An increasing number of Latino agricultural workers are arriving with kidney failure at Atlanta’s Grady Memorial Hospital, according to Valerie Vi Mac, a postdoctoral researcher at Emory University’s Nell Hodgson Woodruff School of Nursing. Many of them wait all day for dialysis, a life-sustaining process that relies on a machine to substitute the kidneys’ functions of removing excess water, salt and toxins from the body.
Workers are unable to use the dialysis machines until all the other patients have finished because the hospital prioritizes insured patients, and many agricultural jobs do not provide health insurance. Grady offers a reduced pay program for low-income DeKalb or Fulton residents, but Latino agricultural workers typically live in rural areas or lack the necessary documents for an application.
“It’s not like a regular dialysis patient where it’s three times a week,” Mac said. “It’s whenever they can get care. ”
Mac expects that this problem will worsen in future years, especially for Central American immigrants in the United States. Chronic kidney disease of unknown etiology (CKDu) is an epidemic in agricultural communities worldwide, particularly in Central America, according to a 2019 review published in the New England Journal of Medicine.
Mac and Emory faculty members Linda McCauley, Vicki Hertzberg and Jeff Sands plan to study the cause of CKDu and acute kidney injury in U.S. Latino agricultural workers with a four-year $2.2 million research grant from the National Institute for Occupational Safety and Health.
There are multiple potential reasons that CKDu has increasingly impacted agricultural workers, and extreme physical activity in the heat may be one of them, according to the New England Journal of Medicine.
A 2018 study by Mac and her colleagues found that the odds that a worker would have an acute kidney injury at any given time increased by 22 percent for each five beat-per-minute increase in their heart rate, and by 37 percent for each 5-degree temperature increase.
Because this demographic struggles to access treatment, Mac said that it is crucial to more precisely determine a cause so that preventative measures can be taken.
“Many of our workers are scared to access the healthcare system. … And another part of it is that in other countries, dialysis isn’t readily available,” Mac said. “If they get sick and go back home, it’s almost like a death sentence.”
The upcoming study differs from past research because it will evaluate workers multiple times over two years to establish a sequential cause-and-effect relationship between heat exposure and biomarkers of kidney injury and disease.
“We expect that this [upcoming] study will give policymakers a reason to pass some heat protections for workers,” Mac said.
Currently, only California, Washington and Minnesota have heat-related standards for farm workers.
