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0461 Can a intervention reduce the risk of chronic kidney disease among sugarcane workers?
  1. Wegman David1,
  2. Jenny Apelqvist2,
  3. Theo Bodin3,
  4. Matteo Bottai3,
  5. Ulf Ekström2,
  6. Ramón Garcia-Trabanino4,
  7. Jason Glaser5,
  8. Christer Hogstedt3,
  9. Kristina Jakobsson6,10,
  10. Emmanuel Jarquín7,
  11. Rebekah Lucas8,
  12. Sandra Peraza9,
  13. Ilana Weiss5,
  14. Catharina Wesseling3
  1. 1University of Massachusetts Lowell, Lowell, Massachusetts, USA
  2. 2Department of Laboratory Medicine, Division of Clinical Chemistry and Pharmacology, Lund University, Lund, Sweden
  3. 3Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
  4. 4Centro de Hemodiálisis, San Salvador, El Salvador
  5. 5La Isla Network, Ada, Michigan, USA
  6. 6Section of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
  7. 7Agencia para el Desarrollo y la Salud Agropecuaria (AGDYSA), San Salvador, El Salvador
  8. 8School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
  9. 9Faculty of Chemistry and Pharmacy, University of El Salvador, Ciudad Universitaria, San Salvador, El Salvador
  10. 10Division of Occupational and Environmental Medicine, Institute of Laboratory Medicine, Lund University, Lund, Sweden


Background The Central American kidney disease epidemic persists despite efforts to identify cause(s) and introduce clear, evidence-based interventions to protect workers. Evidence suggests that chronic dehydration during heavy work in hot environments contributes to morbidity. An intervention was introduced to determine if risk could be reduced in sugarcane workers.

Objective To assess efforts to implement a Water.Rest.Shade intervention in one setting where sugarcane cutting was believed to increase CKDu in the workforce.

Methods The intervention was introduced mid-way through the harvest in one of two work groups. The intervention group received water throughout the day with scheduled rest breaks in shaded settings. Health data (anthropometric and questionnaires), blood and urine were collected four times over a-six-month harvest. Daily wet bulb globe temperatures (WBGT) were recorded.

Results There were significant changes in biomarkers across-shift and across-harvest that reduced the markers of dehydration (changes of urine osmolality and serum albumin) and reduced rate of loss in estimated glomerular filtration rate (eGFR). Cross-shift change in eGFR was reduced in the group receiving the intervention. Significant decreased eGFR over the harvest appeared to stop after the intervention in those receiving the Water.Rest.Shade program.

Conclusion Preliminary evidence indicates a Water.Rest.Shade intervention program reduces the impact of heat stress on acute and over-harvest biomarkers of kidney function. Potential long-term benefits of such an intervention need to be confirmed in long-term follow-up and in other settings. Further research is needed to determine whether biomarker changes predict reduced risk of CKDu in this type of work.

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