Chronic kidney disease of undetermined cause (CKDu), affects millions of workers in Latin America and Asia. Treatment is expensive, resulting in early death for those affected. Strenuous work in extreme heat without sufficient rest and hydration is considered a main driver. Industrial agriculture is the most affected, especially the sugarcane sector. Without prevention, this epidemic is likely to accelerate due to climate change. Increasing temperatures, coupled with decreasing precipitation in drier agricultural regions, is also causing pesticides and other toxins to concentrate at higher levels.

As a response to this heat stress related disease, we have collectively implemented the Adelante Initiative, a workplace intervention with focus on adequate water, and rest in shade together with improved ergonomics, designed to prevent CKDu among workers at a sugarcane mill in Nicaragua.

Due to the high prevalence of CKDu among sugarcane workers, we are concentrating our efforts in this sector; from there we will adapt the program to other geographies and industries.

Our proposed project builds on current efforts and investigates the following:

1) the immediate and long-term impact the intervention has on workforce health (kidney health and heat related injuries) and productivity.

2) the economic and social impacts on those affected by the disease and whether our intervention aids in resilience, including mitigating migration pressures.

3) the economic burden on health systems treating CKDu.

4) an analysis of public health policies to understand what policies, or absence of policy, have contributed to the disease while investigating what policies are required to effectively address it.

The knowledge gained will create the groundwork to scale and adapt our programs to other industries and geographies. As climate change means more extreme temperatures in already impacted regions, and the likelihood that regions further north and south of the equator will also be impacted by CKDu, it is essential a model to protect worker health and productivity is developed.