Joseph Kupferman1, Oriana Ramírez-Rubio2, Juan José Amador2, Damaris López-Pilarte2, Elissa H Wilker3, Rebecca L Laws4, Caryn Sennett4, Ninoska Violeta Robles5, Jorge Luis Lau6, Alejandro José Salinas6, James S Kaufman7, Daniel E Weiner8, Madeleine K Scammell4, Michael D McClean4, Daniel R Brooks9, David J Friedman10. 1. Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. 2. Department of Epidemiology, Boston University School of Public Health, Boston, MA. 3. Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA. 4. Department of Environmental Health, Boston University School of Public Health, Boston, MA. 5. Centro Nacional de Diagnóstico y Referencia, Nicaraguan Ministry of Health, Nicaragua. 6. Especialistas en Medicina Interna, Chichigalpa, Nicaragua. 7. Research Service, VA New York Harbor Healthcare System and Department of Medicine, New York University School of Medicine, New York, NY. 8. Division of Nephrology, Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, MA. 9. Department of Epidemiology, Boston University School of Public Health, Boston, MA. Electronic address: danbrook@bu.edu. 10. Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Electronic address: dfriedma@bidmc.harvard.edu.
Abstract
RATIONALE & OBJECTIVE: Mesoamerican nephropathy (MeN), a form of chronic kidney disease (CKD) of unknown cause in Central America, affects young individuals working in physically strenuous occupations. Repeated episodes of work-related kidney injury may lead to CKD in this setting. We aimed to better understand the burden and natural history of acute kidney injury (AKI) in workers at risk for MeN. STUDY DESIGN: Cross-sectional study of active sugarcane workers, followed by prospective follow-up of individuals with AKI. SETTING & PARTICIPANTS: 326 sugarcane workers with normal preharvest serum creatinine (Scr) values and no history of CKD in an MeN hotspot in Nicaragua near the end of the harvest, and prospective follow-up of workers with AKI. PREDICTOR: AKI during the harvest, as defined by Scr level increase ≥ 0.3mg/dL over baseline to a level ≥ 1.3mg/dL. OUTCOMES: Kidney function trajectory and development of CKD over 12 months. ANALYTICAL APPROACH: Linear regression models were used to analyze the association between job category and kidney function. For workers with AKI, the effect of time on Scr level was evaluated using linear mixed effects. RESULTS: 34 of 326 participants were found to have AKI, with a median late-harvest Scr level of 1.64mg/dL in the AKI group. Workers without AKI had a median Scr level of 0.88mg/dL. AKI was more common among cane cutters compared with other field workers. Participants with AKI had variable degrees of kidney function recovery, with median 6- and 12-month Scr values of 1.25 and 1.27mg/dL, respectively (P < 0.001 for each follow-up value compared to late-harvest Scr). When we compared workers' kidney function before the AKI episode to their kidney function at last follow-up, 10 participants with AKI developed de novo estimated glomerular filtration rate < 60mL/min/1.73m2 and 11 had a >30% decrease in estimated glomerular filtration rate. LIMITATIONS: Follow-up limited to 1 year and some loss to follow-up in the prospective component of the study. Broad definition of AKI that includes both acute and subacute kidney injury. CONCLUSIONS: In a group of sugarcane workers with normal preharvest kidney function, newly decreased kidney function developing during the harvest season was common. Of those with kidney injury, nearly half had established CKD 12 months later.
RATIONALE & OBJECTIVE: Mesoamerican nephropathy (MeN), a form of chronic kidney disease (CKD) of unknown cause in Central America, affects young individuals working in physically strenuous occupations. Repeated episodes of work-related kidney injury may lead to CKD in this setting. We aimed to better understand the burden and natural history of acute kidney injury (AKI) in workers at risk for MeN. STUDY DESIGN: Cross-sectional study of active sugarcane workers, followed by prospective follow-up of individuals with AKI. SETTING & PARTICIPANTS: 326 sugarcane workers with normal preharvest serum creatinine (Scr) values and no history of CKD in an MeN hotspot in Nicaragua near the end of the harvest, and prospective follow-up of workers with AKI. PREDICTOR: AKI during the harvest, as defined by Scr level increase ≥ 0.3mg/dL over baseline to a level ≥ 1.3mg/dL. OUTCOMES: Kidney function trajectory and development of CKD over 12 months. ANALYTICAL APPROACH: Linear regression models were used to analyze the association between job category and kidney function. For workers with AKI, the effect of time on Scr level was evaluated using linear mixed effects. RESULTS: 34 of 326 participants were found to have AKI, with a median late-harvest Scr level of 1.64mg/dL in the AKI group. Workers without AKI had a median Scr level of 0.88mg/dL. AKI was more common among cane cutters compared with other field workers. Participants with AKI had variable degrees of kidney function recovery, with median 6- and 12-month Scr values of 1.25 and 1.27mg/dL, respectively (P < 0.001 for each follow-up value compared to late-harvest Scr). When we compared workers' kidney function before the AKI episode to their kidney function at last follow-up, 10 participants with AKI developed de novo estimated glomerular filtration rate < 60mL/min/1.73m2 and 11 had a >30% decrease in estimated glomerular filtration rate. LIMITATIONS: Follow-up limited to 1 year and some loss to follow-up in the prospective component of the study. Broad definition of AKI that includes both acute and subacute kidney injury. CONCLUSIONS: In a group of sugarcane workers with normal preharvest kidney function, newly decreased kidney function developing during the harvest season was common. Of those with kidney injury, nearly half had established CKD 12 months later.
Authors: Susan R Mendley; Adeera Levin; Ricardo Correa-Rotter; Bonnie R Joubert; Elizabeth A Whelan; Brian Curwin; Erik H Koritzinsky; Denise M Gaughan; Paul L Kimmel; Shuchi Anand; Pedro Ordunez; Ludovic Reveiz; Diane S Rohlman; Madeleine K Scammell; Robert O Wright; Robert A Star Journal: Kidney Int Date: 2019-08-02 Impact factor: 10.612
Authors: Ryan Ferguson; Sarah Leatherman; Madeline Fiore; Kailey Minnings; Martha Mosco; James Kaufman; Eric Kerns; Juan Jose Amador; Daniel R Brooks; Melissa Fiore; Rulan S Parekh; Louis Fiore Journal: J Am Soc Nephrol Date: 2020-05-29 Impact factor: 10.121
Authors: Sinead A Keogh; Jessica H Leibler; Caryn M Sennett Decker; Juan Jose Amador Velázquez; Emmanuel R Jarquin; Damaris Lopez-Pilarte; Ramon Garcia-Trabanino; Iris S Delgado; Zoe E Petropoulos; David J Friedman; Magaly Rosario Amador Sánchez; Raul Guevara; Michael D McClean; Daniel R Brooks; Madeleine K Scammell Journal: BMC Nephrol Date: 2022-07-07 Impact factor: 2.585
Authors: Axel Andersson; Erik Hansson; Ulf Ekström; Anders Grubb; Magnus Abrahamson; Kristina Jakobsson; Yiyi Xu Journal: Occup Environ Med Date: 2022-03-30 Impact factor: 4.948
Authors: Erik Hansson; Jason Glaser; Kristina Jakobsson; Ilana Weiss; Catarina Wesseling; Rebekah A I Lucas; Jason Lee Kai Wei; Ulf Ekström; Julia Wijkström; Theo Bodin; Richard J Johnson; David H Wegman Journal: Nutrients Date: 2020-06-02 Impact factor: 5.717
Authors: Zoe E Petropoulos; Oriana Ramirez-Rubio; Madeleine K Scammell; Rebecca L Laws; Damaris Lopez-Pilarte; Juan José Amador; Joan Ballester; Cristina O'Callaghan-Gordo; Daniel R Brooks Journal: Int J Environ Res Public Health Date: 2021-05-19 Impact factor: 3.390