PT  - JOURNAL ARTICLE
AU  - Dallas S Shi
AU  - Virginia M Weaver
AU  - Michael J Hodgson
AU  - Aaron W Tustin
TI  - Hospitalised heat-related acute kidney injury in indoor and outdoor workers in the USA
AID  - 10.1136/oemed-2021-107933
DP  - 2021 Nov 07
TA  - Occupational and Environmental Medicine
PG  - oemed-2021-107933
4099  - http://oem.bmj.com/content/early/2021/11/07/oemed-2021-107933.short
4100  - http://oem.bmj.com/content/early/2021/11/07/oemed-2021-107933.full
AB  - Objectives To characterise heat-related acute kidney injury (HR-AKI) among US workers in a range of industries.Methods Two data sources were analysed: archived case files of the Occupational Safety and Health Administration’s (OSHA) Office of Occupational Medicine and Nursing from 2010 through 2020; and a Severe Injury Reports (SIR) database of work-related hospitalisations that employers reported to federal OSHA from 2015 to 2020. Confirmed, probable and possible cases of HR-AKI were ascertained by serum creatinine measurements and narrative incident descriptions. Industry-specific incidence rates of HR-AKI were computed. A capture–recapture analysis assessed under-reporting in SIR.Results There were 608 HR-AKI cases, including 22 confirmed cases and 586 probable or possible cases. HR-AKI occurred in indoor and outdoor industries including manufacturing, construction, mail and package delivery, and solid waste collection. Among confirmed cases, 95.2% were male, 50.0% had hypertension and 40.9% were newly hired workers. Incidence rates of AKI hospitalisations from 1.0 to 2.5 hours per 100 000 workers per year were observed in high-risk industries. Analysis of overlap between the data sources found that employers reported only 70.6% of eligible HR-AKI hospitalisations to OSHA, and only 41.2% of reports contained a consistent diagnosis.Conclusions Workers were hospitalised with HR-AKI in diverse industries, including indoor facilities. Because of under-reporting and underascertainment, national surveillance databases underestimate the true burden of occupational HR-AKI. Clinicians should consider kidney risk from recurrent heat stress. Employers should provide interventions, such as comprehensive heat stress prevention programmes, that include acclimatisation protocols for new workers, to prevent HR-AKI.OSHA's Severe Injury Reports (SIR) data are available in a public, open access repository. The OOMN data are available upon reasonable request.