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Workload and cross-harvest kidney injury in a Nicaraguan sugarcane worker cohort

Hansson, Erik LU ; Glaser, Jason ; Weiss, Ilana ; Ekström, Ulf LU ; Apelqvist, Jenny LU ; Hogstedt, Christer ; Peraza, Sandra ; Lucas, Rebekah ; Jakobsson, Kristina and Wesseling, Catharina , et al. (2019) In Occupational and environmental medicine 76(11). p.818-826
Abstract

OBJECTIVES: To examine the association between workload and kidney injury in a fieldworker cohort with different levels of physically demanding work over a sugarcane harvest, and to assess whether the existing heat prevention efforts at a leading occupational safety and health programme are sufficient to mitigate kidney injury. METHODS: Biological and questionnaire data were collected before (n=545) and at the end (n=427) of harvest among field support staff (low workload), drip irrigation workers (moderate), seed cutters (high) and burned sugarcane cutters (very high). Dropouts were contacted (87%) and reported the reason for leaving work. Cross-harvest incident kidney injury (IKI) was defined as serum creatinine increase ≥0.30 mg/dL... (More)

OBJECTIVES: To examine the association between workload and kidney injury in a fieldworker cohort with different levels of physically demanding work over a sugarcane harvest, and to assess whether the existing heat prevention efforts at a leading occupational safety and health programme are sufficient to mitigate kidney injury. METHODS: Biological and questionnaire data were collected before (n=545) and at the end (n=427) of harvest among field support staff (low workload), drip irrigation workers (moderate), seed cutters (high) and burned sugarcane cutters (very high). Dropouts were contacted (87%) and reported the reason for leaving work. Cross-harvest incident kidney injury (IKI) was defined as serum creatinine increase ≥0.30 mg/dL or ≥1.5 times the baseline value, or among dropouts reporting kidney injury leading to leaving work. RESULTS: Mean cross-harvest estimated glomerular filtration rate change was significantly associated with workload, increasing from 0 mL/min/1.73 m2 in the low-moderate category to -5 mL/min/1.73 m2 in the high and -9 mL/min/1.73 m2 in the very high workload group. A similar pattern occurred with IKI, where low-moderate workload had 2% compared with 27% in the very high workload category. A healthy worker selection effect was detected, with 32% of dropouts reporting kidney injury. Fever and C reactive protein elevation were associated with kidney injury. CONCLUSIONS: Workers considered to have the highest workload had more cross-harvest kidney damage than workers with less workload. Work practices preventing heat stress should be strengthened and their role in preventing kidney damage examined further. Future occupational studies on chronic kidney disease of unknown aetiology should account for a healthy worker effect by pursuing those lost to follow-up.

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Contribution to journal
publication status
published
subject
keywords
CKDu, Heat stress, Inflammation, Kidney, Workload
in
Occupational and environmental medicine
volume
76
issue
11
pages
9 pages
publisher
BMJ Publishing Group
external identifiers
  • scopus:85073182353
  • pmid:31611303
ISSN
1470-7926
DOI
10.1136/oemed-2019-105986
language
English
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yes
id
cdfd5fe3-07ad-4bba-86eb-df7023fcbd8a
date added to LUP
2019-10-21 12:11:53
date last changed
2020-01-21 03:00:20
@article{cdfd5fe3-07ad-4bba-86eb-df7023fcbd8a,
  abstract     = {<p>OBJECTIVES: To examine the association between workload and kidney injury in a fieldworker cohort with different levels of physically demanding work over a sugarcane harvest, and to assess whether the existing heat prevention efforts at a leading occupational safety and health programme are sufficient to mitigate kidney injury. METHODS: Biological and questionnaire data were collected before (n=545) and at the end (n=427) of harvest among field support staff (low workload), drip irrigation workers (moderate), seed cutters (high) and burned sugarcane cutters (very high). Dropouts were contacted (87%) and reported the reason for leaving work. Cross-harvest incident kidney injury (IKI) was defined as serum creatinine increase ≥0.30 mg/dL or ≥1.5 times the baseline value, or among dropouts reporting kidney injury leading to leaving work. RESULTS: Mean cross-harvest estimated glomerular filtration rate change was significantly associated with workload, increasing from 0 mL/min/1.73 m2 in the low-moderate category to -5 mL/min/1.73 m2 in the high and -9 mL/min/1.73 m2 in the very high workload group. A similar pattern occurred with IKI, where low-moderate workload had 2% compared with 27% in the very high workload category. A healthy worker selection effect was detected, with 32% of dropouts reporting kidney injury. Fever and C reactive protein elevation were associated with kidney injury. CONCLUSIONS: Workers considered to have the highest workload had more cross-harvest kidney damage than workers with less workload. Work practices preventing heat stress should be strengthened and their role in preventing kidney damage examined further. Future occupational studies on chronic kidney disease of unknown aetiology should account for a healthy worker effect by pursuing those lost to follow-up.</p>},
  author       = {Hansson, Erik and Glaser, Jason and Weiss, Ilana and Ekström, Ulf and Apelqvist, Jenny and Hogstedt, Christer and Peraza, Sandra and Lucas, Rebekah and Jakobsson, Kristina and Wesseling, Catharina and Wegman, David H.},
  issn         = {1470-7926},
  language     = {eng},
  number       = {11},
  pages        = {818--826},
  publisher    = {BMJ Publishing Group},
  series       = {Occupational and environmental medicine},
  title        = {Workload and cross-harvest kidney injury in a Nicaraguan sugarcane worker cohort},
  url          = {http://dx.doi.org/10.1136/oemed-2019-105986},
  doi          = {10.1136/oemed-2019-105986},
  volume       = {76},
  year         = {2019},
}