University of Massachusetts Lowell, 7 Camden Place, Cambridge, MA 02138, USA.
Scand J Work Environ Health. 2018 Jan 1;44(1):16-24. doi: 10.5271/sjweh.3659. Epub 2017 Jul 7.
Objective The aim of this study was to assess the potential to reduce kidney function damage during the implementation of a water, rest, shade (WRS) and efficiency intervention program among sugarcane workers. Methods A WRS intervention program adapted from the US Occupational Safety and Health Administration (OSHA) coupled with an efficiency program began two months into the 5-month harvest. One of the two groups of workers studied was provided with portable water reservoirs, mobile shaded tents, and scheduled rest periods. Health data (anthropometric and questionnaires), blood, and urine were collected at baseline and at three subsequent times over the course of the harvest. Daily wet bulb globe temperatures (WBGT) were recorded. Results Across a working day there were changes in biomarkers indicating dehydration (urine osmolality) and serum albumin and reduced estimated glomerular filtration rate (eGFR). Cross-shift eGFR decrease was present in both groups; -10.5 mL/min/1.73m2 [95% confidence interval (95% CI) -11.8- -9.1], but smaller for the intervention group after receiving the program. Decreased eGFR over the 5-month harvest was seen in both groups: in the one receiving the intervention -3.4 mL/min/1.73m (95% CI -5.5- -1.3) and in the other -5.3 (95% CI -7.9- -2.7). The decrease appeared to halt after the introduction of the intervention in the group receiving the program. Conclusion A WRS and efficiency intervention program was successfully introduced for workers in sugarcane fields and appears to reduce the impact of heat stress on acute and over-harvest biomarkers of kidney function. Further research is needed to determine whether biomarker changes predict reduced risk of chronic kidney disease in this type of work.
目的 本研究旨在评估在甘蔗工人中实施水、休息、遮荫（WRS）和效率干预计划对减少肾功能损害的潜力。
方法 从美国职业安全与健康管理局（OSHA）改编而来的 WRS 干预计划与效率计划在收获的两个月后开始实施。在研究的两组工人中，一组提供便携式水箱、移动遮阳帐篷和定期休息时间。在收获过程中，在基线和随后的三个时间点收集健康数据（人体测量和问卷调查）、血液和尿液。记录每日湿球黑球温度（WBGT）。
结果 在一个工作日内，有生物标志物变化表明脱水（尿液渗透压）和血清白蛋白减少以及估算肾小球滤过率（eGFR）降低。两组都出现跨班次 eGFR 下降；-10.5 mL/min/1.73m2[95%置信区间（95%CI）-11.8- -9.1]，但接受该计划的干预组较小。在两组中，5 个月的收获期间 eGFR 均下降：接受干预的一组为-3.4 mL/min/1.73m（95%CI-5.5- -1.3），另一组为-5.3（95%CI-7.9- -2.7）。在接受干预的组中引入该计划后，eGFR 的下降似乎停止了。
结论 为甘蔗工人成功引入了 WRS 和效率干预计划，似乎减轻了热应激对肾功能的急性和过度收获生物标志物的影响。需要进一步研究以确定生物标志物变化是否可以预测这种类型工作中慢性肾脏病风险降低。
