Evidence map›Paper›PMID 40803826›Full record

ArticleOccupational and environmental medicine2025

Rest, shade, hydration and hygiene for the prevention of kidney injuries and inflammation in a Nicaraguan sugarcane worker cohort.

Erik Hansson, Jason Glaser, Ilana Weiss, Esteban Arias-Monge, Felipe Pacheco-Zenteno, Nathan H Raines, Michael Silva-Peñaherrera, Javier Vasquez, Zoey E Castellón, Scarlette Poveda and 8 more

Abstract read
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In one paragraph

Article in Occupational and environmental medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Erik HanssonLa Isla Network, Washington, District of Columbia, USA erik.hansson@amm.gu.se.ORCID 0000-0002-9779-6820
Jason GlaserLa Isla Network, Washington, District of Columbia, USA.
Ilana WeissLa Isla Network, Washington, District of Columbia, USA.
Esteban Arias-MongeLa Isla Network, Washington, District of Columbia, USA.
Felipe Pacheco-ZentenoLa Isla Network, Washington, District of Columbia, USA.ORCID 0000-0002-2582-7878
Nathan H RainesDivision of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.ORCID 0000-0003-3297-9447
Michael Silva-PeñaherreraLa Isla Network, Washington, District of Columbia, USA.
Javier VasquezLa Isla Network, Washington, District of Columbia, USA.
Zoey E CastellónLa Isla Network, Washington, District of Columbia, USA.
Scarlette PovedaLa Isla Network, Washington, District of Columbia, USA.
Fatima I Cerda-GranadosLa Isla Network, Washington, District of Columbia, USA.
William Martinez-CuadraLa Isla Network, Washington, District of Columbia, USA.
Denis ChavarriaOccupational Health Management, Ingenio San Antonio/Nicaragua Sugar Estates Limited, Chichigalpa, Nicaragua.
Rebekah A I LucasLa Isla Network, Washington, District of Columbia, USA.
Ulf EkströmLa Isla Network, Washington, District of Columbia, USA.
Kristina JakobssonLa Isla Network, Washington, District of Columbia, USA.
Catharina WesselingLa Isla Network, Washington, District of Columbia, USA.
David H WegmanLa Isla Network, Washington, District of Columbia, USA.ORCID 0000-0001-6393-5020

Funding

Nicotinamide Adenine Dinucleotide (NAD+) Metabolism During Observational and Experimental Heat Stress and the Effect of Niacinamide Among Individuals at Risk for Mesoamerican NephropathyK23DK138320 · NIDDK · BETH ISRAEL DEACONESS MEDICAL CENTER · PI Nathan Raines · 2024 to 2026
$574k
NIDDK NIH HHS K23 DK138320
6 · The paper itself

Abstract

objectivesTo 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).

methodsWe 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.

results1044 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).

conclusionKidney 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.

Indexed as

Acute Kidney InjuryAgricultural Workers' DiseasesInflammationOccupational DiseasesRenal Insufficiency, ChronicAdultBiomarkersCohort StudiesC-Reactive ProteinCreatinineFarmersFemaleHumansMaleMiddle AgedNicaraguaBiomarkersC-Reactive ProteinCreatinineClimateKidney DiseasesOccupational HealthWorkersWorkload

Identifiers

PMID40803826
PMCPMC12421119

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.