CHWE Researchers Publish Groundbreaking Study on Preventing Heat-Associated Kidney Disease

A team of researchers from the Centers for Health, Work & Environment (CHWE) at the Colorado School of Public Health has published a new study in Annals of Global Health that offers a systems-based approach to protecting workers in hot climates from developing kidney disease. The study, “A Systems-Based Approach for the Prevention of Heat-Associated Kidney Disease in Latin American Workers,” highlights the role of climate as a multiplier of workplace health risks and demonstrates the importance of a Total Worker Health^® approach to prevention.

Rising Public Health Concern

Chronic kidney disease of non-traditional origin (CKDnt), sometimes called Mesoamerican Nephropathy, has emerged as a growing health crisis among agricultural workers in Central America. In Guatemala, young sugarcane workers have been disproportionately affected, with research pointing to a combination of extreme heat exposure, dehydration, and other environmental and occupational hazards as risk factors.

Lead author and CHWE research assistant professor,  Miranda Dally, DrPH, MS, emphasized the urgency of the issue:

“When young agricultural workers develop kidney disease in their twenties or thirties, it devastates entire households. Our work is about preventing that tragedy.”

A Total Worker Health (TWH) Approach

The study draws on an eight-year partnership between CHWE researchers and the Guatemalan agro-industrial company Pantaleon. Using the TWH framework, the team designed and evaluated interventions addressing hydration, rest, work schedules, nutrition, and recovery, all while embedding these strategies within company culture.

Total Worker Health^® is a holistic approach to worker well-being that integrates occupational safety and health protection with health promotion to prevent worker injury and illness and to advance health and well-being. Learn more.

Researchers found that combining immediate, transactional interventions—such as hydration education and electrolyte replacement programs—with longer-term, transformational changes in organizational culture was key to improving outcomes. Between 2015 and 2023, the incidence of reduced kidney function among sugarcane workers declined from an estimated 10% to 7%, underscoring the potential impact of sustained, evidence-based interventions.

Implementation Science in Action

The team applied the Consolidated Framework for Implementation Research (CFIR) and the RE-AIM model to ensure that interventions were not only effective but also scalable and sustainable. This rigorous evaluation revealed that success depended on continuous monitoring, leadership buy-in, and active participation from workers themselves.

Key interventions included:

• Hydration and heat stress education programs
• Incentive-based hydration monitoring
• Electrolyte supplementation trials
• Adjusted work schedules to reduce heat exposure
• Mid-season kidney function screenings
• Leadership training inTWH principles

Global Relevance

While the research focused on sugarcane workers in Guatemala, the principles extend far beyond agriculture and Latin America. As global temperatures rise, millions of workers worldwide are at increased risk of heat-related illnesses.

“What we’ve learned in Guatemala has implications for workers everywhere and these lessons can inform policy and practice worldwide,” Dally said.

Moving Forward

The study underscores the urgency of addressing environment-related occupational health risks with comprehensive, participatory approaches. By bridging research, practice, and corporate leadership, CHWE faculty and partners are setting a precedent for protecting worker health in a changing environment.

The full article is available in Annals of Global Health: https://annalsofglobalhealth.org/articles/10.5334/aogh.4760