Occupational Heat Exposure and Renal Dysfunction

农业工人是一个特别容易患上与高温有关的疾病的职业部门。职业 暴露在高温下会导致受伤、疾病、生产力下降和死亡，这些风险一直很好。 记录在NIOSH关于职业暴露于高温和高温环境的优先文件中。此外 对于这些已知的与高温有关的健康威胁，近年来研究人员提出了炎热环境的理论 温度和艰苦的工作可能在不明原因的慢性肾脏疾病的发展中起作用 病因(CKDu)，一种发生在年轻的、原本健康的农业工人身上的疾病，已在 许多热带国家，并导致数万人死亡。慢性肾脏疾病的负担是 随着需要替代治疗的个人发病率和流行率的增加而在全球范围内增长， 结果不佳，成本较高。在农业工人中，人们假设暴露在高温下， 脱水，容量耗竭，以及高温和/或其他暴露的组合可能在 出现肾功能减退。对CKDU的研究大多集中在农业上 中美洲和其他环境温度不断上升的国家的工人。我们目前的研究 佛罗里达州农业工人对高温的生理反应研究显示，1/2的工人开始 他们的工作日尿液集中，其中3人在这个州和192个州中结束了工作日 工人在2-3个工作日的过程中，33%的人血清肌酐升高表明急性 至少一个工作日的肾脏损伤(AKI)。AKI最显著的预测因素是热度指数的增加。 在这些耐人寻味的观察结果的推动下，并与NIOSH的战略优先事项保持一致，以减少 ，我们建议招募和研究佛罗里达州90名农业工人的队列， 为期两年，研究环境热暴露、肾脏生物标志物之间的相互关系 功能、AKI持续时间和肾功能退化指标。具体来说，我们的目标是：1)确定 如果肾脏生物标记物、AKI和肾功能持续下降与环境和 农业工人高温暴露2年以上；2)非靶向使用 代谢组学分析探讨农业AKI与肾功能退化的生理途径 工人；3)确定接触佛罗里达州农作物上常用的杀虫剂是否独立相关 或修改观察到的肾功能变化，如果这些关系被以下因素改变 吸烟和止痛药的使用；以及4)使用R2P方法，开发教育干预工具包 针对工人和其他相关利益攸关方(例如，保健提供者和农业雇主)，旨在 促进水分和健康的肾功能。这项研究的产出和结果将产生关键 关于工人对高温的生理反应的信息，并导致制定干预措施和 保护农业工人和其他弱势群体长期健康的政策。

Agricultural workers are an occupational sector particularly vulnerable to heat-related illness. Occupational exposure to heat can result in injuries, disease, reduced productivity, and death and these risks have been well documented in NIOSH priority documents on occupational exposure to heat and hot environments. In addition to these known heat-related health threats, in recent years researchers have theorized that hot environmental temperatures and strenuous work may play a role in the development of chronic kidney disease of unknown etiology (CKDu), a disease that strikes young otherwise healthy, agricultural workers, and has been reported in many tropical countries and resulted in tens of thousands of deaths. The burden of chronic kidney disease is growing globally with increasing incidence and prevalence of individuals requiring replacement therapy, with poor outcomes and high cost. Among agricultural workers, it has been hypothesized that heat exposure, dehydration, volume depletion, and the combination of heat and/or other exposures may play a role in the development of decreased renal function. Most of the studies of CKDu have been conducted on agricultural workers in Central America and other countries with rising environmental temperatures. Our current research on physiologic response to heat among agricultural workers in Florida has revealed that ½ of the workers start their workday with concentrated urine, and 3 of them end their workday in this state and that among 192 workers followed over the course of 2-3 workdays, 33% had serum creatinine increases indicative of acute kidney injury (AKI) on at least one workday. The most significant predictor for AKI was increase in heat index. Motivated by these intriguing observations and in alignment with the NIOSH strategic priority to reduce chronic disease in workers, we propose to recruit and study a cohort of 90 Florida agricultural workers over a two year period to examine the inter-relationships between environmental heat exposure, biomarkers of renal function, persistence of AKI and indicators of renal function degradation. Specifically, we aim to: 1) Determine if renal biomarkers, AKI, and sustained decrease in renal function are associated with environmental and exertional heat exposure in heat-exposed agricultural workers over two years; 2) Use non-targeted metabolomic analysis to explore physiologic pathways of AKI and degradation of renal function in agricultural workers; 3) Determine if exposure to pesticides commonly used on Florida crops are independently associated or modify observed changes in renal function, and if these relationships are modified by factors such as smoking and pain medication use; and 4) Using an r2p approach, develop an educational intervention toolkit for workers and other relevant stakeholders (e.g., health care providers and agricultural employers) aimed to promote hydration and healthy renal function. The outputs and outcomes of this study will yield key information on workers physiological response to heat and lead to the development of interventions and policies to protect the long-term health of agricultural workers and other vulnerable populations.