Abstract
Objective. We examined heat stress symptoms and urine markers of chronic kidney disease (CKDu) in Sri Lanka to assess differences between endemic vs. non-endemic regions and by occupation. Sample and Methods. We assessed a total of 475 villagers. In the endemic region, 293 were agricultural workers and 67 were not working primarily in agriculture. In the non-endemic region, 76 were agricultural workers. Of the residents, 218 were assessed for neutrophil gelatinase-associated lipocalin (NGAL), an early predictor of acute kidney injury, along with urine markers of chronic kidney disease. Results. The mean (sd) age of the sample was 45.2 (12.6), with males comprising 52.7%; 7.2% reported kidney disease (n = 34), and 5.7% reported diabetes (n = 27). The heat stress index (mean (sd)) was highest among agricultural workers in the endemic region (8.05 (5.9)), intermediate in non-agricultural workers in the endemic region (4.61 (4.5)), and lowest among agricultural workers in the non-endemic region (3.85 (3.3)); p < 0.0001. Correlations were higher between NGAL and serum microalbumin in the endemic agricultural worker sample than in the other two samples (Spearman’s r = 0.34 vs. 0.15 and 0.20). Conclusions. Both heat stress symptoms and NGAL values were higher among agricultural workers in endemic CKDu regions. Correlations between NGAL and microalbumin suggested a link between acute kidney injury and chronic kidney disease in the more-exposed sample.
Highlights
Climate change has led to increases in the prevalence of heat stress, including chronic dehydration, heat exhaustion, and heat stroke, with an increasing heat load on agriculture workers, especially in tropical regions [1]
This research showed that both heat stress symptoms and neutrophil gelatinaseassociated lipocalin (NGAL) values were higher among agricultural workers in endemic CKDu regions
The heat stress symptom index reliably distinguished people in endemic and non-endemic regions, though these results must remain tentative without a biomarker of CKDu risk
Summary
Climate change has led to increases in the prevalence of heat stress, including chronic dehydration, heat exhaustion, and heat stroke, with an increasing heat load on agriculture workers, especially in tropical regions [1] These workers face increasing risk of chronic kidney disease in the absence of hypertension and diabetes (“chronic kidney disease of unexplained origin”, CKDu). In Sri Lanka, heat stress may be associated with risk of chronic kidney disease among agricultural workers [5]. The objective of the study was to examine acute kidney injury measured by NGAL values as a precursor to chronic kidney disease (CKDu) among agricultural workers in Sri Lanka, and to determine its relation to heat stress symptoms
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