Introduction Chronic kidney disease of nontraditional cause (CKDnt), is a risk for millions of workers in Latin America and Asia. Treatment is expensive, resulting in early death for those affected. Strenuous work in extreme heat without sufficient rest and hydration is an important driver. Without prevention, this epidemic will likely accelerate due to climate change.

Objectives We established the Adelante Initiative, a workplace intervention focusing on heat stress mitigation, together with improved ergonomics, and organizational assessment designed to prevent CKDnt among workers at a sugarcane mill in Nicaragua. We aim to adapt the program to other geographies and industries.

Methods PREP builds on Adelante, investigating the following: 1)immediate and long-term impact of the intervention has on workforce health and productivity; 2)economic and social impacts on those affected by CKDnt and whether intervention promotes resilience 3)the economic burden on health systems treating CKDnt; 4) analysis of public and private policies to understand what policy factors (present or absent), have contributed to the disease and what policies are required to address it.

Preliminary observations Despite the inconsistent implementation of intervention there is a 72% reduction of kidney injury. The economic burden in households with CKDnt is dire. CKDnt is depleting health systems. Current public and private policies are insufficient to address CKDnt though signs are encouraging within the development sector and some industries.

Conclusions Knowledge gained will create the groundwork to expand to other sugarcane mils and eventually other industries at-risk for heat stress and CKDnt. Climate change means more extreme temperatures in already impacted regions and the likelihood that regions further north and south of the equator will also be impacted by CKDnt. It is essential to develop a model to protect worker health and productivity. Occupational heat stress and resulting CKDnt require increased attention and resources.