{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T05:41:52Z","timestamp":1793166112864,"version":"4.5.0"},"reference-count":33,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T00:00:00Z","timestamp":1754956800000},"content-version":"unspecified","delay-in-days":72,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000001","name":"National Science Foundation","doi-asserted-by":"publisher","award":["2017885"],"award-info":[{"award-number":["2017885"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]},{"name":"German Investment Corporation","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"German Ministry of Economic Development and Cooperation","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"University of Gothenburg, Sweden","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"DOI":"10.13039\/501100006636","name":"Swedish Research Council for Health, Working Life and Welfare","doi-asserted-by":"crossref","award":["2019-01548"],"award-info":[{"award-number":["2019-01548"]}],"id":[{"id":"10.13039\/501100006636","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Lunds University Hospital","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"DOI":"10.13039\/100019774","name":"Belmont Forum","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100019774","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000192","name":"National Oceanic and Atmospheric Administration","doi-asserted-by":"publisher","award":["2017885"],"award-info":[{"award-number":["2017885"]}],"id":[{"id":"10.13039\/100000192","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004343","name":"Stavros Niarchos Foundation","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100004343","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000270","name":"Natural Environment Research Council","doi-asserted-by":"publisher","award":["NE\/T013702\/1"],"award-info":[{"award-number":["NE\/T013702\/1"]}],"id":[{"id":"10.13039\/501100000270","id-type":"DOI","asserted-by":"publisher"}]},{"name":"ENBEL","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"La Isla Network","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Occup Environ Med"],"accepted":{"date-parts":[[2025,7,26]]},"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To study the effect of a progressively enhanced rest\u2013shade\u2013hydration\u2013hygiene (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).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We analysed serum creatinine and C-reactive protein (CRP) and leukocyturia from samples obtained before and at the end of four harvest seasons (H1\u20134). An increase in creatinine\u22650.30\u2009mg\/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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>1044 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&lt;0.01), AKI (20\/1000 worker-months to 8\/1000 worker-months, p&lt;0.01) and end-harvest leukocyturia (26% to 1%, p&lt;0.01), and less rise in cross-harvest CRP (median 1.75-fold increase in H1 to 1.00 in H4, p&lt;0.01).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Kidney 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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/oemed-2025-110128","type":"journal-article","created":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T07:35:27Z","timestamp":1755070527000},"page":"270-277","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Rest, shade, hydration and hygiene for the prevention of kidney injuries and inflammation in a Nicaraguan sugarcane worker cohort"],"prefix":"10.1136","volume":"82","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9779-6820","authenticated-orcid":false,"given":"Erik","family":"Hansson","sequence":"first","affiliation":[{"name":"La Isla Network, Washington, District of Columbia, USA"},{"name":"School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Glaser","sequence":"additional","affiliation":[{"name":"La Isla Network, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilana","family":"Weiss","sequence":"additional","affiliation":[{"name":"La Isla Network, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esteban","family":"Arias-Monge","sequence":"additional","affiliation":[{"name":"La Isla Network, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2582-7878","authenticated-orcid":false,"given":"Felipe","family":"Pacheco-Zenteno","sequence":"additional","affiliation":[{"name":"La Isla Network, Washington, District of Columbia, USA"},{"name":"School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3297-9447","authenticated-orcid":false,"given":"Nathan H","family":"Raines","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Silva-Pe\u00f1aherrera","sequence":"additional","affiliation":[{"name":"La Isla Network, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Vasquez","sequence":"additional","affiliation":[{"name":"La Isla Network, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoey E","family":"Castell\u00f3n","sequence":"additional","affiliation":[{"name":"La Isla Network, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scarlette","family":"Poveda","sequence":"additional","affiliation":[{"name":"La Isla Network, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatima I","family":"Cerda-Granados","sequence":"additional","affiliation":[{"name":"La Isla Network, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Martinez-Cuadra","sequence":"additional","affiliation":[{"name":"La Isla Network, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis","family":"Chavarria","sequence":"additional","affiliation":[{"name":"Occupational Health Management, Ingenio San Antonio\/Nicaragua Sugar Estates Limited, Chichigalpa, Nicaragua"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebekah A I","family":"Lucas","sequence":"additional","affiliation":[{"name":"La Isla Network, Washington, District of Columbia, USA"},{"name":"School of Sport Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulf","family":"Ekstr\u00f6m","sequence":"additional","affiliation":[{"name":"La Isla Network, Washington, District of Columbia, USA"},{"name":"Department of Laboratory Medicine, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina","family":"Jakobsson","sequence":"additional","affiliation":[{"name":"La Isla Network, Washington, District of Columbia, USA"},{"name":"School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catharina","family":"Wesseling","sequence":"additional","affiliation":[{"name":"La 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study of chronic kidney disease in five Mesoamerican countries: associations with crop and heat","volume":"21","author":"Hansson","year":"2021","journal-title":"BMC Public Health"},{"key":"2025082506550700000_82.6.270.3","doi-asserted-by":"publisher","DOI":"10.1177\/21650799241235410"},{"key":"2025082506550700000_82.6.270.4","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2018.04.014"},{"key":"2025082506550700000_82.6.270.5","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.4269\/ajtmh.17-0260","article-title":"Clinical Evidence of Acute Mesoamerican Nephropathy","volume":"97","author":"Fischer","year":"2017","journal-title":"Am J Trop Med 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biomarkers for prediction of kidney function trajectory among sugarcane cutters: a comparative test accuracy study","volume":"12","author":"Hansson","year":"2022","journal-title":"BMJ Open"},{"key":"2025082506550700000_82.6.270.11","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1097\/JOM.0000000000001529","article-title":"Risk Factors and Mechanisms Underlying Cross-Shift Decline in Kidney Function in Guatemalan Sugarcane Workers","volume":"61","author":"Sorensen","year":"2019","journal-title":"J Occup Environ Med"},{"key":"2025082506550700000_82.6.270.12","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph19073779","article-title":"Workplace Intervention for Heat Stress: Essential Elements of Design, Implementation, and Assessment","volume":"19","author":"Glaser","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"2025082506550700000_82.6.270.13","doi-asserted-by":"crossref","first-page":"16","DOI":"10.5271\/sjweh.3659","article-title":"Intervention to 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KDIGO clinical practice guideline for acute kidney injury. 2012. Available: https:\/\/kdigo.org\/wp-content\/uploads\/2016\/10\/KDIGO-2012-AKI-Guideline-English.pdf"},{"key":"2025082506550700000_82.6.270.15","doi-asserted-by":"crossref","first-page":"43","DOI":"10.5271\/sjweh.4057","article-title":"Targeting workload to ameliorate risk of heat stress in industrial sugarcane workers","volume":"49","author":"Lucas","year":"2023","journal-title":"Scand J Work Environ Health"},{"key":"2025082506550700000_82.6.270.16","unstructured":"McClean MD , Laws RL , Ramirez Rubio O , et al . Industrial Hygiene\/Occupational Health Assessment: Evaluating Potential Hazards Associated with Chemicals and Work Practices at the Ingenio San Antonio. 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A measure of the return on ingenio san antonio\u2019s investment in the adelante initiative: an initial estimate of costs and benefits of a water, rest and shade intervention. La Isla Network; 2020. Available: https:\/\/repositories.lib.utexas.edu\/items\/7363a371-444e-4ce1-8ca9-16460c7c4308"},{"key":"2025082506550700000_82.6.270.31","unstructured":"Pan American Health Organization . 52nd Directing Council: Chronic Kidney Disease in Agricultural Communities in Central America. Washington, DC, USA, 2013. 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