Date of Award

Fall 2019

Degree Type



Epidemiology and Biostatistics

Director of Thesis

Myriam Torres

First Reader

Dr. Myriam Torres

Second Reader

Dr. Edena Guimaraes


Throughout many Central American countries, incidence of chronic kidney disease (CKD) has been on the rise. The disease mainly affects agricultural workers and differs from typical CKD. Patients in these countries often do not have preexisting conditions such as diabetes or hypertension known to be traditional causes of CKD. They also experience increased damage to the kidney tubules, rather than the glomeruli generally more heavily impacted. There has been speculation regarding the causes of CKDnT (chronic kidney disease of nontraditional causes), but no consensus has been reached. Two major hypotheses to explain the high prevalence among Central American sugarcane workers are patterns of cyclical dehydration throughout the work shift, and exposure to agrochemicals. While dehydration-induced damage is the favored hypothesis at this time, other factors cannot be eliminated without further research.

In order to reduce the incidence of CKDnT among sugarcane workers, certain policies could be established. First, shaded break areas and more break time allotted throughout the work day would help lower the body temperatures of workers. Secondly, masks and protective clothing should be required or, at the least, more highly regulated in order to reduce agrochemical exposure. Programs such as that led by the Caja Costarricense Seguro Social should continue to educate all citizens about the importance of drinking water.

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