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

ObjectivesTo 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.MethodsBased 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.ResultsIn 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.ConclusionKidney 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.

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Kidney-Detrimental Factors and Estimated Glomerular Filtration Rate in Preterm Newborns: The Role of Nutrition

Nutrients ◽

10.3390/nu12030651 ◽

2020 ◽

Vol 12 (3) ◽

pp. 651

Author(s):

Alice Monzani ◽

Ilaria Crespi ◽

Giulia Genoni ◽

Alberto Edefonti ◽

Giovanni Montini ◽

...

Keyword(s):

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Injury Risk ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Kidney Injury ◽

The Other ◽

Risk Scores ◽

Preterm Newborns

Background: Kidney function in preterm newborns may be impaired by many factors. Methods: 71 newborns with gestational age (GA) < 32 weeks were enrolled. Serum creatinine (sCr), cystatin C (CysC), beta-trace protein (BTP) and urea were measured at T0 (3rd day of life) and T36 (GA 36 weeks), and estimated glomerular filtration rate (eGFR) was calculated according to different formulas at T36. Pre-natal and post-natal kidney injury risk scores were calculated. Results: Newborns with GA ≤ 28 weeks had higher sCr at T0, and lower sCr, BTP and higher urea levels at T36 (p = 0.007, p = 0.005 and p = 0.029, respectively). eGFR values were not different according to GA when calculated by the formulas using only CysC, but were higher in subjects with GA ≤ 28 weeks according to the other formulas. The post-natal score was positively correlated with eGFR according to sCr-based formulas, but the correlations did not persist when adjusted for urea levels and GA. Conclusions: CysC-based eGFR values are not influenced by GA. Post-natal score shows a direct correlation with eGFR according to sCr-based formulas, not persisting after adjustment for GA and urea levels, implying the importance of the nutritional status, since more premature subjects receive a more aggressive nutritional regimen, testified by higher urea levels.

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Workload and cross-harvest kidney injury in a Nicaraguan sugarcane worker cohort

Occupational and Environmental Medicine ◽

10.1136/oemed-2019-105986 ◽

2019 ◽

Vol 76 (11) ◽

pp. 818-826 ◽

Cited By ~ 10

Author(s):

Erik Hansson ◽

Jason Glaser ◽

Ilana Weiss ◽

Ulf Ekström ◽

Jenny Apelqvist ◽

...

Keyword(s):

Occupational Safety ◽

Selection Effect ◽

Kidney Injury ◽

Kidney Damage ◽

Reactive Protein ◽

Worker Selection ◽

High Workload ◽

Group A ◽

Lost To Follow Up ◽

Very High

ObjectivesTo examine the association between workload and kidney injury in a fieldworker cohort with different levels of physically demanding work over a sugarcane harvest, and to assess whether the existing heat prevention efforts at a leading occupational safety and health programme are sufficient to mitigate kidney injury.MethodsBiological and questionnaire data were collected before (n=545) and at the end (n=427) of harvest among field support staff (low workload), drip irrigation workers (moderate), seed cutters (high) and burned sugarcane cutters (very high). Dropouts were contacted (87%) and reported the reason for leaving work. Cross-harvest incident kidney injury (IKI) was defined as serum creatinine increase ≥0.30 mg/dL or ≥1.5 times the baseline value, or among dropouts reporting kidney injury leading to leaving work.ResultsMean cross-harvest estimated glomerular filtration rate change was significantly associated with workload, increasing from 0 mL/min/1.73 m2 in the low-moderate category to −5 mL/min/1.73 m2 in the high and −9 mL/min/1.73 m2 in the very high workload group. A similar pattern occurred with IKI, where low-moderate workload had 2% compared with 27% in the very high workload category. A healthy worker selection effect was detected, with 32% of dropouts reporting kidney injury. Fever and C reactive protein elevation were associated with kidney injury.ConclusionsWorkers considered to have the highest workload had more cross-harvest kidney damage than workers with less workload. Work practices preventing heat stress should be strengthened and their role in preventing kidney damage examined further. Future occupational studies on chronic kidney disease of unknown aetiology should account for a healthy worker effect by pursuing those lost to follow-up.

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Neonatal acute kidney injury risk stratification score: STARZ study

Pediatric Research ◽

10.1038/s41390-021-01573-9 ◽

2021 ◽

Author(s):

Sanjay Wazir ◽

Sidharth Kumar Sethi ◽

Gopal Agarwal ◽

Abhishek Tibrewal ◽

Rohan Dhir ◽

...

Keyword(s):

Acute Kidney Injury ◽

Risk Stratification ◽

Injury Risk ◽

Kidney Injury ◽

Risk Stratification Score

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Using kinetic eGFR to identify acute kidney injury risk in children undergoing cardiac transplantation

Pediatric Research ◽

10.1038/s41390-020-01307-3 ◽

2021 ◽

Author(s):

Minnie N. Dasgupta ◽

Maria E. Montez-Rath ◽

Seth A. Hollander ◽

Scott M. Sutherland

Keyword(s):

Acute Kidney Injury ◽

Cardiac Transplantation ◽

Injury Risk ◽

Kidney Injury

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Assessment of acute kidney injury risk using a machine-learning guided generalized structural equation model: a cohort study

BMC Nephrology ◽

10.1186/s12882-021-02238-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Wen En Joseph Wong ◽

Siew Pang Chan ◽

Juin Keith Yong ◽

Yen Yu Sherlyn Tham ◽

Jie Rui Gerald Lim ◽

...

Keyword(s):

Acute Kidney Injury ◽

High Risk ◽

Hospital Mortality ◽

Structural Equation Model ◽

Structural Equation ◽

Injury Risk ◽

Kidney Injury ◽

Equation Model ◽

Surgical Icu ◽

One Year

Abstract Background Acute kidney injury is common in the surgical intensive care unit (ICU). It is associated with poor patient outcomes and high healthcare resource usage. This study’s primary objective is to help identify which ICU patients are at high risk for acute kidney injury. Its secondary objective is to examine the effect of acute kidney injury on a patient’s prognosis during and after the ICU admission. Methods A retrospective cohort of patients admitted to a Singaporean surgical ICU between 2015 to 2017 was collated. Patients undergoing chronic dialysis were excluded. The outcomes were occurrence of ICU acute kidney injury, hospital mortality and one-year mortality. Predictors were identified using decision tree algorithms. Confirmatory analysis was performed using a generalized structural equation model. Results A total of 201/940 (21.4%) patients suffered acute kidney injury in the ICU. Low ICU haemoglobin levels, low ICU bicarbonate levels, ICU sepsis, low pre-ICU estimated glomerular filtration rate (eGFR) and congestive heart failure was associated with the occurrence of ICU acute kidney injury. Acute kidney injury, together with old age (> 70 years), and low pre-ICU eGFR, was associated with hospital mortality, and one-year mortality. ICU haemoglobin level was discretized into 3 risk categories for acute kidney injury: high risk (haemoglobin ≤9.7 g/dL), moderate risk (haemoglobin between 9.8–12 g/dL), and low risk (haemoglobin > 12 g/dL). Conclusion The occurrence of acute kidney injury is common in the surgical ICU. It is associated with a higher risk for hospital and one-year mortality. These results, in particular the identified haemoglobin thresholds, are relevant for stratifying a patient’s acute kidney injury risk.

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