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Hydration Status, Kidney Function, and Kidney Injury in Florida Agricultural Workers

Mix, Jacqueline, PhD, MPH; Elon, Lisa, MS, MPH; Vi Thien Mac, Valerie, PhD, RN; Flocks, Joan, JD; Economos, Eugenia; Tovar-Aguilar, Antonio, J., PhD; Stover Hertzberg, Vicki, PhD, FASA; McCauley, Linda, A., PhD, RN

Journal of Occupational and Environmental Medicine: May 2018 - Volume 60 - Issue 5 - p e253–e260
doi: 10.1097/JOM.0000000000001261

Objective: Recent findings suggest that laboring in hot occupational environments is related to kidney damage in agricultural workers. We examined hydration status and kidney function in 192 Florida agricultural workers.

Methods: Blood and urine samples were collected over 555 workdays during the summers of 2015 and 2016. Urine-specific gravity (USG), serum creatinine, and other kidney function markers were examined pre- and post-shift on each workday. Multivariable mixed modeling was used to examine the association of risk factors with hydration status and acute kidney injury (AKI).

Results: Approximately 53% of workers were dehydrated (USG ≥1.020) pre-shift and 81% post-shift; 33% of participants had AKI on at least one workday. The odds of AKI increased 47% for each 5-degree (°F) increase in heat index.

Conclusion: A strikingly high prevalence of dehydration and AKI exists in Florida agricultural workers.

Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia (Drs Mix, Mac, Stover Hertzberg, McCauley); Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia (Ms Elon); Center for Governmental Responsibility, Levin College of Law, University of Florida, Gainesville, Florida (Ms Flocks); and Farmworker Association of Florida, Apopka, Florida (Economos, Dr Tovar-Aguilar).

Address correspondence to: Jacqueline Mix, PhD, MPH, Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd NE, Atlanta, GA 30322 (

Funding for this study was provided by the National Institute for Occupational Safety and Health award number R01OH010657.

The authors have no conflicts of interest.

Copyright © 2018 by the American College of Occupational and Environmental Medicine