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      Occupational Heat Stress and Kidney Health: From Farms to Factories

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          Abstract

          Millions of workers around the world are exposed to high temperatures, intense physical activity, and lax labor practices that do not allow for sufficient rehydration breaks. The extent and consequences of heat exposure in different occupational settings, countries, and cultural contexts is not well studied. We conducted an in-depth review to examine the known effects of occupational heat stress on the kidney. We also examined methods of heat-stress assessment, strategies for prevention and mitigation, and the economic consequences of occupational heat stress. Our descriptive review summarizes emerging evidence that extreme occupational heat stress combined with chronic dehydration may contribute to the development of CKD and ultimately kidney failure. Rising global temperatures, coupled with decreasing access to clean drinking water, may exacerbate the effects of heat exposure in both outdoor and indoor workers who are exposed to chronic heat stress and recurrent dehydration. These changes create an urgent need for health researchers and industry to identify work practices that contribute to heat-stress nephropathy, and to test targeted, robust prevention and mitigation strategies. Preventing occupational heat stress presents a great challenge for a concerted multidisciplinary effort from employers, health authorities, engineers, researchers, and governments.

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          Most cited references68

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          Acute kidney injury, mortality, length of stay, and costs in hospitalized patients.

          The marginal effects of acute kidney injury on in-hospital mortality, length of stay (LOS), and costs have not been well described. A consecutive sample of 19,982 adults who were admitted to an urban academic medical center, including 9210 who had two or more serum creatinine (SCr) determinations, was evaluated. The presence and degree of acute kidney injury were assessed using absolute and relative increases from baseline to peak SCr concentration during hospitalization. Large increases in SCr concentration were relatively rare (e.g., >or=2.0 mg/dl in 105 [1%] patients), whereas more modest increases in SCr were common (e.g., >or=0.5 mg/dl in 1237 [13%] patients). Modest changes in SCr were significantly associated with mortality, LOS, and costs, even after adjustment for age, gender, admission International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis, severity of illness (diagnosis-related group weight), and chronic kidney disease. For example, an increase in SCr >or=0.5 mg/dl was associated with a 6.5-fold (95% confidence interval 5.0 to 8.5) increase in the odds of death, a 3.5-d increase in LOS, and nearly 7500 dollars in excess hospital costs. Acute kidney injury is associated with significantly increased mortality, LOS, and costs across a broad spectrum of conditions. Moreover, outcomes are related directly to the severity of acute kidney injury, whether characterized by nominal or percentage changes in serum creatinine.
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            American College of Sports Medicine position stand. Exercise and fluid replacement.

            This Position Stand provides guidance on fluid replacement to sustain appropriate hydration of individuals performing physical activity. The goal of prehydrating is to start the activity euhydrated and with normal plasma electrolyte levels. Prehydrating with beverages, in addition to normal meals and fluid intake, should be initiated when needed at least several hours before the activity to enable fluid absorption and allow urine output to return to normal levels. The goal of drinking during exercise is to prevent excessive (>2% body weight loss from water deficit) dehydration and excessive changes in electrolyte balance to avert compromised performance. Because there is considerable variability in sweating rates and sweat electrolyte content between individuals, customized fluid replacement programs are recommended. Individual sweat rates can be estimated by measuring body weight before and after exercise. During exercise, consuming beverages containing electrolytes and carbohydrates can provide benefits over water alone under certain circumstances. After exercise, the goal is to replace any fluid electrolyte deficit. The speed with which rehydration is needed and the magnitude of fluid electrolyte deficits will determine if an aggressive replacement program is merited.
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              Workplace heat stress, health and productivity – an increasing challenge for low and middle-income countries during climate change

              Background Global climate change is already increasing the average temperature and direct heat exposure in many places around the world. Objectives To assess the potential impact on occupational health and work capacity for people exposed at work to increasing heat due to climate change. Design A brief review of basic thermal physiology mechanisms, occupational heat exposure guidelines and heat exposure changes in selected cities. Results In countries with very hot seasons, workers are already affected by working environments hotter than that with which human physiological mechanisms can cope. To protect workers from excessive heat, a number of heat exposure indices have been developed. One that is commonly used in occupational health is the Wet Bulb Globe Temperature (WBGT). We use WBGT to illustrate assessing the proportion of a working hour during which a worker can sustain work and the proportion of that same working hour that (s)he needs to rest to cool the body down and maintain core body temperature below 38°C. Using this proportion a ‘work capacity’ estimate was calculated for selected heat exposure levels and work intensity levels. The work capacity rapidly reduces as the WBGT exceeds 26–30°C and this can be used to estimate the impact of increasing heat exposure as a result of climate change in tropical countries. Conclusions One result of climate change is a reduced work capacity in heat-exposed jobs and greater difficulty in achieving economic and social development in the countries affected by this somewhat neglected impact of climate change.
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                Author and article information

                Contributors
                Journal
                Kidney Int Rep
                Kidney Int Rep
                Kidney International Reports
                Elsevier
                2468-0249
                31 August 2017
                November 2017
                31 August 2017
                : 2
                : 6
                : 998-1008
                Affiliations
                [1 ]Nephrology Division, Pro-rim Foundation, Joinville, Santa Catarina, Brazil
                [2 ]School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Parana, Brazil
                [3 ]Renal and Metabolic Division, George Institute for Global Health, Sydney, New South Wales, Australia
                [4 ]Division of Nephrology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
                [5 ]Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada
                [6 ]Department of and Epidemiology and Biostatistics, Western University, London, Ontario, Canada
                Author notes
                [] Correspondence: Louise Moist, Schulich School of Medicine, Western University, London Health Sciences Centre, Victoria Hospital, 800 Commissioners Road East, London, Ontario N6A 5W9, Canada.Schulich School of MedicineWestern UniversityLondon Health Sciences CentreVictoria Hospital800 Commissioners Road EastLondonOntario N6A 5W9Canada louise.moist@ 123456lhsc.on.ca
                Article
                S2468-0249(17)30370-4
                10.1016/j.ekir.2017.08.012
                5733743
                29270511
                5571dfd9-a582-4a94-b263-6d5aff2ed8de
                © 2017 International Society of Nephrology. Published by Elsevier Inc.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 30 June 2017
                : 2 August 2017
                : 21 August 2017
                Categories
                Review

                acute kidney injury,chronic kidney disease,chronic kidney disease of unknown etiology,climate change,heat exposure,mesoamerican nephropathy,occupational heat stress

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