Abstract
BACKGROUND AND AIM: Chronic kidney disease of undetermined aetiology (CKDu) has been reported among workers under heat stress. Epidemiological evidence was lacking in Asian countries. We aimed to investigate the impacts of hot weather and farming occupation on CKDu in Taiwan. METHODS: We obtained the data from the annual screening program for chronic diseases in Taiwan's largest rice-farming county from May to October in 2005–2014. Working population aged 15–60 years was included. CKDu was defined as an estimated glomerular filtration rate 60 ml/min/1.73m² at age under 60 years, with the following exclusion criteria which also applied for non-CKDu population: hypertension, diabetes, proteinuria, haematuria, or using Chinese herbal medicine. Ambient temperature at township level was obtained from Taiwan’ Central Weather Bureau. We estimated the prevalence odds ratio (POR) of CKDu for changes in temperature, adjusted by education, type of occupation, urbanization, smoking, body mass index, and comorbidities. RESULTS:There were 201 CKDu cases and 16,891 non-CKDu population. The prevalence of CKDu was 2.3% in the farmers and 0.9% in the non-farmers. The crude and adjusted POR of CKDu among farmers was 2.82 (2.16–3.69) and 1.67 (1.19–2.33) compared to non-farmers. In the month of health screening examination, monthly averages of ambient temperature (°C) were slightly higher for the CKDu cases (daily mean = 28.1 ± 1.3) than for the non-CKDu participants (daily mean = 27.9 ± 1.5). The crude and adjusted POR of CKDu per unit (°C) increase of ambient temperature was 1.13 (1.03–1.25) and 1.13 (1.02–1.25) for daily max, 1.17 (1.06–1.31) and 1.14 (1.02–1.27) for daily min, and 1.20 (1.07–1.33) and 1.17 (1.05–1.31) for daily mean temperature. CONCLUSIONS:Hot weather and working as farmer might contribute independently to the risk of CKDu in Taiwan, and the two risk factors showed no synergic effect. CKDu risk factors other than heat exposure should be considered among Taiwanese farmers. KEYWORDS: chronic kidney disease of undetermined aetiology, Far East, heat stress, farmers, agriculture workers
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