{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T20:56:14Z","timestamp":1791924974986,"version":"4.3.4"},"reference-count":42,"publisher":"BMJ","issue":"12","funder":[{"DOI":"10.13039\/100007773","name":"Danone","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007773","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2016,11,17]]},"published-print":{"date-parts":[[2016,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To study Mesoamerican nephropathy (MeN) and its risk factors in three hot occupations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Chinandega and Le\u00f3n municipalities, a MeN hotspot on the Nicaraguan Pacific coast, January\u2013February 2013.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>194 male workers aged 17\u201339\u2005years: 86 sugarcane cutters, 56 construction workers, 52 small-scale farmers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>\n                      (1) Differences between the three occupational groups in prevalences\/levels of socioeconomic, occupational, lifestyle and health risk factors for chronic kidney disease (CKD) and in biomarkers of kidney function and hydration; (2) differences in prevalences\/levels of CKD risk factors between workers with reduced estimated glomerular filtration rate (eGFR\n                      <jats:sub>CKD-EPI<\/jats:sub>\n                      &lt;80\u2005mL\/min\/1.73\u2005m\n                      <jats:sup>2<\/jats:sup>\n                      ) and workers with normal kidney function (eGFR\n                      <jats:sub>CKD-EPI<\/jats:sub>\n                      \u226580\u2005mL\/min\/1.73\u2005m\n                      <jats:sup>2<\/jats:sup>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Sugarcane cutters were more exposed to heat and consumed more fluid on workdays and had less obesity, lower blood sugar, lower blood pressure and a better lipid profile. Reduced eGFR occurred in 16%, 9% and 2% of sugarcane cutters, construction workers and farmers, respectively (trend cane &gt; construction &gt; farming, p=0.003). Significant trends (cane &gt; construction &gt; farming) were also observed for high serum urea nitrogen (blood urea nitrogen (BUN) &gt;20\u2005mg\/dL), high serum creatinine (SCr &gt;1.2\u2005mg\/dL), low urinary pH (\u22645.5) and high BUN\/SCr ratio (&gt;20) but not for high urinary specific gravity (\u22651.030). Sugarcane cutters also more often had proteinuria and blood and leucocytes in the urine. Workers with eGFR &lt;80\u2005mL\/min\/1.73\u2005m\n                      <jats:sup>2<\/jats:sup>\n                      reported a higher intake of water and lower intake of sugary beverages. Serum uric acid levels related strongly and inversely to eGFR levels (adj \u03b2 \u221210.4\u2005mL\/min\/1.73\u2005m\n                      <jats:sup>2<\/jats:sup>\n                      , 95% CI \u221212.2 to \u22128.5, p&lt;0.001). No associations were observed for other metabolic risk factors, pesticides, non-steroidal anti-inflammatory drugs or alcohol. Among cane cutters, consumption of electrolyte hydration solution appeared preventive (adj \u03b2 8.1\u2005mL\/min\/1.73\u2005m\n                      <jats:sup>2<\/jats:sup>\n                      , p=0.09).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Heat stress, dehydration and kidney dysfunction were most common among sugarcane cutters. Kidney dysfunction also occurred to a lesser extent among construction workers, but hardly at all among small-scale farmers. High serum uric acid was associated with reduced kidney function.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2016-011034","type":"journal-article","created":{"date-parts":[[2016,12,8]],"date-time":"2016-12-08T22:15:20Z","timestamp":1481235320000},"page":"e011034","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":146,"title":["Heat stress, hydration and uric acid: a cross-sectional study in workers of three occupations in a hotspot of Mesoamerican nephropathy in Nicaragua"],"prefix":"10.1136","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5523-9981","authenticated-orcid":false,"given":"Catharina","family":"Wesseling","sequence":"first","affiliation":[{"name":"Unit of Occupational Medicine, Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, 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