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Manual harvesting of sugarcane is preceded by burning the fields to remove dead foliage and facilitate cutting. Silica is an abundant mineral that may exist in different forms in soil and can accumulate in sugarcane plants. Recent research suggests that occupational exposure to respirable silica increases the risk for traditional CKD and targets proximal tubular cells. There is a need to identify and characterize potentially preventable nephrotoxic exposures that may put workers at risk for the development of CKDu.
Due to their high metabolic function, the tubules are especially sensitive to PM 2.5, heavy metals, and other toxicants. These particles can pass through the glomeruli into the urine with reabsorption into renal tubular cells. Although mechanisms underlying the relationship of PM exposure and kidney dysfunction are not clear, it is known that particles less than 10 microns and, in particular ultrafine particles, can penetrate the pulmonary region of the lungs and enter the circulatory system. A few recent studies in United States veteran and Medicare populations have found that ambient PM with a ≤2.5 µm (PM 2.5) diameter concentration is associated with a higher risk of declining kidney function, incident CKD, and end stage renal disease. However, little is known about the deleterious effects of PM exposure on the kidney. To date, the existing studies assessing the impacts of PM exposure have focused on respiratory impacts and cardiovascular disease. There are limited data related to particulate matter (PM) exposure and attendant health impacts among sugarcane workers. There is an urgent need to address the causes and propose improvements in workplace and environmental conditions to benefit this vulnerable working population. Proposed contributing environmental exposures that have not been thoroughly examined include air pollutants, heavy metals, and agrochemicals. Studies suggest that recurrent dehydration, exposure to high temperatures, and physically demanding working conditions contribute to CKDu risk. It principally affects men aged between their 20s and 40s, and results in chronic tubulointerstitial nephritis. In Central America, CKDu (also referred to as Mesoamerican nephropathy) has been predominantly identified among sugarcane workers and is estimated to have caused over 20,000 deaths in the last 10 years. The etiology remains uncertain the disease is not related to traditional risk factors such as diabetes, hypertension, aging, or glomerular disease. Future studies should investigate the potential role of silica, heavy metals, and agrochemicals in the etiology of chronic kidney disease in this population.Īgricultural workers across the world experience a disproportionate burden of chronic kidney disease of unknown origin (CKDu). Conclusion: Sugarcane workers are exposed to high concentrations of particulate matter. Glyphosate was not detectable in analyzed air samples but was detectable at concentrations ranging from 81–165 ppb in soil samples. Concentrations of aluminum and calcium ranged from 2–7 μg/m 3. Putatively, the silica was in the amorphous form. The amount of crystalline silica was below 5 μg, yet the percentage of total silica was ~17% by weight. The elemental composition of particles was largely silicon. Results: The average mass concentration for particulate matter (PM) 2.5 and PM 100 exposures were 360 µg/m 3 (range: 32 to 1500 µg/m 3) and 555 µg/m 3 (range: 229 to 1170 µg/m 3), respectively. Methods: Air, soil, and ash samples were collected and analyzed using scanning electron microscopy, X-ray diffraction, inductively coupled plasma mass spectrometry, and an enzyme-linked immunosorbent assay. We conducted a pilot study among worker proxies in Guatemala to characterize exposures to particulate matter, silica, heavy metals, and glyphosate, as well as to examine potential nephrotoxic exposures. Background: Sugarcane workers in Central America experience a heavy burden of chronic kidney disease of unknown origin.