{
  "abstract": "Objectives To study the effect of a progressively enhanced rest–shade–hydration–hygiene (RSHH) intervention on kidney injury and inflammation biomarkers, and rates of clinical acute kidney injury (AKI) in Nicaraguan sugarcane workers with a very high rate of chronic kidney disease of non-traditional origin (CKDnt).Methods We analysed serum creatinine and C-reactive protein (CRP) and leukocyturia from samples obtained before and at the end of four harvest seasons (H1–4). An increase in creatinine≥0.30 mg/dL over the harvest was considered incident kidney injury (IKI). Rates of clinically diagnosed AKI were obtained from medical records. Each season the RSHH intervention included progressively longer and more frequent rest periods with improved access to shade and hydration, implementation monitoring, qualitative interviews and health outcome assessments.Results 1044 workers were followed for 1938 person-harvests. Among burned cane cutters, the job group with the highest workload and worst outcomes initially, there were decreasing rates of IKI (21% in H1 to 1% in H4, p<0.01), AKI (20/1000 worker-months to 8/1000 worker-months, p<0.01) and end-harvest leukocyturia (26% to 1%, p<0.01), and less rise in cross-harvest CRP (median 1.75-fold increase in H1 to 1.00 in H4, p<0.01).Conclusion Kidney outcomes among outdoor heat-stressed workers at high risk of CKDnt improved as a structured RSHH intervention was implemented and committed to by workplace management. The findings support a causal relationship between occupational heat stress, kidney injury and CKDnt and point to possibilities for prevention.",
  "authors": [
    {
      "affiliations": [
        "La Isla Network, Washington, District of Columbia, USA",
        "School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"
      ],
      "name": "Erik Hansson"
    },
    {
      "affiliations": [
        "La Isla Network, Washington, District of Columbia, USA"
      ],
      "name": "Jason Glaser"
    },
    {
      "affiliations": [
        "La Isla Network, Washington, District of Columbia, USA"
      ],
      "name": "Ilana Weiss"
    },
    {
      "affiliations": [
        "La Isla Network, Washington, District of Columbia, USA"
      ],
      "name": "Esteban Arias-Monge"
    },
    {
      "affiliations": [
        "La Isla Network, Washington, District of Columbia, USA",
        "School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"
      ],
      "name": "Felipe Pacheco-Zenteno"
    },
    {
      "affiliations": [
        "Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA"
      ],
      "name": "Nathan H Raines"
    },
    {
      "affiliations": [
        "La Isla Network, Washington, District of Columbia, USA"
      ],
      "name": "Michael Silva-Peñaherrera"
    },
    {
      "affiliations": [
        "La Isla Network, Washington, District of Columbia, USA"
      ],
      "name": "Javier Vasquez"
    },
    {
      "affiliations": [
        "La Isla Network, Washington, District of Columbia, USA"
      ],
      "name": "Zoey E Castellón"
    },
    {
      "affiliations": [
        "La Isla Network, Washington, District of Columbia, USA"
      ],
      "name": "Scarlette Poveda"
    },
    {
      "affiliations": [
        "La Isla Network, Washington, District of Columbia, USA"
      ],
      "name": "Fatima I Cerda-Granados"
    },
    {
      "affiliations": [
        "La Isla Network, Washington, District of Columbia, USA"
      ],
      "name": "William Martinez-Cuadra"
    },
    {
      "affiliations": [
        "Occupational Health Management, Ingenio San Antonio/Nicaragua Sugar Estates Limited, Chichigalpa, Nicaragua"
      ],
      "name": "Denis Chavarria"
    },
    {
      "affiliations": [
        "La Isla Network, Washington, District of Columbia, USA",
        "School of Sport Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK"
      ],
      "name": "Rebekah A I Lucas"
    },
    {
      "affiliations": [
        "La Isla Network, Washington, District of Columbia, USA",
        "Department of Laboratory Medicine, Lund University, Lund, Sweden"
      ],
      "name": "Ulf Ekström"
    },
    {
      "affiliations": [
        "La Isla Network, Washington, District of Columbia, USA",
        "School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"
      ],
      "name": "Kristina Jakobsson"
    },
    {
      "affiliations": [
        "La Isla Network, Washington, District of Columbia, USA"
      ],
      "name": "Catharina Wesseling"
    },
    {
      "affiliations": [
        "La Isla Network, Washington, District of Columbia, USA",
        "University of Massachusetts Lowell, Lowell, Massachusetts, USA"
      ],
      "name": "David H Wegman"
    }
  ],
  "title": "Rest, shade, hydration and hygiene for the prevention of kidney injuries and inflammation in a Nicaraguan sugarcane worker cohort",
  "uid": "8804579c-763c-5232-a3e1-d03e0fada834"
}