Heat stress, dehydration, and kidney function in sugarcane cutters in El Salvador – A cross-shift study of workers at risk of Mesoamerican nephropathy

• Published in: Environmental research 2015-10, Vol.142, p.746-755
• Main Authors: García-Trabanino, Ramón, Jarquín, Emmanuel, Wesseling, Catharina, Johnson, Richard J, González-Quiroz, Marvin, Weiss, Ilana, Glaser, Jason, José Vindell, Juan, Stockfelt, Leo, Roncal, Carlos, Harra, Tamara, Barregard, Lars
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Chronic kidney disease; Creatinine; Cutters; Dehydration; Dehydration - complications; Dehydration - physiopathology; eGFR; El Salvador; Environmental Health and Occupational Health; Farmers; Female; Glomerular Filtration Rate; Heat stress; Heat Stress Disorders - complications; Heat Stress Disorders - physiopathology; Humans; Kidney - physiopathology; Kidney Diseases - complications; Kidney Diseases - physiopathology; Kidneys; Male; Medicin och hälsovetenskap; Mesoamerican nephropathy; Middle Aged; Miljömedicin och yrkesmedicin; Noon; Risk Factors; Saccharum; Serums; Specific gravity; Sugarcane work; Uric acid; Young Adult
• ISSN: 0013-9351; 1096-0953; 1096-0953
• DOI: 10.1016/j.envres.2015.07.007

An epidemic of progressive kidney failure afflicts sugarcane workers in Central America. Repeated high-intensity work in hot environments is a possible cause. To assess heat stress, dehydration, biomarkers of renal function and their possible associations. A secondary aim was to evaluate the prevalence of pre-shift renal damage and possible causal factors. Sugarcane cutters (N=189, aged 18–49 years, 168 of them male) from three regions in El Salvador were examined before and after shift. Cross-shift changes in markers of dehydration and renal function were examined and associations with temperature, work time, region, and fluid intake were assessed. Pre-shift glomerular filtration rate was estimated (eGFR) from serum creatinine. The mean work-time was 4 (1.4–11) hours. Mean workday temperature was 34–36°C before noon, and 39–42°C at noon. The mean liquid intake during work was 0.8L per hour. There were statistically significant changes across shift. The mean urine specific gravity, urine osmolality and creatinine increased, and urinary pH decreased. Serum creatinine, uric acid and urea nitrogen increased, while chloride and potassium decreased. Pre-shift serum uric acid levels were remarkably high and pre-shift eGFR was reduced (