Heat stress, dehydration, and kidney function in sugarcane cutters in EI Salvador - A cross-shift study of workers at risk of Mesoamerican nephropathy
Heat stress, dehydration, and kidney function in sugarcane cutters in EI Salvador - A cross-shift study of workers at risk of Mesoamerican nephropathy
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DOI：
10.1016/j.envres.2015.07.007
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发表时间：
2015-10-01
影响因子：
8.3
通讯作者：
Barregard, Lars
中科院分区：
文献类型：
--
作者：
Garcia-Trabanino, Ramon;Jarquin, Emmanuel;Barregard, Lars
背景：一种进步性肾脏衰竭的流行病困扰着中美洲的甘蔗工人。在热环境中重复的高强度工作是可能的原因。目标：评估热应力，脱水，肾功能的生物标志物及其可能的关联。第二个目的是评估迁移前肾脏损害和可能的因果因素的患病率。转移。检查了脱水和肾功能标记的跨偏移变化，并评估了温度，工作时间，区域和液体摄入量的关联。从血清肌酐估算了移位前的肾小球滤过率（EGFR）：平均工作时间为4（1.4-11）小时。中午之前的平均工作日温度为34-36摄氏度，中午为39-42度。工作期间的平均液体摄入量为每小时0.8 l。整个转移都有统计学上的显着变化。平均尿液特异性重力，尿液渗透压和肌酐增加，尿液pH值降低。血清肌酐，尿酸和尿素氮增加，而氯化物和钾则减少。改换前血清尿酸水平非常高，换档前EGFR降低（<60 ml/min）（14％）（14％）。结论：EGFR降低的高患病率，交叉转移变化是一致的在炎热和潮湿的环境中，由于剧烈的工作是重要的因果因素而复发的脱水。病理生理学可能包括减少肾血流，对管状重吸收的高需求以及尿酸水平升高。 （c）2015年作者。由Elsevier Inc.出版
Background: An epidemic of progressive kidney failure afflicts sugarcane workers in Central America. Repeated high-intensity work in hot environments is a possible cause.Objectives: To assess heat stress, dehydration, biomarkers of renal function and their possible associations. A secondary aim was to evaluate the prevalence of pre-shift renal damage and possible causal factors.Methods: Sugarcane cutters (N=189, aged 18-49 years, 168 of them male) from three regions in El Salvador were examined before and after shift. Cross-shift changes in markers of dehydration and renal function were examined and associations with temperature, work time, region, and fluid intake were assessed. Pre-shift glomerular filtration rate was estimated (eGFR) from serum creatinine.Results: The mean work-time was 4 (1.4-11) hours. Mean workday temperature was 34-36 degrees C before noon, and 39-42 degrees C at noon. The mean liquid intake during work was 0.8 L per hour. There were statistically significant changes across shift. The mean urine specific gravity, urine osmolality and creatinine increased, and urinary pH decreased. Serum creatinine, uric acid and urea nitrogen increased, while chloride and potassium decreased. Pre-shift serum uric acid levels were remarkably high and pre-shift eGFR was reduced (< 60 mL/min) in 23 male workers (14%).Conclusions: The high prevalence of reduced eGFR, and the cross-shift changes are consistent with recurrent dehydration from strenuous work in a hot and humid environment as an important causal factor. The pathophysiology may include decreased renal blood flow, high demands on tubular reabsorption, and increased levels of uric acid. (C) 2015 The Authors. Published by Elsevier Inc.