Chronic Kidney Disease Among Workers: A Review of the Literature

This issue of Workplace Health & Safety contains a Continuing Nursing Education Module for 1.0 contact hour of continuing nursing education credit will be awarded by AAOHN upon successful completion of the posttest and evaluation.

A certificate will be awarded when the following requirements are met by the participant: (1) Participant logs on to the AAOHN LMS website at www.aaohn.org/education/online-learning-center and enrolls in the course ($10 members; $15 non-members); (2) The completed posttest and course evaluation are entered online at http://www.aaohn.org by May 2021; (3) A score of 75% (6 correct answers) is achieved by the participant.

Upon completion of this lesson, the occupational health nurse will be able to:

• Explain the unique characteristics of chronic kidney disease of undetermined etiology (CKDu).

• Discuss the importance of investigating the factors associated with CKDu.

• Identify the population at risk for CKDu.

The American Association of Occupational Health Nurses, Inc. is an Approved Provider of continuing nursing education by the American Association of Occupational Health Nurses, Inc., an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. The American Association of Occupational Health Nurses, Inc. is additionally approved as a CNE provider by the California Board of Registered Nursing (#CEP9283).

Contact hours received for successful completion of the posttest and evaluation may be used for relicensure, certification, and re-certification.

1. Chronic kidney disease of unknown etiology (CKDu) is:

2. A complex disease process presenting with renal dysfunction

3. Posing a higher risk for workers with hypertension

4. Only affecting workers over 70 year of age

Articles that met the inclusion criteria in this literature review include:

Evaluation of CKDu in female agricultural workers

Studies published in Spanish

Qualitative studies only

Studies conducted in Mesoamerica

Leptospira bacteria can:

Be transmitted via soil and water contaminated by sewage

Cause fever of >102° F., cough, and weight loss

Increase the risk of renal stones

Be a factor that increases susceptibility to CKDu

Studies conducted in the United States demonstrated:

Female agricultural workers were at a higher risk for CKDu than their male counterparts

A decrease in the serum creatinine (SCr) at the end of the shift

That agricultural workers lived in a chronic state of dehydration

That in a Florida study 53% of agricultural workers started their shift well hydrated.

Clinical features of CKDu include:

Serum creatinine (SCr) >1.2mg/dL or an estimated glomerular filtration rate (eGFR) <60ml/min/1.73m2

Hyperkalemia, hypernatremia, and hypouricemia

Constipation, vomiting, and orbital swelling

Presence of biomarkers such as EGFR mutations

The literature review on CKDu demonstrated:

Definitive evidence that heat stress was the cause of the development of CKDu

A risk for the global spread of CKDu

No consistent definition or etiology of CKDu

That more research is needed on CKDu in the United States and Nordic countries.

CKDu is a phenomenon that affects mostly:

Workers born in the Eastern part of the United States

Health care workers that work long shifts

Agricultural workers from regions located in Central America

Service industry workers from South America

One etiologic hypothesis for CKDu include:

Heat stress and dehydration

Family history of renal disease

Pregnancy

Ingestion of a high protein diet