Occupational Heat Exposure and Renal Dysfunction

农业工人是一个特别容易受到与热有关的疾病影响的职业部门。职业 暴露在高温下会导致受伤、疾病、生产力下降和死亡，这些风险已经得到了很好的解决。 在NIOSH关于职业暴露于高温和高温环境的优先文件中有记录。此外 对于这些已知的与热有关的健康威胁，近年来研究人员提出了一个理论，即热环境 温度和繁重的工作可能在未知的慢性肾脏疾病的发展中发挥作用 病因学（CKDu），一种袭击年轻健康农业工人的疾病， 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体的发病率和患病率的增加， 效果差，成本高。在农业工人中，有人假设热暴露， 脱水、血容量不足以及热和/或其他暴露的组合可能在 肾功能下降。CKDu的大部分研究都是在农业方面进行的 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 一项关于佛罗里达农业工人对高温的生理反应的研究显示， 他们的工作日与浓缩尿，其中3人结束了他们的工作日在这种状态下，192 在2-3个工作日的随访过程中，33%的工人血清肌酐升高，表明急性 至少一个工作日发生肾损伤（阿基）。阿基最重要的预测因素是热指数的增加。 受这些有趣的观察结果的启发，并与NIOSH战略优先事项保持一致， 慢性疾病的工人，我们建议招募和研究一个队列的90名佛罗里达农业工人超过 为期两年的时间，以检查环境热暴露、肾损害的生物标志物 阿基的持续性和肾功能退化的指标。具体而言，我们的目标是：1）确定 如果肾生物标志物、阿基和肾功能持续下降与环境和 2）使用非靶向的热暴露的农业工人的劳动热暴露超过两年; 代谢组学分析，以探索农业阿基和肾功能退化的生理途径 工人; 3）确定暴露于佛罗里达作物常用的农药是否独立相关 或改变观察到的肾功能变化，并且如果这些关系被诸如 吸烟和使用止痛药;以及4）使用r2 p方法，开发教育干预工具包 对于工人和其他相关利益攸关方（例如，卫生保健提供者和农业雇主）， 促进水合作用和健康的肾功能。本研究的产出和成果将产生关键的 关于工人对热的生理反应的信息，并导致制定干预措施， 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.