Examining the evidence: occupational heat stress contributes to chronic kidney disease

26th March 2020

Earlier this year, the Pan-American Health Organization (PAHO) backed a  report that examines the epidemic of chronic kidney disease as non-traditional origin in Nicaragua, El Salvador, Costa Rica and Guatemala. Chronic kidney disease has been reported on sugarcane farms as well as cotton, corn and rice farms. The highest risk is in sugarcane, specifically for the cutters of burned and seed cane.

The report proposes the existing evidence is enough to consider CKDnt is an occupational disease driven by work-related heat stress that warrants immediate preventive action – especially in the view of climate change.

Key findings from the report

  • Cane cutting in industrial agriculture requires unusually high physical exertion, 6-7 days a week over a 5-6 months harvest period. It is described as well above what military personnel experience during multi-day operations.
  • The start of the harvest, when workers acclimatise to physically demanding work, was associated with the biggest differences in hydration levels and kidney function.
  • Heat stress resulting from a combination of metabolic and external heat has emerged as a major risk for CKDnt from a range of studies.
  • Smallholder farmers have more control over their working conditions than labourers and are less at risk for disease.
  • The evidence for occupational heat stress is strong enough to require primary prevention.
  • Early research shows adequately implemented water-rest-shade programmes are beneficial to prevent kidney dysfunction.

A more in-depth summary of the report is available to download in English and in Spanish.

Bonsucro advocates for safe working conditions for workers on farms to prevent heat stress, dehydration and accidents. We are a key member in the Adelante Initiative to protect workers’ health by developing safer working practices to prevent CKDnt. The Initiative is a partnership between Bonsucro, La Isla Network (LIN), Nicaragua Sugar Estates Limited and The Nicaraguan Sugar Producers Committee.

The Adelante Initiative recently welcomed Fair Trade USA as partner organisation. Fair Trade USA will contribute by working with LIN to adapt current prevention programmes in the sugarcane sector to other at-risk crops, while also supporting the dissemination of findings to their network and stakeholders.

Findings from the Adelante Initiative are shared through our platform twice a year to allow Bonsucro’s global network to learn from the process and adapt their own practices. Some practical suggestions include a timetable for manual cutters starting work at 6am and finishing at midday with regular short breaks and setting up an occupational health team with checklists to ensure work is undertaken in safe conditions.

The PAHO report adds to the body of evidence that occupational heat stress in industrial agriculture contributes to chronic kidney disease. As weather patterns shift and the temperature increases, the risk of developing kidney disease grows, especially for vulnerable agricultural workers. Together, the Bonsucro membership can help prevent the onset and progression of kidney disease due to work in the cane industry.