Abstract
Identify early biomarkers and mechanisms of acute kidney injury in workers at risk of developing chronic kidney disease of unknown origin (CKDu). We assessed cross-shift changes in kidney function and biomarkers of injury in 105 healthy sugarcane workers. We obtained pre-harvest clinical data as well as daily environmental, clinical, and productivity data for each worker. The average percent decline in cross-shift estimated glomerular filtration rate (eGFR) was 21.8% (standard deviation [SD] 13.6%). Increasing wet bulb globe temperature (WBGT), high uric acid, decreased urine pH, urinary leukocyte esterase, and serum hyperosmolality were risk factors for decline in kidney function. Sugarcane workers with normal kidney function experience recurrent subclinical kidney injury, associated with elevations in biomarkers of injury that suggest exposure to high temperatures and extreme physical demands.
Highlights
We evaluated the association between potential risk factors and percent change in estimated glomerular filtration rate (eGFR) across the work shift using linear mixed-effects univariate and multivariable models with random intercepts for individuals
The combined evidence relating kidney function to wet bulb globe temperature (WBGT) and other biomarkers of injury leads us to conclude that heat stress is a contributory risk factor for acute kidney injury in this population
Our data suggest that the daily acute changes in kidney function are the consequence of an interstitial inflammatory process, which is consistent with the current understanding of chronic kidney disease of unknown origin (CKDu).[10]
Summary
Setting and Study Design This study was conducted across the 2016 to 2017 sugarcane harvest in a population of 105 field workers employed by Pantaleon, a sugarcane agribusiness in Guatemala. A detailed description of the field setting has been described by Butler-Dawson et al.[33]. In this longitudinal study, we prospectively assessed crossshift changes in eGFR, biomarkers of renal function, and biomarkers of heat stress in 105 workers at three separate time points during the harvest season. Field workers undergo a fitness-forwork medical screening and health risk assessment survey. The screening evaluation includes clinical data (age, height, weight, blood pressure, heart rate), demographic information (location of home of residence, occupational history, lifestyle behaviors), and evaluation of eGFR via serum creatinine
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