Chronic kidney disease of undetermined etiology (CKDu) has emerged as a top health concern for agricultural workers in hot climate zones. The disorder has primarily been found in coastal areas of Central America among sugar cane workers, but a recent review surveyed CKDu globally and found that CKDu is present among workers in other tropical zones of the world including Sri Lanka, Tunisia, India, and Egypt.
The etiology is unknown, but the leading hypothesis is that workers in hot climates are subject to repeated heat stress and dehydration from physical exertion in the daytime heat, potentially exacerbated by inadequate fluid replacement. Each such episode of heat stress and dehydration can cause acute kidney injury (AKI) lasting up to 3 days. Repetitive AKI is then hypothesized to manifest as nephropathy affecting the glomeruli and renal tubules, terminating in chronic renal insufficiency and CKD. The disease might also be multifactorial with additional factors such as herbicide and pesticide exposure playing a role.
This research team will study and improve a large, statewide infrastructure that includes electronic health record (EHR) and administrative claims data to assess the incidence and prevalence of CKDu in Florida. The overall goals are to create a component of the data infrastructure that is focused on agricultural worker surveillance and then to use that component to study CKDu in Florida.