Occupational Heat Stress and Chronic Kidney Disease of Uncertain Etiology: An Emerging Public Health Crisis in the Outdoor Workforce

Abstract

Chronic kidney disease of unknown cause (CKDu) is now considered an important occupational and public health problem. It affects predominantly outdoor workers in agriculture, construction, and industries. Whereas typical cases of CKD are usually caused by diabetes and/or hypertension, recent studies have linked CKDu to repeated occupational heat stress, dehydration, and nephrotoxicity in hot work environments. This review incorporates relevant literature on the subject to demonstrate the possible pathways through which chronic heat exposure can lead to renal damage. These pathways include repetitive acute subclinical injury to the kidneys from dehydration and hyperthermia; fructokinase pathway activation from dehydration; oxidative stress pathways; and nephrotoxic effects due to co-exposure to agrochemicals and heavy metals. Considerations regarding occupational health practice are discussed. The rising temperatures due to climate change make heat-related disorders common not just in outdoor occupations but in most industries. Thus, CKDu is a preventable occupational disorder that warrants the attention of environmental health experts, policymakers, and employers.