Preventing kidney injury among sugarcane workers: Promising evidence from enhanced workplace interventions

Research output: Contribution to journalArticle


Objectives: To assess if improvement of working conditions related to heat stress was associated with improved kidney health outcomes among sugarcane harvest workers in Chichigalpa, Nicaragua, a region heavily affected by the epidemic of chronic kidney disease of non-traditional origin. Methods: Based on our findings during the 2017-2018 harvest (harvest 1), recommendations that enhanced the rest schedule and improved access to hydration and shade were given before the 2018-2019 harvest (harvest 2). Actual work conditions during harvest 2 were then observed. Serum creatinine (SCr) was measured before and at end-harvest, and cross-harvest changes in estimated glomerular filtration rate (eGFR) and incident kidney injury (IKI, ie, SCr increase by ≥0.30 mg/dL or ≥1.5 times the baseline value) were compared between harvest 1 and harvest 2 for three jobs with different physical workloads using regression modelling. Workers who left during harvest were contacted at home, to address the healthy worker selection effect. Results: In burned cane cutters, mean cross-harvest eGFR decreased 6 mL/min/1.73 m2 (95% CI 2 to 9 mL/min/1.73 m2) less and IKI was 70% (95% CI 90% to 50%) lower in harvest 2 as compared with harvest 1 data. No such improvements were seen among seed cutters groups with less successful intervention implementation. Conclusion: Kidney injury risk was again elevated in workers with strenuous jobs. The results support further efforts to prevent kidney injury among sugarcane workers, and other heat-stressed workers, by improving access to water, rest and shade. The distinction between design and implementation of such interventions should be recognised.


  • Jason Glaser
  • Erik Hansson
  • Ilana Weiss
  • Catharina Wesseling
  • Kristina Jakobsson
  • Ulf Ekström
  • Jenny Apelqvist
  • Rebekah Lucas
  • Esteban Arias Monge
  • Sandra Peraza
  • Christer Hogstedt
  • David H. Wegman
External organisations
  • London School of Hygiene and Tropical Medicine
  • University of Gothenburg
  • La Isla Network
  • Karolinska Institutet
  • Sahlgrenska University Hospital
  • University of Birmingham
  • University of El Salvador
  • University of Massachusetts Lowell
  • Tecnológico de Costa Rica
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Environmental Health and Occupational Health


  • climate, international occupational health, intervention studies, renal, workload
Original languageEnglish
Pages (from-to)527-534
Number of pages8
JournalOccupational and environmental medicine
Issue number8
Early online date2020 May 13
Publication statusPublished - 2020 Jul
Publication categoryResearch