Introduction
More than 1 in 7 adults are estimated to have chronic kidney disease in the United States, but 90% are unaware that they have it. Chronic kidney disease (CKD) occurs when your kidneys are damaged and cannot properly function anymore. The kidneys are responsible for filtering waste from the blood, and CKU can increase the risk for other serious health issues. Conditions such as diabetes and hypertension can contribute to the development of chronic kidney disease. However, oftentimes, it is the result of a combination of physical, environmental, and social factors. CKD is more prevalent in people over the age of 65 and Black adults. Due to occupational exposures, CKD rates are also disproportionately high in farmworkers.
Stages of Chronic Kidney Disease
CKD is progressive condition broken down into five stages. The stages represent how well your kidneys are functioning based on estimated glomerular filtration rate (eGFR), which is the amount of the waste product creatinine present in the blood. A lower eGFR indicates poor kidney function. In the first three stages, the kidneys are still able to filter blood, while in the last two stages, the kidneys are severely damaged and may stop working altogether. Understanding the stages of CKD is important to understanding the extent of the damage and what steps are needed to stop the progression of the disease.
CKD in Farmworkers
An article from Renal Therapy examined several studies from Central America and South Asia regarding the prevalence of CKD in farmworkers. Alarmingly, they found an abnormally high prevalence of CKD in young and middle-aged men that work in the agriculture sector. Researchers could not attribute this to traditional risk factors like diabetes or hypertension, indicating that other factors may be at play.
One study published in Environmental Research examined the kidney function of migrant farmworkers in Northwestern Mexico. Using office workers as a control, the researchers found three major risk factors impacting the farmworkers. They compared eGFR for farmworkers in traditional fields versus those working in organic fields. The eGFR was significantly lower for those working in traditional fields, suggesting an association between pesticide exposure and kidney function. Comparing office workers and farmworkers, they found that heat strain also led to lower eGFR. Dehydration was another factor that led to decreased eGFR.
Another study from The American Journal of Medicine looked at the risk of kidney disease in agricultural communities in the Great Plains in the United States. The United States Renal Data System has already shown that pesticide exposure is associated with end-stage renal disease. Looking more specifically, the researchers considered the presence of glyphosate in water systems. Beyond exposure from working on farms, anyone living in agricultural communities may face a higher risk of chronic kidney disease.
Impacts of Climate Change
Climate change is contributing to a growing number of extreme weather events around the world. Earth’s temperature has been increasing three times faster than normal since 1982 and 2023 was the warmest year on record. The American Society of Nephrology has issued a statement warning healthcare professionals to take action due to the threat climate change poses to increasing chronic kidney disease rates. With rising temperatures, farmworkers are more likely to face heat strain and dehydration, negatively impacting their kidney function. According to a study from the New England Journal of Medicine, heat stress can impact the kidneys in several ways. Dehydration can increase the reabsorption of toxins and heat stroke can cause acute kidney injury. These factors can also cause the activation of enzymes like aldol reductase which are harmful to the kidneys. As the effects of climate change worsen, it is even more pressing that we address how this endangers farmworkers.
Reducing Risk to Farmworkers
Addressing chronic kidney disease in farmworkers requires targeted prevention efforts to decrease the risk of developing the condition. A study in Occupational and Environmental Medicine assessed the impacts of improving working conditions for sugarcane workers in Nicaragua. The researchers measured eGFR before and after the implementation of these improvements and found promising results. The intervention included several types of changes. Rest was one focus, with the recommendation of 20 more minutes of rest per day, evenly distributing breaks, and allowing for earlier breaks. They also recommended rotating shade tents with the movement of the sun, increasing the number of tents and improving distribution of electrolyte fluid bags. Implementing such interventions in more settings could drastically improve the health of farmworkers around the world.
Conclusion
Chronic kidney disease is a serious condition that can lead to numerous other health problems. Environmental factors play a major role in the development of chronic kidney disease. Farmworkers are particularly susceptible due to pesticide exposure, stress and heat exposure, especially as climate change worsens. Mitigating their risk through interventions like increased breaks and improved electrolyte solution distribution is imperative to improving the health of farmworkers. The rights of migrant farmworkers are often overlooked, but their occupational risk is severe and needs to be addressed.