8274377 From migrant labor to dialysis dependency: a cross-sectional study in dialysis centers in Nepal

<h3>Objective</h3> Migrant workers from countries like Nepal are increasingly employed in physically demanding jobs under extreme environmental conditions, including high heat exposure, which is believed to contribute to kidney injury and disease progression. Chronic kidney disease (CKD) of unknown etiology has emerged among young male workers in similar climates globally. Given Nepal’s heavy reliance on labor migration, it is crucial to explore associations between migration and earlier or more rapid onset of kidney disease. This study aims to assess if early onset of dialysis is associated with labor migration. <h3>Material and Methods</h3> We conducted a cross-sectional study including 683 patients receiving regular hemodialysis across four public dialysis centers in Kathmandu and Chitwan, Nepal. Participants completed structured interviews collecting data on migration history, comorbidities, and dialysis trajectory. Patients were grouped according to migration history and migration destination (Gulf Cooperation Council (GCC), India, Malaysia, Other). Outcomes included age at dialysis initiation and latency between return and dialysis start. Descriptive statistics and logistic regression models were applied, adjusting for sex, diabetes history, age, and region. <h3>Results</h3> Of the included patients, 25% had a history of labor migration. Migrants were predominantly male (87%) and started dialysis at a younger median age (41 vs. 51 years). Compared to non-migrants, migration history was associated with higher odds of starting dialysis before age 40 (adjusted OR 2.22, 95% CI 1.47–3.35). Particularly migrants of GCC countries and Malaysia had significantly elevated odds. Notably, migrants diagnosed abroad were younger at diagnosis and dialysis start than those diagnosed in Nepal. <h3>Conclusions</h3> These findings suggest that working abroad contributes to earlier onset of end-stage kidney disease. Further investigation into occupational exposures is needed to clarify causal pathways. Targeted prevention strategies and improved health surveillance for returning migrant workers are crucial to mitigate future disease burden.