Kidney Week

Abstract: FR-PO0272

Increased Risk of Acute Respiratory Illness and Benefits of COVID-19 Vaccination Among Guatemalan Agricultural Workers with CKD

Session Information

• CKD: Omics, Systemic Stressors, and Targeted Pharmacotherapy
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2201 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Krisher, Lyndsay, Colorado School of Public Health Centers for Health Work and Environment, Aurora, Colorado, United States

Lyndsay Krisher, DrPH, MPH

• Lamb, Molly, Colorado School of Public Health Center for Global Health, Aurora, Colorado, United States

Molly Lamb, PhD

• Stutzman, Jenae, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, United States

Jenae Stutzman, MD

• Barrientos, Diva M., Fundacion para la Salud Integral de los Guatemaltecos, Coatepeque, Guatemala

Diva M. Barrientos, MSc

• Rojop, Neudy, Fundacion para la Salud Integral de los Guatemaltecos, Coatepeque, Guatemala

Neudy Rojop, MSc

• Arias, Kareen, Fundacion para la Salud Integral de los Guatemaltecos, Coatepeque, Guatemala

Kareen Arias, MMSc

• Bradley, Claire Wickson, Fundacion para la Salud Integral de los Guatemaltecos, Coatepeque, Guatemala

Claire Wickson Bradley

• Mejia, Wanda Nineth, Fundacion para la Salud Integral de los Guatemaltecos, Coatepeque, Guatemala

Wanda Nineth Mejia, RN

• Lofgren, Hannah, Centers for Disease Control and Prevention, Atlanta, Georgia, United States

Hannah Lofgren

• Iwamoto, Chelsea A., Centers for Disease Control and Prevention, Atlanta, Georgia, United States

Chelsea A. Iwamoto, MPH

• del Cid, Julio, Fundacion para la Salud Integral de los Guatemaltecos, Coatepeque, Guatemala

Julio del Cid

• Paiz, Claudia, Fundacion para la Salud Integral de los Guatemaltecos, Coatepeque, Guatemala

Claudia Paiz

• Monzon, José C., Centers for Disease Control and Prevention, Atlanta, Georgia, United States

José C. Monzon, MD, MSc

• Weikel, Blair W., Colorado School of Public Health Center for Global Health, Aurora, Colorado, United States

Blair W. Weikel, MPH

• Bunker, Aditi, Heidelberg University Institute of Global Health, Heidelberg, Germany

Aditi Bunker

• Bolanos Ventura, Guillermo Antonio, Fundacion para la Salud Integral de los Guatemaltecos, Coatepeque, Guatemala

Guillermo Antonio Bolanos Ventura, MD

• Fowlkes, Ashley L., Centers for Disease Control and Prevention, Atlanta, Georgia, United States

Ashley L. Fowlkes, ScD, MPH

• Carreon, Joseph Daniel, Centers for Disease Control and Prevention, Atlanta, Georgia, United States

Joseph Daniel Carreon

• Leidman, Eva Z., Centers for Disease Control and Prevention, Atlanta, Georgia, United States

Eva Z. Leidman, PhD

• Asturias, Edwin J., Colorado School of Public Health Center for Global Health, Aurora, Colorado, United States

Edwin J. Asturias, MD

• Newman, Lee S., Colorado School of Public Health Centers for Health Work and Environment, Aurora, Colorado, United States

Lee S. Newman, MD, MA

• Olson, Daniel, Colorado School of Public Health Center for Global Health, Aurora, Colorado, United States

Daniel Olson, MD, PhD

Background

Though chronic kidney disease (CKD) of unknown origin is an emerging public health concern in Central American agricultural workers, it is unknown whether it may place them at greater risk of respiratory illness, more severe disease, and if COVID-19 vaccination decreased that risk.

Methods

From 2020 to 2024, we conducted a prospective cohort study among banana farm workers in Guatemala. Participants self-reported acute respiratory illness (ARI), defined as cough, fever, or dyspnea. Workers with ARI were tested for SARS-CoV-2 by RT-PCR and completed surveys at days 0, 7, and 28 to assess clinical and absenteeism outcomes. Serum creatinine was collected at enrollment, annually, and during acute illness visits, to calculate estimated glomerular filtration rate (eGFR). COVID-19 vaccination data were collected from the national vaccine registry. We estimated the burden of Stage 3 (eGFR <60 mL/min/1.73m2 at any timepoint) and Stage 2 (eGFR<90 on >2 timepoints) CKD. We used multivariable regression to evaluate ARI and COVID-19 outcomes according to CKD status and COVID-19 vaccination.

Results

Of the 2,804 workers with at least one eGFR measurement, 139 (5.0%) were classified as Stage 3 CKD. Among those with at least two eGFRs (n=1,875), 318 (17%) had Stage 2 CKD. Participants with Stage 3 CKD were frequently older (35.3 vs 30.3 years, p<0.0001), male field workers (78.5% vs 68.6%, p=0.001) and were living in low-elevation (<500 meters) municipalities with higher heat index compared to workers without CKD. They were more likely to have an ARI (adjusted relative risk [aRR]=1.71, 95% confidence interval [CI]=1.19-2.46) and PCR-confirmed COVID-19 (aRR=2.03, CI=1.09-4.88). COVID-19 vaccination was associated with reduced COVID-19-associated absenteeism in the overall cohort (5 vs 6 days/illness, p<0.0001), and among workers with Stage 2 CKD (1 vs 6 days, p=0.06) and Stage 3 CKD (1 vs 6 days, p=0.16). Vaccination was associated with lower risk of prolonged (>5 days) absenteeism (22.1% vs 42.7%, p=0.0014).

Conclusion

We identified a high prevalence of CKD in this population, which was associated with greater risk for respiratory illness and COVID-19 infection. Work-based COVID-19 vaccination significantly reduced respiratory illness, COVID-19, and absenteeism, with larger effects among workers with CKD.

Acknowledgment

We thank the following for their contributions to this research: University of Colorado-Trifinio Research Team, the University of Colorado Center for Global Health administration, the Centers for Disease Control and Prevention, AgroAmerica, and most importantly, the research participants. This work is funded by the NIH/NIAID 1K23AI143967, CDC-CAR/CGH CDC_GH002243, and Investigator-initiated contributions by Roche Diagnostics and Sanofi Pasteur.

Funding

• Other NIH Support – Roche Diagnostics and Sanofi Pasteur