Heat Stress and Non-Traditional Chronic Kidney Disease (CKDnt) Among Nepali Migrant Workers: A Climate-Sensitive Global Health Perspective

Climate change-driven heat exposure is an emerging global health crisis with profound implications for outdoor and manual laborers. Among the most concerning outcomes is chronic kidney disease of non-traditional origin (CKDnt), increasingly documented in regions experiencing extreme temperatures. Nepali migrant workers, primarily employed in construction, manufacturing, and agriculture across Gulf Cooperation Council (GCC) countries, face severe occupational heat exposure with limited labor protections. This perspective examines how chronic heat stress contributes to kidney injury among Nepali migrant workers, synthesizing pathophysiologic mechanisms, epidemiologic trends, qualitative evidence on working conditions, and weaknesses in global and national policy responses. Drawing from comparative findings from countries that are global hotspots of CKDnt, we argue that CKDnt reflects a convergence of climate change, labor exploitation, and global inequity. Strengthening Wet Bulb Globe Temperature (WBGT)-based heat-protection protocols, embedding comprehensive renal screening into migration systems, reforming bilateral labor agreements, and advancing international recognition of CKDnt as a climate-sensitive occupational disease are urgent priorities. Addressing this issue is essential not only for safeguarding migrant health but also for advancing climate justice and sustainable development.