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Environmental metal exposures and kidney function of Guatemalan sugarcane workers



Exposure to environmental metals can cause nephrotoxicity. There is an international epidemic of chronic kidney disease of unknown cause (CKDu). Whether metal exposures contribute to kidney dysfunction in populations at risk for CKDu remains unresolved.


Urinary metals (arsenic, cadmium, nickel, and uranium) were examined in 222 sugarcane cutters in Guatemala at three time points over 1 year.


We explored the relationships between metal concentrations and markers of kidney function using multivariable linear mixed-effect models.


Arsenic, cadmium, and nickel were detected in the majority of the 340 urine samples and were generally within limits previously considered to be nonnephrotoxic. Nevertheless, higher urine cadmium was inversely associated with estimated glomerular filtration rate (eGFR) (β: −4.23, 95% confidence interval [CI]: −6.92, −1.54) and positively associated with neutrophil gelatinase-associated lipocalin (NGAL) (β: 2.92, 95% CI: 1.20, 4.64). Higher urine arsenic was also inversely associated with eGFR (β: −4.36, 95% CI: −7.07, −1.64).


Our findings suggest that exposures to metals, including cadmium and arsenic, might contribute to kidney toxicity seen in workers at risk for CKDu. These findings are consistent with the potential for metal nephrotoxicity at lower than expected levels in the setting of manual work in a very hot environment.

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Fig. 1: Study timeline and design.


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The authors would like to thank all their collaborators including Hillary Yoder, MS, Stephen Brindley, MS, Nicholas Smith, and all the workers who have made this work possible. The authors would also like to acknowledge Trace Metals Core Facility at the Mailman School of Public Health, Columbia University, for the analysis of the urine samples.


This study was supported by Centers for Disease Control and Prevention (U19 OH011227) and National Institutes of Health (NIH) (R21 ES028826), and in part by Pantaleon and the Chancellor, University of Colorado, CU Anschutz Campus. Metal laboratory analysis was supported by NIH grants P30 ES009089 and P42 ES010349. Funders had no role in data analysis, interpretation of data, writing the manuscript, or the decision to submit the findings for publication.

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Correspondence to Jaime Butler-Dawson.

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The University of Colorado has a memorandum of agreement with Pantaleon, a Guatemala-based agribusiness. Pantaleon provides partial financial support for research through a contract with the university and has provided access to the employees who volunteered to participate in this research project. The University of Colorado employed appropriate research methods in keeping with academic freedom, based conclusions on critical analysis of the evidence, and reported findings fully and objectively. The terms of this arrangement have been reviewed and approved by the University of Colorado in accordance with its conflict of interest policies.

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Butler-Dawson, J., James, K.A., Krisher, L. et al. Environmental metal exposures and kidney function of Guatemalan sugarcane workers. J Expo Sci Environ Epidemiol 32, 461–471 (2022).

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  • Metal exposure
  • Kidney function
  • Agricultural workers

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