Occupational Heat Exposure and Renal Dysfunction

职业热暴露与肾功能障碍

• 批准号: 10415025
• 负责人: Linda A. McCauley
• 金额: $ 57.2万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10415025
• 关键词: Occupational; Heat; Exposure; Renal; Dysfunction

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.

农业工人是一个特别容易患与热有关的疾病的职业部门。职业 暴露在高温下可能会导致受伤、疾病、生产力下降和死亡，这些风险已得到充分证实 NIOSH 优先文件中记录了有关职业暴露于高温和高温环境的信息。此外 针对这些已知的与高温相关的健康威胁，近年来研究人员提出理论认为，炎热的环境 温度和剧烈工作可能在未知的慢性肾病的发展中发挥作用 病因学 (CKDu)，一种侵袭健康的年轻农业工人的疾病，已在 许多热带国家，并导致数万人死亡。慢性肾脏病的负担是 随着需要替代治疗的个体发病率和患病率的增加，全球范围内不断增长， 效果不佳且成本高。在农业工人中，有人假设热暴露， 脱水、容量不足以及热量和/或其他暴露的组合可能在 肾功能下降的发展。 CKDu的大部分研究都是针对农业进行的 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 关于佛罗里达州农业工人对高温的生理反应的研究表明，有 1/2 的工人开始 他们的工作日都带有浓缩尿液，其中 3 人在这种状态下结束了工作日，而 192 人中 在 2-3 个工作日内对工人进行随访，33% 的人血清肌酐升高，表明存在急性 至少一个工作日发生肾损伤 (AKI)。 AKI 最重要的预测因素是热指数的增加。 受到这些有趣的观察结果的推动，并与 NIOSH 的战略重点保持一致，以减少 针对工人的慢性病，​​我们建议招募并研究一组 90 名佛罗里达州农业工人，为期一年 两年的时间来检查环境热暴露、肾脏生物标志物之间的相互关系 功能、AKI 持续性和肾功能退化指标。具体来说，我们的目标是： 1) 确定 如果肾脏生物标志物、AKI 和肾功能持续下降与环境和 两年以上受热暴露的农业工人的劳累性热暴露； 2）使用非针对性 代谢组学分析探索农业中 AKI 和肾功能退化的生理途径 工人； 3) 确定接触佛罗里达州作物常用农药是否独立相关 或改变观察到的肾功能变化，并且如果这些关系被以下因素改变 吸烟和使用止痛药； 4) 使用 r2p 方法开发教育干预工具包 对于工人和其他相关利益相关者（例如医疗保健提供者和农业雇主）而言，旨在 促进水合作用和健康的肾功能。这项研究的产出和成果将产生关键 有关工人对热的生理反应的信息，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。