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Many young Nepali migrant workers developed end-stage renal disease (ESRD) while working abroad. Mandatory pre-departure tests done estimate a very low prevalence of kidney disease. The etiology of kidney disease remains unknown, but exposure to recurrent heat stress and chemicals have been suggested as potential risk factors. Our study aims to understand the demographic and occupational characteristics of returning migrant workers (RMW) currently on hemodialysis.
Cross-sectional study was conducted in 2 large hemodialysis centers in Kathmandu from April through May of 2023. Questionnaire with emphasis on occupational exposure to heat and chemicals and migrant history were administered to all patients 18-80 years of age receiving in-center hemodialysis. Ethical approval was obtained from the Nepal Health Research Council.
A total of 339 patients were included in the study (mean age 46.2 ±13.7 yrs.) Among them 28% were returnee migrant workers, of whom 87% were male and 68% worked in the Gulf Cooperation Council (GCC) and Malaysia. Returnee migrant workers were on average 6.4 years younger than non-returnee migrant workers (P <0.001). More than a half of returnee migrant workers were younger than 40 years, compared to 30% of non-returnee migrant workers (P <0.001). The median duration of work abroad was 12 years (IQR 9-16). Health problems were the reason for the return of more than half of the migrant workers were health problems. Significant differences were observed for prevalence of diabetes 11.7% vs 24.1% (P=0.012) and immunologic diseases 5.3% vs 13.9% (P=0.027). Regular use of non-steroidal anti-inflammatory drugs was reports by more than 25% of respondents with no difference observed between groups. Among migrant workers who reported heat exposure at work, 65% were exposed daily. They reported experiencing extreme workload (38%), no breaks (40%), and exhaustion (78%).
RMWs account for more than a quarter of all ESRD patients receiving maintenance hemodialysis in Kathmandu. These workers were significantly younger. Exposure to dust, chemical, aerosols, daily heat and exhaustion was very commonly reported. These findings implicate heat and environmental exposures as potential risk factors for chronic kidney disease of non-traditional etiology (CKD-nT). These results call for further studies in this population to better understand the risk and develop effective strategies that could be adapted to mitigate the risk posed.