Diagnostic Accuracy of Thermal, Hydration, and Heart Rate Assessments in Discriminating Positive Acute Kidney Injury Risk Following Physical Work in the Heat

Details

• Personal Author:
  Chapman CL ; Hostler DP ; Johnson BD ; Schlader ZJ
• Description:
  Occupational heat stress increases the risk of acute kidney injury (AKI). This study presents a secondary analysis to generate novel hypotheses for future studies by investigating the diagnostic accuracy of thermal, hydration, and heart rate assessments in discriminating positive AKI risk following physical work in the heat in unacclimatized individuals. Unacclimatized participants (n = 13, 3 women, age: approx. 23 years) completed four trials involving 2 h of exercise in a 39.7 +/- 0.6 degrees C, 32 +/- 3% relative humidity environment that differed by experimental manipulation of hyperthermia (i.e., cooling intervention) and dehydration (i.e., water drinking). Diagnostic accuracy was assessed via receiver operating characteristic curve analysis. Positive AKI risk was identified when the product of concentrations insulin-like growth factor binding protein 7 and tissue inhibitor of metalloproteinase-2 [IGFBP7·TIMP-2] exceeded 0.3 (ng·mL-1)2·1000-1. Peak absolute core temperature had the acceptable discriminatory ability (AUC = 0.71, p = 0.009), but a relatively large variance (AUC 95% CI: 0.57-0.86). Mean body temperature, urine specific gravity, urine osmolality, peak heart rate, and the peak percent of both maximum heart rate and heart rate reserve had poor discrimination (AUC = 0.66-0.69, p ≤ 0.051). Mean skin temperature, percent change in body mass and plasma volume, and serum sodium and osmolality had no discrimination (p ≥ 0.072). A peak increase in mean skin temperature of >4.7 degrees C had a positive likelihood ratio of 11.0 which suggests clinical significance. These data suggest that the absolute value of peak core temperature and the increase in mean skin temperature may be valuable to pursue in future studies as a biomarker for AKI risk in unacclimatized workers. [Description provided by NIOSH]
• Subjects:
  Biomarkers Cardiovascular System Heat Stress Disorders Hot Temperature Occupational Health Safety
• Keywords:
  AKI Biomarker Author Keywords: Exercise Body Temperature Dehydration Drinking Water Heart Rate Heat Strain Heat Stress Hot Environments Hypohydration Kidneys

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• ISSN:
  1545-9624
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Indiana ; Massachusetts ; New York ; OSHA Region 1 ; OSHA Region 2 ; OSHA Region 4 ; OSHA Region 5 ; Tennessee
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  326-341
• Volume:
  21
• Issue:
  5
• NIOSHTIC Number:
  nn:20069401
• Citation:
  J Occup Environ Hyg 2024 May; 21(5):326-341
• Contact Point Address:
  Zachary J. Schlader, Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN
• Email:
  zschlade@iu.edu
• Federal Fiscal Year:
  2024
• Performing Organization:
  Indiana University, Bloomington
• Peer Reviewed:
  True
• Start Date:
  20190901
• Source Full Name:
  Journal of Occupational and Environmental Hygiene
• End Date:
  20240831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:1ca8e138588b6d6f98c86fe9e7cb081f830c172c43c3bee055b085c7132d342d561b23ba46bbe2dba640803238bf4500bffb839f500a3956b0fdebd92a4c9ba7
• Download URL:
  https://stacks.cdc.gov/view/cdc/207886/cdc_207886_DS1.pdf
• File Type:
  [PDF - 2.83 MB ]