ArticleRevista panamericana de salud publica = Pan American journal of public health2020
Chronic kidney disease of non-traditional origin in Mesoamerica: a disease primarily driven by occupational heat stress.
Article in Revista panamericana de salud publica = Pan American journal of public health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 76 papers, 1 of them a synthesis that pooled it.
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Who cites it
76 citing papers in PubMed, 1 synthesis or guideline pooled it, 140 citations in OpenAlex.
- Environmental risk factors for chronic kidney disease of non-traditional causes in tropical coastal areas: A systematic review and meta-analysis.PLoS neglected tropical diseases · 2025Pooled it
- Hydrating with a higher-fructose sport drink does not worsen acute kidney injury risk during simulated work-related heat stress.American journal of physiology. Regulatory, integrative and comparative physiology · 2026Trial
- Longitudinal assessment of kidney function in migrant farm workers.Environmental research · 2021Trial
- Impact of heatwave exposure on chronic kidney disease risk among middle-aged and older adults: evidence from the China health and retirement longitudinal study.BMC nephrology · 2026Article
- Kidney health among adolescents living in a high-risk region for CKDu.BMC nephrology · 2026Article
- Review
- Time-series analysis of the incidence trend of heat stress-related disorders in a hot and humid climate in a process industry.Scientific reports · 2026Article
- Toenail metal concentrations and kidney health among young people at risk of chronic kidney disease of uncertain etiology.Environmental epidemiology (Philadelphia, Pa.) · 2026Article
- Quantifying the impact of heat stress on labour productivity in outdoor workplaces in Southern India amid a changing climate.Scientific reports · 2026Article
- Mesoamerican nephropathy: A silent epidemic at the nexus of climate, labor, and health.AIMS public health · 2026Article
- Leveraging data analytics to enhance public health system performance in Peru.Frontiers in public health · 2026Review
- One day of environment-induced heat stress causes injury to the murine kidney.Experimental physiology · 2025Article
- Longitudinal Estimated GFR Trajectories Among Workers at High Risk for CKD of Unknown Etiology.Kidney international reports · 2025Article
- Biomarkers of Kidney Function and Injury Across Fire Seasons and During a Mid-Season Fire Incident in the Wildland Firefighter Exposure and Health Effect (WFFEHE) Study.American journal of industrial medicine · 2025Article
- Role of heat shock proteins in renal function and adaptation to heat stress: Implications for global warming.World journal of nephrology · 2025Review
- Ethical Considerations for Research in CKD of Unknown Etiology: Reflections From an Ethics Panel at the Fourth International Workshop on CKD of Unknown Etiology.Kidney international reports · 2025Article
- Rest, shade, hydration and hygiene for the prevention of kidney injuries and inflammation in a Nicaraguan sugarcane worker cohort.Occupational and environmental medicine · 2025Article
- Understanding Changes in Serum Creatinine During Work in Heat.Kidney international reports · 2025Article
- Resilience and adaptive strategies for managing stigma in Chinese people with chronic kidney disease.Scientific reports · 2025Article
- Development, validation, and reliability of a questionnaire to assess risk-factors of chronic kidney disease of unknown etiology.Journal of nephrology · 2025Article
16 more citing papers are in PubMed but not listed here.
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Authors and funding
12 authors at 7 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The death toll of the epidemic of chronic kidney disease of nontraditional origin (CKDnt) in Mesoamerica runs into the tens of thousands, affecting mostly young men. There is no consensus on the etiology. Anecdotal evidence from the 1990s pointed to work in sugarcane; pesticides and heat stress were suspected. Subsequent population-based surveys supported an occupational origin with overall high male-female ratios in high-risk lowlands, but small sex differences within occupational categories, and low prevalence in non-workers. CKDnt was reported in sugarcane and other high-intensity agriculture, and in non-agricultural occupations with heavy manual labor in hot environments, but not among subsistence farmers. Recent studies with stronger designs have shown cross-shift changes in kidney function and hydration biomarkers and cross-harvest kidney function declines related to heat and workload. The implementation of a water-rest-shade intervention midharvest in El Salvador appeared to halt declining kidney function among cane cutters. In Nicaragua a water-rest-shade program appeared sufficient to prevent kidney damage among cane workers with low-moderate workload but not among cutters with heaviest workload. Studies on pesticides and infectious risk factors have been largely negative. Non-occupational risk factors do not explain the observed epidemiologic patterns. In conclusion, work is the main driver of the CKDnt epidemic in Mesoamerica, with occupational heat stress being the single uniting factor shown to lead to kidney dysfunction in affected populations. Sugarcane cutters with extreme heat stress could be viewed as a sentinel occupational population. Occupational heat stress prevention is critical, even more so in view of climate change.
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