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Chapman CL, Johnson BD, Hostler DP, Schlader ZJ. Diagnostic accuracy of thermal, hydration, and heart rate assessments in discriminating positive acute kidney injury risk following physical work in the heat. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2024; 21:326-341. [PMID: 38512776 DOI: 10.1080/15459624.2024.2315161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Occupational heat stress increases the risk of acute kidney injury (AKI). This study presents a secondary analysis to generate novel hypotheses for future studies by investigating the diagnostic accuracy of thermal, hydration, and heart rate assessments in discriminating positive AKI risk following physical work in the heat in unacclimatized individuals. Unacclimatized participants (n = 13, 3 women, age: ∼23 years) completed four trials involving 2 h of exercise in a 39.7 ± 0.6 °C, 32 ± 3% relative humidity environment that differed by experimental manipulation of hyperthermia (i.e., cooling intervention) and dehydration (i.e., water drinking). Diagnostic accuracy was assessed via receiver operating characteristic curve analysis. Positive AKI risk was identified when the product of concentrations insulin-like growth factor binding protein 7 and tissue inhibitor of metalloproteinase-2 [IGFBP7∙TIMP-2] exceeded 0.3 (ng∙mL-1)2∙1000-1. Peak absolute core temperature had the acceptable discriminatory ability (AUC = 0.71, p = 0.009), but a relatively large variance (AUC 95% CI: 0.57-0.86). Mean body temperature, urine specific gravity, urine osmolality, peak heart rate, and the peak percent of both maximum heart rate and heart rate reserve had poor discrimination (AUC = 0.66-0.69, p ≤ 0.051). Mean skin temperature, percent change in body mass and plasma volume, and serum sodium and osmolality had no discrimination (p ≥ 0.072). A peak increase in mean skin temperature of >4.7 °C had a positive likelihood ratio of 11.0 which suggests clinical significance. These data suggest that the absolute value of peak core temperature and the increase in mean skin temperature may be valuable to pursue in future studies as a biomarker for AKI risk in unacclimatized workers.
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Affiliation(s)
- Christopher L Chapman
- Military Performance Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Blair D Johnson
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
| | - David P Hostler
- Department of Exercise & Nutrition Sciences, University at Buffalo, Buffalo, New York
| | - Zachary J Schlader
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, Indiana
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Holliday MW, Majeti RN, Sheikh-Hamad D. Chronic Interstitial Nephritis in Agricultural Communities: Observational and Mechanistic Evidence Supporting the Role of Nephrotoxic Agrochemicals. Clin J Am Soc Nephrol 2024; 19:538-545. [PMID: 37678249 PMCID: PMC11020436 DOI: 10.2215/cjn.0000000000000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/31/2023] [Indexed: 09/09/2023]
Abstract
Chronic interstitial nephritis in agricultural communities (CINAC) is an epidemic of kidney disease affecting specific tropical and subtropical regions worldwide and is characterized by progressive CKD in the absence of traditional risk factors, such as hypertension and diabetes. CINAC prevalence is higher among young, male agricultural workers, but it also affects women, children, and nonagricultural workers in affected areas. Biopsies from patients with CINAC across regions commonly demonstrate tubular injury with lysosomal aggregates, tubulointerstitial inflammation, and fibrosis and variable glomerular changes. Each endemic area holds environmental risk factors and patient/genetic milieus, resulting in uncertainty about the cause(s) of the disease. Currently, there is no specific treatment available for CINAC. We highlight survey findings of Houston-based migrant workers with CINAC and draw similarities between kidney injury phenotype of patients with CINAC and mice treated chronically with paraquat, an herbicide used worldwide. We propose potential pathways and mechanisms for kidney injury in patients with CINAC, which may offer clues for potential therapies.
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Affiliation(s)
- Michael W. Holliday
- Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas
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Gonzalez-Quiroz M, Heggeseth B, Camacho A, Oomatia A, Al-Rashed AM, Zhang Y, McCreight A, Jewell N, Aragon A, Nitsch D, Pearce N, Caplin B. Population-level detection of early loss of kidney function: 7-year follow-up of a young adult cohort at risk of Mesoamerican nephropathy. Int J Epidemiol 2024; 53:dyad151. [PMID: 37930052 PMCID: PMC10859140 DOI: 10.1093/ije/dyad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Mesoamerican nephropathy is a leading contributor to premature mortality in Central America. Efforts to identify the cause are hampered by difficulties in distinguishing associations with potential initiating factors from common exposures thought to exacerbate the progression of all forms of established chronic kidney disease (CKD). We explored evidence of disease onset or departure from the healthy estimated glomerular filtration rate distribution [departure from ∼eGFR(healthy)] in an at-risk population. METHODS Two community-based cohorts (adults aged 18-30 years, n = 351 and 420) from 11 rural communities in Northwest Nicaragua were followed up over 7 and 3 years respectively. We examined associations with both (i) incident CKD and (ii) the time point of departure from ∼eGFR(healthy), using a hidden Markov model. RESULTS CKD occurred in men only (male incidence rate: 0.7%/year). Fifty-three (out of 1878 visits, 2.7%) and 8 (out of 1067 visits, 0.8%) episodes of probable departure from ∼eGFR(healthy) occurred in men and women, respectively. Cumulative time in sugarcane work and symptoms of excess occupational sun exposure were associated with incident CKD. The same exposures were associated with probability of departure from ∼eGFR(healthy) in time-updated analyses along with measured and self-reported weight loss, nausea, vomiting and cramps, as well as non-steroidal anti-inflammatory drug use. CONCLUSIONS CKD burden in this population is high and risk factors for established disease are occupational. Additionally, a syndrome suggesting an alternative exposure is associated with evidence of disease onset supporting a possible separate unknown initiating factor for which further investigation is needed. Interventions to reduce the impact of occupational risks should be pursued meanwhile.
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Affiliation(s)
- Marvin Gonzalez-Quiroz
- Department of Renal Medicine, University College London, London, UK
- Wuqu’ Kawoq Maya Health Alliance, Chimaltenango, Guatemala
| | - Brianna Heggeseth
- Department of Mathematics, Statistics, and Computer Science, Macalester College, St Paul, MN, USA
| | - Armando Camacho
- Research Centre on Health, Work and Environment, National Autonomous University of Nicaragua, León (UNAN-Leon), León, Nicaragua
| | - Amin Oomatia
- Department of Renal Medicine, University College London, London, UK
| | - Ali M Al-Rashed
- Department of Renal Medicine, University College London, London, UK
| | - Yixuan Zhang
- Department of Mathematics, Statistics, and Computer Science, Macalester College, St Paul, MN, USA
| | - Alexander McCreight
- Department of Mathematics, Statistics, and Computer Science, Macalester College, St Paul, MN, USA
| | - Nicholas Jewell
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Aurora Aragon
- Wuqu’ Kawoq Maya Health Alliance, Chimaltenango, Guatemala
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Ben Caplin
- Department of Renal Medicine, University College London, London, UK
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Strasma A, Reyes ÁM, Aragón A, López I, Park LP, Hogan SL, Thielman N, Wyatt C, González-Quiroz M. Kidney disease characteristics, prevalence, and risk factors in León, Nicaragua: a population-based study. BMC Nephrol 2023; 24:335. [PMID: 37953252 PMCID: PMC10641961 DOI: 10.1186/s12882-023-03381-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/28/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND CKD of unknown etiology (CKDu) disproportionately affects young people in Central America who lack traditional CKD risk factors (diabetes and hypertension) and has instead been variably linked to heat stress, occupational and environmental exposures, nephrotoxic medications, and/or genetic susceptibility. This study aimed to estimate the prevalence of CKD and identify risk factors for traditional CKD and CKDu in Nicaragua. METHODS Surveys and assessment for CKD markers in urine and serum were performed in 15-59 year olds in households of the León municipality of Nicaragua. The survey included questions on demographics, health behaviors, occupation, and medical history. Participants with CKD were subdivided into traditional CKD and suspected CKDu based on history of diabetes, hypertension, or other specified conditions. A multinomial logistic regression model was used to identify factors associated with traditional CKD and suspected CKDu, compared to the non-CKD reference group. RESULTS In 1795 study participants, CKD prevalence was 8.6%. Prevalence in males was twofold higher than females (12% vs 6%). Of those with CKD, 35% had suspected CKDu. Both traditional CKD and CKDu were associated with male sex and increasing age. Traditional CKD was associated with a family history of CKD, history of urinary tract infections, and lower socioeconomic status, while CKDu was associated with drinking well water and a lower body mass index. CONCLUSIONS Both traditional CKD and CKDu are significant burdens in this region. Our study supports previous hypotheses of CKDu etiology and emphasizes the importance of CKD screening.
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Affiliation(s)
- Anna Strasma
- Department of Medicine, Division of Nephrology, Duke University School of Medicine, Durham, NC, USA.
- Duke Global Health Institute, Durham, NC, USA.
| | - Ángel Mejía Reyes
- Bioanalysis and Immunology Research Group, National Autonomous University of Honduras, Tegucigalpa, Honduras
| | - Aurora Aragón
- WUQU' KAWOQ, Maya Health Alliance, Chimaltenango, Guatemala
| | - Indiana López
- WUQU' KAWOQ, Maya Health Alliance, Chimaltenango, Guatemala
| | - Lawrence P Park
- Duke Global Health Institute, Durham, NC, USA
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Susan L Hogan
- Department of Medicine, Division of Nephrology and Hypertension and the UNC Kidney Center, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Nathan Thielman
- Duke Global Health Institute, Durham, NC, USA
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Christina Wyatt
- Department of Medicine, Division of Nephrology, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Marvin González-Quiroz
- WUQU' KAWOQ, Maya Health Alliance, Chimaltenango, Guatemala
- Department of Renal Medicine, University College London, London, UK
- School of Medicine, Universidad Nacional de Chimborazo, Riobamba, Ecuador
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Stem AD, Rogers KL, Roede JR, Roncal-Jimenez CA, Johnson RJ, Brown JM. Sugarcane ash and sugarcane ash-derived silica nanoparticles alter cellular metabolism in human proximal tubular kidney cells. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 332:121951. [PMID: 37301454 PMCID: PMC10321436 DOI: 10.1016/j.envpol.2023.121951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
Multiple epidemics of chronic kidney disease of an unknown etiology (CKDu) have emerged in agricultural communities around the world. Many factors have been posited as potential contributors, but a primary cause has yet to be identified and the disease is considered likely multifactorial. Sugarcane workers are largely impacted by disease leading to the hypothesis that exposure to sugarcane ash produced during the burning and harvest of sugarcane could contribute to CKDu. Estimated exposure levels of particles under 10 μm (PM10) have been found to be exceptionally high during this process, exceeding 100 μg/m3 during sugarcane cutting and averaging ∼1800 μg/m3 during pre-harvest burns. Sugarcane stalks consist of ∼80% amorphous silica and generate nano-sized silica particles (∼200 nm) following burning. A human proximal convoluted tubule (PCT) cell line was subjected to treatments ranging in concentration from 0.025 μg/mL to 25 μg/mL of sugarcane ash, desilicated sugarcane ash, sugarcane ash-derived silica nanoparticles (SAD SiNPs) or manufactured pristine 200 nm silica nanoparticles. The combination of heat stress and sugarcane ash exposure on PCT cell responses was also assessed. Following 6-48 h of exposure, mitochondrial activity and viability were found to be significantly reduced when exposed to SAD SiNPs at concentrations 2.5 μg/mL or higher. Oxygen consumption rate (OCR) and pH changes suggested significant alteration to cellular metabolism across treatments as early as 6 h following exposure. SAD SiNPs were found to inhibit mitochondrial function, reduce ATP generation, increase reliance on glycolysis, and reduce glycolytic reserve. Metabolomic analysis revealed several cellular energetics pathways (e.g., fatty acid metabolism, glycolysis, and TCA cycle) are significantly altered across ash-based treatments. Heat stress did not influence these responses. Such changes indicate that exposure to sugarcane ash and its derivatives can promote mitochondrial dysfunction and disrupt metabolic activity of human PCT cells.
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Affiliation(s)
- Arthur D Stem
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Keegan L Rogers
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - James R Roede
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Carlos A Roncal-Jimenez
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Jared M Brown
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Arroyo G, Soto G, García S, Pérez-Folgar J, Bailón P, Acabal B, Cocón A, Díaz-Moscoso M, Nave F. Prevalence of kidney disease of unknown etiology in agricultural workers, Guatemala. Rev Panam Salud Publica 2023; 47:e84. [PMID: 37266488 PMCID: PMC10231270 DOI: 10.26633/rpsp.2023.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/17/2023] [Indexed: 06/03/2023] Open
Abstract
Objectives To determine the prevalence of kidney disease of unknown etiology in banana, melon, and tomato workers in north-eastern Guatemala, and to evaluate the usefulness of a cystatin C blood test for early detection of renal disease. Methods This was a cross-sectional, farm-based study of 462 agricultural workers conducted from June to September 2021. Epidemiological and demographic characteristics of the workers were collected through a self-administered questionnaire. Blood samples were obtained to determine glucose, creatinine and cystatin C levels. Anthropometric and clinical data were also recorded. Results The prevalence of kidney disease of unknown etiology was 3.03% (95% confidence interval (CI): 1.36-4.70%) based on glomerular filtration rate (GFR-EPI) < 60 mL/min/1.73 m2, with a significantly higher prevalence in banana workers (5.67%; 95% CI: 2.16-9.18%) than melon workers (p = 0.009) and tomato workers (p = 0.044). Ten workers (2.16%) had reduced kidney function (GFR-EPI 60-90 mL/min/1.73 m2). The levels of cystatin C showed less variability (coefficient of variation 46.4%) than those of creatinine (coefficient of variation 67.0%), and cystatin C levels in cases with abnormal and reduced kidney function were significantly different from cases with normal kidney function (p < 0.001). Conclusions Surveillance of the health of active farm workers and improvement of working conditions, such as sun protection, adequate hydration, and sufficient breaks, are recommended. The significant differences in cystatin C levels between cases with abnormal and reduced kidney function and those with normal kidney function suggest that cystatin C could be a useful measure for early detection of renal disease.
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Affiliation(s)
- Gerardo Arroyo
- Universidad de San Carlos de GuatemalaGuatemala CityGuatemalaUniversidad de San Carlos de Guatemala, Guatemala City, Guatemala.
| | - Gabriella Soto
- Universidad de San Carlos de GuatemalaGuatemala CityGuatemalaUniversidad de San Carlos de Guatemala, Guatemala City, Guatemala.
| | - Sofía García
- Universidad de San Carlos de GuatemalaGuatemala CityGuatemalaUniversidad de San Carlos de Guatemala, Guatemala City, Guatemala.
| | - Jorge Pérez-Folgar
- Universidad de San Carlos de GuatemalaGuatemala CityGuatemalaUniversidad de San Carlos de Guatemala, Guatemala City, Guatemala.
| | - Paola Bailón
- Universidad de San Carlos de GuatemalaGuatemala CityGuatemalaUniversidad de San Carlos de Guatemala, Guatemala City, Guatemala.
| | - Brenda Acabal
- Universidad de San Carlos de GuatemalaGuatemala CityGuatemalaUniversidad de San Carlos de Guatemala, Guatemala City, Guatemala.
| | - Anita Cocón
- Universidad de San Carlos de GuatemalaGuatemala CityGuatemalaUniversidad de San Carlos de Guatemala, Guatemala City, Guatemala.
| | - Mario Díaz-Moscoso
- Centro Universitario de Oriente (CUNORI)ChiquimulaGuatemalaCentro Universitario de Oriente (CUNORI), Chiquimula, Guatemala.
| | - Federico Nave
- Universidad de San Carlos de GuatemalaGuatemala CityGuatemalaUniversidad de San Carlos de Guatemala, Guatemala City, Guatemala.
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Nayak S, Rehman T, Patel K, Dash P, Alice A, Kanungo S, Palo SK, Pati S. Factors Associated with Chronic Kidney Disease of Unknown Etiology (CKDu): A Systematic Review. Healthcare (Basel) 2023; 11:healthcare11040551. [PMID: 36833085 PMCID: PMC9956943 DOI: 10.3390/healthcare11040551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/18/2023] [Accepted: 01/25/2023] [Indexed: 02/16/2023] Open
Abstract
(1) Background: Despite ample research, the factors, specific causes, and pathways associated with chronic kidney disease of unknown etiology (CKDu) remain elusive. Therefore, we performed a systematic review to explore the potential etiologies for the development of CKDu globally. (2) Methods: A systematic literature review was conducted using databases CINAHL, Cochrane Library, Embase, Google Scholar, MEDLINE, and PsycINFO on the specific causes and pathophysiology related to CKDu from inception until April 2021. Study selection, data extraction of included articles, and quality appraisal were assessed. The narrative approach was used to summarize and comprehend the findings. (3) Results: Our study included 25 studies, considering 38,351 participants. Twelve studies were case-control, ten were cross-sectional, and three were cohort designs. All articles were from low-and middle-income countries (LMICs). The findings suggest 12 factors are associated with CKDu. Most studies (n = 8) identified farming and water sources as the factors related to CKDu, with heavy metal toxicity coming in second (n = 7). (4) Conclusion: The systematic review reported various factors associated with CKDu, from which most studies reported farming, water sources, and heavy metal poisoning. Considering the findings, the study recommends future strategies and public health initiatives to prevent the epidemiological/environmental factors contributing to CKDu.
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Cajina-Aguirre CL, Strasma AK, Álvarez-Novoa RJ. Global Dialysis Perspective: Nicaragua. KIDNEY360 2023; 4:110-113. [PMID: 36700913 PMCID: PMC10101595 DOI: 10.34067/kid.0005572022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022]
Affiliation(s)
- Carmen L. Cajina-Aguirre
- Department of Physiological Sciences, Faculty of Medical Sciences, National Autonomous University of Nicaragua, Managua, Nicaragua
| | - Anna K. Strasma
- Division of Nephrology, Duke University School of Medicine, Durham, North Carolina
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Carstens MH, García N, Mandayam S, Workeneh B, Pastora I, Calderón C, Bertram KA, Correa D. Safety of Stromal Vascular Fraction Cell Therapy for Chronic Kidney Disease of Unknown Cause (Mesoamerican Nephropathy). Stem Cells Transl Med 2022; 12:7-16. [PMID: 36545894 PMCID: PMC9887091 DOI: 10.1093/stcltm/szac080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/29/2022] [Indexed: 12/24/2022] Open
Abstract
Chronic kidney disease of unknown cause (CKDu), also known as Mesoamerican nephropathy, typically presents as an ischemic nephropathy with chronic tubulointerstitial fibrosis in normotensive patients, rapidly progressing to kidney failure. In this first-in-human, open-label, safety study, we followed 18 patients with CKDu (stages 3-5) for 36 months after receiving a single infusion of angiogenic/anti-fibrotic autologous adipose-derived stromal vascular fraction (SVF) cells into their kidneys bilaterally via renal artery catheterization. SVF therapy was safe and well tolerated. There were no SVF-related serious adverse events and no procedural complications. Color Doppler evaluation at 2 months demonstrated increased perfusion to the interlobar and/or arcuate artery levels in each kidney evaluated (36/36) with a reduction in resistance index at the hilar artery (35/36) kidneys. Beyond 12 months, patients with initial eGFR <30 mL/minute/1.73 m2 deteriorated, whereas those ≥30 mL/minute/1.73 m2 further sustained their renal function, suggesting a possible renal protective effect in that group.
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Affiliation(s)
- Michael H Carstens
- Corresponding author: Michael H. Carstens, MD, FACS, Wake Forest Institute of Regenerative Medicine, 971 Technology Way, Winston-Salem, NC 27101, USA. Tel: +1 571 228 9940;
| | - Nelson García
- Department of Medicine, Universidad Nacional Autónoma de Nicaragua, León, Nicaragua,Nephrology section, Ministerio de Salud, República de Nicaragua
| | - Sreedhar Mandayam
- Department of Nephrology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Biruh Workeneh
- Department of Nephrology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Indiana Pastora
- Department of Medicine, Universidad Nacional Autónoma de Nicaragua, León, Nicaragua
| | - Carlos Calderón
- Department of Cardiology, Hospital San Juan de Dios, San José, Costa Rica
| | - Kenneth A Bertram
- Wake Forest University Institute for Regenerative Medicine, Winston-Salem, NC, USA
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Lin Y, Heng S, Anand S, Deshpande SK, Small DS. Hemoglobin Levels Among Male Agricultural Workers: Analyses From the Demographic and Health Surveys to Investigate a Marker for Chronic Kidney Disease of Uncertain Etiology. J Occup Environ Med 2022; 64:e805-e810. [PMID: 36472566 PMCID: PMC9731347 DOI: 10.1097/jom.0000000000002703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Estimate agricultural work's effect on hemoglobin (Hgb) level in men. A negative effect may indicate presence of chronic kidney disease of uncertain etiology. METHODS We use Demographic and Health Surveys data from seven African and Asian countries and use matching to control for seven confounders. RESULTS On average, Hgb levels were 0.09 g/dL lower among agricultural workers compared with matched controls. Significant effects were observed in Ethiopia, India, Lesotho, and Senegal, with effects from 0.07 to 0.30 g/dL lower Hgb level among agricultural workers. The findings were robust to multiple control groups and a modest amount of unmeasured confounding. CONCLUSIONS Men engaged in agricultural work in four of the seven countries studied have modestly lower Hgb levels. Our data support integrating kidney function assessments within Demographic and Health Surveys and other population-based surveys.
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Affiliation(s)
- Yuzhou Lin
- From the Department of Statistics, Harvard University, Cambridge, Massachusetts (Mr Lin); Department of Biostatistics, School of Global Public Health, New York University, New York, New York (Dr Heng); Division of Nephrology, Stanford University, Palo Alto, California (Dr Anand); Department of Statistics, University of Wisconsin-Madison, Madison, Wisconsin (Dr Deshpande); Department of Statistics and Data Science, University of Pennsylvania, Philadelphia, Pennsylvania (Dr Small)
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Aoun M, Chelala D. Where do you live and what do you do? Two questions that might impact your kidney health. FRONTIERS IN NEPHROLOGY 2022; 2:1011964. [PMID: 37675017 PMCID: PMC10479685 DOI: 10.3389/fneph.2022.1011964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/13/2022] [Indexed: 09/08/2023]
Abstract
In many cases the social determinants of health need to be assessed through their interaction with environmental factors. This review looks at the impact of physical location and occupation of individuals on their kidney health. It examines the effect of living at high altitude on kidney function and the relationship between extreme cold or hot temperatures and the incidence of kidney injury. It reviews as well the many occupations that have been linked to kidney disease in high-income and low-and-middle-income countries. As a conclusion, this overview proposes preventive recommendations that could be individualized based on weather, altitude, socio-economic level of the country and occupation of the individual.
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Affiliation(s)
- Mabel Aoun
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
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Al-Bouwarthan M, AlMulla AA, Yaseen M. The impact of heat on kidney health: A PRISMA-compliant bibliometric analysis. Medicine (Baltimore) 2022; 101:e30328. [PMID: 36086778 PMCID: PMC10980493 DOI: 10.1097/md.0000000000030328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 07/19/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Exposure to excessive heat can impact kidney health. Climate change is projected to aggravate this impact. An analysis of articles published between 1958 and 2021 was conducted to explore the progress of the research on this issue. METHODS This study included a bibliometric analysis wherein Web of Science was used to generate a list of all published articles related to the impact of heat on kidney health. Basic information about the articles, such as titles, authors' names, keywords, and citations, were recorded and analyzed. RESULTS A total of 226 published articles related to the impact of heat on kidney health were identified as of November 20, 2021. Most of these articles (93%) were published within the last decade. The United States was the most prominent country in terms of research productivity and collaboration. Researchers from the United States were well represented among the top 20 contributors of published articles on the study issue. The productivity of the top 20 authors varied between 6 and 32 articles each. A total of 25 common words used by the authors were identified. The most frequently used keywords were chronic kidney disease, heat stress, acute kidney injury, Mesoamerican nephropathy, and climate change. Keyword analysis revealed 3 distinct major research clusters in the existing scientific research on the impact of heat on kidney health: chronic kidney disease of unknown etiology, heat stress and renal physiology, and the effect of climate change on kidney health. CONCLUSIONS Research on heat-related kidney injury has witnessed rapid development in recent decades, motivated by the emergence of chronic kidney disease of unknown etiology and climate change. Developing countries in hot regions must increase their productivity in this research area through international collaboration and partnerships.
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Affiliation(s)
- Mohammed Al-Bouwarthan
- Department of Environmental Health, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulaziz A. AlMulla
- Department of Environmental Health, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Muhammad Yaseen
- Faculty of Sciences, Department of Mathematics and Statistics, University of Agriculture, Faisalabad, Pakistan
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Holliday MW, Li Q, Bustamante EG, Niu J, Huang L, Espina IM, Dominguez JR, Truong L, Murray KO, Fan L, Anumudu SJ, Shah M, Fischer RS, Vangala C, Mandayam S, Perez J, Pan JS, Ali S, Awan AA, Sheikh-Hamad D. Potential Mechanisms Involved in Chronic Kidney Disease of Unclear Etiology. Clin J Am Soc Nephrol 2022; 17:1293-1304. [PMID: 35944911 PMCID: PMC9625092 DOI: 10.2215/cjn.16831221] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/15/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES The etiology of chronic kidney disease of unclear etiology, also known as Mesoamerican nephropathy, remains unclear. We investigated potential etiologies for Mesoamerican nephropathy in an immigrant dialysis population. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Migrants with Mesoamerican nephropathy kidney failure (n=52) were identified by exclusion of known causes of kidney disease and compared using a cross-sectional survey with demographically similar patients with kidney failure from other causes (n=63) and age/sex/place of origin-matched healthy participants (n=16). Survey results were extended to the bench; C57BL/6 mice (n=73) received 10-15 weekly intraperitoneal injections of paraquat (a reactive oxygen species-generating herbicide) or vehicle. Kidney function, histology, and expression of organic cation transporter-2 (proximal tubule entry for paraquat) and multidrug and toxin extrusion 1 (extrusion pathway) were examined. Kidney biopsies from Nicaraguan patients with acute Mesoamerican nephropathy were stained for the above transporters and compared with patients with tubulointerstitial nephritis and without Mesoamerican nephropathy. RESULTS Patients with Mesoamerican nephropathy and kidney failure were young agricultural workers, almost exclusively men; the majority were from Mexico and El Salvador; and they had prior exposures to agrochemicals, including paraquat (27%). After adjustment for age/sex, exposure to any agrochemical or paraquat was associated with Mesoamerican nephropathy kidney failure (odds ratio, 4.86; 95% confidence interval, 1.82 to 12.96; P=0.002 and odds ratio, 12.25; 95% confidence interval, 1.51 to 99.36; P=0.02, respectively). Adjusted for age/sex and other covariates, 1 year of agrochemical exposure was associated with Mesoamerican nephropathy kidney failure (odds ratio, 1.23; 95% confidence interval, 1.04 to 1.44; P=0.02). Compared with 16 matched healthy controls, Mesoamerican nephropathy kidney failure was significantly associated with exposure to paraquat and agrochemicals. Paraquat-treated male mice developed kidney failure and tubulointerstitial nephritis consistent with Mesoamerican nephropathy. Organic cation transporter-2 expression was higher in male kidneys versus female kidneys. Paraquat treatment increased organic cation transporter-2 expression and decreased multidrug and toxin extrusion 1 expression in male kidneys; similar results were observed in the kidneys of Nicaraguan patients with Mesoamerican nephropathy. CONCLUSIONS Exposure to agrochemicals is associated with Mesoamerican nephropathy, and chronic exposure of mice to paraquat, a prototypical oxidant, induced kidney failure similar to Mesoamerican nephropathy.
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Affiliation(s)
- Michael W. Holliday
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Center for Translational Research on Inflammatory Diseases, Houston, Texas
| | - Qingtian Li
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Jingbo Niu
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Luping Huang
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Ilse M. Espina
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Jose R. Dominguez
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Luan Truong
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas
| | - Kristy O. Murray
- School of Tropical Medicine and Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Lei Fan
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, People's Republic of China
| | - Samaya J. Anumudu
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Maulin Shah
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Rebecca S.B. Fischer
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, Houston, Texas
| | - Chandan Vangala
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Sreedhar Mandayam
- Section of Nephrology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jose Perez
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Jenny S. Pan
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Sehrish Ali
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Ahmed A. Awan
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - David Sheikh-Hamad
- The Selzman Institute for Kidney Health and Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Center for Translational Research on Inflammatory Diseases, Houston, Texas
- Department of Nutrition, Harris Health System, Houston, Texas
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14
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He L, Xue B, Wang B, Liu C, Gimeno Ruiz de Porras D, Delclos GL, Hu M, Luo B, Zhang K. Impact of high, low, and non-optimum temperatures on chronic kidney disease in a changing climate, 1990-2019: A global analysis. ENVIRONMENTAL RESEARCH 2022; 212:113172. [PMID: 35346653 PMCID: PMC9907637 DOI: 10.1016/j.envres.2022.113172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/14/2022] [Accepted: 03/22/2022] [Indexed: 05/07/2023]
Abstract
BACKGROUND Although a few studies have reported the relationship between high and low temperatures and chronic kidney disease (CKD), the global burden of CKD attributable to extreme heat and cold in recent decades remains unknown. METHODS Based on the Global Burden of Disease Study (GBD) 2019, we obtained data on age-standardized mortality rates (ASMR) and age-standardized rates of disability-adjusted life years (ASDR) per 100 000 population of the CKD attributable to non-optimum temperatures from 1990 to 2019. The annual mean temperature of each country was used to divide each country into five climate zones (tropical, subtropical, warm-temperate, cool-temperate, and boreal). The locally weighted regression model was used to estimate the burden for different climate zones and Socio-demographic index (SDI) regions. RESULTS In 1990, the ASMR and ASDR due to high temperature estimated -0.01 (95% UI, -0.74 to 0.44) and -0.32 (-21.66 to 12.66) per 100 000 population, respectively. In 2019, the ASMR and ASDR reached 0.10 (-0.28 to 0.38) and 2.71 (-8.07 to 10.46), respectively. The high-temperature burden increased most rapidly in tropical and low SDI regions. There were 0.99 (0.59 to 1.39) ASMR attributable to low-temperature in 1990, which increased to 1.05 (0.61-1.49) in 2019. While the ASDR due to low temperature declined from 22.03 (12.66 to 30.64) in 1990 to 20.43 (11.30 to 29.26) in 2019. Overall, the burden of CKD attributable to non-optimal temperatures has increased from 1990 to 2019. CKD due to hypertension and diabetes mellitus were the primary causes of CKD death attributable to non-optimum temperatures in 2019 with males and older adults being more susceptible to these temperatures. CONCLUSIONS The CKD burden due to high, low, and non-optimum temperatures varies considerably by regions and countries. The burden of CKD attributable to high temperature has been increasing since 1990.
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Affiliation(s)
- Li He
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, 730000, People's Republic of China
| | - Baode Xue
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, 730000, People's Republic of China
| | - Bo Wang
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, 730000, People's Republic of China
| | - Ce Liu
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, 730000, People's Republic of China
| | - David Gimeno Ruiz de Porras
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA; Southwest Center for Occupational and Environmental Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - George L Delclos
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA; Southwest Center for Occupational and Environmental Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA
| | - Ming Hu
- School of Architecture, Planning and Preservation, University of Maryland, College Park, MD, 20742, USA
| | - Bin Luo
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu, 730000, People's Republic of China.
| | - Kai Zhang
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY, 12144, USA.
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15
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Keogh SA, Leibler JH, Sennett Decker CM, Amador Velázquez JJ, Jarquin ER, Lopez-Pilarte D, Garcia-Trabanino R, Delgado IS, Petropoulos ZE, Friedman DJ, Amador Sánchez MR, Guevara R, McClean MD, Brooks DR, Scammell MK. High prevalence of chronic kidney disease of unknown etiology among workers in the Mesoamerican Nephropathy Occupational Study. BMC Nephrol 2022; 23:238. [PMID: 35794550 PMCID: PMC9261054 DOI: 10.1186/s12882-022-02861-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 06/20/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Mortality from chronic kidney disease of unknown etiology (CKDu) is extremely high along the Pacific coast of Central America, particularly among sugarcane workers. The Mesoamerican Nephropathy Occupational Study (MANOS) is a prospective cohort study of CKDu among agricultural and non-agricultural workers in El Salvador and Nicaragua. The objective of this manuscript is to describe the MANOS cohort recruitment, baseline data collection, and CKDu prevalence after two rounds. METHODS Workers with no known diabetes, hypertension, or CKD were recruited from sugarcane, corn, plantain, brickmaking, and road construction industries (n = 569). Investigators administered questionnaires, collected biological samples, and observed workers for three consecutive workdays at the worksite. Serum specimens were analyzed for kidney function parameters, and used to calculate estimated glomerular filtration rate (eGFR). At six months, serum was collected again prior to the work shift. CKD at baseline is defined as eGFR ≤ 60 ml/min/1.73m2 at both timepoints. Age-standardized prevalence was calculated by industry, country, and demographic measures. Kidney function parameters were compared by CKD status. RESULTS Prevalence of CKD at baseline was 7.4% (n = 42). Age-standardized prevalence was highest in Salvadoran sugarcane (14.1%), followed by Salvadoran corn (11.6%), and Nicaraguan brickmaking (8.1%). Nicaraguan sugarcane had the lowest prevalence, likely due to kidney function screenings prior to employment. CONCLUSION Despite efforts to enroll participants without CKD, our identification of prevalent CKD among agricultural and non-agricultural workers in the MANOS cohort indicates notable kidney disease in the region, particularly among sugarcane workers.
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Affiliation(s)
- Sinead A Keogh
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St. T4W, Boston, MA, 02118, USA
| | - Jessica H Leibler
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St. T4W, Boston, MA, 02118, USA
| | - Caryn M Sennett Decker
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St. T4W, Boston, MA, 02118, USA
| | - Juan Jose Amador Velázquez
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St. T4W, Boston, MA, 02118, USA.,Department of Epidemiology, Boston University School of Public Health, 715 Albany St. T3E, Boston, MA, USA
| | - Emmanuel R Jarquin
- Agencia para el Desarrollo y la Salud Agropecuaria (AGDYSA), San Salvador, El Salvador
| | - Damaris Lopez-Pilarte
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St. T4W, Boston, MA, 02118, USA.,Department of Epidemiology, Boston University School of Public Health, 715 Albany St. T3E, Boston, MA, USA
| | - Ramon Garcia-Trabanino
- Agencia para el Desarrollo y la Salud Agropecuaria (AGDYSA), San Salvador, El Salvador.,Centro de Hemodiálisis, San Salvador, El Salvador.,Emergency Social Fund for Health, Tierra Blanca, El Salvador
| | - Iris S Delgado
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St. T4W, Boston, MA, 02118, USA.,Department of Epidemiology, Boston University School of Public Health, 715 Albany St. T3E, Boston, MA, USA
| | - Zoe E Petropoulos
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St. T4W, Boston, MA, 02118, USA
| | - David J Friedman
- Division of Nephrology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Magaly Rosario Amador Sánchez
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St. T4W, Boston, MA, 02118, USA.,Department of Epidemiology, Boston University School of Public Health, 715 Albany St. T3E, Boston, MA, USA
| | - Raul Guevara
- Agencia para el Desarrollo y la Salud Agropecuaria (AGDYSA), San Salvador, El Salvador
| | - Michael D McClean
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St. T4W, Boston, MA, 02118, USA
| | - Daniel R Brooks
- Department of Epidemiology, Boston University School of Public Health, 715 Albany St. T3E, Boston, MA, USA
| | - Madeleine K Scammell
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St. T4W, Boston, MA, 02118, USA.
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16
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Bonafede M, Levi M, Pietrafesa E, Binazzi A, Marinaccio A, Morabito M, Pinto I, de’ Donato F, Grasso V, Costantini T, Messeri A. Workers’ Perception Heat Stress: Results from a Pilot Study Conducted in Italy during the COVID-19 Pandemic in 2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138196. [PMID: 35805854 PMCID: PMC9266050 DOI: 10.3390/ijerph19138196] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/22/2022] [Accepted: 07/01/2022] [Indexed: 11/17/2022]
Abstract
Many workers are exposed to the effects of heat and often to extreme temperatures. Heat stress has been further aggravated during the COVID-19 pandemic by the use of personal protective equipment to prevent SARS-CoV-2 infection. However, workers’ risk perception of heat stress is often low, with negative effects on their health and productivity. The study aims to identify workers’ needs and gaps in knowledge, suggesting the adaptation of measures that best comply with the needs of both workers and employers. A cross-sectional online questionnaire survey was conducted in Italy in the hottest months of 2020 (June–October) through different multimedia channels. The data collected were analyzed using descriptive statistics; analytical tests and analysis of variance were used to evaluate differences between groups of workers. In total, 345 questionnaires were collected and analyzed. The whole sample of respondents declared that heat is an important contributor to productivity loss and 83% of workers did not receive heat warnings from their employer. In this context, the internet is considered as the main source of information about heat-related illness in the workplace. Results highlight the need to increase workers’ perception of heat stress in the workplace to safeguard their health and productivity. About two-thirds of the sample stated that working in the sun without access to shaded areas, working indoors without adequate ventilation, and nearby fire, steam, and hot surfaces, represent the main injuries’ risk factors.
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Affiliation(s)
- Michela Bonafede
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), 00143 Rome, Italy; (M.B.); (E.P.); (A.B.); (A.M.)
| | - Miriam Levi
- Epidemiology Unit, Department of Prevention, Local Health Authority Tuscany Centre, 50135 Florence, Italy;
| | - Emma Pietrafesa
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), 00143 Rome, Italy; (M.B.); (E.P.); (A.B.); (A.M.)
| | - Alessandra Binazzi
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), 00143 Rome, Italy; (M.B.); (E.P.); (A.B.); (A.M.)
| | - Alessandro Marinaccio
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), 00143 Rome, Italy; (M.B.); (E.P.); (A.B.); (A.M.)
| | - Marco Morabito
- Institute of Bioeconomy, National Research Council (IBE-CNR), 50019 Florence, Italy;
| | - Iole Pinto
- Physical Agents Sector, Regional Public Health Laboratory, 53100 Siena, Italy;
| | - Francesca de’ Donato
- Department of Epidemiology Lazio Regional Health Service, ASL ROMA 1, 00147 Rome, Italy; (F.d.D.); (T.C.)
| | - Valentina Grasso
- LaMMA Consortium—Weather Forecaster and Researcher at Laboratory of Monitoring and Environmental Modelling for Sustainable Development, 50019 Florence, Italy;
| | - Tiziano Costantini
- Department of Epidemiology Lazio Regional Health Service, ASL ROMA 1, 00147 Rome, Italy; (F.d.D.); (T.C.)
| | - Alessandro Messeri
- LaMMA Consortium—Weather Forecaster and Researcher at Laboratory of Monitoring and Environmental Modelling for Sustainable Development, 50019 Florence, Italy;
- Climate and Sustainability Foundation, 50100 Florence, Italy
- AMPRO—Professional Weather Association, 00142 Rome, Italy
- Correspondence: ; Tel.: +39-055-522-6041
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17
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Andersson A, Hansson E, Ekström U, Grubb A, Abrahamson M, Jakobsson K, Xu Y. Large difference but high correlation between creatinine and cystatin C estimated glomerular filtration rate in Mesoamerican sugarcane cutters. Occup Environ Med 2022; 79:497-502. [PMID: 35354651 PMCID: PMC9209661 DOI: 10.1136/oemed-2021-107990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 03/06/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To explore the relationship between creatinine and cystatin C based estimated glomerular filtration rate (eGFR) in actively working sugarcane cutters. METHODS This cohort study included 458 sugarcane cutters from Nicaragua and El Salvador. Serum samples were taken before and at end of harvest seasons and analysed for creatinine and cystatin C. Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas were used to calculate eGFRs based on creatinine (eGFRcr), cystatin C (eGFRcys) and both creatinine and cystatin C (eGFRcrcys) at each time point. Bland-Altman plots and paired t-tests were used to compare the difference between eGFRcr and eGFRcys, and the difference in eGFRs between before and at end of the harvest seasons. RESULTS The mean eGFRcr was higher than eGFRcys in both cohorts; absolute difference 22 mL/min/1.73 m2 (95% CI 21 to 23) in Nicaragua and 13 mL/min/1.73 m2 (95% CI 11 to 15) in El Salvador. Correlations between eGFRcr and eGFRcys were high, with r=0.69, 0.77 and 0.67 in Nicaragua at pre-harvest, end-harvest and cross-harvest, and r=0.89, 0.89 and 0.49 in El Salvador. CONCLUSIONS Creatinine increases among heat-stressed workers reflect reduced glomerular filtration as estimated using eGFRcys, a marker independent of muscle mass and metabolism. The discrepancy between eGFRcr and eGFRcys may indicate reduced glomerular filtration of larger molecules and/or systemic bias in CKD-EPI performance in this population.
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Affiliation(s)
- Axel Andersson
- School of Public Health and Community Medicine, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden .,La Isla Network, Washington, District of Columbia, USA
| | - Erik Hansson
- School of Public Health and Community Medicine, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden.,La Isla Network, Washington, District of Columbia, USA
| | - Ulf Ekström
- La Isla Network, Washington, District of Columbia, USA.,Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Anders Grubb
- Department of Laboratory Medicine, Lund University, Lund, Sweden
| | | | - Kristina Jakobsson
- School of Public Health and Community Medicine, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden.,Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Yiyi Xu
- School of Public Health and Community Medicine, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
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18
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Jolly AM, Thomas J. Chronic kidney disease of unknown etiology in India: a comparative study with Mesoamerican and Sri Lankan nephropathy. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:15303-15317. [PMID: 34984612 DOI: 10.1007/s11356-021-16548-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/11/2021] [Indexed: 06/14/2023]
Abstract
Chronic kidney disease of unknown etiology [CKDu] is a condition characterized by decline in kidney function and is not associated with diabetic nephropathy or hypertensive nephropathy. In this review, we have done a detailed literature analysis on CKDu in India, and then had a comparison with that of Mesoamerica and Sri Lanka. In India, CKDu became the second most common type of CKD after diabetic nephropathy. Silica was seen in the groundwater of both India and Sri Lanka, whereas in Mesoamerica silica exposure through particulate matter was seen among CKDu communities. DDE is a common agrochemical seen in both India and Sri Lanka. The risk factors vary from region to region and it is important to categorize CKDu population based on the risk factors to avoid misinterpretation of the condition as non-CKDu category and to evade further complications. More studies have to be conducted to reveal the detailed pathophysiological mechanisms and its relation with irrational exploitation of environmental resources.
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Affiliation(s)
- Aleeta Maria Jolly
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Ponekkara, Kerala, India
| | - Jaya Thomas
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Ponekkara, Kerala, India.
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19
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Villalvazo P, Carriazo S, Martin-Cleary C, Ortiz A. Aguascalientes: one of the hottest chronic kidney disease (CKD) hotspots in Mexico and a CKD of unknown aetiology mystery to be solved. Clin Kidney J 2021; 14:2285-2294. [PMID: 34754425 PMCID: PMC8573004 DOI: 10.1093/ckj/sfab136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 01/05/2023] Open
Abstract
In a recent issue of Clinical Kidney Journal (CKJ), Gutierrez-Peña et al. reported a high incidence and prevalence of advanced chronic kidney disease (CKD) in Aguascalientes, Mexico. This contradicts Global Burden of Disease estimates, which should be updated. A key component of this high burden of CKD relates to young people ages 20-40 years in whom the cause of CKD was unknown [CKD of unknown aetiology (CKDu)]. The incidence of kidney replacement therapy in this age group in Aguascalientes is among the highest in the world, second only to Taiwan. However, high-altitude Aguascalientes, with a year-round average temperature of 19°C, does not fit the geography of other CKDu hotspots. Furthermore, kidney biopsies in young people showed a high prevalence of focal segmental glomerulosclerosis. Potential causes of CKDu in Aguascalientes include the genetic background (no evidence, although podocytopathy genes should be explored) and environmental factors. The highest prevalence of CKD was found in Calvillo, known for guava farming. Thus guava itself, known to contain bioactive, potentially nephrotoxic molecules and pesticides, should be explored. Additionally, there are reports of water sources in Aguascalientes contaminated with heavy metals and/or pesticides. These include fluoride (increased levels found in Calvillo drinking water) as well as naturally occurring arsenic, among others. Fluoride may accumulate in bone and cause kidney disease years later, and maternal exposure to excess fluoride may cause kidney disease in offspring. We propose a research agenda to clarify the cause of CKDu in Aguascalientes that should involve international funders. The need for urgent action to identify and stem the cause of the high incidence of CKD extends to other CKD hotspots in Mexico, including Tierra Blanca in Veracruz and Poncitlan in Jalisco.
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Affiliation(s)
| | - Sol Carriazo
- IIS-Fundacion Jimenez Diaz UAM and School of Medicine, UAM, Madrid, Spain
| | | | - Alberto Ortiz
- IIS-Fundacion Jimenez Diaz UAM and School of Medicine, UAM, Madrid, Spain
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20
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Valdivia Mazeyra MF, Muñoz Ramos P, Serrano R, Alonso Riaño M, Gil Giraldo Y, Quiroga B. Mesoamerican nephropathy: A not so unknown chronic kidney disease. Nefrologia 2021; 41:612-619. [PMID: 36165150 DOI: 10.1016/j.nefroe.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 03/18/2021] [Indexed: 06/16/2023] Open
Abstract
From 2000, Mesoamerican region has reached an important rate of chronic kidney disease of unknown etiology. Under the name of Meroamerican Nephropathy (MeN) several hypotheses (including dehydration, heat stress, environmental or toxic exposure or even infections) have tried to explain the etiology this new disease. MeN affects young men, agricultural workers exposed to high temperatures. MeN courses with unspecific symptoms as low-grade fever and dysuria and progressive kidney disease with impaired renal function and hydroelectrolyte disturbances. The diagnosis requires kidney biopsy showing tubule-interstitial nephritis (usually at chronic stage). Although MeN conditions a high morbi-mortality in endemic regions, there is a lack of specific treatment and only preventive measures have demonstrated some effect of prognosis (avoid heat stress, constant hydration). In this review we aim to summarize the available information of MeN, illustrating the information in a case report.
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Affiliation(s)
| | | | - Rosario Serrano
- Servicio de Anatomía Patológica, Hospital Universitario de La Princesa, Madrid, Spain
| | - Marina Alonso Riaño
- Servicio de Anatomía Patológica, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Yohana Gil Giraldo
- Servicio de Nefrología, Hospital Universitario de La Princesa, Madrid, Spain
| | - Borja Quiroga
- Servicio de Nefrología, Hospital Universitario de La Princesa, Madrid, Spain.
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21
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Wijkström J, Gonzalez-Quiroz M, Leiva R, Trujillo ZC, Elinder CG, Wernerson A. Mesoamerican Nephropathy and Kidney Disease Progression: A Case Series of Individuals With Kidney Biopsies From Nicaragua and El Salvador. Kidney Med 2021; 3:871-873. [PMID: 34693268 PMCID: PMC8515091 DOI: 10.1016/j.xkme.2021.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Julia Wijkström
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Renal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Marvin Gonzalez-Quiroz
- Research Centre on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua, León (UNAN-León), León, Nicaragua.,Department of Renal Medicine, University College London, London, United Kingdom
| | - Ricardo Leiva
- Department of Nephrology, Hospital Nacional Rosales, San Salvador, El Salvador
| | - Zulma Cruz Trujillo
- Department of Nephrology, Hospital Nacional Rosales, San Salvador, El Salvador
| | - Carl-Gustaf Elinder
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Annika Wernerson
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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22
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Butler-Dawson J, Barnoya J, Brindley S, Krisher L, Fan W, Asensio C, Newman LS. Cross-sectional study examining the accuracy of self-reported smoking status as compared to urinary cotinine levels among workers at risk for chronic kidney disease of unknown origin in Guatemala. BMJ Open 2021; 11:e050374. [PMID: 34697113 PMCID: PMC8547360 DOI: 10.1136/bmjopen-2021-050374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 10/06/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES There is a lack of information on cotinine levels in rural populations in low-income and middle-income countries like Guatemala. Therefore, there is a need to explore smoking status and biomarkers of tobacco use in epidemiological research in rural, low-income populations, in particular those at-risk for chronic kidney disease of unknown origin (CKDu). DESIGN We evaluated self-reported smoking status against urinary cotinine levels, the gold standard biomarker of tobacco smoke exposure, among agricultural workers at four separate cross-sectional time points. SETTING Guatemala. PARTICIPANTS 283 sugarcane workers. PRIMARY OUTCOME MEASURES Compared self-reported smoking status and urinary cotinine levels in two agricultural worker studies. RESULTS Self-reported smoking prevalence was 12% among workers. According to cotinine levels (≥50 ng/mL), the smoking prevalence was 34%. Self-reported smoking status had 28% sensitivity and 96% specificity. Urinary cotinine levels show that smoking prevalence is underestimated in this worker population. CONCLUSIONS According to our findings, smoking status should be objectively measured with biomarkers rather than self-reported in CKDu epidemiological research. Self-reported smoking status is likely an underestimate of the true smoking prevalence among agricultural workers. Research on the CKDu epidemic in Central America and other parts of the world might be underestimating tobacco exposure as a potential contributor to the development of CKDu.
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Affiliation(s)
- Jaime Butler-Dawson
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Joaquin Barnoya
- Integra Cancer Institute, Guatemala City, Guatemala
- Unit for Cardiovascular Surgery, Unidad de Cirugía Cardiovascular de Guatemala, UNICAR, Guatemala City, Guatemala
| | - Stephen Brindley
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Lyndsay Krisher
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Wenyi Fan
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | | | - Lee S Newman
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
- Center for Health, Work and Environment, Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, School of Medicine, and Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
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23
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McKinley JM, Mueller U, Atkinson PM, Ofterdinger U, Cox SF, Doherty R, Fogarty D, Egozcue JJ, Pawlowsky-Glahn V. Chronic kidney disease of unknown origin is associated with environmental urbanisation in Belfast, UK. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2021; 43:2597-2614. [PMID: 32583129 PMCID: PMC8275563 DOI: 10.1007/s10653-020-00618-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 06/08/2020] [Indexed: 05/02/2023]
Abstract
Chronic kidney disease (CKD), a collective term for many causes of progressive renal failure, is increasing worldwide due to ageing, obesity and diabetes. However, these factors cannot explain the many environmental clusters of renal disease that are known to occur globally. This study uses data from the UK Renal Registry (UKRR) including CKD of uncertain aetiology (CKDu) to investigate environmental factors in Belfast, UK. Urbanisation has been reported to have an increasing impact on soils. Using an urban soil geochemistry database of elemental concentrations of potentially toxic elements (PTEs), we investigated the association of the standardised incidence rates (SIRs) of both CKD and CKD of uncertain aetiology (CKDu) with environmental factors (PTEs), controlling for social deprivation. A compositional data analysis approach was used through balances (a special class of log contrasts) to identify elemental balances associated with CKDu. A statistically significant relationship was observed between CKD with the social deprivation measures of employment, income and education (significance levels of 0.001, 0.01 and 0.001, respectively), which have been used as a proxy for socio-economic factors such as smoking. Using three alternative regression methods (linear, generalised linear and Tweedie models), the elemental balances of Cr/Ni and As/Mo were found to produce the largest correlation with CKDu. Geogenic and atmospheric pollution deposition, traffic and brake wear emissions have been cited as sources for these PTEs which have been linked to kidney damage. This research, thus, sheds light on the increasing global burden of CKD and, in particular, the environmental and anthropogenic factors that may be linked to CKDu, particularly environmental PTEs linked to urbanisation.
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Affiliation(s)
- Jennifer M McKinley
- School of Natural and Built Environment, Queen's University Belfast, Belfast, Northern Ireland.
| | - Ute Mueller
- School of Science, Edith Cowan University, Perth, WA, Australia
| | - Peter M Atkinson
- School of Natural and Built Environment, Queen's University Belfast, Belfast, Northern Ireland
- Lancaster Environment Centre, Lancaster University, Lancaster, UK
| | - Ulrich Ofterdinger
- School of Natural and Built Environment, Queen's University Belfast, Belfast, Northern Ireland
| | - Siobhan F Cox
- School of Natural and Built Environment, Queen's University Belfast, Belfast, Northern Ireland
| | - Rory Doherty
- School of Natural and Built Environment, Queen's University Belfast, Belfast, Northern Ireland
| | | | - J J Egozcue
- Department of Civil and Environmental Engineering, U. Politécnica de Cataluña (UPC), Barcelona, Spain
| | - V Pawlowsky-Glahn
- Department of Computer Sciences, Applied Mathematics, and Statistics, University of Girona, Girona, Spain
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24
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Valdivia Mazeyra MF, Muñoz Ramos P, Serrano R, Alonso Riaño M, Gil Giraldo Y, Quiroga B. Mesoamerican nephropathy: A not so unknown chronic kidney disease. Nefrologia 2021; 41:S0211-6995(21)00100-4. [PMID: 34140176 DOI: 10.1016/j.nefro.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022] Open
Abstract
From 2000, Mesoamerican region has reached an important rate of chronic kidney disease of unknown etiology. Under the name of Meroamerican Nephropathy (MeN) several hypotheses (including dehydration, heat stress, environmental or toxic exposure or even infections) have tried to explain the etiology this new disease. MeN affects young men, agricultural workers exposed to high temperatures. MeN courses with unspecific symptoms as low-grade fever and dysuria and progressive kidney disease with impaired renal function and hydroelectrolyte disturbances. The diagnosis requires kidney biopsy showing tubule-interstitial nephritis (usually at chronic stage). Although MeN conditions a high morbi-mortality in endemic regions, there is a lack of specific treatment and only preventive measures have demonstrated some effect of prognosis (avoid heat stress, constant hydration). In this review we aim to summarize the available information of MeN, illustrating the information in a case report.
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Affiliation(s)
| | | | - Rosario Serrano
- Servicio de Anatomía Patológica, Hospital Universitario de La Princesa, Madrid, España
| | - Marina Alonso Riaño
- Servicio de Anatomía Patológica, Hospital Universitario 12 de Octubre, Madrid, España
| | - Yohana Gil Giraldo
- Servicio de Nefrología, Hospital Universitario de La Princesa, Madrid, España
| | - Borja Quiroga
- Servicio de Nefrología, Hospital Universitario de La Princesa, Madrid, España.
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25
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Gunawardena S, Dayaratne M, Wijesinghe H, Wijewickrama E. A Systematic Review of Renal Pathology in Chronic Kidney Disease of Uncertain Etiology. Kidney Int Rep 2021; 6:1711-1728. [PMID: 34169213 PMCID: PMC8207327 DOI: 10.1016/j.ekir.2021.03.898] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/06/2021] [Accepted: 03/29/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Despite much research on chronic kidney disease of uncertain etiology (CKDu) in Sri Lanka and the Mesoamerican nephropathy, the etiology and pathogenesis of this disease remains elusive. The pathology has broadly been described as chronic tubulointerstitial nephritis and no specific signature lesions have been identified. METHODS A scoping review was conducted through MEDLINE and Google Scholar databases for peer-reviewed publications on biopsy studies related to CKDu - Sri Lanka and Mesoamerican nephropathy to develop a comparative and critical analysis of the renal pathology found in these patients. RESULTS Thirteen studies met the selection criteria. Interstitial fibrosis was the predominant lesion in all the studies. Tubulointerstitial and glomerular abnormalities showed a more variable distribution. No characteristic histopathological feature was reported other than a proximal tubular lysosomal inclusion body which was claimed to indicate a toxic etiology. Three main pathogenetic mechanisms were postulated: repeated acute insults leading to scarring, low-grade chronic insults leading to non-inflammatory fibrosis, and tubulointerstitial damage in combination with glomerular injury. The main limitations in the interpretation and comparative analysis of these studies were the heterogeneity in case selection and biopsy reporting. CONCLUSIONS Although no characteristic histopathological feature could be found in CKDu-Sri Lanka or Mesoamerican nephropathy, there are noticeable differences between these two groups in the frequency and severity of the glomerular and tubulointerstitial changes which warrant more explorative studies preferably on kidneys in early stages of the disease. Future strategies should ensure that more uniform selection criteria and reporting methods are used.
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Affiliation(s)
- Sameera Gunawardena
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Maleesha Dayaratne
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Harshima Wijesinghe
- Department of Pathology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Eranga Wijewickrama
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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26
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Stallings TL, Riefkohl Lisci A, McCray NL, Weiner DE, Kaufman JS, Aschengrau A, Ma Y, LaValley MP, Ramírez-Rubio O, Jose Amador J, López-Pilarte D, Laws RL, Winter M, McSorley VE, Brooks DR, Applebaum KM. Dysuria, heat stress, and muscle injury among Nicaraguan sugarcane workers at risk for Mesoamerican nephropathy. Scand J Work Environ Health 2021; 47:377-386. [PMID: 34003295 PMCID: PMC8259701 DOI: 10.5271/sjweh.3963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objectives: Nicaraguan sugarcane workers, particularly cane cutters, have an elevated prevalence of chronic kidney disease of unknown origin, also referred to as Mesoamerican nephropathy (MeN). The pathogenesis of MeN may include recurrent heat stress, crystalluria, and muscle injury with subsequent kidney injury. Yet, studies examining the frequency of such events in long-term, longitudinal studies are limited. Methods: Using employment and medical data for male workers at a Nicaraguan sugarcane company, we classified months of active work as either work as a cane cutter or other sugarcane job and determined occurrence of dysuria, heat events and muscle events. Work months and events occurred January 1997 to June 2010. Associations between cane cutting and each outcome were analyzed using logistic regression based on generalized estimating equations for repeated events, controlling for age. Results: Among 242 workers with 7257 active work months, 19.5% of person-months were as a cane cutter. There were 160, 21, and 16 episodes of dysuria, heat events, and muscle events, respectively. Compared with work months in other jobs, cane cutting was associated with an elevated odds of dysuria [odds ratio 2.40 (95% confidence interval 1.56–3.68)]. The number of heat and muscle events by cane cutter and other job were limited. Conclusions: Working as a cane cutter compared with other jobs in the sugarcane industry was associated with increased dysuria, supporting the hypothesis that cane cutters are at increased risk of events suspected of inducing or presaging clinically evident kidney injury.
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Affiliation(s)
- Tiffany L Stallings
- The George Washington University, Milken Institute School of Public Health, Department of Environmental and Occupational Health, 950 New Hampshire Ave., NW, Suite 400, Washington, DC 20052, USA.
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27
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Venugopal V, Latha PK, Shanmugam R, Krishnamoorthy M, Omprashanth R, Lennqvist R, Johnson P. Epidemiological evidence from south Indian working population-the heat exposures and health linkage. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2021; 31:177-186. [PMID: 32892212 DOI: 10.1038/s41370-020-00261-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 08/05/2020] [Accepted: 08/21/2020] [Indexed: 06/11/2023]
Abstract
Changing climate and rising temperatures are predicted to affect millions of workers due to heat stress risks, especially in tropical settings. We used a cross-sectional study design to profile the heat exposures of ~1500 workers from eight-industrial sectors using a QuesTemp wet bulb globe temperature (WBGT) monitor, quantified the heat-strain indicators viz., rise in Core Body Temperature (CBT), Sweat Rate (SwR), and Urine Specific Gravity (USG) by standard methods and evaluated the health impacts of heat stress using a structured questionnaire. Heat exposures (Avg.WBGT: 28.4 ± 2.6 °C) exceeded the Threshold Limit Value (TLV) for 70% of workers and was significantly associated with the rise in CBT >1 °C in 11.3% and elevated USG >1.020 in 10.5% of the workers. The heat-exposed workers had 2.3 times higher odds of reporting adverse health outcomes (84%) compared to the unexposed workers (95% CI: 1.74-3.19; p value ≤ 0.0001). Mild reduction in kidney function observed in 49% of salt - pan workers, and a high prevalence of kidney stones (33%) among the 91 steelworkers subjected to kidney ultrasound had a significant association with chronic high WBGT exposure above the TLV (p value < 0.034). Further, in-depth assessments are warranted to develop strategies for interventions and protective labor policies to avert adverse occupational health and productivity consequences for millions of workers globally, especially in the rising temperature scenario.
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Affiliation(s)
- Vidhya Venugopal
- Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
| | - P K Latha
- Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Rekha Shanmugam
- Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Manikandan Krishnamoorthy
- Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - R Omprashanth
- Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Robin Lennqvist
- Department of Public Health and Community Medicine/Section of Occupational and Environmental Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Priscilla Johnson
- Department of Physiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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28
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Redmon JH, Levine KE, Lebov J, Harrington J, Kondash AJ. A comparative review: Chronic Kidney Disease of unknown etiology (CKDu) research conducted in Latin America versus Asia. ENVIRONMENTAL RESEARCH 2021; 192:110270. [PMID: 33035557 DOI: 10.1016/j.envres.2020.110270] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/19/2020] [Accepted: 09/19/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The incidence of chronic kidney disease of unknown or uncertain etiology (CKDu) is recognized as a global non-communicable health crisis. The goal of this work is to compare the types of research studies in Latin America and Asia, two regions with increasing CKDu incidence. METHODS A comparative literature review was conducted to evaluate the CKDu research design for peer-reviewed articles published from 2015 to 2019. Full texts were reviewed to identify study location, study type, study design, risk factors evaluated, and if applicable, sample type and number. RESULTS In Asia and Latin America, 82 and 65 articles were identified in total, respectively, with 55 field studies in Asia versus 34 in Latin America. In Asia, research was focused on drinking water (34), heavy metals (20), and agrochemical product usage (19) as potential risk factors. In Latin America, research focused mostly on heat stress/dehydration (36) and agrochemical product usage (18) as potential CKDu risk factors. Biological samples were collected more frequently than environmental samples, especially in Latin America. DISCUSSION Research to pinpoint the risk factors associated with CKDu to date is not standardized and typically limited in geographical scope. The emphasis of CKDu research varies by geographic region, with a greater priority placed on water quality and chemical exposure in Asia, versus dehydration and heat stress in Latin America. Using a harmonized approach to CKDu research would yield improved understanding of the risk factors associated with CKDu and how they compare across affected regions.
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Affiliation(s)
| | | | - Jill Lebov
- RTI International, Research Triangle Park, NC, USA
| | | | - A J Kondash
- RTI International, Research Triangle Park, NC, USA
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29
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Gunasekara T, De Silva PMC, Herath C, Siribaddana S, Siribaddana N, Jayasumana C, Jayasinghe S, Cardenas-Gonzalez M, Jayasundara N. The Utility of Novel Renal Biomarkers in Assessment of Chronic Kidney Disease of Unknown Etiology (CKDu): A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9522. [PMID: 33353238 PMCID: PMC7766480 DOI: 10.3390/ijerph17249522] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 12/25/2022]
Abstract
Chronic Kidney Disease (CKD) is a globally prevalent non-communicable disease with significant mortality and morbidity. It is typically associated with diabetes and hypertension; however, over the last two decades, an emergence of CKD of unknown etiology (CKDu) has claimed thousands of lives in several tropical agricultural communities. CKDu is associated with gradual loss of renal function without initial symptoms until reaching complete kidney failure and eventually death. The most impacted are young adult males of lower socio-economic strata. Since the disease progression can be successfully attenuated through early detection, the development of superior screening and management measures is of utmost importance. In contrast to the conventional biomarkers, novel biomarkers with improved sensitivity and specificity are being discussed as promising tools for early diagnosis of the disease. This review summarizes emerging novel biomarkers used in assessing CKD and discusses the current utility and diagnostic potential of such biomarkers for CKDu screening in clinical settings of different communities impacted by CKDu. Our goal is to provide a framework for practitioners in CKDu impacted regions to consider the use of these novel biomarkers through this synthesis. The increased use of these biomarkers will not only help to validate their diagnostic power further and establish potential prognostic value but may also provide critical insights into sites and mechanisms of renal damage.
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Affiliation(s)
- T.D.K.S.C. Gunasekara
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara 81000, Sri Lanka;
| | - P. Mangala C.S. De Silva
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara 81000, Sri Lanka;
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Chula Herath
- Department of Nephrology, Sri Jayawardenapura General Hospital, Sri Jayawardenepura Kotte 10100, Sri Lanka;
| | - Sisira Siribaddana
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Mihintale 50300, Sri Lanka;
| | - Nipuna Siribaddana
- Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Mihintale 50300, Sri Lanka;
| | - Channa Jayasumana
- Department of Pharmacology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Mihintale 50300, Sri Lanka;
| | - Sudheera Jayasinghe
- Department of Pharmacology, Faculty of Medicine, University of Ruhuna, Matara 81000, Sri Lanka;
| | - Maria Cardenas-Gonzalez
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
- Mexican Council of Science and Technology, Consejo Nacional de Ciencia y Tecnología, Mexico City 03940, Mexico
| | - Nishad Jayasundara
- The Nicholas School of the Environment, Duke University, Durham, NC 27708, USA;
- The School of Marine Sciences, University of Maine, Orono, ME 04469, USA
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Workplace Screening Identifies Clinically Significant and Potentially Reversible Kidney Injury in Heat-Exposed Sugarcane Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228552. [PMID: 33218070 PMCID: PMC7698805 DOI: 10.3390/ijerph17228552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/12/2020] [Accepted: 11/14/2020] [Indexed: 12/14/2022]
Abstract
An epidemic of chronic kidney disease of unknown origin (CKDu) has emerged in the past two decades in agricultural communities, characterized by progressive renal failure with a dearth of early clinical symptoms. The aim of this study is to improve understanding of the natural history of this disease and to evaluate the impact of an educational and behavioral intervention on the trajectories of renal decline among a cohort of Guatemalan sugarcane workers. We identified groups of workers based on their kidney function during a longitudinal parent study conducted among sugarcane workers during the 2016–2017 harvest season. At the study’s first time point in February 2017, workers who developed abnormal kidney function (AKF) (estimated glomerular filtration rate, eGFR, <60 mL/min per 1.73 m2) were placed in the AKF group, workers with reduced kidney function (RKF) (eGFR 60–89) were placed in the RKF group, and workers who maintained normal kidney function (NKF) (eGFR ≥ 90) were placed in the NKF group. As part of the study, a health promotion, behavioral and educational intervention centered on water, electrolytes, rest, and shade (WERS) was provided to all study participants. We then prospectively analyzed renal function at the three study time points in February, March, and April. Additional data collected from previous harvests allowed for retrospective analysis and we compared the rate of change in eGFR over the previous five years (2012 to 2016) for each identified group. Mixed effects linear regression with random intercepts for the workers was used to investigate the difference in rates of change for the three groups and to assess the impact of the intervention study on rate of change of kidney function during the study compared to each group’s prior trajectory, utilizing the retrospective data collected during the five years prior to the study intervention. Between 2012 and 2016, eGFR declined at a rate of 0.18 mL/min per 1.73 m2 per year for the NKF group (95% CI: −0.66, 0.29, p = 0.45), 2.02 per year for the RKF group (95% CI: 1.00, 3.03, p = 0.0001) and 7.52 per year for the AKF group (95% CI: 6.01, 9.04, p < 0.0001). All study groups stabilized or improved their trajectory of decline during the intervention. This study supports the need to institute WERS interventions and to include mid-harvest screening protocols and longitudinal tracking of kidney function among sugarcane workers at high risk of CKDu. Early detection of rapid kidney function decline combined with appropriate interventions hold promise for stopping or slowing progression of renal insufficiency among these workers.
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31
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Sanchez Polo V, Garcia-Trabanino R, Rodriguez G, Madero M. Mesoamerican Nephropathy (MeN): What We Know so Far. Int J Nephrol Renovasc Dis 2020; 13:261-272. [PMID: 33116757 PMCID: PMC7588276 DOI: 10.2147/ijnrd.s270709] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/25/2020] [Indexed: 11/23/2022] Open
Abstract
In 2002, a report from El Salvador described a high incidence of chronic kidney disease (CKD) of unknown cause, mostly in young males from specific coastal areas. Similar situations were observed along the Pacific Ocean coastline of other Central American countries and southern Mexico (Mesoamerica). This new form of CKD has been denominated Mesoamerican endemic nephropathy (MeN). The typical presentation of MeN is a young male from an endemic area with a family history of CKD, low eGFR, high serum creatinine, low level of albuminuria, hypokalemia, hyperuricemia, and urine urate crystals. Kidney biopsy demonstrating tubulointerstitial nephritis remains the gold standard for diagnosis but is available only for a minority. Commonly proposed causes include thermal stress/dehydration and/or exposure to environmental pollutants. However, likely, a third factor, which could be genetic or epigenetic, could contribute to the cause and development of the disease, along with social determinants. Currently, preventive measures focus on minimizing workers exposure to thermal stress/dehydration. There are many research opportunities and priorities should include clinical trials to evaluate the efficacy and safety of the current treatment protocols, along with etiological and genetic studies, and the development of kidney disease data systems. Although there is scant and controversial literature with regard s to the etiology, diagnosis and management of the disease, our aim is to provide the reader a vision of the disease based on our experience.
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Affiliation(s)
| | - Ramon Garcia-Trabanino
- Centro de Hemodiálisis, San Salvador, El Salvador
- Fondo Social de Emergencia Para la Salud, Tierra Blanca, El Salvador
| | - Guillermo Rodriguez
- Service of Nephrology, Hospital Dr. R.A. Calderón Guardia, Caja Costarricense de Seguro Social, San José, Costa Rica
| | - Magdalena Madero
- Division of Nephrology, Instituto Nacional de Cardiología Ignacio Chávez, México, México
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32
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Creatinine Fluctuations Forecast Cross-Harvest Kidney Function Decline Among Sugarcane Workers in Guatemala. Kidney Int Rep 2020; 5:1558-1566. [PMID: 32954081 PMCID: PMC7486184 DOI: 10.1016/j.ekir.2020.06.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/09/2020] [Accepted: 06/23/2020] [Indexed: 12/19/2022] Open
Abstract
Background Chronic kidney disease of unknown origin (CKDu) is an epidemic that disproportionately affects young agriculture workers in hot regions. It has been hypothesized that repeated acute kidney injury (AKI) may play a role in the development of disease. Methods Latent class mixed models were used to identify groups of Guatemalan sugarcane harvesters based on their daily changes in creatinine over 6 consecutive days in 2018. Exponential smoothing state space models were used to forecast end-of-season creatinine between the identified groups. Percent change in estimated glomerular filtration rate (eGFR) across the harvest was compared between groups. Results Twenty-nine percent (n = 30) of the 103 workers experienced repeated severe fluctuations in creatinine across shift. The model with multiplicative error, multiplicative trend, and multiplicative seasonality was able to accurately forecast end-of-season creatinine in the severe group (mean percentage error [MPE]: −4.7%). eGFR of workers in the severe group on average decreased 20% across season compared to 11% decline for those in the moderate group (95% confidence interval for difference: −17% to 0%). Conclusions Daily fluctuations in creatinine can be used to forecast end-of-season creatinine in sugarcane harvesters. Workers who experience repeat severe daily fluctuations in creatinine, on average, experience a greater reduction in kidney function across the season.
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Hansson E, Glaser J, Jakobsson K, Weiss I, Wesseling C, Lucas RAI, Wei JLK, Ekström U, Wijkström J, Bodin T, Johnson RJ, Wegman DH. Pathophysiological Mechanisms by which Heat Stress Potentially Induces Kidney Inflammation and Chronic Kidney Disease in Sugarcane Workers. Nutrients 2020; 12:E1639. [PMID: 32498242 PMCID: PMC7352879 DOI: 10.3390/nu12061639] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/22/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic kidney disease of non-traditional origin (CKDnt) is common among Mesoamerican sugarcane workers. Recurrent heat stress and dehydration is a leading hypothesis. Evidence indicate a key role of inflammation. METHODS Starting in sports and heat pathophysiology literature, we develop a theoretical framework of how strenuous work in heat could induce kidney inflammation. We describe the release of pro-inflammatory substances from a leaky gut and/or injured muscle, alone or in combination with tubular fructose and uric acid, aggravation by reduced renal blood flow and increased tubular metabolic demands. Then, we analyze longitudinal data from >800 sugarcane cutters followed across harvest and review the CKDnt literature to assess empirical support of the theoretical framework. RESULTS Inflammation (CRP elevation and fever) and hyperuricemia was tightly linked to kidney injury. Rehydrating with sugary liquids and NSAID intake increased the risk of kidney injury, whereas electrolyte solution consumption was protective. Hypokalemia and hypomagnesemia were associated with kidney injury. DISCUSSION Heat stress, muscle injury, reduced renal blood flow and fructose metabolism may induce kidney inflammation, the successful resolution of which may be impaired by daily repeating pro-inflammatory triggers. We outline further descriptive, experimental and intervention studies addressing the factors identified in this study.
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Affiliation(s)
- Erik Hansson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, 405 30 Gothenburg, Sweden;
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
| | - Jason Glaser
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Kristina Jakobsson
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, 405 30 Gothenburg, Sweden;
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- Occupational and Environmental Medicine, Sahlgrenska University Hospital, Box 414, 405 30 Gothenburg, Sweden
| | - Ilana Weiss
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
| | - Catarina Wesseling
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 171 65 Solna, Sweden;
| | - Rebekah A. I. Lucas
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, 142 Edgbaston Park Rd, Birmingham B15 2TT, UK
| | - Jason Lee Kai Wei
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, 2 Medical Drive, MD9, National University of Singapore, Singapore 117593, Singapore;
- Global Asia Institute, National University of Singapore, 10 Lower Kent Ridge Rd, Singapore 119076, Singapore
- N.1 Institute for Health, National University of Singapore, 28 Medical Dr, Singapore 117456, Singapore
| | - Ulf Ekström
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lund University, 221 85 Lund, Sweden
| | - Julia Wijkström
- Division of Renal Medicine, Department of Clinical Science Intervention and Technology, Karolinska Institutet, 141 86 Stockholm, Sweden;
| | - Theo Bodin
- Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 171 65 Solna, Sweden;
| | - Richard J. Johnson
- Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Aurora, CO 80045, USA;
| | - David H. Wegman
- La Isla Network, 1441 L Street NW, Washington, DC 20005, USA; (J.G.); (I.W.); (C.W.); (R.A.I.L.); (U.E.); (D.H.W.)
- Department of Work Environment, University of Massachusetts Lowell, Lowell, MA 01845, USA
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Hansson E, Glaser J, Weiss I, Ekström U, Apelqvist J, Hogstedt C, Peraza S, Lucas R, Jakobsson K, Wesseling C, Wegman DH. Workload and cross-harvest kidney injury in a Nicaraguan sugarcane worker cohort. Occup Environ Med 2020; 76:818-826. [PMID: 31611303 PMCID: PMC6839725 DOI: 10.1136/oemed-2019-105986] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/20/2019] [Accepted: 09/18/2019] [Indexed: 12/29/2022]
Abstract
Objectives To examine the association between workload and kidney injury in a fieldworker cohort with different levels of physically demanding work over a sugarcane harvest, and to assess whether the existing heat prevention efforts at a leading occupational safety and health programme are sufficient to mitigate kidney injury. Methods Biological and questionnaire data were collected before (n=545) and at the end (n=427) of harvest among field support staff (low workload), drip irrigation workers (moderate), seed cutters (high) and burned sugarcane cutters (very high). Dropouts were contacted (87%) and reported the reason for leaving work. Cross-harvest incident kidney injury (IKI) was defined as serum creatinine increase ≥0.30 mg/dL or ≥1.5 times the baseline value, or among dropouts reporting kidney injury leading to leaving work. Results Mean cross-harvest estimated glomerular filtration rate change was significantly associated with workload, increasing from 0 mL/min/1.73 m2 in the low-moderate category to −5 mL/min/1.73 m2 in the high and −9 mL/min/1.73 m2 in the very high workload group. A similar pattern occurred with IKI, where low-moderate workload had 2% compared with 27% in the very high workload category. A healthy worker selection effect was detected, with 32% of dropouts reporting kidney injury. Fever and C reactive protein elevation were associated with kidney injury. Conclusions Workers considered to have the highest workload had more cross-harvest kidney damage than workers with less workload. Work practices preventing heat stress should be strengthened and their role in preventing kidney damage examined further. Future occupational studies on chronic kidney disease of unknown aetiology should account for a healthy worker effect by pursuing those lost to follow-up.
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Affiliation(s)
- Erik Hansson
- La Isla Network, Washington, District of Columbia, USA.,School of Public Health, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
| | - Jason Glaser
- La Isla Network, Washington, District of Columbia, USA .,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ilana Weiss
- La Isla Network, Washington, District of Columbia, USA
| | - Ulf Ekström
- La Isla Network, Washington, District of Columbia, USA.,Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lund University Faculty of Medicine, Lund, Sweden
| | - Jenny Apelqvist
- La Isla Network, Washington, District of Columbia, USA.,Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lund University Faculty of Medicine, Lund, Sweden
| | - Christer Hogstedt
- La Isla Network, Washington, District of Columbia, USA.,Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institute, Stockholm, Sweden
| | - Sandra Peraza
- La Isla Network, Washington, District of Columbia, USA.,Facultad de Quimica y Farmacia, Universidad de El Salvador, San Salvador, El Salvador.,Programa SALTRA/ES, San Salvador, El Salvador
| | - Rebekah Lucas
- La Isla Network, Washington, District of Columbia, USA.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Kristina Jakobsson
- La Isla Network, Washington, District of Columbia, USA.,School of Public Health, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden.,Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Catharina Wesseling
- La Isla Network, Washington, District of Columbia, USA.,Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institute, Stockholm, Sweden
| | - David H Wegman
- La Isla Network, Washington, District of Columbia, USA.,University of Massachusetts Lowell, Lowell, Massachusetts, USA
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Dally M, Butler-Dawson J, Cruz A, Krisher L, Johnson RJ, Asensio C, Pilloni WD, Asturias EJ, Newman LS. Longitudinal trends in renal function among first time sugarcane harvesters in Guatemala. PLoS One 2020; 15:e0229413. [PMID: 32142520 PMCID: PMC7059928 DOI: 10.1371/journal.pone.0229413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/05/2020] [Indexed: 01/07/2023] Open
Abstract
Introduction Chronic kidney disease of unknown origin (CKDu) is an epidemic concentrated in agricultural communities in Central and South America, including young, male sugarcane harvesters. The purpose of this analysis is to understand early changes in kidney function among a cohort of first-time sugarcane harvesters and to determine risk factors for kidney function decline. Methods Joint latent class mixed models were used to model sub-population kidney function trajectory over the course of 4 years (2012–2016). Probability weighted logistic regression was used to determine personal health, community, and individual behavior risk factors associated with sub-population assignment. Data analysis occurred in 2019. Results Of 181 new workers median age 19 years old (IQR: 4), 39 (22%) were identified as having non-stable kidney function with an annual age-adjusted decline of estimated glomerular filtration rate (eGFR) of -1.0 ml/min per 1.73 m2 (95% CI: -3.4, 1.3). Kidney function (OR: 0.96; 95% CI: 0.93, 0.98), mild hypertension (OR: 5.21; 95% CI: 2.14, 13.94), and having a local home of residence (OR: 7.12; 95% CI: 2.41, 26.02) prior to employment in sugarcane were associated with non-stable eGFR sub-population assignment. Conclusions Mild hypertension may be an early indicator of the development of CKDu. A better understanding of preexisting risk factors is needed to determine why individuals are entering the workforce with reduced kidney function and elevated blood pressure and increased risk of renal function decline.
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Affiliation(s)
- Miranda Dally
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- * E-mail:
| | - Jaime Butler-Dawson
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Alex Cruz
- Pantaleon, Guatemala City, Guatemala
| | - Lyndsay Krisher
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Richard J. Johnson
- Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | | | | | - Edwin J. Asturias
- Division of Pediatric Infectious Diseases, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, United States of America
- Center for Global Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Lee S. Newman
- Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- Division of Pulmonary Sciences and Critical Care Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
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Wesseling C, Glaser J, Rodríguez-Guzmán J, Weiss I, Lucas R, Peraza S, da Silva AS, Hansson E, Johnson RJ, Hogstedt C, Wegman DH, Jakobsson K. Chronic kidney disease of non-traditional origin in Mesoamerica: a disease primarily driven by occupational heat stress. Rev Panam Salud Publica 2020; 44:e15. [PMID: 31998376 PMCID: PMC6984407 DOI: 10.26633/rpsp.2020.15] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/09/2020] [Indexed: 12/30/2022] Open
Abstract
The death toll of the epidemic of chronic kidney disease of nontraditional origin (CKDnt) in Mesoamerica runs into the tens of thousands, affecting mostly young men. There is no consensus on the etiology. Anecdotal evidence from the 1990s pointed to work in sugarcane; pesticides and heat stress were suspected. Subsequent population-based surveys supported an occupational origin with overall high male-female ratios in high-risk lowlands, but small sex differences within occupational categories, and low prevalence in non-workers. CKDnt was reported in sugarcane and other high-intensity agriculture, and in non-agricultural occupations with heavy manual labor in hot environments, but not among subsistence farmers. Recent studies with stronger designs have shown cross-shift changes in kidney function and hydration biomarkers and cross-harvest kidney function declines related to heat and workload. The implementation of a water-rest-shade intervention midharvest in El Salvador appeared to halt declining kidney function among cane cutters. In Nicaragua a water-rest-shade program appeared sufficient to prevent kidney damage among cane workers with low-moderate workload but not among cutters with heaviest workload. Studies on pesticides and infectious risk factors have been largely negative. Non-occupational risk factors do not explain the observed epidemiologic patterns. In conclusion, work is the main driver of the CKDnt epidemic in Mesoamerica, with occupational heat stress being the single uniting factor shown to lead to kidney dysfunction in affected populations. Sugarcane cutters with extreme heat stress could be viewed as a sentinel occupational population. Occupational heat stress prevention is critical, even more so in view of climate change.
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Affiliation(s)
- Catharina Wesseling
- La Isla NetworkLa Isla NetworkWashington DCUnited States of AmericaLa Isla Network, Washington DC, United States of America.
- Karolinska InstitutetKarolinska InstitutetStockholmSwedenKarolinska Institutet, Stockholm, Sweden
| | - Jason Glaser
- La Isla NetworkLa Isla NetworkWashington DCUnited States of AmericaLa Isla Network, Washington DC, United States of America.
| | - Julieta Rodríguez-Guzmán
- Pan-American Health OrganizationPan-American Health OrganizationWashington DCUnited States of AmericaPan-American Health Organization, Washington DC, United States of America
| | - Ilana Weiss
- La Isla NetworkLa Isla NetworkWashington DCUnited States of AmericaLa Isla Network, Washington DC, United States of America.
| | - Rebekah Lucas
- University of BirminghamUniversity of BirminghamBirminghamUnited KingdomUniversity of Birmingham, Birmingham, United Kingdom
| | - Sandra Peraza
- University of El SalvadorUniversity of El SalvadorSan SalvadorEl SalvadorUniversity of El Salvador, San Salvador, El Salvador
| | - Agnes Soares da Silva
- Pan-American Health OrganizationPan-American Health OrganizationWashington DCUnited States of AmericaPan-American Health Organization, Washington DC, United States of America
| | - Erik Hansson
- University of GothenburgUniversity of GothenburgGothenburgSwedenUniversity of Gothenburg, Gothenburg, Sweden
| | - Richard J. Johnson
- University of Colorado at DenverUniversity of Colorado at DenverAuroraUnited States of AmericaUniversity of Colorado at Denver, Aurora, United States of America
| | - Christer Hogstedt
- Karolinska InstitutetKarolinska InstitutetStockholmSwedenKarolinska Institutet, Stockholm, Sweden
| | - David H. Wegman
- University of Massachusetts LowellUniversity of Massachusetts LowellLowellUnited States of AmericaUniversity of Massachusetts Lowell, Lowell, United States of America
| | - Kristina Jakobsson
- University of GothenburgUniversity of GothenburgGothenburgSwedenUniversity of Gothenburg, Gothenburg, Sweden
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Anand S, Caplin B, Gonzalez-Quiroz M, Schensul SL, Bhalla V, Parada X, Nanayakkara N, Fire A, Levin A, Friedman DJ, Aguilar-Gonzalez A, Abbot K, Abeysekara T, Amann K, Anand S, Ashuntantang G, Bhalla V, Brooks D, Caplin B, Chavarria D, Christoph D, Rotter RC, De Broe M, De Silva PMC, Dominguez J, Eckardt KU, Fader D, Finkelstein F, Fire A, Fischer R, Friedman D, Ganguli A, Garcia Trabinho RA, Glaser J, Gonzalez Quiroz MA, Fischer R, Haider L(L, Harris D, Herath C, Herrera R, Hradsky A, Hoy W, Jakobsson K, Jayasinghe S, Jaysummana C, Jha V, Johnson R, Kambham N, Karanasema N, Kaze F, Kimmel P, Koritzinsky E, Langham R, Le Bellego L, Levin A, Levin N, Lyuckx V, Madero M, Martin E, Malik C, Moist L, Moxey-Mims M, Nanayakkara N, Narva A, Nerbass F, O'Donoghue D, Orantes C, Parada X, Pearce N, Ratnayake C, Roy-Chaudhury P, Ruggiero A, Sanchez-Lozada LG, Saran R, Schensul S, Segantini L, Seksek I, Sheikh-Hamad D, Star R, Strani L, Vlahos P, Wegman DH, Weiss I, Wijewickrama E, Wijkstrom J, Wise P, Wright E, Yang CW, Yeates K. Epidemiology, molecular, and genetic methodologies to evaluate causes of CKDu around the world: report of the Working Group from the ISN International Consortium of Collaborators on CKDu. Kidney Int 2019; 96:1254-1260. [DOI: 10.1016/j.kint.2019.09.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/19/2019] [Accepted: 09/27/2019] [Indexed: 11/30/2022]
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Smpokou ET, González-Quiroz M, Martins C, Alvito P, Le Blond J, Glaser J, Aragón A, Wesseling C, Nitsch D, Pearce N, Norman J, Lindh CH, Morton J, Caplin B. Environmental exposures in young adults with declining kidney function in a population at risk of Mesoamerican nephropathy. Occup Environ Med 2019; 76:920-926. [PMID: 31562235 DOI: 10.1136/oemed-2019-105772] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/28/2019] [Accepted: 09/01/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVES There is an epidemic of Mesoamerican nephropathy (MeN) in Central America, where sugarcane production is prominent. Numerous causes are proposed, but to date limited evidence supports any one hypothesis. A nested case-control study using biosamples from a rural, community-based follow-up study of 350 young adults from Northwest Nicaragua at risk of MeN was conducted with the aim of characterising the associations between urinary concentrations of metals, pesticides and mycotoxins from samples collected in the first 6 months and decline in kidney function over 2 years. METHODS Urine samples collected at baseline (pre-sugarcane harvest) and the first 6 month follow-up (post-sugarcane harvest) visit were tested. Twelve metals and metalloids (aluminium, total arsenic, cadmium, chromium, cobalt, copper, lead, manganese, mercury, selenium, silicon and strontium) were analysed by inductively coupled plasma-mass spectrometry. Twelve pesticides or their metabolites (2,4-dichlorophenoxyacetic acid, 3-phenoxybenzoic acid, 4-fluoro-3-phenoxybenzoic acid, chloro-3,3,3-trifluoro-1-propen-1-yl-2,2-dimethylcyclopropanecarboxylic acid, cis/trans 3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid, ethylenethiourea, glyphosate, 4-chloro-2-methylphenoxy acetic acid, 3-hydroxy-pyrimetanil, 5-hydroxytiabendazole, hydroxy-tebuconazole and 3,5,6-trichloro-2-pyridinol) and two mycotoxins (ochratoxin A (OTA) and citrinin (CIT)) were analysed by liquid chromatography coupled-mass spectrometry. Differences in the creatinine-corrected urinary concentrations of the measured exposures between outcome groups (participants with stable vs declining kidney function) were examined. RESULTS Elevated levels of aluminium and total arsenic as well as metabolites of several pesticides were detected across the population. No differences were identified between the declining and stable groups in the levels of metals or pesticides tested. OTA and CIT were below the limit of detection. CONCLUSIONS The tested metals, metalloids, pesticides and mycotoxins were not associated with loss of kidney function in participants at-risk of MeN.
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Affiliation(s)
| | - Marvin González-Quiroz
- Department of Renal Medicine, University College London, London, UK.,Research Centre on Health, Work and Environment, National Autonomous University of Nicaragua at León (UNAN-León), León, Nicaragua
| | - Carla Martins
- Department of Food and Nutrition, National Institute of Health Dr Ricardo Jorge (INSA), Lisboa, Portugal.,Centre for Environmental and Marine Studies, University of Aveiro, Aveiro, Portugal
| | - Paula Alvito
- Department of Food and Nutrition, National Institute of Health Dr Ricardo Jorge (INSA), Lisboa, Portugal.,Centre for Environmental and Marine Studies, University of Aveiro, Aveiro, Portugal
| | | | - Jason Glaser
- Executive, La Isla Network, Ada, Michigan, USA.,Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Aurora Aragón
- Research Centre on Health, Work and Environment, National Autonomous University of Nicaragua at León (UNAN-León), León, Nicaragua
| | - Catharina Wesseling
- Executive, La Isla Network, Ada, Michigan, USA.,Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Neil Pearce
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Department of Medical Statistics, Faculty of Epidemiology and Population Health, Centre for Global NCDs, London School of Hygiene and Tropical Medicine, London, UK
| | - Jill Norman
- Department of Renal Medicine, University College London, London, UK
| | - Christian H Lindh
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Jackie Morton
- HSE Science and Research Centre, Health and Safety Executive, Buxton, UK
| | - Ben Caplin
- Department of Renal Medicine, University College London, London, UK
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Gonzalez-Quiroz M, Nitsch D, Hamilton S, O'Callaghan Gordo C, Saran R, Glaser J, Correa-Rotter R, Jakobsson K, Singh A, Gunawardena N, Levin A, Remuzzi G, Caplin B, Pearce N. Rationale and population-based prospective cohort protocol for the disadvantaged populations at risk of decline in eGFR (CO-DEGREE). BMJ Open 2019; 9:e031169. [PMID: 31551387 PMCID: PMC6773312 DOI: 10.1136/bmjopen-2019-031169] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION A recently recognised form of chronic kidney disease (CKD) of unknown origin (CKDu) is afflicting communities, mostly in rural areas in several regions of the world. Prevalence studies are being conducted in a number of countries, using a standardised protocol, to estimate the distribution of estimated glomerular filtration rate (eGFR), and thus identify communities with a high prevalence of reduced glomerular filtration rate (GFR). In this paper, we propose a standardised minimum protocol for cohort studies in high-risk communities aimed at investigating the incidence of, and risk factors for, early kidney dysfunction. METHODS AND ANALYSIS This generic cohort protocol provides the information to establish a prospective population-based cohort study in low-income settings with a high prevalence of CKDu. This involves a baseline survey that included key elements from the DEGREE survey (eg, using the previously published DEGREE methodology) of a population-representative sample, and subsequent follow-up visits in young adults (without a pre-existing diagnosis of CKD (eGFR<60 mL/min/1.73m2), proteinuria or risk factors for CKD at baseline) over several years. Each visit involves a core questionnaire, and collection and storage of biological samples. Local capacity to measure serum creatinine will be required so that immediate feedback on kidney function can be provided to participants. After completion of follow-up, repeat measures of creatinine should be conducted in a central laboratory, using reference standards traceable to isotope dilution mass spectrometry (IDMS) quality control material to quantify the main outcome of eGFR decline over time, alongside a description of the early evolution of disease and risk factors for eGFR decline. ETHICS AND DISSEMINATION Ethical approval will be obtained by local researchers, and participants will provide informed consent before the study commences. Participants will typically receive feedback and advice on their laboratory results, and referral to a local health system where appropriate.
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Affiliation(s)
- Marvin Gonzalez-Quiroz
- Research Centre on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua, León, Nicaragua
- Centre for Nephrology, University College London, London, UK
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Sophie Hamilton
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Cristina O'Callaghan Gordo
- Campus Mar, Instituto de Salud Global Barcelona, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Rajiv Saran
- Division of Nephrology, Department of Internal Medicine & Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
- University of Michigan, Ann Arbor, Michigan, USA
| | | | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico City, Mexico
| | - Kristina Jakobsson
- Department of Public Health and Community Medicine, Insitute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Occupational and Environmental Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Ajay Singh
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Adeera Levin
- Division of Nepohrology UBC, University of British Columbia, Vancouver, British Columbia, Canada
| | - Giuseppe Remuzzi
- Instituto di Ricerche Farmacologiche Mario Negri - IRCCS, Milan, Italy
| | - Ben Caplin
- Centre for Nephrology, University College London, London, UK
| | - Neil Pearce
- Deparment of Medical Statistics and Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Global NCDs, London School of Hygiene and Tropical Medicine, London, UK
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Mendley SR, Levin A, Correa-Rotter R, Joubert BR, Whelan EA, Curwin B, Koritzinsky EH, Gaughan DM, Kimmel PL, Anand S, Ordunez P, Reveiz L, Rohlman DS, Scammell MK, Wright RO, Star RA. Chronic kidney diseases in agricultural communities: report from a workshop. Kidney Int 2019; 96:1071-1076. [PMID: 31563333 DOI: 10.1016/j.kint.2019.06.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/05/2019] [Accepted: 06/18/2019] [Indexed: 01/23/2023]
Abstract
In June 2018, the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institute of Environmental Health Sciences sponsored a workshop to identify research gaps in an increasingly common form of chronic kidney disease in agricultural communities, often termed "CKDu." The organizers invited a broad range of experts who provided diverse expertise and perspectives, many of whom had never addressed this particular epidemic. Discussion was focused around selected topics, including identifying and mitigating barriers to research in CKDu, creating a case definition, and defining common data elements. All hypotheses regarding etiology were entertained, and meeting participants discussed potential research strategies, choices in study design, and novel tools that may prove useful in this disease. Achievements of the workshop included robust cross-disciplinary discussion and preliminary planning of research goals and design. Specific challenges in implementing basic and clinical research and interventions in low- and middle-income countries were recognized. A balanced approach to leveraging local resources and capacity building without overreaching was emphasized.
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Affiliation(s)
- Susan R Mendley
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, British Columbia, Canada
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencas Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Bonnie R Joubert
- Population Health Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA
| | - Elizabeth A Whelan
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Washington, DC, USA
| | - Brian Curwin
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Washington, DC, USA
| | - Erik H Koritzinsky
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Denise M Gaughan
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Paul L Kimmel
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Shuchi Anand
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Pedro Ordunez
- Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, Washington, DC, USA
| | - Ludovic Reveiz
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Diane S Rohlman
- College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Madeleine K Scammell
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Robert O Wright
- Department of Environmental Medicine and Public Health, Mount Sinai School of Medicine, New York, New York, USA
| | - Robert A Star
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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Abstract
PURPOSE OF REVIEW Chronic kidney disease (CKD) can cluster in geographic locations or in people of particular genetic ancestries. We explore APOL1 nephropathy and Balkan nephropathy as examples of CKD clustering that illustrate genetics and environment conspiring to cause high rates of kidney disease. Unexplained hotspots of kidney disease in Asia and Central America are then considered from the perspective of potential gene × environment interactions. RECENT FINDINGS We report on evidence supporting both genes and environment in these CKD hotspots. Differing genetic susceptibility between populations and within populations may explain why causal environmental risk factors have been so hard to identify conclusively. Similarly, one cannot explain why these epidemics of kidney disease are happening now without invoking environmental changes. SUMMARY Approaches to these CKD hotspots are of necessity becoming more holistic. Genetic studies may help us identify the environmental triggers by teaching us about disease biology and may empower environmental risk factor studies by allowing for stratification of study participants by genetic susceptibility.
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Johnson RJ, Wesseling C, Newman LS. Chronic Kidney Disease of Unknown Cause in Agricultural Communities. N Engl J Med 2019; 380:1843-1852. [PMID: 31067373 DOI: 10.1056/nejmra1813869] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Richard J Johnson
- From the Division of Renal Diseases and Hypertension (R.J.J.), the Colorado Consortium on Climate Change and Health (R.J.J., L.S.N.), the Center for Health, Work & Environment, and the Departments of Environmental and Occupational Health and Epidemiology, Colorado School of Public Health (L.S.N.), and the Division of Pulmonary Sciences and Critical Care Medicine (L.S.N.), University of Colorado Anschutz Medical Campus, and the Division of Nephrology, Rocky Mountain Regional Veterans Health Administration Hospital, Department of Veterans Affairs (R.J.J.) - all in Aurora; the Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm (C.W.); and La Isla Network, Washington, DC (C.W.)
| | - Catharina Wesseling
- From the Division of Renal Diseases and Hypertension (R.J.J.), the Colorado Consortium on Climate Change and Health (R.J.J., L.S.N.), the Center for Health, Work & Environment, and the Departments of Environmental and Occupational Health and Epidemiology, Colorado School of Public Health (L.S.N.), and the Division of Pulmonary Sciences and Critical Care Medicine (L.S.N.), University of Colorado Anschutz Medical Campus, and the Division of Nephrology, Rocky Mountain Regional Veterans Health Administration Hospital, Department of Veterans Affairs (R.J.J.) - all in Aurora; the Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm (C.W.); and La Isla Network, Washington, DC (C.W.)
| | - Lee S Newman
- From the Division of Renal Diseases and Hypertension (R.J.J.), the Colorado Consortium on Climate Change and Health (R.J.J., L.S.N.), the Center for Health, Work & Environment, and the Departments of Environmental and Occupational Health and Epidemiology, Colorado School of Public Health (L.S.N.), and the Division of Pulmonary Sciences and Critical Care Medicine (L.S.N.), University of Colorado Anschutz Medical Campus, and the Division of Nephrology, Rocky Mountain Regional Veterans Health Administration Hospital, Department of Veterans Affairs (R.J.J.) - all in Aurora; the Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm (C.W.); and La Isla Network, Washington, DC (C.W.)
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Ó Flatharta T, Flynn A, Mulkerrin EC. Heat-related chronic kidney disease mortality in the young and old: differing mechanisms, potentially similar solutions? BMJ Evid Based Med 2019; 24:45-47. [PMID: 30262459 PMCID: PMC6580774 DOI: 10.1136/bmjebm-2018-110971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 07/19/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Tomás Ó Flatharta
- Department of Geriatric Medicine, University Hospital Galway, Galway, Ireland
| | - Aidan Flynn
- Department of Cardiology, Portiuncula University Hospital, Galway, Ireland
| | - Eamon C Mulkerrin
- Clinical Research Facility, Department of Medicine, National University of Ireland, Galway, Ireland
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Pearce N, Caplin B. Let's take the heat out of the CKDu debate: more evidence is needed. Occup Environ Med 2019; 76:357-359. [PMID: 30928904 DOI: 10.1136/oemed-2018-105427] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 01/22/2019] [Accepted: 02/06/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Neil Pearce
- Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ben Caplin
- Department of Renal Medicine, University College London, London, UK
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Chapman E, Haby MM, Illanes E, Sanchez-Viamonte J, Elias V, Reveiz L. Risk factors for chronic kidney disease of non-traditional causes: a systematic review. Rev Panam Salud Publica 2019; 43:e35. [PMID: 31093259 PMCID: PMC6461065 DOI: 10.26633/rpsp.2019.35] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/19/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To evaluate the potential associations between chronic kidney disease of uncertain or non-traditional etiology (CKDnT) and agrochemicals, heat stress, heavy metals, and other factors identified in the literature in any region of the world and at any time. METHODS This was a systematic review of the most frequent exposures suspected to be possible causes of CKDnT. A search was conducted of PubMed, LILACS, World Wide Science electronic databases, among other sources. Only medium- and high-quality studies were included. The synthesis of evidence included a narrative synthesis, meta-analysis, and meta-regression. RESULTS Four systematic reviews and 61 primary studies were included. Results of the meta-analysis suggest that exposure to agrochemicals and working in agriculture increase the risk of CKDnT, but this only reached significance for working in agriculture. When cross-sectional studies were excluded, agrochemical exposure became significant. However, there is substantial heterogeneity in the effect sizes. CONCLUSIONS Based on the existing evidence and the precautionary principle, it is important to implement preventive measures to mitigate the damage caused by CKDnT to both agricultural workers and their communities (i.e., improvement of working conditions, cautious management of agrochemicals, etc.). More high-quality research is needed to measure impact and to build the evidence base.
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Affiliation(s)
- Evelina Chapman
- Campus Universitário Darcy Ribeiro Campus Universitário Darcy Ribeiro Oswaldo Cruz Foundation (Fiocruz) Brasilia Brazil Oswaldo Cruz Foundation (Fiocruz), Campus Universitário Darcy Ribeiro, Brasilia, Brazil
| | - Michelle M Haby
- Universidad de Sonora Universidad de Sonora Department of Chemical and Biological Sciences HermosilloSonora Mexico Department of Chemical and Biological Sciences, Universidad de Sonora, Hermosillo, Sonora, Mexico
| | - Eduardo Illanes
- Universidad Mayor, a Ringgold standard institution Universidad Mayor, a Ringgold standard institution School of Psychology Santiago Chile School of Psychology, Universidad Mayor, a Ringgold standard institution, Santiago, Chile
| | - Julian Sanchez-Viamonte
- Facultad de Ciencias Médicas de la Universidad Nacional de La Plata Facultad de Ciencias Médicas de la Universidad Nacional de La Plata Escuela Universitaria de Recursos Humanos del Equipo de Salud Informática en Ciencias de la Salud Buenos Aires Argentina Informática en Ciencias de la Salud, Escuela Universitaria de Recursos Humanos del Equipo de Salud, Facultad de Ciencias Médicas de la Universidad Nacional de La Plata, Buenos Aires, Argentina
| | - Vanessa Elias
- Pan American Health Organization/World Health Organization Pan American Health Organization/World Health Organization Department of Evidence and Intelligence for Action in Health WashingtonDC United States of America Department of Evidence and Intelligence for Action in Health, Pan American Health Organization/World Health Organization, Washington, DC, United States of America
| | - Ludovic Reveiz
- Pan American Health Organization/World Health Organization Pan American Health Organization/World Health Organization Department of Evidence and Intelligence for Action in Health WashingtonDC United States of America Department of Evidence and Intelligence for Action in Health, Pan American Health Organization/World Health Organization, Washington, DC, United States of America
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Sorensen CJ, Butler-Dawson J, Dally M, Krisher L, Griffin BR, Johnson RJ, Lemery J, Asensio C, Tenney L, Newman LS. Risk Factors and Mechanisms Underlying Cross-Shift Decline in Kidney Function in Guatemalan Sugarcane Workers. J Occup Environ Med 2019; 61:239-250. [PMID: 30575695 PMCID: PMC6416034 DOI: 10.1097/jom.0000000000001529] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Identify early biomarkers and mechanisms of acute kidney injury in workers at risk of developing chronic kidney disease of unknown origin (CKDu). METHODS We assessed cross-shift changes in kidney function and biomarkers of injury in 105 healthy sugarcane workers. We obtained pre-harvest clinical data as well as daily environmental, clinical, and productivity data for each worker. RESULTS The average percent decline in cross-shift estimated glomerular filtration rate (eGFR) was 21.8% (standard deviation [SD] 13.6%). Increasing wet bulb globe temperature (WBGT), high uric acid, decreased urine pH, urinary leukocyte esterase, and serum hyperosmolality were risk factors for decline in kidney function. CONCLUSIONS Sugarcane workers with normal kidney function experience recurrent subclinical kidney injury, associated with elevations in biomarkers of injury that suggest exposure to high temperatures and extreme physical demands.
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Affiliation(s)
- Cecilia J Sorensen
- Center for Health, Work & Environment (Dr Sorensen, Dr Butler-Dawson, Ms Dally, Ms Krisher, Ms Tenney, Dr Newman); Department of Emergency Medicine, University of Colorado School of Medicine (Dr Sorensen, Dr Lemery); Colorado Consortium on Climate Change and Human Health (Dr Sorensen, Dr Butler-Dawson, Ms Dally, Ms Krisher, Dr Johnson, Dr Lemery, Ms Tenney, Dr Newman); Department of Environmental and Occupational Health (Dr Butler-Dawson, Ms Dally, Ms Krisher, Ms Tenney, Dr Newman), Colorado School of Public Health; Division of Renal Diseases and Hypertension (Dr Griffin, Dr Johnson); Pantaleon, Guatemala (Mr Asensio); Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, School of Medicine (Dr Newman), University of Colorado, Aurora, Colorado
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Pearce N, Caplin B, Gunawardena N, Kaur P, O’Callaghan-Gordo C, Ruwanpathirana T. CKD of Unknown Cause: A Global Epidemic? Kidney Int Rep 2019; 4:367-369. [PMID: 30899862 PMCID: PMC6409411 DOI: 10.1016/j.ekir.2018.11.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Ben Caplin
- Centre for Nephrology, Department of Renal Medicine, Division of Medicine, University College London, London, UK
| | | | - Prabhdeep Kaur
- Department of Non-communicable Diseases, National Institute of Epidemiology (Indian Council of Medical Research), Chennai, India
| | - Cristina O’Callaghan-Gordo
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain
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Mahalingasivam V, Caplin B. Chronic kidney disease of undetermined aetiology: tens of thousands of premature deaths, yet too much remains unknown. Nephrol Dial Transplant 2019; 34:1839-1841. [DOI: 10.1093/ndt/gfz014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Indexed: 01/30/2023] Open
Affiliation(s)
| | - Ben Caplin
- Department of Renal Medicine, University College London, London, UK
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50
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Gonzalez-Quiroz M, Smpokou ET, Pearce N, Caplin B, Nitsch D. Identification of young adults at risk of an accelerated loss of kidney function in an area affected by Mesoamerican nephropathy. BMC Nephrol 2019; 20:21. [PMID: 30651081 PMCID: PMC6335797 DOI: 10.1186/s12882-018-1193-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 12/20/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND After two-years of follow-up of 263 apparently healthy 18- to 30-year-old men in communities affected by Mesoamerican nephropathy (MeN), we identified three distinct case groups: a subgroup with (i) established renal dysfunction (case-group 1); individuals with (ii) a rapid decline in kidney function (case-group 2); and individuals with (iii) stable kidney function (non-cases). This paper investigates whether local tests are potentially useful for the timely identification of these case groups. METHODS Creatinine levels were measured in local laboratories every six months for two years. Aliquots were sent to a centralized laboratory for measurements of cystatin C and creatinine levels. We investigated agreement between the locally and centrally measured creatinine-based Chronic Kidney disease Epidemiology Collaboration (CKD-EPI) equation for estimating the Glomerular Filtration Rate (eGFR). A logistic regression analysis was used to assess predictive factors for case groups 1 and 2 compared to non-cases. Predictive variables were locally measured eGFR, and urinary neutrophil gelatinase-associated lipocalin (uNGAL) levels. The discrimination performance of the model was assessed using the area under the receiver operating characteristic curve (AUC). RESULTS Considerable variation in local eGFR measurements was observed. The prediction model for case-group 1 included baseline kidney function and with or without uNGAL (AUC = 0.98, 95% confidence interval (CI), 0.91-1.00). The prediction model for case-group 2 also required eGFRScr at six and twelve months after baseline, with or without uNGAL levels (AUC = 0.88; 95% CI 0.80-0.99). CONCLUSIONS Established renal dysfunction was detected at a single time point using local measurements and uNGAL. For the detection of a rapid decline in kidney function over time, at least 2 more measurements at six and twelve months are needed.
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Affiliation(s)
- Marvin Gonzalez-Quiroz
- Research Centre on Health, Work and Environment (CISTA), National Autonomous University of Nicaragua at León (UNAN-León), Campus Médico, Facultad de Ciencias Médica, edificio C, León, Nicaragua
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Nephrology, University College London, London, UK
| | | | - Neil Pearce
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Ben Caplin
- Centre for Nephrology, University College London, London, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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