For over three decades, an epidemic of chronic kidney disease (CKD), not related to well-known risk factors like diabetes and hypertension, and thus named CKD of unknown origin (CKDu) has been detected in agricultural and other heavy labourers in Central America, especially sugarcane workers. CKDu is also increasingly observed in manual rural workers in other hot regions, such as Sri Lanka, India, and Egypt.

There are probably multiple risk factors for CKDu, as for most non-communicable diseases, but there is a growing body of evidence that labour practices, specifically strenuous work in heat without sufficient rest or hydration, is an important driver of the disease. Thus, this disease can be seen as having a direct link to climate change and is likely to become even more prevalent in the near future unless workplace heat stress is mitigated. As a response to this disease, members of the current project consortia have collectively implemented the Adelante Initiative at a large sugarcane mill in Nicaragua. Adelante is a scientific evaluation of workplace interventions that focus on adequate water and rest in shade together with improved ergonomics, aiming to prevent CKDu in workers while preserving productivity. The PREP program will build on the Adelante Initiative and will have three different themes:

I. To evaluate the immediate and long-term impact of a Water, Rest, and Shade intervention on workforce health (kidney health and heat related symptoms) and productivity in the sugar industry;

II. To examine the economic and social impacts on individuals, families, communities, the company and health systems affected by CKDu and whether workplace interventions to reduce heat stress and the risk for CKDu aids resilience, including mitigating migration pressures;

III. To examine the policies, or absence of policies (at multiple administrative scales) that have contributed to the CKDu disease and what policies are required to effectively address it in a future changing climate.

This program is an interdisciplinary effort that brings together researchers with expertise in occupational hygiene, medicine, health economics, plus social and political sciences. The research methods range from advanced physiological measurements, focus groups and interviews, document analysis, to semi-structured interviews and participatory workshops. Using this coordinated, interdisciplinary approach we will evaluate how occupational health and safety interventions affects worker’s health at an individual level as well as the social and economic effects in the local community, and company return-of-investment.

Together with workers, management, certifying institutions, national authorities, and consumers we will build toolkits and educational materials for those affected and those wishing to improve protection for workers in industrial agricultural and other manual outdoor work. Our findings will be broadly shared via scientific communications, workshops with worker/management, production of web-based material, films for the general public, and collaboration with media. PREP will enhance our knowledge on risk factors for CKDu in industrial agricultural workers in a hot climate, and produce evidence-based toolkits and other educational material for prevention of heat stress and its consequences, directed to the industry, governments and other stakeholders. By furthering our understanding of where and who are affected, while providing viable solutions, we can help governments and industry take a proactive and cost-effective approach to address CKDu and its associated challenges. There is a need to demonstrate that such an investment will be more economical than suffering the social and economic impact of doing nothing or inadequately attempting to treat an issue that is likely to get worse in a warming world.