Chronic kidney disease has become a problem for almost half of the adult men in Chichigalpa, Nicaragua. The disease seems to the linked to the men’s work cutting sugar cane. The exact cause of the problem is unknown but it is suspected that dehydration is a factor due to the hot working conditions with limited time for breaks. Read more:  Chronic kidney disease might be less of a risk associated with their jobs if sugarcane workers were allowed enough time to take breaks to prevent dehydration from occurring, as dehydration itself can cause long term harm to the kidneys. 
As a consumer of sugarcane products I care about whether sugarcane workers are allowed their right to protect their health during their workday. As a human I care about the worker’s pain and shortened lifespans and about their families. Chronic kidney disease and kidney dialysis treatment require the patient to follow a very restrictive diet and the treatment requires the patient to stay attached to the dialysis machine for hours every few days. Providing adequate breaks to the workers now seems like an easier strategy in the long run, to me.
There is also a question of gender representation — Why aren’t half of the women suffering from chronic kidney failure too? If the disease was caused by something in the environment it would show up in a more even distribution, men and women would be sick in equal numbers. If the disease is associated with cutting sugarcane then maybe women aren’t getting it because more men then women are working as sugarcane cutters. Likely cutting sugarcane is very physically demanding work and male skeletal structure and muscle mass on average simply is stronger and larger than female anatomy. Machines able to navigate sugarcane fields might be invented to do the job but that solution would be taking away yet more jobs from humans and a risky job, unfortunately, is better than no job for many people because, unlike corporations, people have to eat to survive.
Working in hot conditions causes a loss of fluid and electrolytes contained in sweat and overheating may further increase the amount of sweat that is produced. Evaporation of sweat can have a cooling effect on the body. Intense physical exercise in hot and humid conditions may cause losses of up to three liters of sweat which is almost equivalent to the water content of the body’s blood supply.  Workers need to have enough time to drink, eat and cool down to help prevent the risk of acute dehydration and the risk of it causing lasting damage to the kidneys.
Allowing workers frequent breaks in the shade might give their bodies time to cool down and slow down the loss of nutrients caused by excessive sweating, and allow them enough time to drink water and have a salty magnesium rich snack to replace the nutrients that were lost in sweat or used by the kidneys. The water and potassium in a piece of fruit and a salty magnesium rich snack like tortilla chips would help replace the water, sodium, potassium, and magnesium that are essential for the kidneys function.  The kidneys have to have enough nutrients to be able to filter out the toxins that are produced daily as a normal part of physiology and any extra toxins created by a job with hard physical labor and then still have enough nutrients to filter out any additional toxins that may have been absorbed from working around the agricultural chemicals.
4/18/2017, Update: dehydration is still suspected to be involved in the increased incidence of chronic kidney disease in agricultural workers. The problem is more widespread however than just Nicaragua. Pesticides from agriculture or silica from contaminated ground water is suspected to be involved. Use of painkillers and alcohol in the evenings combined with the limited access of water during the work day is also suspected to add to the risk of chronic kidney damage occurring. 
“Associations were reported with agricultural work, agrochemical exposure, dehydration, hypertension, homemade alcohol use and family history of chronic kidney disease. There is no strong evidence for a single cause, and multiple environmental, occupational and social factors are probably involved.” 
Part of the problem is that symptoms don’t occur until fairly serious permanent damage has developed. Earlier diagnosis by use of more frequent screening of certain lab tests may help but families need to eat and someone needs to work. Young adult sons take over when their father is no longer able to work. The disabled men are a financial and physical burden for the family and the number of widows has increased in many of the areas that have been experiencing an increase in the number of adult workers with severe chronic kidney disease. A sense of futility in the men may be part of the problem too – you can’t prevent what you don’t feel you have any control over. 
Preventative health care can help prevent damaging chemicals from collecting in the kidneys. And having adequate magnesium and water throughout the day and evening can help the kidneys detoxify and remove the chemicals before damage develops. Having water and some salty snacks or peanuts along with alcoholic beverages in the evening can help the body detoxify and remove the toxic effect of alcohol before it has a chance to cause damage to the kidneys either.
Agricultural companies might save money on employee turnover and sick days if they provided filtered water  and adequate work breaks, especially during the hottest part of the day.
A video about the condition and research regarding the increased incidence in El Salvador is available with subtitles in English, Enfermedad Renal Crónica: NefroSalva Clínico (El Salvador): 
/Disclosure: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./
- “Associations were reported with agricultural work, agrochemical exposure, dehydration, hypertension, homemade alcohol use and family history of chronic kidney disease. There is no strong evidence for a single cause, and multiple environmental, occupational and social factors are probably involved.” https://www.ncbi.nlm.nih.gov/pubmed/24878644
- Enfermedad Renal Crónica: NefroSalva Clínico (El Salvador), a video from El Salvador: https://www.youtube.com/watch?v=Tk9wcMyRG1E&feature=youtu.be
- 6 types of water filtering devices designed for developing nations: http://inhabitat.com/6-water-purifying-devices-for-clean-drinking-water-in-the-developing-world/