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Decreased Kidney Function Among Agricultural Workers in El Salvador

Peraza, Sandra; Wesseling, Catharina; Aragon, Aurora; Leiva, Ricardo; Garcia-Trabanino, Ramon Antonio; Torres, Cecilia; Jakobsson, Kristina LU ; Elinder, Carl Gustaf and Hogstedt, Christer (2012) In American Journal of Kidney Diseases 59(4). p.531-540
Abstract
Background: An epidemic of chronic kidney disease of unknown cause has emerged along the Pacific coast of Central America, particularly in relatively young male sugarcane workers. In El Salvador, we examined residence and occupations at different altitudes as surrogate risk factors for heat stress. Study Design: Cross-sectional population-based survey. Setting & Participants: Populations aged 20-60 years of 5 communities in El Salvador, 256 men and 408 women (participation, 73%): 2 coastal communities with current sugarcane and past cotton production and 3 communities above 500 m with sugarcane, coffee, and service-oriented economies. Predictor: Participant sex, age, residence, occupation, agricultural history by crop and altitude, and... (More)
Background: An epidemic of chronic kidney disease of unknown cause has emerged along the Pacific coast of Central America, particularly in relatively young male sugarcane workers. In El Salvador, we examined residence and occupations at different altitudes as surrogate risk factors for heat stress. Study Design: Cross-sectional population-based survey. Setting & Participants: Populations aged 20-60 years of 5 communities in El Salvador, 256 men and 408 women (participation, 73%): 2 coastal communities with current sugarcane and past cotton production and 3 communities above 500 m with sugarcane, coffee, and service-oriented economies. Predictor: Participant sex, age, residence, occupation, agricultural history by crop and altitude, and traditional risk factors for CKD. Outcomes: Serum creatinine (SCr) level greater than the normal laboratory range for sex, estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2), and proteinuria categorized as low (protein excretion >= 30-<300 mg/dL) and high grade (>= 300 mg/dL). Results: Of the men in the coastal communities, 30% had elevated SCr levels and 18% had eGFR <60 mL/min/1.73 m(2) compared with 4% and 1%, respectively, in the communities above 500 m. For agricultural workers, prevalences of elevated SCr levels and eGFR <60 mL/min/1.73 m(2) were highest for coastal sugarcane and cotton plantation workers, but were not increased in sugarcane workers at 500 m or subsistence farmers. Women followed a weaker but similar pattern. Proteinuria was infrequent, of low grade, and not different among communities, occupations, or sexes. The adjusted ORs of decreased kidney function for 10-year increments of coastal sugarcane or cotton plantation work were 3.1 (95% CI, 2.0-5.0) in men and 2.3 (95% CI, 1.4-3.7) in women. Limitations: The cross-sectional nature of the study limits etiologic interpretations. Conclusion: Agricultural work on lowland sugarcane and cotton plantations was associated with decreased kidney function in men and women, possibly related to strenuous work in hot environments with repeated volume depletion. Am J Kidney Dis. 59(4): 531-540. (C) 2012 by the National Kidney Foundation, Inc. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Agriculture, cotton, sugarcane, chronic kidney disease, Central America, descriptive epidemiology, El Salvador, occupational and environmental, health, heat stress, volume depletion
in
American Journal of Kidney Diseases
volume
59
issue
4
pages
531 - 540
publisher
Elsevier
external identifiers
  • wos:000302117500323
  • scopus:84858973331
ISSN
1523-6838
DOI
10.1053/j.ajkd.2011.11.039
language
English
LU publication?
yes
id
0e9da2f9-ace0-48e4-be62-4047150a91e3 (old id 2587552)
date added to LUP
2012-06-01 09:36:22
date last changed
2017-10-29 03:16:32
@article{0e9da2f9-ace0-48e4-be62-4047150a91e3,
  abstract     = {Background: An epidemic of chronic kidney disease of unknown cause has emerged along the Pacific coast of Central America, particularly in relatively young male sugarcane workers. In El Salvador, we examined residence and occupations at different altitudes as surrogate risk factors for heat stress. Study Design: Cross-sectional population-based survey. Setting &amp; Participants: Populations aged 20-60 years of 5 communities in El Salvador, 256 men and 408 women (participation, 73%): 2 coastal communities with current sugarcane and past cotton production and 3 communities above 500 m with sugarcane, coffee, and service-oriented economies. Predictor: Participant sex, age, residence, occupation, agricultural history by crop and altitude, and traditional risk factors for CKD. Outcomes: Serum creatinine (SCr) level greater than the normal laboratory range for sex, estimated glomerular filtration rate (eGFR) &lt;60 mL/min/1.73 m(2), and proteinuria categorized as low (protein excretion &gt;= 30-&lt;300 mg/dL) and high grade (&gt;= 300 mg/dL). Results: Of the men in the coastal communities, 30% had elevated SCr levels and 18% had eGFR &lt;60 mL/min/1.73 m(2) compared with 4% and 1%, respectively, in the communities above 500 m. For agricultural workers, prevalences of elevated SCr levels and eGFR &lt;60 mL/min/1.73 m(2) were highest for coastal sugarcane and cotton plantation workers, but were not increased in sugarcane workers at 500 m or subsistence farmers. Women followed a weaker but similar pattern. Proteinuria was infrequent, of low grade, and not different among communities, occupations, or sexes. The adjusted ORs of decreased kidney function for 10-year increments of coastal sugarcane or cotton plantation work were 3.1 (95% CI, 2.0-5.0) in men and 2.3 (95% CI, 1.4-3.7) in women. Limitations: The cross-sectional nature of the study limits etiologic interpretations. Conclusion: Agricultural work on lowland sugarcane and cotton plantations was associated with decreased kidney function in men and women, possibly related to strenuous work in hot environments with repeated volume depletion. Am J Kidney Dis. 59(4): 531-540. (C) 2012 by the National Kidney Foundation, Inc.},
  author       = {Peraza, Sandra and Wesseling, Catharina and Aragon, Aurora and Leiva, Ricardo and Garcia-Trabanino, Ramon Antonio and Torres, Cecilia and Jakobsson, Kristina and Elinder, Carl Gustaf and Hogstedt, Christer},
  issn         = {1523-6838},
  keyword      = {Agriculture,cotton,sugarcane,chronic kidney disease,Central America,descriptive epidemiology,El Salvador,occupational and environmental,health,heat stress,volume depletion},
  language     = {eng},
  number       = {4},
  pages        = {531--540},
  publisher    = {Elsevier},
  series       = {American Journal of Kidney Diseases},
  title        = {Decreased Kidney Function Among Agricultural Workers in El Salvador},
  url          = {http://dx.doi.org/10.1053/j.ajkd.2011.11.039},
  volume       = {59},
  year         = {2012},
}