Biomarkers of Kidney Injury Among Nicaraguan Sugarcane Workers

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• 作者：Rebecca L. Laws ; PhD ; MPH¹ ; ^{rlaws@bu.edu" class="auth_mail" title="E-mail the corresponding author} ; Daniel R. Brooks ; DSc² ; Juan José ; Amador ; MD ; MPH² ; Daniel E. Weiner ; MD ; MS³ ; James S. Kaufman ; MD⁴ ; ⁵ ; Oriana Ramí ; rez-Rubio ; MD ; PhD ; MPH² ; ⁶ ; Alejandro Riefkohl ; MD² ; Madeleine K. Scammell ; DSc¹ ; Damaris Ló ; pez-Pilarte ; MPH² ; José ; Marcel Sá ; nchez ; Lic² ; Chirag R. Parikh ; MD ; PhD⁷ ; ⁸ ; Michael D. McClean ; ScD¹
• 关键词：Chronic kidney disease (CKD) ; Mesoamerican Nephropathy (MeN) ; neutrophil gelatinase-associated lipocalin (NGAL) ; interleukin 18 (IL-18) ; N-acetyl-β-d-glucosaminidase (NAG) ; estimated glomerular filtration rate (eGFR) ; tubulointerstitial ; urine tubular injury biomarker ; acute kidney injury (AKI) ; volume depletion ; heat stress ; renal disease etiology ; occupational safety
• 刊名：American Journal of Kidney Diseases
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：67
• 期：2
• 页码：209-217
• 全文大小：274 K

文摘

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.