Occupational heat exposure and the risk of chronic kidney disease of nontraditional origin in the United States

Christopher L Chapman, Hayden W. Hess, Rebekah Lucas, Jason Glaser, Rajiv Saran, Jennifer Bragg-Gresham, David Wegman, Erik Hansson, Christopher T. Minson, Zachary Schlader

Research output: Contribution to journalReview articlepeer-review


Occupational heat exposure is linked to the development of kidney injury and disease in individuals who frequently perform physically demanding work in the heat. For instance, in Central America, an epidemic of chronic kidney disease of nontraditional origin (CKDnt) is occurring among manual laborers, whereas potentially related epidemics have emerged in India and Sri Lanka. There is growing concern that workers in the United States suffer with CKDnt, but reports are limited. One of the leading hypotheses is that repetitive kidney injury caused by physical work in the heat can progress to CKDnt. Whether heat stress is the primary causal agent or accelerates existing underlying pathology remains contested. However, the current evidence supports that heat stress induces tubular kidney injury, which is worsened by higher core temperatures, dehydration, longer work durations, muscle damaging exercise, and consumption of beverages containing high levels of fructose. The purpose of this narrative review is to identify occupations that may place US workers at greater risk of kidney injury and CKDnt. Specifically, we reviewed the scientific literature to characterize the demographics, environmental conditions, physiological strain (i.e., core temperature increase, dehydration, heart rate), and work durations in sectors typically experiencing occupational heat exposure, including farming, wildland firefighting, landscaping, and utilities. Overall, the surprisingly limited available evidence characterizing occupational heat exposure in US workers supports the need for future investigations to understand this risk of CKDnt.
Original languageEnglish
Pages (from-to)R141-R151
Number of pages11
JournalAmerican Journal of Physiology
Issue number2
Early online date29 Jun 2021
Publication statusPublished - 1 Aug 2021

Bibliographical note

Funding Information:
This manuscript was supported by awards from the National Institute of Occupational Safety and Health Grant R01OH011528 (to Z.J.S.) and National Heart, Lung, and Blood Institute Grant R01HL144128 (to C.T.M.). R.S. is PI and J.B.-G. is Co-I on the US Centers for Disease Control and Prevention’s CKD Surveillance System for the United States (Supporting, Maintaining and Improving the Surveillance System for Chronic Kidney Disease in the US, Cooperative Agreement No., U58 DP006254, funded by the Centers for Disease Control and Prevention).

Publisher Copyright:
© 2021 the American Physiological Society.


  • Biomarker
  • Exercise
  • Heat strain
  • Heat stress
  • Mesoamerican nephropathy

ASJC Scopus subject areas

  • Physiology
  • Physiology (medical)


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