WORLD KIDNEY DAY
JNEPHROL 2013; 26 ( 5 ) : 949-952
DOI: 10.5301/JN.2013.11454
Risk factors for kidney diseases and
awareness of blood pressure and proteinuria in
general population and in high school students:
Italian report for World Kidney Days 2012-2013
Pasquale Esposito1, Alessandro Balducci2, Vittorio E. Andreucci2 ; and Local Coordinators*
Unit of Nephrology, Dialysis and Transplantation, San Matteo IRCCS Policlinic and University of Pavia, Pavia - Italy
Fondazione Italiana del Rene Onlus - Italy
1
2
*Square Project: V.M. Agate (Palmanova, UD), A.M. Anelli (Pistoia), L. Apicella (Salerno), D. Avino (Vairano Scalo, CE), Y.
Battaglia (Ferrara), P.L. Bedani (Ferrara), G. Bellinghieri (Messina), A.M. Bernardi (Rovigo), C. Bonifati (Corato, BA), M.
Borzumati (Verbania), P.L. Botti (Mantova), M. Brigante (Campobasso), F. Brighina (San Nicola La Strada, CE), P. Calzavara
(Conegliano, TV), C. Caputo (Albenga, SV), F. Cardone (Lavello, PZ), F. Cavatorta (Imperia), N. Confessore (Scafati, SA),
M. Cossu (Sassari), E. Costantino (Gavardo, BS), G. Costantino (Messina), L. D’Apice (Caserta), R. D’Arcangelo (Arzano,
NA), F. Dagostino (Corato, BA), A. Dal Canton (Pavia), G. Delgado (Teano, CE), R. Di Pietro (Napoli), C. Esposito (Pavia),
P. Esposito (Pavia), E. Fasianos (Altamura, BA), F. Fiorini (Rovigo), P. Galeotti (Viterbo), G. Garibotto (Genova), A. Gemelli
(Rovigo), M.C. Gregorini (Reggio Emilia), P. Iuliano (Benevento), L. La Peccerella (Benevento), M. Liuzzi (Benevento), M.
Merola (Sorrento, NA), C. Montesano (Imperia), L.F. Morrone (Benevento), M. Napoli (Galatina, LE), F. Napolitano (Corato,
BA), S. Paglia (Lavello, PZ), M. Parravano (Sora, FR), S. Pasquali (Reggio Emilia), A. Rosa (Benevento), M.L. Sambati (Taranto), P. Schiavone (Brindisi), E. Sozzo (Galatina, LE), A. Storari (Ferrara), R. Tarchini (Mantova), G. Tirino (Montesarchio,
BN), L. Turchetta (Sora, FR).
School Project: G. Bellinghieri (Messina), G. Beltrame (Torino), M. Bozzi (Bari), E. Casolino (Rionero in Vulture, PZ), E. Centrone (Ruvo di Puglia, BA), M. Ciccarelli (Reggio Calabria), T. Cicchetti (Rossano, CS), C. Colturi (Sondrio), E. Costantino
(Gavardo, BS), G. Costantino (Messina), F. Dagostino (Corato, BA), E. Fasianos (Altamura, BA), P. Galeotti (Viterbo), Garibotto (Genova), F. Indraccolo (S. Fermo della Battaglia, CO), M. Lombardi (Borgo S. Lorenzo, FI), C. Minoretti (S. Fermo
della Battaglia, CO), F. Napolitano (Corato, BA), R. Parsi (Alcamo, TP), F. Petrarulo (Bari), E. Prati (Desenzano del Garda,
BS), F. Quarello (Torino), V. Rondanini (Palmi, RC), D. Russo (Barletta), P. Tira (Manerbio, BS), S. Turina (Manerbio, BS),
W.D. Valentini (Rieti)
Introduction
World Kidney Day (WKD), established by the International
Society of Nephrology and the International Federation
of Kidney Foundations (IFKF) in 2006, is a global effort to
“raise awareness of the importance of our kidneys to our
overall health and to reduce the frequency and impact of
kidney disease and its associated health problems worldwide” (1). Many countries participate by organizing health
screening events, public lectures, press conferences, political activities and other efforts.
In Italy, the WKD was planned and conducted by the Fondazione Italiana del Rene (FIR; National Kidney Foundation
of Italy), in collaboration with the Italian Society of Nephrology (SIN) and the Red Cross of Italy. Italian WKD focused
on 2 projects: the Square Project” and School Project. The
Square Project was intended for the general population and
the School Project for students attending the fifth year of
Italian high school. Data collected during past WKDs have
been previously published (2-5). In this article, the data for
both projects, collected for the WKDs of years 2012 and
2013, are reported.
© 2013 Società Italiana di Nefrologia - ISSN 1121-8428
949
Esposito et al: Italian report for World Kidney Days 2012-2013
Chronic kidney disease (CKD) affects about 10% of the
adult general population, and recently, it has been estimated that at birth the overall lifetime risk of CKD stage
3a is about 60% (6).
This high prevalence rate, together with the elevated
cost of treatment and the fact that preventive measures
are not yet fully in place, makes CKD a public health
problem (7).
Moreover, the link between CKD and cardiovascular disease (CVD) is well established, and the number of people
with both kidney disease and CVD continues to climb at
an alarming rate. Indeed, CKD accelerates the progression of heart disease and increases the likelihood of major cardiovascular events and related death (8). Therefore, it is of vital importance to prevent and treat kidney
diseases also to decrease cardiovascular morbidity and
mortality.
By considering the complex interrelationship between
CKD and preventable risk factors, such as hypertension,
obesity, dyslipidemia and smoking, a screening program
must occur at primary care level, also because there is
consistent evidence that progression of CKD can be reduced by changing lifestyle, controlling blood pressure
(BP) and using kidney protective drugs (9, 10).
These are the reasons for the IFKF and FIR actively promoting WKD as a valuable prevention program.
Methods
The Square Project was organized with mobile clinics
or gazebos with an examination room and restrooms for
urine collection. The mobile clinics were parked in the
central squares of participant cities. The School Project
was carried out in many cities using school facilities and
after obtaining informed consent from parents for minorage students (11).
Participants voluntarily answered a questionnaire that
addressed awareness of kidney function, kidney disease,
hypertension, dialysis, kidney transplantation, diabetes
and proteinuria. BP was measured in a seated position;
a complete urine test was performed with a dipstick on
specimens collected just after the administration of the
questionnaire. Subjects were considered proteinuric
when the urine dipstick was positive for proteinuria ≥30
mg/dL, and hypertensive if their BP was ≥140/90 mm
Hg or they were taking antihypertensive medication. In
the presence of an abnormal urinary dipstick and/or BP
result, participants were invited to contact either the nephrologists involved in the survey or their general practitioner for confirmation of data and further evaluation.
950
Results
From the Square Project, data for 6,242 participants (3,424
in 2012 and 2,818 in 2013) were collected in many Italian
cities. Of these, 18% (1,115) had participated in previous
WKDs, a percentage that was higher than that of past
WKDs (5%). The clinical characteristics of the whole cohort
are reported in Table I.
The main risk factors for renal diseases – hypertension, diabetes, smoking, obesity and dyslipidemia – were differently
represented in the subjects evaluated. In particular, the
prevalence of hypertension, which included subjects receiving hypertensive therapy and subjects found with high
BP, was significantly lower than that previously recorded
(n=2,604, 42% vs. 53%-57% for the past WKDs). Simultaneously, we observed a decrease in the percentage of
individuals found to be hypertensive for the first time (12%
vs. 23.5% of all subjects). This encouraging finding was accompanied by evidence of an improved awareness of BP
control both in the whole cohort (75% vs. 60% recorded in
the past WKDs) and in patients on antihypertensive therapy
(91% vs. 80%).
With regard to the factors potentially correlated with BP levels, a significant association was observed between body
mass index (BMI) and both systolic and diastolic BP (Fig. 1).
Proteinuria was found in 249 subjects (4%) and was associated with the presence of diabetes, hypertension, urinary
infections and other kidney diseases. Unlike hypertension,
TABLE I
CLINICAL CHARACTERISTICS OF PARTICIPANTS IN THE
SQUARE PROJECT FOR 2012-2013 (N=6,242)
Age, years
Males, no. (%)
Hypertensive subjects, no. (%)
52.8 ± 8.5
3,064 (49)
2,604 (41.7)
Body mass index, kg/m2
25.9 ± 6.8
Abdominal circumference, cm
100 ± 13.7
Smokers, no. (%)
1,162 (18.6)
Diabetes, no. (%)
500 (8)
Hypercholesterolemia, no. (%)
Proteinuria on urine dipstick, no. (%)
1,588 (25)
249 (4)
For definition of hypertension and proteinuria see the text.
Data are expressed as means ± SD, or numbers (%).
© 2013 Società Italiana di Nefrologia - ISSN 1121-8428
JNEPHROL 2013; 26 ( 5 ) : 949-952
Fig. 1 - Correlations
of body mass index
(BMI) with systolic (A)
and diastolic (B) blood
pressure (BP) levels in
subjects participating
in the Square Project
(p<0.001). SBP = systolic blood pressure; DBP
= diastolic blood pressure.
A
B
TABLE II
CLINICAL CHARACTERISTICS OF PARTICIPANTS IN THE
SCHOOL PROJECT FOR 2012-2013 (N=2,798)
Age, years
18.1 ± 3.5
Males, no. (%)
1,317 (47)
Body mass index, kg/m
22.1 ± 3.6
Abdominal circumference, cm
81.8 ± 3.5
Smokers, no. (%)
661 (23.6)
2
Data are expressed as means ± SD, or numbers (%).
Fig. 2 - Distribution of urinary results in students enrolled in
the School Project who presented proteinuria on dipstick
(n=393); leuk = leukocyturia; Prot = proteinuria.
awareness of proteinuria was still low among the population evaluated (about 20%).
During WKD 2012 and 2013, 900 and 1,898 participants,
respectively, took part in the School Project. The characteristics of the participants are reported in Table II.
Almost all students were conscious of the importance of
hypertension control, and 56% of them had had a previous
BP measurement, while 71 participants (2.5%) presented
elevated BP levels. Knowledge of the role and the function
of the kidneys (93%), as well as awareness of the meaning
of terms such chronic kidney disease (77%), dialysis (70%)
and transplantation (89%) was greatly increased compared
with past WKDs. In contrast, such as in the general population, awareness of the term proteinuria was low (9.8%). The
main sources of information were parents (36%), teachers
(27%) and physicians (10%). A urine dipstick exam was
performed in 96% of the cohort, and 393 students (14.5%)
presented proteinuria, 417 (15%) leukocyturia and 329
(12%) hematuria, percentages that were slightly higher
than those for past WKDs. The whole spectrum of urinary
results found in proteinuric subjects is shown in Figure 2.
Conclusions
WKD is an opportunity for kidney professionals to call attention to the growing public health threats of kidney and
heart diseases. Results for the 2012-2013 Italian WKDs
highlight that awareness of the importance of BP control is
growing in both the general and young population probably
also thanks to initiatives like WKD. On the other hand, the
success of this kind of preventive program is proven by the
high percentage of subjects who repeatedly participated in
the different WKDs.
Many efforts remain to improve the understanding of the
importance of proteinuria, as well as the close relationship
between kidney and heart diseases.
More information about preventing, recognizing and managing kidney disease is available on the WKD (http://www.
worldkidneyday.org) and FIR websites (http://www.fondazioneitalianadelrene.org).
© 2013 Società Italiana di Nefrologia - ISSN 1121-8428
951
Esposito et al: Italian report for World Kidney Days 2012-2013
Financial support This study was financially supported: for WKD
2012, by Abbott s.r.l., Amgen-Dompè S.p.A., Aproten Plasmon
s.r.l., Genzyme s.r.l., Nephrocare S.p.A. and Roche S.p.A.; for WKD
2013, by AbbVie s.r.l., Amgen-Dompè S.p.A., Aproten Heinz Italia
s.r.l., Genzyme s.r.l., Nephrocare S.p.A. and Sanofi Aventis S.p.A.
Conflict of interest: None.
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Address for correspondence:
Pasquale Esposito, MD
Unit of Nephrology, Dialysis and Transplantation
Fondazione IRCCS Policlinico “San Matteo” di Pavia
Viale Camillo Golgi 19
27100 Pavia, Italy
[email protected]
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© 2013 Società Italiana di Nefrologia - ISSN 1121-8428