TY - JOUR
T1 - Biomarkers of Kidney Injury among Nicaraguan Sugarcane Workers
AU - Laws, Rebecca L.
AU - Brooks, Daniel R.
AU - Amador, Juan José
AU - Weiner, Daniel E.
AU - Kaufman, James S.
AU - Ramírez-Rubio, Oriana
AU - Riefkohl, Alejandro
AU - Scammell, Madeleine K.
AU - López-Pilarte, Damaris
AU - Sánchez, José Marcel
AU - Parikh, Chirag R.
AU - McClean, Michael D.
N1 - Funding Information:
Support: The funds were provided by the Compliance Advisor/Ombudsman (CAO), the independent accountability mechanism for social and environmental issues of the International Finance Corporation (IFC)/Multilateral Investment Guarantee Agency (MIGA) of the World Bank Group, and the Comité Nacional de Productores de Azúcar (CNPA). The CAO managed all funds and maintained the contract to conduct the research. Dr Parikh was supported by a grant from the National Institutes of Health (NIH; K24DK090203 ). Dr Ramírez-Rubio was funded by the Enrique Najera predoctoral grant awarded by the Spanish Society of Epidemiology and the Instituto de Salud Carlos III. Dr Laws was funded by an NIH training grant ( T32 ES014562 ) and a Science to Achieve Results (STAR) Fellowship Assistance agreement (no. FP-91764901-0) awarded by the US Environmental Protection Agency (EPA). The EPA does not endorse any products or commercial services mentioned in this publication. The views expressed in this publication are solely those of the authors.
Funding Information:
Financial Disclosure: Funding for future studies is being provided by the CNPA and Los Azucareros Del Istmo Centroamericano (AICA) and is being managed by the CDC Foundation. Donors have not reviewed or influenced the content of this article. Dr Parikh is listed as a co-inventor on an IL-18 patent granted to the University of Colorado (no monetary value). The other authors declare that they have no other relevant financial interests.
Publisher Copyright:
© 2016 National Kidney Foundation, Inc.
PY - 2016/2/1
Y1 - 2016/2/1
N2 - Background In Central America, an epidemic of chronic kidney disease of unknown cause disproportionately affects young male agricultural workers. Study Design Longitudinal cohort study. Setting & Participants 284 sugarcane workers in 7 jobs were recruited from one company in northwestern Nicaragua. Blood and urine samples were collected before and near the end of the 6-month harvest season. Predictors Job category (cane cutter, seeder, seed cutter, agrichemical applicator, irrigator, driver, and factory worker); self-reported water and electrolyte solution intake. Outcomes & Measurements Changes in levels of urinary kidney injury biomarkers normalized to urine creatinine level, including neutrophil gelatinase-associated lipocalin (NGAL), interleukin 18 (IL-18), N-acetyl-β-d-glucosaminidase (NAG), and albumin; serum creatinine-based estimated glomerular filtration rate (eGFR). Results Mean eGFR was 113 mL/min/1.73 m2 and <5% of workers had albuminuria. Field workers had increases in NGAL and IL-18 levels that were 1.49 (95% CI, 1.06 to 2.09) and 1.61 (95% CI, 1.12 to 2.31) times as high, respectively, as in non-field workers. Cane cutters and irrigators had the greatest increases in NGAL levels during the harvest, whereas cane cutters and seeders had the greatest increases in IL-18 levels. Electrolyte solution consumption was associated with lower mean NGAL and NAG levels among cane cutters and lower mean IL-18 and NAG levels among seed cutters; however, there was no overall effect of hydration among all workers. On average, workers with the largest increases in NGAL and NAG levels during the harvest had declines in eGFRs of 4.6 (95% CI, 1.0 to 8.2) and 3.1 (95% CI, -0.6 to 6.7) mL/min/1.73 m2, respectively. Limitations Surrogate exposure measure, loss to follow-up. Conclusions Results are consistent with the hypothesis that occupational heat stress and volume depletion may be associated with the development of kidney disease, and future studies should directly measure these occupational factors. The presence of urine tubular injury markers supports a tubulointerstitial disease that could occur with repeated tubular injury.
AB - Background In Central America, an epidemic of chronic kidney disease of unknown cause disproportionately affects young male agricultural workers. Study Design Longitudinal cohort study. Setting & Participants 284 sugarcane workers in 7 jobs were recruited from one company in northwestern Nicaragua. Blood and urine samples were collected before and near the end of the 6-month harvest season. Predictors Job category (cane cutter, seeder, seed cutter, agrichemical applicator, irrigator, driver, and factory worker); self-reported water and electrolyte solution intake. Outcomes & Measurements Changes in levels of urinary kidney injury biomarkers normalized to urine creatinine level, including neutrophil gelatinase-associated lipocalin (NGAL), interleukin 18 (IL-18), N-acetyl-β-d-glucosaminidase (NAG), and albumin; serum creatinine-based estimated glomerular filtration rate (eGFR). Results Mean eGFR was 113 mL/min/1.73 m2 and <5% of workers had albuminuria. Field workers had increases in NGAL and IL-18 levels that were 1.49 (95% CI, 1.06 to 2.09) and 1.61 (95% CI, 1.12 to 2.31) times as high, respectively, as in non-field workers. Cane cutters and irrigators had the greatest increases in NGAL levels during the harvest, whereas cane cutters and seeders had the greatest increases in IL-18 levels. Electrolyte solution consumption was associated with lower mean NGAL and NAG levels among cane cutters and lower mean IL-18 and NAG levels among seed cutters; however, there was no overall effect of hydration among all workers. On average, workers with the largest increases in NGAL and NAG levels during the harvest had declines in eGFRs of 4.6 (95% CI, 1.0 to 8.2) and 3.1 (95% CI, -0.6 to 6.7) mL/min/1.73 m2, respectively. Limitations Surrogate exposure measure, loss to follow-up. Conclusions Results are consistent with the hypothesis that occupational heat stress and volume depletion may be associated with the development of kidney disease, and future studies should directly measure these occupational factors. The presence of urine tubular injury markers supports a tubulointerstitial disease that could occur with repeated tubular injury.
KW - Chronic kidney disease (CKD)
KW - Mesoamerican Nephropathy (MeN)
KW - N-acetyl-β-d-glucosaminidase (NAG)
KW - acute kidney injury (AKI)
KW - estimated glomerular filtration rate (eGFR)
KW - heat stress
KW - interleukin 18 (IL-18)
KW - neutrophil gelatinase-associated lipocalin (NGAL)
KW - occupational safety
KW - renal disease etiology
KW - tubulointerstitial
KW - urine tubular injury biomarker
KW - volume depletion
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U2 - 10.1053/j.ajkd.2015.08.022
DO - 10.1053/j.ajkd.2015.08.022
M3 - Article
C2 - 26454687
AN - SCOPUS:84951084377
SN - 0272-6386
VL - 67
SP - 209
EP - 217
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -