• Joseph Kupferman, Oriana Ramírez-Rubio, Juan José Amador, Damaris López-Pilarte, Elissa H Wilker, Rebecca L Laws, Caryn Sennett, Ninoska Violeta Robles, Jorge Luis Lau, Alejandro José Salinas, James S Kaufman, Daniel E Weiner, Madeleine K Scammell, Michael D McClean, Daniel R Brooks, and David J Friedman.
• Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
• Am. J. Kidney Dis. 2018 Oct 1; 72 (4): 475-482.

Rationale & ObjectiveMesoamerican nephropathy (MeN), a form of chronic kidney disease (CKD) of unknown cause in Central America, affects young individuals working in physically strenuous occupations. Repeated episodes of work-related kidney injury may lead to CKD in this setting. We aimed to better understand the burden and natural history of acute kidney injury (AKI) in workers at risk for MeN.Study DesignCross-sectional study of active sugarcane workers, followed by prospective follow-up of individuals with AKI.Setting & Participants326 sugarcane workers with normal preharvest serum creatinine (Scr) values and no history of CKD in an MeN hotspot in Nicaragua near the end of the harvest, and prospective follow-up of workers with AKI.PredictorAKI during the harvest, as defined by Scr level increase ≥ 0.3mg/dL over baseline to a level ≥ 1.3mg/dL.OutcomesKidney function trajectory and development of CKD over 12 months.Analytical ApproachLinear regression models were used to analyze the association between job category and kidney function. For workers with AKI, the effect of time on Scr level was evaluated using linear mixed effects.Results34 of 326 participants were found to have AKI, with a median late-harvest Scr level of 1.64mg/dL in the AKI group. Workers without AKI had a median Scr level of 0.88mg/dL. AKI was more common among cane cutters compared with other field workers. Participants with AKI had variable degrees of kidney function recovery, with median 6- and 12-month Scr values of 1.25 and 1.27mg/dL, respectively (P < 0.001 for each follow-up value compared to late-harvest Scr). When we compared workers' kidney function before the AKI episode to their kidney function at last follow-up, 10 participants with AKI developed de novo estimated glomerular filtration rate < 60mL/min/1.73m2 and 11 had a >30% decrease in estimated glomerular filtration rate.LimitationsFollow-up limited to 1 year and some loss to follow-up in the prospective component of the study. Broad definition of AKI that includes both acute and subacute kidney injury.ConclusionsIn a group of sugarcane workers with normal preharvest kidney function, newly decreased kidney function developing during the harvest season was common. Of those with kidney injury, nearly half had established CKD 12 months later.Copyright © 2018 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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