Published Papers

Intervention to diminish dehydration and kidney damage among sugarcane workers

Investigators

Catharina Wesseling

Journal

Scandinavian Journal of Work, Environment & Health

Published date:

1 Jan 2018

Objective The aim of this study was to assess the potential to reduce kidney function damage during the implementation of a water, rest, shade (WRS) and efficiency intervention program among sugarcane workers. Methods A WRS intervention program adapted from the US Occupational Safety and Health Administration (OSHA) coupled with an efficiency program began two months into the 5-month harvest. One of the two groups of workers studied was provided with […]

Kidney function in sugarcane cutters in Nicaragua–A longitudinal study of workers at risk of Mesoamerican nephropathy

Investigators

Richard Johnson

Journal

Environmental Research

Published date:

1 May 2016

Background: Chronic kidney disease is common among sugarcane workers in Central America. The main risk factor seems to be repeated high-intensity work in hot environments. Several cross-sectional studies have been performed but few longitudinal studies. Objectives: The aim of the study was to examine whether kidney function changes over a few months of work during the harvest period. Methods: A group of male sugarcane cutters in Nicaragua (N=29, aged 17-38 […]

Kidney Injury from Recurrent Heat Stress and Rhabdomyolysis: Protective Role of Allopurinol and Sodium Bicarbonate

Investigators

Richard Johnson

Journal

American Journal of Nephrology

Published date:

2 Nov 2018

Background: Heat stress and rhabdomyolysis are major risk factors for the occurrence of repeated acute kidney injury in workers exposed to heat and strenuous work. These episodes, in turn, may progress to chronic kidney disease. Objective: The purpose of this study was to test the effect of allopurinol (AP) and sodium bicarbonate on the kidney injury induced by recurrent heat stress dehydration with concomitant repeated episodes of rhabdomyolysis. Methods: The […]

Markers of kidney tubular and interstitial injury and function among sugarcane workers with cross-harvest serum creatinine elevation

Investigators

Kristina Jakobsson

Journal

Occupational & Environmental Medicine

Published date:

31 Dec 2021

Objectives: Serum creatinine (SCr) is a routine marker of kidney injury but also increases with dehydration and muscular work. This study was to elucidate whether increase in SCr is associated with more specific markers of kidney tubular and interstitial injury and function, during prolonged heat stress among workers at high risk of chronic kidney disease of non-traditional origin (CKDnt). Methods: Urine monocyte chemoattractant protein-1 (MCP-1), kidney injury molecule-1 (KIM-1), calbindin, […]

Occupational heat exposure and the risk of chronic kidney disease of nontraditional origin in the United States

Investigators

Zachary Schlader

Journal

American Journal of Physiology-Regulatory, Integrative and Comparative Physiology

Published date:

1 Aug 2021

Occupational heat exposure is linked to the development of kidney injury and disease in individuals who frequently perform physically demanding work in the heat. For instance, in Central America, an epidemic of chronic kidney disease of nontraditional origin (CKDnt) is occurring among manual laborers, whereas potentially related epidemics have emerged in India and Sri Lanka. There is growing concern that workers in the United States suffer with CKDnt, but reports […]

Occupational Heat Stress and Kidney Health in Salt Pan Workers

Investigators

Kristina Jakobsson

Journal

Kidney International Reports

Published date:

20 Apr 2023

Introduction: Work in heat affects millions of workers. Although kidney function in agricultural workers is increasingly researched, nonagricultural studies are scarce. In coastal salt pans, the absence of occupational exposures to pesticides and other toxicants allows assessment of heat stress alone. Methods: Seven Indian salt pans were surveyed from 2017 to 2020. Job-specific workload was assessed. Heat stress was characterized as exceeding the wet bulb globe temperature (WBGT)-threshold limit value […]

Pathophysiological Mechanisms by which Heat Stress Potentially Induces Kidney Inflammation and Chronic Kidney Disease in Sugarcane Workers

Investigators

David Wegman

Journal

Nutrients

Published date:

2 Jun 2020

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 […]

Point-of-care biomarkers for prediction of kidney function trajectory among sugarcane cutters: a comparative test accuracy study

Investigators

Kristina Jakobsson

Journal

BMJ Open

Published date:

18 Nov 2022

Objectives: Heat-stressed Mesoamerican workers, such as sugarcane cutters, suffer from high rates of chronic kidney disease of non-traditional origin (CKDnt). We aimed to identify easily available early markers of rapid kidney function decline in a population at high risk of CKDnt. Design: The accuracy of different biomarkers measured during harvest for prediction of cross-harvest kidney function decline were assessed in an exploratory study group, and the performance of the most […]

Prevalence of and risk factors for chronic kidney disease of unknown aetiology in India: secondary data analysis of three population-based cross-sectional studies

Investigators

Kristina Jakobsson

Journal

BMJ Open

Published date:

7 Mar 2019

Objectives: To assess whether chronic kidney disease of unknown aetiology (CKDu) is present in India and to identify risk factors for it using population-based data and standardised methods. Design: Secondary data analysis of three population-based cross-sectional studies conducted between 2010 and 2014. Setting: Urban and rural areas of Northern India (states of Delhi and Haryana) and Southern India (states of Tamil Nadu and Andhra Pradesh). Participants: 12 500 individuals without […]

Prevalence Studies on CKDu Need Stringent Reporting on Outcomes to Enhance Comparability

Investigators

Jason Glaser

Journal

International Journal of Environmental Research and Public Health

Published date:

5 Oct 2020

Prevalence studies on Chronic Kidney Disease of unknown etiology (CKDu) need stringent reporting on outcomes following existing guidelines. Only by doing so, the much-needed comparisons between occupations, regions and climates for the elucidation of the etiology/etiologies of CKDu, and subsequently for its prevention, are possible. We, here, comment on methodological issues in a recently published study on rice farmers from West Java, Indonesia.

Preventing kidney injury among sugarcane workers: promising evidence from enhanced workplace interventions

Investigators

David Wegman

Journal

Occupational & Environmental Medicine

Published date:

13 May 2020

Objectives: To assess if improvement of working conditions related to heat stress was associated with improved kidney health outcomes among sugarcane harvest workers in Chichigalpa, Nicaragua, a region heavily affected by the epidemic of chronic kidney disease of non-traditional origin. Methods: Based on our findings during the 2017-2018 harvest (harvest 1), recommendations that enhanced the rest schedule and improved access to hydration and shade were given before the 2018-2019 harvest […]

Rationale and population-based prospective cohort protocol for the disadvantaged populations at risk of decline in eGFR (CO-DEGREE)

Investigators

Kristina Jakobsson

Journal

BMC Nephrology

Published date:

13 Jan 2017

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 […]

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