Hyperthermia Predicts Cross-Shift Acute Kidney Injury Risk in Construction Workers

Details

• Journal Article:
  Kidney International Reports
• Personal Author:
  Tourula, Erica ; Specht, Jonathan W. ; Hite, M. Jo ; Walker, Charlie ; Garcia, Serena A. ; Khandpekar, Omkar M. ; Yoder, Hilary A. ; Zoh, Roger S. ; Johnson, Blair D. ; Wegman, David H. ; Glaser, Jason ; Amorim, Fabiano T. ; Schlader, Zachary J.
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• Description:
  Up to 70% of the global workforce is regularly exposed to excessive heat. The resulting occupational heat stress increases the likelihood of elevations in core temperature (i.e., hyperthermia) that in turn, elevate the risk of heat-related injuries and illnesses. This now includes chronic kidney disease (CKD), where cases do not present with typical risk factors (e.g., obesity, diabetes, hypertension, etc.), and is therefore termed CKD of nontraditional causes. Although the etiology of CKD of nontraditional causes is not fully understood, rodent models suggest that single or repeated hyperthermia exposures can cause acute kidney injury (AKI) that, over time, can progress to CKD. This is supported by observations that workers at high risk for CKD of nontraditional causes (e.g., sugarcane workers) frequently encounter occupational heat stress and also exhibit high rates of hospital admission for AKI. Clinical, laboratory-based studies simulating occupational heat stress have demonstrated that AKI risk, estimated from the product of urinary insulin-like growth factor-binding protein 7 (IGFBP7) and tissue inhibitor of metalloproteinases-2 (TIMP-2), IGFBP7*TIMP-2, a US Food and Drug Administration-approved biomarker for assessing the risk for AKI, is elevated in a hyperthermia-dependent manner. This AKI risk is further elevated by the presence of dehydration, which is common during occupational heat stress because of insufficient fluid intake to offset body water losses due to sweating. Although in agriculture workers hyperthermia and dehydration have been shown to increase the likelihood of AKI (determined via cross-shift changes in serum creatinine), whether the laboratory-based observations of urinary IGFBP7*TIMP-2, which avoids some of the limitations associated with using changes in serum creatinine to define AKI during occupational heat stress, translate to the field setting is unknown. Likely because of frequent and simultaneous exposures to both excessive environmental heat and heavy work construction workers are the largest employment sector frequently exposed to occupational heat stress in the US, and the construction sector accounts for the highest number of occupational heat-related hospitalized AKI events. Data from 1 study of Saudi Arabian residential construction workers indicate that 18% of workers suffered kidney injury (as measured by an albumin-to-creatinine ratio > 30 mg/g) across the hot summer months. Despite this background, the role of hyperthermia and dehydration exposure in the development of AKI risk (i.e., cross-shift urinary IGFBP7*TIMP-2) in construction workers is unknown. Therefore, we tested the hypothesis that during the summer in the Midwest and Southwest regions of the US, cross-work shift AKI risk is predicted by hyperthermia and dehydration. Description provided by NIOSH
• Subjects:
  • Construction
  • Hot Temperature
  • Heat Stress Disorders
  • Kidney
  • Occupational Health
  • Safety
• Keywords:
  • Heat exposure
  • Heat stress
  • Dehydration
  • Kidney disorders
  • Outdoor workers
  • Hot environments
  • Hyperthermia
  • Construction workers
  • Author Keywords: acute kidney injury
  • dehydration
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• ISSN:
  2468-0249
• Document Type:
  Text
• Funding:
  Cooperative Agreement
• Genre:
  Journal Article
• Place as Subject:
  Boston Region OSHA ; Chicago Region OSHA ; Dallas Region OSHA ; District of Columbia ; Indiana ; Massachusetts ; New Mexico ; Philadelphia Region OSHA
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  4 pdf pages
• Volume:
  10
• Issue:
  8
• NIOSHTIC Number:
  nn:20071805
• Citation:
  Kidney Int Rep 2025 Aug; 10(8):2856-2859
• Contact Point Address:
  Zachary J. Schlader, Department of Kinesiology, Indiana University School of Public Health, 1025 E. Seventh St., Ste 112, Bloomington, Indiana 47405, USA
• Email:
  zschlade@iu.edu
• Federal Fiscal Year:
  2025
• Performing Organization:
  Indiana University, Bloomington
• Peer Reviewed:
  True
• Start Date:
  2019/09/01
• End Date:
  2024/08/31
• Download URL:
  https://stacks.cdc.gov/view/cdc/260029/cdc_260029_DS1.pdf
• File Type:
  [PDF - 735.62 KB]
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:05768db29751f3276c8d577f5e12df0f4886f5d7bc21291e041b37e718e6dbc5f0a0aea801381d539f8dd7973af2e02d648c4ca36d09efd7a5bc3a175bf34242