Creatinine Fluctuations Forecast Cross-Harvest Kidney Function Decline Among Sugarcane Workers in Guatemala

Miranda Dally; Jaime Butler-Dawson; Richard J Johnson; Lyndsay Krisher; Diana Jaramillo; Kira L Newman; Lee S Newman

doi:10.1016/j.ekir.2020.06.032

Creatinine Fluctuations Forecast Cross-Harvest Kidney Function Decline Among Sugarcane Workers in Guatemala

Kidney Int Rep. 2020 Jul 12;5(9):1558-1566. doi: 10.1016/j.ekir.2020.06.032. eCollection 2020 Sep.

Authors

Miranda Dally^{1

2}, Jaime Butler-Dawson^{1

2}, Richard J Johnson³, Lyndsay Krisher^{1

2}, Diana Jaramillo¹, Kira L Newman⁴, Lee S Newman^{1

2

5

6}

Affiliations

¹ Center for Health, Work, & Environment, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
² Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
³ Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
⁴ Internal Medicine Residency Program, University of Washington, Seattle, Washington, USA.
⁵ Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
⁶ Division of Pulmonary Sciences and Critical Care Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.

Abstract

Background: Chronic kidney disease of unknown origin (CKDu) is an epidemic that disproportionately affects young agriculture workers in hot regions. It has been hypothesized that repeated acute kidney injury (AKI) may play a role in the development of disease.

Methods: Latent class mixed models were used to identify groups of Guatemalan sugarcane harvesters based on their daily changes in creatinine over 6 consecutive days in 2018. Exponential smoothing state space models were used to forecast end-of-season creatinine between the identified groups. Percent change in estimated glomerular filtration rate (eGFR) across the harvest was compared between groups.

Results: Twenty-nine percent (n = 30) of the 103 workers experienced repeated severe fluctuations in creatinine across shift. The model with multiplicative error, multiplicative trend, and multiplicative seasonality was able to accurately forecast end-of-season creatinine in the severe group (mean percentage error [MPE]: -4.7%). eGFR of workers in the severe group on average decreased 20% across season compared to 11% decline for those in the moderate group (95% confidence interval for difference: -17% to 0%).

Conclusions: Daily fluctuations in creatinine can be used to forecast end-of-season creatinine in sugarcane harvesters. Workers who experience repeat severe daily fluctuations in creatinine, on average, experience a greater reduction in kidney function across the season.

Keywords: AKI; agricultural workers; chronic kidney disease of unknown origin; forecasting; kidney function decline; occupational health.

Abstract

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