Kupferman J, et al. - Researchers performed this cross-sectional study of active sugarcane workers, followed by prospective follow-up of individuals with acute kidney injury (AKI), focusing on the burden and natural history of AKI in workers at risk for Mesoamerican nephropathy (MeN), a form of chronic kidney disease (CKD) of unknown cause in Central America. They found that the development of newly decreased kidney function during the harvest season was commonly seen in a group of sugarcane workers with normal preharvest kidney function. They also documented the establishment of CKD 12 months later in nearly half of those who suffered kidney injury.

Methods

• Researchers performed a cross-sectional study of active sugarcane workers, followed by prospective follow-up of individuals with AKI.
• They examined 326 sugarcane workers with normal preharvest serum creatinine (Scr) values and no history of CKD in an MeN hotspot in Nicaragua near the end of the harvest, and carried out a prospective follow-up of workers with AKI.
• AKI during the harvest, as defined by Scr level increase ≥ 0.3 mg/dL over baseline to a level ≥ 1.3 mg/dL was included as predictor.
• Kidney function trajectory and development of CKD over 12 months were assessed as outcomes.
• Using linear regression models, they determined the link between job category and kidney function.
• They used linear mixed effects to assess the impact of time on Scr level for workers with AKI.

Results

• AKI was found in 34 of 326 participants, with a median late-harvest Scr level of 1.64 mg/dL in the AKI group.
• A median Scr level of 0.88 mg/dL was detected in workers without AKI.
• Among cane cutters vs other field workers, the development of AKI was more commonly reported.
• Variable degrees of kidney function recovery was observed among participants with AKI, with median 6- and 12-month Scr values of 1.25 and 1.27 mg/dL, respectively (P < 0.001 for each follow-up value compared to late-harvest Scr).
• Comparison of workers’ kidney function before the AKI episode to their kidney function at last follow-up revealed development of de novo estimated glomerular filtration rate < 60 mL/min/1.73 m² in 10 participants with AKI and 11 had a >30% decrease in estimated glomerular filtration rate.