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

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Preventing kidney injury among sugarcane workers : Promising evidence from enhanced workplace interventions. / Glaser, Jason; Hansson, Erik; Weiss, Ilana; Wesseling, Catharina; Jakobsson, Kristina; Ekström, Ulf; Apelqvist, Jenny; Lucas, Rebekah; Arias Monge, Esteban; Peraza, Sandra; Hogstedt, Christer; Wegman, David H.

I: Occupational and environmental medicine, 13.05.2020.

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Glaser, Jason ; Hansson, Erik ; Weiss, Ilana ; Wesseling, Catharina ; Jakobsson, Kristina ; Ekström, Ulf ; Apelqvist, Jenny ; Lucas, Rebekah ; Arias Monge, Esteban ; Peraza, Sandra ; Hogstedt, Christer ; Wegman, David H. / Preventing kidney injury among sugarcane workers : Promising evidence from enhanced workplace interventions. I: Occupational and environmental medicine. 2020.

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TY - JOUR

T1 - Preventing kidney injury among sugarcane workers

T2 - Promising evidence from enhanced workplace interventions

AU - Glaser, Jason

AU - Hansson, Erik

AU - Weiss, Ilana

AU - Wesseling, Catharina

AU - Jakobsson, Kristina

AU - Ekström, Ulf

AU - Apelqvist, Jenny

AU - Lucas, Rebekah

AU - Arias Monge, Esteban

AU - Peraza, Sandra

AU - Hogstedt, Christer

AU - Wegman, David H.

PY - 2020/5/13

Y1 - 2020/5/13

N2 - 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.

AB - 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.

KW - climate

KW - international occupational health

KW - intervention studies

KW - renal

KW - workload

U2 - 10.1136/oemed-2020-106406

DO - 10.1136/oemed-2020-106406

M3 - Article

JO - Occupational and Environmental Medicine

JF - Occupational and Environmental Medicine

SN - 1470-7926

ER -