Violation of the National Institute of Occupational Safety and Health (NIOSH) heat stress recommendations by exceeding the allowable wet bulb globe temperature (WBGT) for a given work intensity and work-rest ratio augments acute kidney injury (AKI) risk. Here we tested the hypothesis that exceeding the allowable work intensity at a given WBGT and work-rest ratio would also worsen AKI risk. Twelve healthy adults completed two NIOSH recommendation compliant trials and one noncompliant trial consisting of a 4 h (half workday) exposure. Work-rest ratio was fixed at 30 min of walking and 30 min of rest each hour. Work intensity (metabolic heat production) was prescribed as a function of WBGT- 412±51 W (27.3±0.3°C; high intensity compliant [Chigh]), 290±75 W (31.6±0.2°C; low intensity compliant [Clow]), and 410±61 W (31.7±0.2°C; high intensity noncompliant [NChigh]). AKI risk was quantified by the product of urinary insulin-like growth factor-binding protein 7 and tissue inhibitor of metalloproteinase 2 normalized to urine specific gravity ([IGFBP7•TIMP-2]USG). Peak core temperature was higher in NChigh trial (38.3±0.4°C) compared to the compliant trials (Chigh: 38.0±0.3°C; Clow: 37.8±0.4°C; p≤0.0095). [IGFBP7•TIMP-2]USG increased from pre- to immediately postexposure in all trials (time effect: p=0.0454) but the peak increase was not different between trials (Chigh: 0.89±1.7 [ng/mL]2/1000; Clow: 0.78±1.7 [ng/mL]2/1000; NChigh: 1.0±1.4 [ng/mL]2/1000; p=0.7811). Violating the NIOSH recommendations by exceeding either the allowable work intensity (i.e., NChigh versus Clow) or WBGT (i.e., NChigh versus Chigh) resulted in a modest elevation in peak core temperature but did not modify AKI risk.
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