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Johns Hopkins Receives New Grant to Study the Relationship between Heat and Chronic Kidney Disease

Photography by Ed Kashi/VII

Dinesh Neupane, an assistant scientist at the Johns Hopkins Bloomberg School of Public Health, received a grant, together with the University of Gothenburg, from the Swedish Research Council to examine the relationship between heat and chronic kidney disease among migrant and non-migrant workers in Nepal. Neupane, who is based out of the Department of International Health at the Bloomberg School, will co-lead the project.

The project aims to assess the prevalence and determinants of chronic kidney disease among migrants and non-migrants in Nepal, as well as estimate the economic burden and social impact of the disease on individuals, families, communities, and the Nepalese health system. The project will investigate both chronic kidney disease of traditional and non-traditional origins. Chronic kidney disease of non-traditional origins (CKDnt) refers to cases not related to commonly known risk factors such as diabetes, hypertension, heart disease, older age, and obesity.

Nepalese adults, most of them male, often serve as migrant workers in neighboring countries due to a shortage of work in their home country. Much of the work is heavy manual labor, where they are exposed to the heat for long periods of time each day. The association between heat and CKDnt has been documented among other workers who share exposure to heavy manual labor and heat, such as sugarcane workers, gold miners, construction workers, and brick kiln workers, but there has not been a study documenting the disease among migrant workers.

Prevention in these communities is key because CKD is asymptomatic until the late stage, meaning a person will not know they have it until it is too late to effectively treat. Despite its importance as a contributing factor of CKD among workers in occupational settings with substantial exposure to heat, heat stress itself has not been thoroughly explored as a direct cause of kidney disease. This study aims to fill a gap in knowledge by examining the prevalence of chronic kidney disease among migrant workers exposed to heat through heavy manual labor outdoors and non-migrants, who have not been exposed.

“As global temperatures rise, there is a need to understand the impact of heat and its relationship to health such as chronic kidney disease, and how best to mitigate the effects while protecting livelihoods,” says Neupane.

The study will be conducted in Lekhnath, Nepal. In addition to examining prevalence of chronic kidney disease, the project will also examine the economic and social burden of the disease. CKD creates a burden on the Nepalese health system, and the project will look at how the care and treatment of CKD affects the accessibility and quality of other health care issues, such as vaccination; maternal, newborn, and child health; and communicable disease control. The project will also look at how CKD creates a burden on households by comparing the economic health of households with someone with CKD to households without CKD.

Project staff will develop and distribute educational materials for preventing heat-related CKDnt to migrants and their families, as well as to the local and national community and other stakeholders. Researchers will adapt study findings for use by policymakers and advocates working to protect migrant workers and their families. Investigators will also map where those with CKD worked and for whom, creating the possibility for engagement with employers and working on improved protections.

Other collaborators on the project include La Isla Network, Nepal Development Society, Macquarie University, the University of Birmingham, and the University of Austin. The data collected from this study will allow for comparison between this research and ongoing programs collaborators of this study are currently conducting in Central America on heat and CKDnt.