil, exposed and not exposed to heat stress. Factory workers exposed to heat stress (wet bulb globe temperature ≥28.9) and not exposed to heat were identified by management and invited to participate. Clinical and biochemical markers of hydration and kidney function were evaluated before and after a single 8.5 h work shift (lunch time not included). Feasibility outcomes included rates of enrolment, % completion of study protocols, and time to complete data collection. This study was deemed feasible with 80% enrolment and 90% completion of the protocol. Among the preselected workers, the enrolment rate was 91%. All subjects completed the physiological measures and blood collection and 95% completed the urine studies. Mean time to complete data collection pre-shift was 19.1 ± 4.2 min and post-shift: 14.3 ± 4.0 min. Workers exposed to heat stress had a greater decline in estimated glomerular filtration rate compared to controls over the work shift (–13 ± 11 vs. –5 ± 7 mL/min; p < 0.01). We demonstrated the feasibility and challenges of conducting future hydration and kidney function research among indoor factory workers. Further study is needed to determine if exposure to indoor heat contributes to a decline in kidney function.

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