Is Climate Change Responsible For The Increase In Chronic Kidney Disease Among Agricultural Workers? 1

Over recent years, there has been a distinct rise in cases of Chronic Kidney Disease (CKD) among agricultural workers, originating in several countries across the world. The disease has killed tens of thousands of these agricultural workers. An article published in the New England Journal of Medicine found that the rising temperatures, attributed to climate change, are a contributing factor to the increase in reports of CKD.

In 2002, a study in El Salvador reported the escalation of CKD across Central America. In the following years, various studies conducted in Central America found similar results, reporting above-average rates of CKD among sugarcane workers and other agriculture laborers. As of 2017, CKD is now the second leading cause of death in both El Salvador and Nicaragua.

Surprisingly, the same 2002 study found that these particular cases of CKD were not caused by any of the characteristic preconditions of the disease, such as diabetes or hypertension. The authors of the article published in the New England Journal of Medicine noted, “One striking finding is that the regions in which chronic kidney disease has been reported tend to be the hottest regions in the various countries.” Agricultural laborers, who often work in 40-degree heat, are particularity susceptible to dehydration and heatstroke, which are directly linked to acute kidney injury and the development of chronic kidney failure. A study found that in a single work shift, sugarcane workers had a mean weight loss of 2.6 kg as a result of dehydration.

Intraregional findings from the article further solidified the correlation between heat exposure and kidney failure. Interestingly enough, agricultural practices specialized at sea level tend to be concentrated zones of CKD due to the higher temperatures associated with this altitude. On the other hand, those practices found at high altitudes, such as coffee plantations, are significantly less vulnerable to CKD because of low environmental heat pressures.

In Central America, policies have been introduced that reduce heat exposure and encourage hydration with water and electrolytes. The World Health and Efficiency Program enforced a hydration and shade intervention comprised of various prevention methods which require frequent breaks and the provision of tents at work sites. While these programs of prevention have made minor improvements in mitigating CKD, they have by no means nullified the threat of the disease. Remedial measures have yet to be implemented for those already suffering from CKD, who face the challenge of seeking medical treatment for their condition. It is seemingly an impossible feat for those coming from low-income families and resource-poor communities to receive frequent dialysis treatments or obtain transplants.

CKD is one of many diseases that will be worsened as a result of climate change. Acute kidney injury has already made the journey northward, becoming apparent in places like Florida and California. Because this epidemic is being exacerbated by climate change, an effective remedy would be to limit the harmful human activities causing this global phenomenon. But, on a micro-scale, physicians and law-makers are grappling with mending this by-product of climate change and implementing mechanisms of prevention. Cecilia Sorensen, MD, of the Colorado School of Public Health and the University of Colorado School of Medicine says, “If we are to address both the CKD and other climate-related diseases, we will have to integrate environmental information into clinical and public health practice and build robust early-warning systems focused on vulnerable communities and climate-sensitive diseases…so we can respond rapidly.”