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Environ Res. 2015 Oct;142:746-55. doi: 10.1016/j.envres.2015.07.007. Epub 2015 Jul 23.

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

Author information

1
Scientific Board, Department of Investigation, Hospital Nacional Rosales, San Salvador, El Salvador. Electronic address: rgt@anhaes.org.
2
Agency for Agricultural Health and Development (AGDYSA), San Salvador, El Salvador. Electronic address: emmrijarquin@gmail.com.
3
Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. Electronic address: inekewesseling@gmail.com.
4
Division of Kidney Diseases and Hypertension, University of Colorado, Denver, CO, United State. Electronic address: Richard.Johnson@ucdenver.edu.
5
Research Centre on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua at León, (UNAN-León), León, Nicaragua; Department of Non-communicable Disease Epidemiology of London School of Hygiene and Tropical Medicine, London, UK. Electronic address: marvin99_00@yahoo.es.
6
The La Isla Foundation, León, Nicaragua. Electronic address: ilana@laislafoundation.org.
7
The La Isla Foundation, León, Nicaragua. Electronic address: jason@laislafoundation.org.
8
Universidad Nacional de El Salvador, El Salvador. Electronic address: juanjosevindell@gmail.com.
9
Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, P.B 414, SE 405 30, Gothenburg, Sweden. Electronic address: leo.stockfelt@amm.gu.se.
10
Division of Kidney Diseases and Hypertension, University of Colorado, Denver, CO, United State. Electronic address: Carlos.Roncal@ucdenver.edu.
11
Division of Kidney Diseases and Hypertension, University of Colorado, Denver, CO, United State. Electronic address: tamara.harra@ucdenver.edu.
12
Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, P.B 414, SE 405 30, Gothenburg, Sweden. Electronic address: lars.barregard@amm.gu.se.

Abstract

BACKGROUND:

An epidemic of progressive kidney failure afflicts sugarcane workers in Central America. Repeated high-intensity work in hot environments is a possible cause.

OBJECTIVES:

To assess heat stress, dehydration, biomarkers of renal function and their possible associations. A secondary aim was to evaluate the prevalence of pre-shift renal damage and possible causal factors.

METHODS:

Sugarcane cutters (N=189, aged 18-49 years, 168 of them male) from three regions in El Salvador were examined before and after shift. Cross-shift changes in markers of dehydration and renal function were examined and associations with temperature, work time, region, and fluid intake were assessed. Pre-shift glomerular filtration rate was estimated (eGFR) from serum creatinine.

RESULTS:

The mean work-time was 4 (1.4-11) hours. Mean workday temperature was 34-36 °C before noon, and 39-42 °C at noon. The mean liquid intake during work was 0.8L per hour. There were statistically significant changes across shift. The mean urine specific gravity, urine osmolality and creatinine increased, and urinary pH decreased. Serum creatinine, uric acid and urea nitrogen increased, while chloride and potassium decreased. Pre-shift serum uric acid levels were remarkably high and pre-shift eGFR was reduced (<60 mL/min) in 23 male workers (14%).

CONCLUSIONS:

The high prevalence of reduced eGFR, and the cross-shift changes are consistent with recurrent dehydration from strenuous work in a hot and humid environment as an important causal factor. The pathophysiology may include decreased renal blood flow, high demands on tubular reabsorption, and increased levels of uric acid.

KEYWORDS:

Chronic kidney disease; Dehydration; Heat stress; Mesoamerican nephropathy; Specific gravity; Sugarcane work; Uric acid; eGFR

PMID:
26209462
DOI:
10.1016/j.envres.2015.07.007
[Indexed for MEDLINE]
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