Occupational Heat Exposure and Renal Dysfunction

职业热暴露与肾功能障碍

• 批准号: 10415025
• 负责人: Linda A. McCauley
• 金额: $ 57.2万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10415025
• 关键词: Occupational; Heat; Exposure; Renal; Dysfunction

Agricultural workers are an occupational sector particularly vulnerable to heat-related illness. Occupational exposure to heat can result in injuries, disease, reduced productivity, and death and these risks have been well documented in NIOSH priority documents on occupational exposure to heat and hot environments. In addition to these known heat-related health threats, in recent years researchers have theorized that hot environmental temperatures and strenuous work may play a role in the development of chronic kidney disease of unknown etiology (CKDu), a disease that strikes young otherwise healthy, agricultural workers, and has been reported in many tropical countries and resulted in tens of thousands of deaths. The burden of chronic kidney disease is growing globally with increasing incidence and prevalence of individuals requiring replacement therapy, with poor outcomes and high cost. Among agricultural workers, it has been hypothesized that heat exposure, dehydration, volume depletion, and the combination of heat and/or other exposures may play a role in the development of decreased renal function. Most of the studies of CKDu have been conducted on agricultural workers in Central America and other countries with rising environmental temperatures. Our current research on physiologic response to heat among agricultural workers in Florida has revealed that ½ of the workers start their workday with concentrated urine, and 3 of them end their workday in this state and that among 192 workers followed over the course of 2-3 workdays, 33% had serum creatinine increases indicative of acute kidney injury (AKI) on at least one workday. The most significant predictor for AKI was increase in heat index. Motivated by these intriguing observations and in alignment with the NIOSH strategic priority to reduce chronic disease in workers, we propose to recruit and study a cohort of 90 Florida agricultural workers over a two year period to examine the inter-relationships between environmental heat exposure, biomarkers of renal function, persistence of AKI and indicators of renal function degradation. Specifically, we aim to: 1) Determine if renal biomarkers, AKI, and sustained decrease in renal function are associated with environmental and exertional heat exposure in heat-exposed agricultural workers over two years; 2) Use non-targeted metabolomic analysis to explore physiologic pathways of AKI and degradation of renal function in agricultural workers; 3) Determine if exposure to pesticides commonly used on Florida crops are independently associated or modify observed changes in renal function, and if these relationships are modified by factors such as smoking and pain medication use; and 4) Using an r2p approach, develop an educational intervention toolkit for workers and other relevant stakeholders (e.g., health care providers and agricultural employers) aimed to promote hydration and healthy renal function. The outputs and outcomes of this study will yield key information on workers physiological response to heat and lead to the development of interventions and policies to protect the long-term health of agricultural workers and other vulnerable populations.

农业工作者是一个占领部门，特别容易受到与热有关的疾病的影响。职业 接触热可以导致伤害，疾病，生产率降低和死亡，这些风险很好 记录在NIOSH优先文件中，有关职业接触热和热环境。此外 对于这些已知的与热有关的健康威胁，近年来，研究人员理论上了炎热的环境 温度和剧烈的工作可能在未知的慢性肾脏疾病的发展中发挥作用 病因（CKDU），这种疾病袭击了年轻的健康，农业工作者，并已报道 许多热带国家，导致成千上万的死亡。慢性肾脏疾病的灼伤是 随着需要替换治疗的个体的发病率和患病率的增加，全球增长， 结果不佳和成本高。在农业工作者中，已经假设热暴露 脱水，体积耗竭以及热量和/或其他暴露的组合可能在 肾功能下降的发展。 CKDU的大多数研究都是在农业上进行的 中美洲和其他国家的工人，环境温度升高。我们目前的研究 关于佛罗里达州农业工人对热量的身体反应，½工人开始 他们用浓缩尿液的工作日，其中3个结束了在这个州的工作日，在192年中 在2-3个工作日的过程中，工人遵循的是33％的血清肌酐增加表明急性 至少一个工作日，肾脏受伤（AKI）。热量指数中最重要的AKI预测指标增加。 这些有趣的观察和与NIOSH战略优先级保持一致的动机，以减少 工人中的慢性病，​​我们建议招募和研究90名佛罗里达农业工人的队列 两年期检查环境热暴露之间的关系，肾脏的生物标志物 功能，AKI的持久性和肾功能降解的指标。具体来说，我们的目的是：1）确定 如果肾脏生物标志物，AKI和肾功能的持续降低与环境和 在两年内，受热农业工人的量热暴露； 2）使用非目标 代谢组分析以探索AKI的生理途径和农业肾功能的降解 工人； 3）确定暴露于佛罗里达农作物上常用的农药是否是独立相关的 或修改观察到的肾功能的变化，如果这些关系是通过因素来修改的 吸烟和使用止痛药； 4）使用R2P方法，开发教育干预工具包 对于工人和其他相关利益相关者（例如医疗保健提供者和农业雇主），旨在 促进水合和健康的肾功能。这项研究的产出和结果将产生关键 有关工人对热量的身体反应的信息，并导致干预措施的发展 保护农业工作者和其他脆弱人群的长期健康的政策。