Skip to main content
NCBI home page
Medicine logoLink to Medicine
. 2022 Sep 9;101(36):e30328. doi: 10.1097/MD.0000000000030328

The impact of heat on kidney health: A PRISMA-compliant bibliometric analysis

Mohammed Al-Bouwarthan a,*, Abdulaziz A AlMulla a, Muhammad Yaseen b
PMCID: PMC10980493  PMID: 36086778

Background:

Exposure to excessive heat can impact kidney health. Climate change is projected to aggravate this impact. An analysis of articles published between 1958 and 2021 was conducted to explore the progress of the research on this issue.

Methods:

This study included a bibliometric analysis wherein Web of Science was used to generate a list of all published articles related to the impact of heat on kidney health. Basic information about the articles, such as titles, authors’ names, keywords, and citations, were recorded and analyzed.

Results:

A total of 226 published articles related to the impact of heat on kidney health were identified as of November 20, 2021. Most of these articles (93%) were published within the last decade. The United States was the most prominent country in terms of research productivity and collaboration. Researchers from the United States were well represented among the top 20 contributors of published articles on the study issue. The productivity of the top 20 authors varied between 6 and 32 articles each. A total of 25 common words used by the authors were identified. The most frequently used keywords were chronic kidney disease, heat stress, acute kidney injury, Mesoamerican nephropathy, and climate change. Keyword analysis revealed 3 distinct major research clusters in the existing scientific research on the impact of heat on kidney health: chronic kidney disease of unknown etiology, heat stress and renal physiology, and the effect of climate change on kidney health.

Conclusions:

Research on heat-related kidney injury has witnessed rapid development in recent decades, motivated by the emergence of chronic kidney disease of unknown etiology and climate change. Developing countries in hot regions must increase their productivity in this research area through international collaboration and partnerships.

Keywords: climate change, dehydration, heat stress, Mesoamerican nephropathy

1. Introduction

It is widely accepted that excessive heat seriously impacts the health of exposed individuals. Climate change is expected to aggravate this impact, particularly in areas with hot climates where the intensity and duration of heat exposure will increase.[1–3] The risk of heat-related health complications is compounded for individuals with low heat tolerance, such as children, elderly people, or workers performing intense activities in hot environments.[4] Depending on the degree of exposure, the health effects can be minor, such as heat rash and heat cramps, or major, with serious effects on vital human systems such as the nervous and cardiovascular systems. This, in turn, can lead to chronic health complications, including psychological distress, cardiovascular disease, and fertility issues.[5–8]

The effect of heat exposure on the renal system is also recognized as a health concern because dehydration resulting from elevated core temperature and increased sweating can result in volume depletion and hyperosmolarity. This can lead to urine acidification, increased urine concentration, and uricosuria, all of which adversely affect the kidneys. Some of these effects include acute kidney injury (AKI), chronic kidney disease (CKD), kidney stones, and urinary tract infections.[9–11]

Recent studies have linked prolonged exposure to heat, chronic dehydration, and repeated AKI to the development of a progressive CKD of unknown etiology (CKDu), referred to as Mesoamerican nephropathy, which has spread among people living and working in the hotter regions along the Pacific Coast of Central America.[12–14] Within a 16-year period (1997–2013), >60,000 cases of Mesoamerican nephropathy were reported in these regions, which led to renal failure and death.[15]

The risk of heat-related kidney health problems has gained increasing recognition in recent decades, and several authors have been working to explore this environmental-related health risk. To contribute to this effort, this article aims to investigate the current state of research regarding various perspectives on heat-related kidney health problems from 1958 to 2021 through bibliometric analysis. This method is widely used to evaluate published research on a specific topic over time based on quantitative indicators such as keyword recurrence, number of citations, most productive authors, journals, institutions, and countries.[16,17] Accelerated development in bibliometric software programs has made this method of analysis capable of handling large volumes of scientific data and producing a significant research impact.[18] Some of these programs, which are widely available and easily accessible, are CiteSpace, HistCite, R. Bibliometrix, ResGap, and VOSviewer as well as scientific databases such as Scopus, PubMed, and Web of Science (WoS).[19–22]

The main objectives of this study were as follows: to conduct a bibliometric analysis and provide a review of the development in this field of research, to evaluate the interactions and connections between researchers and other constituents of research, and to explore “hotspot” topics in this research field.

2. Materials and Methods

The methodology adopted in this study followed the principles of bibliometric analysis applied in similar published bibliometric studies.[23–25] This method used a set of quantitative descriptive techniques for the analysis of scientific information, which was regrouped into 2 main categories: performance analysis and science mapping. The analysis was supported by 3 enrichment techniques: networking, clustering, and visualization.[18]

2.1. Data collection and preparation

The WoS database was used to retrieve the required publication information, following a comprehensive search for published articles on the effect of heat exposure on kidney health. This database was used due to its recognition as an international and multidisciplinary database with strong coverage and flexibility to search for and sort results by given parameters.[26]

The search query included a combination of subject headings and keywords relevant to the study topic: ALL = (kidney) AND ALL=(“heat exposure” OR “heat stress” OR “thermal stress” OR “heat strain” OR dehydration OR “heat waves” OR “extreme heat” OR “summer heat” OR “hot weather” OR “high temperature” OR “hot temperature” OR “climate change”). In total, 2961 documents were retrieved from the WoS database on November 20, 2021. These retrieved documents were initially filtered by excluding 137 non–peer-reviewed publications, including editorial materials, meeting abstracts, notes, news items, and corrections.

Afterward, 2 authors (M.A. and A.A.A.) independently reviewed the titles and abstracts of the remaining documents for inclusion in this study. Disagreements were discussed, followed by a joint full review of the articles of concern, which led to inclusion or exclusion. The exclusion criteria were as follows: publications on irrelevant exposures, such as heavy metals, pesticides, and other toxic chemicals; and publications that evaluated the effect of heat on children’s health, or on plants, animals, fish, and other aquatic organisms.

Two hundred twenty-six publications spanning the period from 1958 to 2021, consisting of articles (n = 177) and review articles (n = 49), were ultimately included in the bibliometric analysis (see Fig. S1, Supplemental Digital Content, http://links.lww.com/MD/H153 which illustrates the selection process for the papers used to conduct the bibliometric analysis in this study).

2.2. Data analysis

Data from these selected publications were extracted from WoS to perform the bibliometric analysis. These data included keywords, authors’ names, country of origin, institution(s), journal(s) of publication, publication dates, citations, g-index, and h-index. These data were input into R software (version 4.0.3) to generate information on publication growth and trends, international and authorial collaborations, citations, and keyword frequency related to the study topic. Furthermore, these data were utilized to create network visualization maps using VOSviewer software (version 1.6.10), in which parameters such as keywords, countries, and authors are represented by circles that vary in size depending on the weight of the item and are distinguished by color. Lines between items represent links, such as co-citation and collaboration, whereas the thickness of the lines represents the strength of each link.[27]

2.3. Ethical approval

Ethical approval was not necessary because this study did not involve human or animal subjects.

3. Results

3.1. Trends in publication productivity

Based on the search query and inclusion criteria, 226 articles published between 1958 and 2021 were selected and analyzed. As illustrated in Figure 1, research publication productivity was limited to 1 article per year on a sporadic basis from 1958 to 2007. After 2007, there was a gradual increase in the published research, reaching a maximum of 42 articles in 2020 (Fig. 1). The overall annual growth rate over the period from 1958 to 2020 was 4.16%.

Figure 1.

Figure 1.

Open in a new tab

Number of published articles related to the impact of heat on kidney health between 1958 and 2021.

3.2. Most productive countries

Globally, 36 countries have contributed to the research on the impact of heat on kidney health (Fig. 2A). Figure 2B shows that 77% of the published articles in this field, both single-country publications (SCP) and multicountry publications, originated from 10 countries. The United States (US) was the most prominent country in terms of productivity and collaboration. Excluding the US, the range of productivity-as-total varied between 1 and 10 articles for the remaining 35 countries.

Figure 2.

Figure 2.

Open in a new tab

Countries’ collaboration networks on research related to the impact of heat on kidney health (A). The top 10 most productive countries in published research. The black color corresponds to SCPs, whereas gray indicates MCP (B). MCP = multicountry publication, SCP = single-country publication.

3.3. Top-cited articles

Table 1 lists the total citations (TC), local citation score, and year of publication for the top 20 most-cited articles. The TC for the top 20 ranged from 71 to 545, while the local citation score ranged from 0 to 77. The publication years ranged from 1967 to 2019. The top 20 most-cited articles were published in 11 different journals.

Table 1.

Top 20 cited articles on the impact of heat on kidney health from 1958 to 2021.

Year First author Source DOI TC TC per year LCS
1972 Fitzsimons[28] Physiol Rev 10.1152/physrev.1972.52.2.468 545 10.90 0
2018 Luyckx et al[29] B World Health Organ 10.2471/BLT.17.206441 224 56.00 2
2014 Correa-Rotter et al[30] Am J Kidney Dis 10.1053/j.ajkd.2013.10.062 203 25.38 66
2016 Glaser et al[31] Clin J Am Soc Nephro 10.2215/CJN.13841215 162 27.00 65
2012 Peraza et al[32] Am J Kidney Dis 10.1053/j.ajkd.2011.11.039 161 16.10 57
2010 Torres et al[33] Am J Kidney Dis 10.1053/j.ajkd.2009.12.012 148 12.33 56
2015 Garcia-Trabanino et al[34] Environ Res 10.1016/j.envres.2015.07.007 140 20.00 77
2008 Hansen et al[35] Int J Epidemiol 10.1093/ije/dyn165 139 9.93 19
2010 Ostro et al[36] Am J Epidemiol 10.1093/aje/kwq231 132 11.00 4
1974 Knochel et al[37] Ann Intern Med 10.7326/0003-4819-81-3-321 127 2.65 14
2007 Clarkson[38] Sports Med 10.2165/00007256-200737040-00022 106 7.07 7
2016 Roncal-Jimenez et al[10] Am J Kidney Dis 10.1053/j.ajkd.2015.08.021 102 17.00 54
1970 Schrier et al[39] Ann Intern Med 10.7326/0003-4819-73-2-213 90 1.73 10
1967 Schrier et al[40] Ann Intern Med 10.7326/0003-4819-67-2-356 90 1.64 8
2016 Lunyera et al[41] Clin J Am Soc Nephro 10.2215/CJN.07500715 87 14.50 14
2016 Wesseling et al[42] Environ Res 10.1016/j.envres.2016.02.002 86 14.33 54
2014 Wesseling et al[43] Am J Kidney Dis 10.1053/j.ajkd.2013.08.014 82 10.25 32
2019 Johnson et al[13] New Engl J Med 10.1056/NEJMra1813869 81 27.00 20
2018 Flouris et al[44] Lancet Planet Health 10.1016/S2542-5196(18)30237-7 75 18.75 5
2013 Weiner et al[45] Clin J Am Soc Nephro 10.2215/CJN.05050512 71 7.89 71
Open in a new tab

DOI = digital object identifier, LCS = local citation score, TC = total citations.

3.4. Authors’ productivity and dominance

The articles selected for analysis were written by 949 authors in total. Of these authors, 19 wrote single-authored articles. As shown in Table 2, R. J. Johnson was the most productive of the 20 top authors, both in terms of total publications (32) and fractionalized count (4.62). On the other hand, C. A. Roncal-Jimenez was the most dominant of the top 10 contributing authors, with a maximum dominance factor of 0.333, and L. Krisher was the least dominant at 0.091 (see Table S1, Supplemental Digital Content, http://links.lww.com/MD/H154, which shows the most productive authors in research related to the impact of heat on kidney health). Ranking authors by the h-index and g-index showed that both R. J. Johnson and C. Wesseling received the highest scores for the h-index (18 and 17, respectively) and g-index (32 and 20, respectively), followed by J. Glaser, with an h-index value of 12 and a g-index value of 16 (Table 2).

Table 2.

Top 20 authors publishing research on the impact of heat on kidney health from 1958 to 2021.

Author Institution h-Index g-Index TC NP AF PYS
Johnson RJ University of Colorado, USA 18 32 1288 32 4.62 2014
Wesseling C Karolinska Institute, Sweden 17 20 1398 20 2.75 2012
Glaser J La Isla Network, USA 12 16 765 16 1.27 2015
Sanchez-Lozada LG National Institute of Cardiology, Mexico 11 16 520 16 1.59 2014
Weiss I La Isla Network, USA 11 13 785 13 1.07 2014
Garcia-Trabanino R Emergency Social Fund for Health of Tierra Blanca, El Salvador 10 11 594 11 2.05 2015
Lanaspa MA University of Colorado, USA 10 12 510 12 1.11 2014
Jakobsson K University of Gothenburg, Sweden 9 10 459 10 1.26 2012
Aragon A National Autonomous University of Nicaragua, Nicaragua 8 8 552 8 0.84 2012
Hogstedt C Karolinska Institute, Sweden 8 12 446 8 0.86 2012
Newman LS University of Colorado, USA 8 11 238 12 1.74 2018
Butler-Dawson J University of Colorado, USA 7 10 157 11 1.40 2018
Correa-Rotter R National Institute of Health Sciences and Nutrition, Mexico 7 7 590 7 1.26 2014
Roncal-Jimenez C University of Colorado, USA 7 7 492 7 0.56 2014
Roncal-Jimenez CA University of Colorado, USA 7 9 153 9 0.92 2016
Wegman DH La Isla Network, USA 7 9 241 9 1.93 2014
Jensen T University of Colorado, USA 6 7 136 7 0.62 2016
Krisher L University of Colorado, USA 6 10 122 10 1.12 2018
Schlader ZJ Indiana University, USA 6 6 98 6 1.07 2017
Sorensen C University of Colorado, USA 6 6 110 6 0.87 2018
Open in a new tab

AF = articles fractionalized, NP = number of publications, PYS = publication year started, TC = total citation.

The level of collaboration among authors investigating the impact of heat on kidney health is demonstrated in this study by their co-citation network (see Fig. S2, Supplemental Digital Content, http://links.lww.com/MD/H155, which illustrates the authors’ co-citation network).

3.5. Distribution and citations of articles by journals

The retrieved and analyzed articles were published in 108 journals. There were top 20 journals, with 96 published articles representing 42% of the analyzed total. In addition to the number of published articles (NP), the ranking was also based on citation analysis using the g- and h-indices (see Table S2, Supplemental Digital Content, http://links.lww.com/MD/H156, which shows the top 20 journals publishing research on the impact of heat on kidney health). The American Journal of Kidney Diseases (impact factor in 2021: 11.1) was classified as the top source in terms of NP (10), TC (715), and h- and g-indices (9 and 10, respectively).

3.6. Keywords analysis

The phrase “chronic kidney disease” appeared most frequently. Two similar keyword phrases also appeared among the most frequent words (“chronic kidney disease of unknown etiology” and “Mesoamerican nephropathy”). There was a high similarity in both author keywords and keywords plus. Overall, the top words relate to 4 main categories: type of kidney injury, clinical diagnosis, risk factors, and population at risk. Words appeared more frequently under the first and third categories (see Table S3, Supplemental Digital Content, http://links.lww.com/MD/H157, which illustrates the most frequent keywords used in published articles related to this research area).

Figure 3 summarizes the results of the keywords analysis using VOSviewer. A total of 25 words that occurred >8 times within all the extracted articles were identified and classified into 3 clusters: CKDu (color: blue), the effect of climate change on kidney health (color: red), and heat stress and renal physiology (color: green).

Figure 3.

Figure 3.

Open in a new tab

Mapping keywords by research clusters on the impact of heat on kidney health from 1958 to 2021 (CKDu, blue; effect of climate change on kidney health, red; heat stress and renal physiology, green). The small distance between keywords indicates a higher frequency of their co-occurrences, and the circle size indicates the keywords’ frequency. CKDu = chronic kidney disease of unknown etiology.

4. Discussion

The impact of heat exposure on kidney health has been a topic of growing interest among other global health research topics related to climatic heat. Yet, as demonstrated in this study, the development in research published yearly, from 1958 to 2007, was limited and sporadic. After that period, the published research showed a consistent growth trend. From 2008 to 2021, a total of 201 articles were published, reaching a peak of 42 articles in 2020. We believe that this substantial growth in research is attributed mainly to growing worldwide concerns about CKDu. This epidemic represents a global health burden; cases have been reported in Central American countries (Costa Rica, El Salvador, Guatemala, Mexico, and Nicaragua),[46] South Asian countries (Sri Lanka and India),[47] and North African countries (Egypt and Tunisia).[48] As noted from our analysis, the research development over this period coincides with the period of increased cases of CKDu burdening the populations of Central America. In this region, the rate of age-standardized disability-adjusted life years attributed to CKDu increased by 100% from 1990 to 2015.[15] The climate change-related rise in mean global temperature and the increased frequency of extreme heat events have been the other driving forces of this rapid research development. The global temperature records registered from 2015 to 2020 characterize these years as having the warmest temperatures to date.[49] Such a rise in temperature related to climate change has been recognized in a large body of literature as a risk factor for the development of kidney diseases.[31,50,51] Accordingly, there has been an increasing demand for scientific research to cope with the expected changes in the spectrum of kidney disease and diagnosis, and for mitigating strategies in healthcare provision from the perspective of climate change.[52–54]

Researchers in the US have published the most articles, ranking the US first in overall production. The US alone contributed >44% of all published articles about the effect of heat exposure on kidney health over the period specified above. This is not surprising, as the US has been ranked as the most prolific publisher of high-quality scientific research from 1996 to 2020 in terms of total published documents, citable documents, citations, self-citations, and h-index.[55] This high scientific publication productivity is believed to be attributed to a number of factors, including US science policy, the federal government’s research investments, the US tradition of scientific research, academic freedom, and the availability of financial support from industries, development partners, and donor agencies.[56,57] Moreover, the US is also subject to frequent extreme heat associated with an increase in hospital admissions. As documented by Gronlund et al,[58] admissions due to kidney disorders increased among older people (> 65 years of age) during moderate heat, extreme heat, and heatwave events by 4.3%, 14.2%, and 23.2%, respectively, based on data collected from 1992 to 2006 from 114 American cities.

The productivity of 4 of the top 10 countries varied by a small margin (10 to 15 articles) among Australia, Mexico, China, and Sweden. The range in the other 5 countries—India, the United Kingdom, Sri Lanka, Brazil, and Belgium—varied between 4 and 7 published articles each. Except for China, the ratios of multicountry publications to total publications among the top 10 countries were relatively high (0.3%–1%), indicating that these countries and the US exhibited a strong preference for international cooperation in regard to heat-related kidney injury, motivated by the growing global concern about CKDu, particularly in regions with hot climates.

In terms of the most relevant sources, the American Journal of Kidney Diseases, Occupational and Environmental Medicine, and PLoS ONE were at the top with the most published articles (n = 10, 8, and 8, respectively). In addition, BMC Nephrology, Kidney International, and Environmental Research published 7, 6, and 6 articles, respectively. The scores for these journals in terms of h-index, g-index, and TC were the highest for the American Journal of Kidney Diseases (9, 10, and 715, respectively). Publishing in journals with such high index scores maximizes the likelihood of an author being cited by other authors, which improves their personal scores on these and other relevant indices.[59] These and the other journals analyzed in the study, >100 in total, are all scholarly publications belonging mostly to the field of medicine, particularly those subfields related to nephrology and the fields of occupational and environmental health and exercise physiology. Such variety in the sources of scientific publications indicates a general interest in the issue of heat-related kidney injury in terms of both influential risk factors and medical treatments.

Regarding the assessment of the most influential publications in this field of research, the principal finding was the identification of 20 highly influential scientific publications from 1972 to 2019. The focus of these publications was mainly on the types and nature of kidney injury (both acute and chronic), causes related to heat and dehydration, diagnosis and treatment methodologies, interventions, and mitigation strategies. The work of J. T. Fitzsimons (1972) had the most citations. This influential publication explores thirst from a broad perspective that includes, among others, the initiation and diminishing mechanisms, assessment techniques, and impacts of thirst.[28] It has been cited 545 times over 49 years, highlighting its importance and relevance to the field of kidney health related to dehydration.

The work of Luyckx et al (2018) was the second-most-cited article, with a TC of 224. It was also the most cited in terms of TC per year, with an average of 56 citations per year. The article discusses the global burden of kidney disease and the actions needed to improve understanding, measurement, prevention, and treatment to reduce this burden.[29] The work of Correa-Rotter et al (2014) was the third most-cited article, with a TC of 203. The article discusses some of the possible etiological reasons for CKDu in Central America, with high relevance given to recurrent dehydration.[30] Notably, the majority of the most-cited articles were published between 2010 and 2018, indicating that research development on the effect of heat on kidney health occurred after this period, which was also demonstrated by the overall development trend of all published articles (Fig. 1). As noted earlier, this trend is attributable to the attention given to the emergence of CKDu in Central America. The above citation analysis is recognized as a measure of the impact of a published article, but not necessarily as a measure of its quality.[60,61]

The analysis of author statistics revealed different ranking results based on the author-impact metrics used. In terms of productivity, the number of publications over time (NP) for the top 20 authors varied between 6 and 32 articles, with R. J. Johnson being the most productive. A major limitation of this quantitative metric is that it overlooks the relevance of important factors such as the value of publishing in journals with a high impact factor, article type, number of co-authors, research topic, and indexing database.[62] In terms of the authors’ TC, the counts varied widely (from 98 to 1398), with both R. J. Johnson and C. Wesseling being the top scorers (1288 and 1398, respectively). An author’s high citation count is considered a recognized interest in his or her field of work and, to some extent, his or her contribution to scientific progress in that field.[63] Excluding the top 4 authors, the h-index and g-index demonstrated variation in ranking the rest of the authors. The h-index is widely recognized for evaluating author impacts in most scientific fields. Despite being one of the most appropriate and widely used author-impact metrics globally, the h-index has been criticized for giving more consideration to the number of articles, rather than their citations. This results in the underestimation of highly influential articles and early career researchers.[64,65] The g-index, on the other hand, focuses more on highly cited articles. For this reason, the calculation method of the g-index results in high scores even for an author with only a few highly cited articles; the opposite is true for the h-index.[64,65]

Collaboration among authors investigating the impact of heat on kidney health was on an individual basis or under the umbrella of their institution. For instance, the Center for Health, Work, and Environment at the University of Colorado has established a partnership with agribusiness, local authorities, and community organizations in Central America to permit a highly qualified research team to investigate the spread of CKDu. This is part of the integrated collaborative efforts of Center for Health, Work, and Environment to improve the health of agricultural workers in the region.[66] Another example is the La Isla Network research team, established in 2016, which has engaged in worldwide studies of CKDu to understand its causes, treatments, and possible intervention measures. This global interdisciplinary team is composed of nephrologists, epidemiologists, public health experts, physiologists, economists, and journalists from different countries (US, Sweden, UK, India, El Salvador, Nicaragua, and others).[67] These and other organized network teams strive to enhance collaboration between local and international authors.

The statistical analysis of keywords, showed that the words “chronic kidney disease,” “heat stress,” “acute kidney injury,” “Mesoamerican nephropathy,” and “climate change” were most frequently used by authors. Other commonly used words among authors were “CKDu,” “dehydration,” “agricultural workers,” and “Central America.” These words denote the main research topics in the field of heat-related kidney injury, with CKDu being the central topic.

Based on the keywords analysis conducted for this study, 3 distinct major research clusters were established (Fig. 3). The first cluster (blue) contains words associated with articles that emphasized CKDu from various perspectives. A high productivity of articles under this cluster was noted between 2014 and 2020. Such high research productivity over this short period emphasizes that CKDu has become an increasingly significant research topic, particularly from the perspective of agricultural work settings, where physically demanding work is performed under frequent heat exposure.[68–70] Prolonged exposure to climatic heat is a substantial cause of dehydration and volume loss among exposed workers, which can lead to AKI, and recurrent AKI episodes can increase the risk of developing CKDu and kidney failure.[34,42,71–73] This phenomenon also relates to the clinical diagnosis and characteristics of the disease and its mitigation strategies.[74–76]

The second identified research cluster (red) represents another research direction: the effect of climate change and its impact on kidney health. Over the last century, the mean global temperature has increased by approximately 1.0°C, associated with more frequent heatwaves as a consequence of climate change.[49,77] The persistence of this environmental phenomenon has profound effects on human health. In addition to classical heat-related illnesses (e.g., heat exhaustion and heat stroke), a wide range of kidney injuries has been linked to exposure to high ambient temperatures.[44,78] Studies from Australia and Korea have found an increase in the risk of AKI-associated hospitalization during hotter summer periods.[35,79] In the US, Fletcher et al (2012) and Ogbomo et al (2017) found an association between an increase in hospitalization due to AKI and an increase in ambient temperature during the summer months and during heatwave events.[80,81] Research in this cluster has explored the relationship between climate change and kidney injuries, the locations where they prevail, the consequent clinical and public health implications, management and prevention strategies, and the areas of research needed to better characterize and understand this environmental health impact.

The third distinct research cluster (green) constitutes a general research area focusing on renal physiology and heat stress, in which heat stress is the net heat load exerted on the body from ambient heat, physical activity performed, and clothes worn. Evidence has linked heat stress exposure to an increased risk of pathological events in the kidneys, namely AKI.[82,83] From this perspective, various studies have been conducted to investigate the integrative responses of the kidneys to heat stress and all possible influencing factors (environmental conditions, hydration status, work intensity and duration, etc). The development and analysis of kidney injury biomarkers have also been the subject of research in this cluster.[68,84–93]

Despite the accelerated development in heat-related kidney health research shown in this study, gaps still exist in the research “hotspot” topics noted in this study. Such gaps exist, particularly in developing countries in Africa, Asia, the Middle East, and South America, which are reflected in their low research contributions and collaboration rates. Collaboration and partnerships with leading international research institutions and health organizations can help counter difficulties and boost research productivity at the national level. International collaborative research efforts will contribute in improving the diagnosis, treatment, and prevention of this serious and globally threatening disease.

5. Conclusion

In this study, we attempted to analyze research progress in heat-related kidney injuries from the historical perspective of published articles. There has been substantial development in this area of research over the last 2 decades. This was motivated by the global recognition of the emergence of CKDu and the potential impacts of climate change intensifying heat stress. The US is the most productive country for research in this field. Future research should focus on the effects of climate change and its impact on kidney health, renal physiology and heat stress, and CKDu and its mitigation strategies, particularly in countries located in hot climatic zones.

Author contributions

Conceptualization: Mohammed Al-Bouwarthan, Abdulaziz A. AlMulla, Muhammad Yaseen

Data curation: Mohammed Al-Bouwarthan, Abdulaziz A. AlMulla, Muhammad Yaseen

Formal analysis: Muhammad Yaseen

Methodology: Mohammed Al-Bouwarthan, Abdulaziz A. AlMulla, Muhammad Yaseen

Validation: Mohammed Al-Bouwarthan, Abdulaziz A. AlMulla

Visualization: Mohammed Al-Bouwarthan, Abdulaziz A. AlMulla, Muhammad Yaseen

Writing—original draft: Mohammed Al-Bouwarthan

Writing—review & editing: Mohammed Al-Bouwarthan, Abdulaziz A. AlMulla

Supplementary Material

medi-101-e30328-s001.pdf (198.7KB, pdf)
medi-101-e30328-s002.pdf (267.5KB, pdf)
medi-101-e30328-s004.pdf (99.5KB, pdf)

Abbreviations:

AKI =
acute kidney injury
CKD =
chronic kidney disease
CKDu =
chronic kidney disease of unknown etiology
DALYs =
disability-adjusted life years
LCS =
local citation score
NP =
number of published articles
SCP =
single-country publications
TC =
total citations
WoS =
Web of Science

All data generated or analyzed during this study are included in this published article [and its supplementary information files] and are publicly available.

How to cite this article: Al-Bouwarthan M, Almulla AA, Yaseen M. The impact of heat on kidney health: A PRISMA-compliant bibliometric analysis. Medicine 2022;101:36(e30328).

Supplemental Digital Content is available for this article.

The authors have no funding and conflicts of interest to disclose.

Contributor Information

Abdulaziz A. AlMulla, Email: aaalmulla@iau.edu.sa.

Muhammad Yaseen, Email: myaseen208@gmail.com.

References

  • [1].Luber G, McGeehin M. Climate change and extreme heat events. Am J Prev Med. 2008;35:429–35. [DOI] [PubMed] [Google Scholar]
  • [2].Varela R, Rodriguez-Diaz L, deCastro M. Persistent heat waves projected for middle east and north Africa by the end of the 21st century. PLoS One. 2020;15:e0242477. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [3].Ebi KL, Capon A, Berry P, et al. Hot weather and heat extremes: health risks. Lancet. 2021;398:698–708. [DOI] [PubMed] [Google Scholar]
  • [4].Kenny GP, Notley SR, Flouris AD, et al. Climate change and heat exposure: impact on health in occupational and general populations. Adams WM, Jardine JF, eds. In: Exertional heat illness: a clinical and evidence-based guide. Cham: Springer International Publishing, 2020:225–61. [Google Scholar]
  • [5].Thonneau P, Bujan L, Multigner L, et al. Occupational heat exposure and male fertility: a review. Hum Reprod. 1998;13:2122–5. [DOI] [PubMed] [Google Scholar]
  • [6].Tawatsupa B, Lim LL, Kjellstrom T, et al. ; The Thai Cohort Study Team. The association between overall health, psychological distress, and occupational heat stress among a large national cohort of 40,913 Thai workers. Glob Health Action. 2010;3:5034. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [7].Cheshire WP, Jr. Thermoregulatory disorders and illness related to heat and cold stress. Auton Neurosci. 2016;196:91–104. [DOI] [PubMed] [Google Scholar]
  • [8].Pradhan B, Kjellstrom T, Atar D, et al. Heat stress impacts on cardiac mortality in Nepali migrant workers in Qatar. Cardiology. 2019;143:37–48. [DOI] [PubMed] [Google Scholar]
  • [9].Nerbass FB, Pecoits-Filho R, Calice-Silva V. The environmental role of hydration in kidney health and disease. Contrib Nephrol. 2021;199:1–14. [DOI] [PubMed] [Google Scholar]
  • [10].Roncal-Jimenez C, Garcia-Trabanino R, Barregard L, et al. Heat stress nephropathy from exercise-induced uric acid crystalluria: a perspective on Mesoamerican nephropathy. Am J Kidney Dis. 2016;67:20–30. [DOI] [PubMed] [Google Scholar]
  • [11].Nerbass FB, Pecoits-Filho R. Can your work affect your kidney’s health? Rev Environ Health. 2019;34:441–6. [DOI] [PubMed] [Google Scholar]
  • [12].Elinder C, Wernerson A, Wijkstrom J. Mesoamerican nephropathy (men). A “new” chronic kidney disease related to occupational heat exposure with repeated deprivation of salts and water. Int J Nephrol Kidney Fail. 2015;1:1–9. [Google Scholar]
  • [13].Johnson RJ, Wesseling C, Newman LS. Chronic kidney disease of unknown cause in agricultural communities. N Engl J Med. 2019;380:1843–52. [DOI] [PubMed] [Google Scholar]
  • [14].Hansson E, Mansourian A, Farnaghi M, et al. An ecological study of chronic kidney disease in five Mesoamerican countries: associations with crop and heat. BMC Public Health. 2021;21:840. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [15].Pan American Health Organization (PAHO). Epidemic of Chronic Kidney Disease in Agricultural Communities in Central America: Case Definitions, Methodological Basis and Approaches for Public Health Surveillance. Washington, DC: PAHO. 2017. Available at: https://www.paho.org/en/documents/epidemic-chronic-kidney-disease-agricultural-communities-central-america-case-definitions [access date February 5, 2022]. [Google Scholar]
  • [16].Ball R, Tunger D. Bibliometric analysis-a new business area for information professionals in libraries? Support for scientific research by perception and trend analysis. Scientometrics. 2006;66:561–77. [Google Scholar]
  • [17].Ellegaard O, Wallin JA. The bibliometric analysis of scholarly production: how great is the impact? Scientometrics. 2015;105:1809–31. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [18].Donthu N, Kumar S, Mukherjee D, et al. How to conduct a bibliometric analysis: an overview and guidelines. J Bus Res. 2021;133:285–96. [Google Scholar]
  • [19].Chen C. Citespace II: detecting and visualizing emerging trends and transient patterns in scientific literature. J Am Soc Inf Sci Technol. 2006;57:359–77. [Google Scholar]
  • [20].Falagas ME, Pitsouni EI, Malietzis GA, et al. Comparison of pubmed, scopus, web of science, and Google scholar: strengths and weaknesses. FASEB J. 2008;22:338–42. [DOI] [PubMed] [Google Scholar]
  • [21].van Eck NJ, Waltman L. Software survey: Vosviewer, a computer program for bibliometric mapping. Scientometrics. 2010;84:523–38. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [22].Linnenluecke MK, Marrone M, Singh AK. Conducting systematic literature reviews and bibliometric analyses. Aust J Manag. 2020;45:175–94. [Google Scholar]
  • [23].Yuan N, Wang L, Zhang X, et al. Bisphenol a and thyroid hormones: bibliometric analysis of scientific publications. Medicine. 2020;99:e23067. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [24].Bao Y, Mehmood K, Saifullah D, et al. Global research on the air quality status in response to the electrification of vehicles. Sci Total Environ. 2021;795:148861. [DOI] [PubMed] [Google Scholar]
  • [25].Seo Y, Park HS, Kim H, et al. A bibliometric analysis of research on herbal medicine for obesity over the past 20 years. Medicine. 2022;101:e29240. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [26].Li K, Rollins J, Yan E. Web of science use in published research and review papers 1997–2017: a selective, dynamic, cross-domain, content-based analysis. Scientometrics. 2018;115:1–20. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [27].Van Eck NJ, Waltman L. VOSviewer Manual Version 1.6.10. Leiden, Netherlands: Leiden University. 2019. Available at: https://www.vosviewer.com/documentation/Manual_VOSviewer_1.6.10.pdf [access date February 5, 2022]. [Google Scholar]
  • [28].Fitzsimons JT. Thirst. Physiol Rev. 1972;52:468–561. [DOI] [PubMed] [Google Scholar]
  • [29].Luyckx VA, Tonelli M, Stanifer JW. The global burden of kidney disease and the sustainable development goals. Bull World Health Organ. 2018;96:414–22D. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [30].Correa-Rotter R, Wesseling C, Johnson RJ. CKD of unknown origin in Central America: the case for a Mesoamerican nephropathy. Am J Kidney Dis. 2014;63:506–20. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [31].Glaser J, Lemery J, Rajagopalan B, et al. Climate change and the emergent epidemic of CKD from heat stress in rural communities: the case for heat stress nephropathy. Clin J Am Soc Nephrol. 2016;11:1472–83. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [32].Peraza S, Wesseling C, Aragon A, et al. Decreased kidney function among agricultural workers in El Salvador. Am J Kidney Dis. 2012;59:531–40. [DOI] [PubMed] [Google Scholar]
  • [33].Torres C, Aragon A, Gonzalez M, et al. Decreased kidney function of unknown cause in Nicaragua: a community-based survey. Am J Kidney Dis. 2010;55:485–96. [DOI] [PubMed] [Google Scholar]
  • [34].Garcia-Trabanino R, Jarquin E, Wesseling C, et al. Heat stress, dehydration, and kidney function in sugarcane cutters in El Salvador—a cross-shift study of workers at risk of Mesoamerican nephropathy. Environ Res. 2015;142:746–55. [DOI] [PubMed] [Google Scholar]
  • [35].Hansen AL, Bi P, Ryan P, et al. The effect of heat waves on hospital admissions for renal disease in a temperate city of Australia. Int J Epidemiol. 2008;37:1359–65. [DOI] [PubMed] [Google Scholar]
  • [36].Ostro B, Rauch S, Green R, et al. The effects of temperature and use of air conditioning on hospitalizations. Am J Epidemiol. 2010;172:1053–61. [DOI] [PubMed] [Google Scholar]
  • [37].Knochel JP, Dotin LN, Hamburger RJ. Heat stress, exercise, and muscle injury: effects on urate metabolism and renal function. Ann Intern Med. 1974;81:321–8. [DOI] [PubMed] [Google Scholar]
  • [38].Clarkson PM. Exertional rhabdomyolysis and acute renal failure in marathon runners. Sports Med. 2007;37:361–3. [DOI] [PubMed] [Google Scholar]
  • [39].Schrier RW, Hano J, Keller HI, et al. Renal, metabolic, and circulatory responses to heat and exercise. Studies in military recruits during summer training, with implications for acute renal failure. Ann Intern Med. 1970;73:213–23. [DOI] [PubMed] [Google Scholar]
  • [40].Schrier RW, Henderson HS, Tisher CC, et al. Nephropathy associated with heat stress and exercise. Ann Intern Med. 1967;67:356–76. [DOI] [PubMed] [Google Scholar]
  • [41].Lunyera J, Mohottige D, Von Isenburg M, et al. CKD of uncertain etiology: a systematic review. Clin J Am Soc Nephrol. 2016;11:379–85. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [42].Wesseling C, Aragon A, Gonzalez M, et al. Kidney function in sugarcane cutters in Nicaragua—a longitudinal study of workers at risk of Mesoamerican nephropathy. Environ Res. 2016;147:125–32. [DOI] [PubMed] [Google Scholar]
  • [43].Wesseling C, Crowe J, Hogstedt C, et al. Resolving the enigma of the Mesoamerican nephropathy: a research workshop summary. Am J Kidney Dis. 2014;63:396–404. [DOI] [PubMed] [Google Scholar]
  • [44].Flouris AD, Dinas PC, Ioannou LG, et al. Workers’ health and productivity under occupational heat strain: a systematic review and meta-analysis. Lancet Planet Health. 2018;2:e521–531. [DOI] [PubMed] [Google Scholar]
  • [45].Weiner DE, McClean MD, Kaufman JS, et al. The Central American epidemic of CKD. Clin J Am Soc Nephrol. 2013;8:504–11. [DOI] [PubMed] [Google Scholar]
  • [46].Correa-Rotter R, Garcia-Trabanino R. Mesoamerican nephropathy. Semin Nephrol. 2019;39:263–71. [DOI] [PubMed] [Google Scholar]
  • [47].Abraham G, Varughese S, Thandavan T, et al. Chronic kidney disease hotspots in developing countries in South Asia. Clin Kidney J. 2016;9:135–41. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [48].Gifford FJ, Gifford RM, Eddleston M, et al. Endemic nephropathy around the world. Kidney Int Rep. 2017;2:282–92. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [49].World Meteorological Organization (WMO). State of the Global Climate 2020. Geneva, Switzerland: WMO. 2021. Available at: https://library.wmo.int/doc_num.php?explnum_id=10618 [access date February 5, 2022]. [Google Scholar]
  • [50].Kjellstrom T, Butler AJ, Lucas RM, et al. Public health impact of global heating due to climate change: potential effects on chronic non-communicable diseases. Int J Public Health. 2010;55:97–103. [DOI] [PubMed] [Google Scholar]
  • [51].Sasai F, Roncal-Jimenez C, Rogers K, et al. Climate change and nephrology. Nephrol Dial Transplant. 2021;gfab258:10.1093/ndt/gfab258. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [52].Barraclough KA, Agar JWM. Green nephrology. Nat Rev Nephrol. 2020;16:257–68. [DOI] [PubMed] [Google Scholar]
  • [53].Stenvinkel P, Shiels PG, Painer J, et al. A planetary health perspective for kidney disease. Kidney Int. 2020;98:261–5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [54].Stauss M, Floyd L, Becker S, et al. Opportunities in the cloud or pie in the sky? Current status and future perspectives of telemedicine in nephrology. Clin Kidney J. 2021;14:492–506. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [55].Scimago Institutions Rankings (SIR). SIR country rank. Available at: https://www.scimagojr.com/countryrank.php [access date February 5, 2022].
  • [56].Mowery DC, Sampat BN. The Bayh-Dole Act of 1980 and university–industry technology transfer: a model for other OECD governments? J Technol Transf. 2004;30:115–27. [Google Scholar]
  • [57].Heng K, Hamid M, Khan A. Factors influencing academics’ research engagement and productivity: a developing countries perspective. Issues Educ Res. 2020;30:965–87. [Google Scholar]
  • [58].Gronlund CJ, Zanobetti A, Schwartz JD, et al. Heat, heat waves, and hospital admissions among the elderly in the United States, 1992-2006. Environ Health Perspect. 2014;122:1187–92. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [59].Bornmann L, Williams R. Can the journal impact factor be used as a criterion for the selection of junior researchers? A large-scale empirical study based on ResearcherID data. J Inf. 2017;11:788–99. [Google Scholar]
  • [60].Wallin JA. Bibliometric methods: pitfalls and possibilities. Basic Clin Pharmacol Toxicol. 2005;97:261–75. [DOI] [PubMed] [Google Scholar]
  • [61].Aksnes DW, Langfeldt L, Wouters P. Citations, citation indicators, and research quality: an overview of basic concepts and theories. Sage Open. 2019;9:2158244019829572158244019829575. [Google Scholar]
  • [62].Gasparyan AY, Yessirkepov M, Duisenova A, et al. Researcher and author impact metrics: variety, value, and context. J Korean Med Sci. 2018;33:e139. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [63].Clarivate. Highly Cited Researchers 2020. Pioneers in Their Fields. Recognized by their Peers. Applauded by the World. London, United Kingdom: Clarivate, 2020. Available at: https://clarivate.com/webofsciencegroup/wp-content/uploads/sites/2/dlm_uploads/2020/11/WS559074072-Highly-Cited-Researchers-2020_Executive-summary_Report_v5-PH.pdf [access date February 5, 2022]. [Google Scholar]
  • [64].Zhang CT. Relationship of the h-index, g-index, and e-index. J Am Soc Inf Sci Technol. 2010;61:625–8. [Google Scholar]
  • [65].Bartolucci F. A comparison between the g-index and the h-index based on concentration. J Assoc Inf Sci Technol. 2015;66:2708–10. [Google Scholar]
  • [66].Center for Health WECSoPH. Center for health, work & environment. 2021. Available at: https://coloradosph.cuanschutz.edu/research-and-practice/centers-programs/chwe [access date February 5, 2022].
  • [67].La Isla Network: about us. La Isla Network. 2021. Available at: https://laislanetwork.org [access date February 5, 2022].
  • [68].Hansson E, Glaser J, Weiss I, et al. Workload and cross-harvest kidney injury in a Nicaraguan sugarcane worker cohort. Occup Environ Med. 2019;76:818–26. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [69].Moyce S, Mitchell D, Armitage T, et al. Heat strain, volume depletion and kidney function in California agricultural workers. Occup Environ Med. 2017;74:402–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [70].Lopez-Galvez N, Wagoner R, Canales RA, et al. Longitudinal assessment of kidney function in migrant farm workers. Environ Res. 2021;202:111686. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [71].Paula Santos U, Zanetta DM, Terra-Filho M, et al. Burnt sugarcane harvesting is associated with acute renal dysfunction. Kidney Int. 2015;87:792–9. [DOI] [PubMed] [Google Scholar]
  • [72].Gonzalez-Quiroz M, Smpokou E-T, Silverwood RJ, et al. Decline in kidney function among apparently healthy young adults at risk of Mesoamerican nephropathy. J Am Soc Nephrol. 2018;29:2200–12. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [73].Mix J, Elon L, Vi Thien Mac V, et al. Hydration status, kidney function, and kidney injury in Florida agricultural workers. J Occup Environ Med. 2018;60:e253–60. [DOI] [PubMed] [Google Scholar]
  • [74].Fischer RSB, Vangala C, Mandayam S, et al. Clinical markers to predict progression from acute to chronic kidney disease in Mesoamerican nephropathy. Kidney Int. 2018;94:1205–16. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [75].Caplin B, Yang C-W, Anand S, et al. The international society of nephrology’s international consortium of collaborators on chronic kidney disease of unknown etiology: report of the working group on approaches to population-level detection strategies and recommendations for a minimum dataset. Kidney Int. 2019;95:4–10. [DOI] [PubMed] [Google Scholar]
  • [76].Gonzalez-Quiroz M, Nitsch D, Hamilton S, et al. Rationale and population-based prospective cohort protocol for the disadvantaged populations at risk of decline in EGFR (co-degree). BMJ Open. 2019;9:e031169. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [77].Perkins-Kirkpatrick SE, Lewis SC. Increasing trends in regional heatwaves. Nat Commun. 2020;11:3357. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [78].Liu J, Varghese BM, Hansen A, et al. Hot weather as a risk factor for kidney disease outcomes: a systematic review and meta-analysis of epidemiological evidence. Sci Total Environ. 2021;801:149806. [DOI] [PubMed] [Google Scholar]
  • [79].Kim SE, Lee H, Kim J, et al. Temperature as a risk factor of emergency department visits for acute kidney injury: a case-crossover study in Seoul, South Korea. Environ Health. 2019;18:55. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [80].Fletcher BA, Lin S, Fitzgerald EF, et al. Association of summer temperatures with hospital admissions for renal diseases in New York state: a case-crossover study. Am J Epidemiol. 2012;175:907–16. [DOI] [PubMed] [Google Scholar]
  • [81].Ogbomo AS, Gronlund CJ, O’Neill MS, et al. Vulnerability to extreme-heat-associated hospitalization in three counties in Michigan, USA, 2000-2009. Int J Biometeorol. 2017;61:833–43. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [82].Hansson E, Glaser J, Jakobsson K, et al. Pathophysiological mechanisms by which heat stress potentially induces kidney inflammation and chronic kidney disease in sugarcane workers. Nutrients. 2020;12:1639. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [83].Chapman CL, Johnson BD, Parker MD, et al. Kidney physiology and pathophysiology during heat stress and the modification by exercise, dehydration, heat acclimation and aging. Temperature. 2021;8:108–59. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [84].Laws RL, Brooks DR, Amador JJ, et al. Biomarkers of kidney injury among Nicaraguan sugarcane workers. Am J Kidney Dis. 2016;67:209–17. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [85].Oliveira RA, Sierra APR, Benetti M, et al. Impact of hot environment on fluid and electrolyte imbalance, renal damage, hemolysis, and immune activation postmarathon. Oxid Med Cell Longev. 2017;2017:9824192. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [86].Schlader ZJ, Chapman CL, Sarker S, et al. Firefighter work duration influences the extent of acute kidney injury. Med Sci Sports Exerc. 2017;49:1745–53. [DOI] [PubMed] [Google Scholar]
  • [87].McDermott BP, Smith CR, Butts CL, et al. Renal stress and kidney injury biomarkers in response to endurance cycling in the heat with and without ibuprofen. J Sci Med Sport. 2018;21:1180–4. [DOI] [PubMed] [Google Scholar]
  • [88].Chapman CL, Johnson BD, Sackett JR, et al. Soft drink consumption during and following exercise in the heat elevates biomarkers of acute kidney injury. Am J Physiol Regul Integr Comp Physiol. 2019;316:R189–98. [DOI] [PubMed] [Google Scholar]
  • [89].Gallo-Ruiz L, Sennett CM, Sanchez-Delgado M, et al. Prevalence and risk factors for CKD among brickmaking workers in La Paz Centro, Nicaragua. Am J Kidney Dis. 2019;74:239–47. [DOI] [PubMed] [Google Scholar]
  • [90].Al-Bouwarthan M, Quinn MM, Kriebel D, et al. Risk of kidney injury among construction workers exposed to heat stress: a longitudinal study from Saudi Arabia. Int J Environ Res Public Health. 2020;17:3775. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [91].Butler-Dawson J, Dally M, Johnson RJ, et al. Association of copeptin, a surrogate marker of arginine vasopressin, with decreased kidney function in sugarcane workers in Guatemala. Ann Nutr Metab. 2020;76:30–6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [92].Chapman CL, Johnson BD, Vargas NT, et al. Both hyperthermia and dehydration during physical work in the heat contribute to the risk of acute kidney injury. J Appl Physiol (1985). 2020;128:715–28. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • [93].Krisher L, Butler-Dawson J, Yoder H, et al. Electrolyte beverage intake to promote hydration and maintain kidney function in Guatemalan sugarcane workers laboring in hot conditions. J Occup Environ Med. 2020;62:e696–703. [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

medi-101-e30328-s001.pdf (198.7KB, pdf)
medi-101-e30328-s002.pdf (267.5KB, pdf)
medi-101-e30328-s003.pdf (391KB, pdf)
medi-101-e30328-s004.pdf (99.5KB, pdf)
medi-101-e30328-s005.pdf (94KB, pdf)

Articles from Medicine are provided here courtesy of Wolters Kluwer Health

RESOURCES