Abstract
Background and aim: Chronic kidney disease of non-traditional cause (CKDnt), a distinct form of kidney disease, has a high prevalence in agricultural communities in Central America. In Nicaragua’s sugarcane industry, cane cutters have the greatest risk of developing CKDnt, possibly due to a high level of physical exertion and exposure to climatic heat. In a longitudinal study, we examined whether time worked as a cane cutter was associated with reduced kidney function during a medical visit. Methods: Employment and medical records from 1997-2010 were linked for 242 men employed at a Nicaraguan sugarcane plantation. Person-months worked were classified as cumulative months worked cutting cane. The outcome was experiencing an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m2 at a medical visit. To examine the association between cane cutting and low eGFR, logistic regression based on generalized estimating equations for repeated events was used to estimate the odds ratio (OR) and the 95% confidence interval (CI), controlling for age. Results: During 14,592 person-months, half of workers were ever a cane cutter, with median of 23 (IQR=39) months cane cutting. 41 workers experienced a low eGFR, with a median of 6 (IQR=8) events. Compared with never cane cutters, the adjusted odds of low medical eGFR for cane cutters was 2.18 (95% CI, 1.11, 4.30), and 4.79 (95% CI, 2.09, 10.99) among those cane cutting for at least 74 months. Additionally, each 6-month increase in time cane cutting was associated with a 1.12-fold increase in low eGFR (95% CI, 1.07, 1.18). Conclusion: Cumulative months as a cane cutter was associated with an exposure-response relationship between low eGFR at medical encounters. eGFR was not routinely taken at medical encounters; the outcome may have captured existing low eGFR or more acute events. Future research into recurrence of acute kidney injury among these workers should be undertaken.
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