Evaluation of heat stress and cumulative incidence of acute kidney injury in sugarcane workers in Guatemala
Evaluation of heat stress and cumulative incidence of acute kidney injury in sugarcane workers in Guatemala
复制标题
DOI：
10.1007/s00420-019-01426-3
复制
发表时间：
2019-10-01
影响因子：
3
通讯作者：
Newman, Lee S.
中科院分区：
文献类型：
--
作者：
Butler-Dawson, Jaime;Krisher, Lyndsay;Newman, Lee S.
目的研究热应激对农业工人肾脏损伤的影响，并探讨其可能导致慢性不明原因肾脏病（CKDu）的机制。水化已被推广为减少肾损伤的关键措施。在存在水化干预的情况下，在危地马拉的甘蔗工人人群中计算急性肾损伤（阿基）的发生率，并评估了几个风险因素。方法对517名甘蔗作业工人在轮班开始和结束的3个时间点进行肾功能测定。我们将阿基定义为血清肌酐较偏移前值升高26.5 μ mol/L或50%或以上。研究了阿基和风险因素之间的关联，包括与水合状态的相互作用。结果2月、3月和4月班后脱水（比重> 1.020）的发生率分别为11%、9%和6%。阿基的累积发生率在2月为53%，3月为54%，4月为51%。阿基与轮班后比重增加（脱水标志物）（OR 1.24，95% CI 1.02-1.52）和电解质溶液摄入量减少（OR 0.94，95% CI 0.89-0.99）相关。结论脱水和电解质消耗不足是阿基的危险因素。然而，即使是水分充足的甘蔗工人也会经常经历阿基。虽然水化是重要的和保护性的，但有必要了解阿基风险的其他因素，并确定与这些工人的预防策略。
Objective Agricultural workers worldwide exposed to heat stress could be at the risk of kidney injury, which could lead to chronic kidney disease of an unknown origin (CKDu). Hydration has been promoted as a key measure to reduce kidney injury. In the presence of a hydration intervention, the incidence of acute kidney injury (AKI) was calculated in a sugarcane worker population in Guatemala and several risk factors were evaluated. Methods We measured kidney function at the beginning and end of the work shift at three time points in 517 sugarcane workers. We defined AKI as an increase in serum creatinine of 26.5 mu mol/L or 50% or more from the pre-shift value. Associations between AKI and risk factors were examined, including interactions with hydration status. Results The prevalence of dehydration post-shift (> 1.020 specific gravity) was 11% in February, 9% in March, and 6% in April. Cumulative incidence of AKI was 53% in February, 54% in March, and 51% in April. AKI was associated with increasing post-shift specific gravity, a dehydration marker, (OR 1.24, 95% CI 1.02-1.52) and with lower electrolyte solution intake (OR 0.94, 95% CI 0.89-0.99). Conclusions Dehydration and insufficient electrolyte consumption are risk factors for AKI. However even well-hydrated sugarcane workers routinely experience AKI. While hydration is important and protective, there is a need to understand other contributors to risk of AKI and identify prevention strategies with these workers.