Hydration Choices, Sugary Beverages, and Kidney Injury in Agricultural Workers in California.

ABSTRACT

PURPOSE: Agricultural workers working in high ambient temperatures are at risk for acute kidney injury. Despite recommendations to maintain hydration, workers likely do not drink enough to protect their renal function. Additionally, new research suggests that rehydration with sugary beverages adds additional risk to kidneys already stressed by high heat and workload. We assessed hydration choices during a work shift and tested associations of rehydration using sugary beverages with acute kidney injury. METHODS: We recruited a convenience sample of workers on farms over two summers. We estimated acute kidney injury via pre- and post-shift serum creatinine readings from capillary blood samples. We used self-reported measures of the volume and type of fluids workers consumed during their shifts. We also measured changes in core body temperature, ambient temperature, and workload. We used logistic regression to estimate associations of sugary drinks with acute kidney injury, while controlling for physiologic and occupational variables. FINDINGS: In our sample of 445 participants, we found that men drink more than women do overall, including more than a liter of water than women (2.9 L compared to 1.9 L, respectively). The total volume workers drank was associated with increased odds of acute kidney injury (adjusted odds ratio 1.47, 95% confidence interval 1.09-1.99). We found no association of sugary drinks with acute kidney injury. CONCLUSIONS: These findings provide important information about what men and women use to hydrate during the work day and suggest that they do not drink enough to maintain adequate hydration. Increased fluid intake during the work day may be a result of vigorous workload, which could explain the increased risk for acute kidney injury. Nurses play an important role in educating agricultural workers about the importance of maintaining hydration at work. CLINICAL RELEVANCE This study advances current knowledge of occupational risk factors for acute kidney injury in agricultural workers. Nurses may be the only point of care for this vulnerable population and are therefore in a unique position to educate on the importance of proper hydration during work.