Point-of-care biomarkers for prediction of kidney function trajectory among sugarcane cutters: a comparative test accuracy study
Objectives Heat-stressed Mesoamerican workers, such as sugarcane cutters, suffer from high rates of chronic kidney disease of non-traditional origin (CKDnt). We aimed to identify easily available early markers of rapid kidney function decline in a population at high risk of CKDnt.Design The accuracy...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/11/e060364.full |
| _version_ | 1811219266626650112 |
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| author | David Wegman Jason Glaser Kristina Jakobsson Erik Hansson Ulf Ekström Catharina Wesseling Denis Chavarria |
| author_facet | David Wegman Jason Glaser Kristina Jakobsson Erik Hansson Ulf Ekström Catharina Wesseling Denis Chavarria |
| author_sort | David Wegman |
| collection | DOAJ |
| description | Objectives Heat-stressed Mesoamerican workers, such as sugarcane cutters, suffer from high rates of chronic kidney disease of non-traditional origin (CKDnt). We aimed to identify easily available early markers of rapid kidney function decline in a population at high risk of CKDnt.Design The accuracy of different biomarkers measured during harvest for prediction of cross-harvest kidney function decline were assessed in an exploratory study group, and the performance of the most promising biomarker was then assessed in an independent confirmation group.Setting Male sugarcane cutters in El Salvador and Nicaragua.Participants 39 male Salvadoran sugarcane cutters sampled fortnightly at ≤9 occasions before and after work shift during harvest. 371 male Nicaraguan sugarcane cutters were sampled as part of routine monitoring during two harvests. Cutters worked at high physical intensity at wet-bulb globe temperatures mostly above 29°C for 6–8 hours per day 6 days a week during the 5–6 months harvest season.Primary outcomes Change in estimated glomerular filtration rate (CKD Epidemiology Collaboration) across the harvest season (ΔeGFRcross-harvest).Results Dipstick leukocyturia after work shift in the El Salvadoran group was the most promising marker, explaining >25% of ΔeGFRcross-harvest variance at 8/9 occasions during harvest. Leukocyturia was associated with experiencing fever, little or dark urine, cramps, headache, dizziness and abdominal pain in the preceding 2-week period. Decreasing blood haemoglobin (Hb) and eGFR during harvest were also predictive of ΔeGFRcross-harvest. In the Nicaraguan confirmation dataset, those having ≥++ leukocyturia at any sampling during harvest had a 13 mL/min/1.73 m2 (95% CI 10 to 16 mL/min/1.73 m2) worse ΔeGFRcross-harvest than those without recorded leukocyturia.Conclusion Leukocyturia and Hb, both measurable with point-of-care methods, may be early indicators for kidney injury and risk for eGFR decline among heat-stressed male workers, thereby facilitating individual-level prevention and research aiming to understand the causes of CKDnt. |
| first_indexed | 2024-04-12T07:24:28Z |
| format | Article |
| id | doaj.art-0ad9d3b5d3c049c19460066650f9d850 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-04-12T07:24:28Z |
| publishDate | 2022-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-0ad9d3b5d3c049c19460066650f9d8502022-12-22T03:42:14ZengBMJ Publishing GroupBMJ Open2044-60552022-11-01121110.1136/bmjopen-2021-060364Point-of-care biomarkers for prediction of kidney function trajectory among sugarcane cutters: a comparative test accuracy studyDavid Wegman0Jason Glaser1Kristina Jakobsson2Erik Hansson3Ulf Ekström4Catharina Wesseling5Denis Chavarria67 University of Massachusetts Lowell, Lowell, Massachusetts, USALa Isla Network, Washington, DC, USALa Isla Network, Washington, DC, USALa Isla Network, Washington, DC, USA1 La Isla Network, Washington, District of Columbia, USALa Isla Network, Washington, DC, USAOccupational Health Management, Ingenio San Antonio/Nicaragua Sugar Estates Limited, Chichigalpa, NicaraguaObjectives Heat-stressed Mesoamerican workers, such as sugarcane cutters, suffer from high rates of chronic kidney disease of non-traditional origin (CKDnt). We aimed to identify easily available early markers of rapid kidney function decline in a population at high risk of CKDnt.Design The accuracy of different biomarkers measured during harvest for prediction of cross-harvest kidney function decline were assessed in an exploratory study group, and the performance of the most promising biomarker was then assessed in an independent confirmation group.Setting Male sugarcane cutters in El Salvador and Nicaragua.Participants 39 male Salvadoran sugarcane cutters sampled fortnightly at ≤9 occasions before and after work shift during harvest. 371 male Nicaraguan sugarcane cutters were sampled as part of routine monitoring during two harvests. Cutters worked at high physical intensity at wet-bulb globe temperatures mostly above 29°C for 6–8 hours per day 6 days a week during the 5–6 months harvest season.Primary outcomes Change in estimated glomerular filtration rate (CKD Epidemiology Collaboration) across the harvest season (ΔeGFRcross-harvest).Results Dipstick leukocyturia after work shift in the El Salvadoran group was the most promising marker, explaining >25% of ΔeGFRcross-harvest variance at 8/9 occasions during harvest. Leukocyturia was associated with experiencing fever, little or dark urine, cramps, headache, dizziness and abdominal pain in the preceding 2-week period. Decreasing blood haemoglobin (Hb) and eGFR during harvest were also predictive of ΔeGFRcross-harvest. In the Nicaraguan confirmation dataset, those having ≥++ leukocyturia at any sampling during harvest had a 13 mL/min/1.73 m2 (95% CI 10 to 16 mL/min/1.73 m2) worse ΔeGFRcross-harvest than those without recorded leukocyturia.Conclusion Leukocyturia and Hb, both measurable with point-of-care methods, may be early indicators for kidney injury and risk for eGFR decline among heat-stressed male workers, thereby facilitating individual-level prevention and research aiming to understand the causes of CKDnt.https://bmjopen.bmj.com/content/12/11/e060364.full |
| spellingShingle | David Wegman Jason Glaser Kristina Jakobsson Erik Hansson Ulf Ekström Catharina Wesseling Denis Chavarria Point-of-care biomarkers for prediction of kidney function trajectory among sugarcane cutters: a comparative test accuracy study BMJ Open |
| title | Point-of-care biomarkers for prediction of kidney function trajectory among sugarcane cutters: a comparative test accuracy study |
| title_full | Point-of-care biomarkers for prediction of kidney function trajectory among sugarcane cutters: a comparative test accuracy study |
| title_fullStr | Point-of-care biomarkers for prediction of kidney function trajectory among sugarcane cutters: a comparative test accuracy study |
| title_full_unstemmed | Point-of-care biomarkers for prediction of kidney function trajectory among sugarcane cutters: a comparative test accuracy study |
| title_short | Point-of-care biomarkers for prediction of kidney function trajectory among sugarcane cutters: a comparative test accuracy study |
| title_sort | point of care biomarkers for prediction of kidney function trajectory among sugarcane cutters a comparative test accuracy study |
| url | https://bmjopen.bmj.com/content/12/11/e060364.full |
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