Doccioli Chiara, Sera Francesco, Stoppa Giorgia, De Marchi Bruna, Catelan Dolores, Ficorilli Antonella, Malavasi Giulia, Biggeri Annibale
Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network-ISPRO, Florence, Italy.
Department of Statistics, Computer Science and Applications G. Parenti, University of Florence, Florence, Italy.
Front Public Health. 2025 May 21;13:1536070. doi: 10.3389/fpubh.2025.1536070. eCollection 2025.
Chronic kidney disease (CKD) represents a growing global public health issue, with an estimated prevalence of around 11% in the most developed countries. This study, conducted as part of the European project CitieS-Health, aimed to estimate the prevalence of CKD in the Serchio Valley, Tuscany, Italy, an area subject to environmental contamination from various sources, including a potentially polluting copper foundry.
This cross-sectional study was conducted from 2019 to 2022 among a representative sample of 400 adults from eight municipalities, integrating a citizen science (CS) approach to enhance public engagement. The study aimed to estimate the prevalence of CKD in the area, as assessed by the decrease of estimated Glomerular Filtration Rate (eGFR). Data on lifestyle, clinical parameters, and environmental exposures were collected, employing a standardized protocol developed by the Disadvantaged Populations eGFR Epidemiology Study (DEGREE). The eGFR was calculated using three equations: CKD-EPI 2009, Modification of Diet in Renal Disease (MDRD), and CKD-EPI 2021. Associations between risk factors and CKD were examined through multivariate analyses.
Results revealed a CKD prevalence of 12.7% using the CKD-EPI 2009 formula, 15.8% with the MDRD equation, and 10.5% according to the CKD-2021 definition, with age, hypertension, and diabetes being significant risk factors. These estimates are significantly higher than the national average reported in Italian studies (6-9%). Moreover, residential proximity to (< 2 km) and employment in the copper foundry resulted associated with eGFR reduction (OR = 1.36; 90%CI = 0.80, 2.29 and OR = 2.14; 90%CI = 0.89, 5.13, respectively; estimated with ordinal logistic regression, CKD defined per 2021 criteria).
In conclusion, the study revealed an increased prevalence of CKD in an area affected by heavy metal pollution, particularly cadmium. These findings underscore the impact of environmental exposures on kidney health, emphasizing the need for targeted interventions and public health measures to mitigate CKD prevalence in pollution-exposed communities.
慢性肾脏病（CKD）是一个日益严重的全球公共卫生问题，在最发达国家估计患病率约为11%。本研究作为欧洲项目CitieS-Health的一部分，旨在估计意大利托斯卡纳塞尔基奥山谷地区CKD的患病率，该地区受到包括潜在污染性铜铸造厂在内的各种来源的环境污染。
这项横断面研究于2019年至2022年在来自八个市镇的400名成年人的代表性样本中进行，采用公民科学（CS）方法以提高公众参与度。该研究旨在估计该地区CKD的患病率，通过估计肾小球滤过率（eGFR）的下降来评估。收集了生活方式、临床参数和环境暴露的数据，采用了由弱势群体eGFR流行病学研究（DEGREE）制定的标准化方案。使用三个方程计算eGFR：CKD-EPI 2009、肾脏病饮食改良（MDRD）和CKD-EPI 2021。通过多变量分析检查危险因素与CKD之间的关联。
结果显示，使用CKD-EPI 2009公式时CKD患病率为12.7%，使用MDRD方程时为15.8%，根据CKD-2021定义为10.5%，年龄、高血压和糖尿病是显著的危险因素。这些估计值明显高于意大利研究报告的全国平均水平（6-9%）。此外，居住在距离铜铸造厂小于2公里处以及在铜铸造厂工作与eGFR降低相关（OR = 1.36；90%CI = 0.80, 2.29和OR = 2.14；90%CI = 0.89, 5.13，分别；用有序逻辑回归估计，CKD根据2021年标准定义）。
总之，该研究揭示了在受重金属污染，特别是镉污染影响的地区CKD患病率增加。这些发现强调了环境暴露对肾脏健康的影响，强调需要采取有针对性的干预措施和公共卫生措施，以降低受污染社区的CKD患病率。
