"Aria di Ricerca in Valle del Serchio": a cross-sectional Citizen Science study to evaluate CKD prevalence and associations with environmental risk factors in the Serchio Valley (Lucca, Tuscany, Italy)

Chiara Doccioli¹Francesco Sera²Giorgia Stoppa^3*Bruna De Marchi^4,5Dolores Catelan³Antonella Ficorilli^6,7Giulia Malavasi⁶Annibale Biggeri³

• ¹Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
• ²Department of Statistics, Computer Science, Applications Giuseppe Parenti, School of Economics and Management, University of Florence, Florence, Tuscany, Italy
• ³Unit of Biostatistics, Epidemiology and Public Health, University of Padua, Padua, Veneto, Italy
• ⁴University of Bergen, Bergen, Hordaland, Norway
• ⁵Epidemiologia e Prevenzione "Giulio A. Maccacaro" Social Enterprise, Milan, Italy
• ⁶Epidemiologia e Prevenzione 'Giulio A. Maccacaro' Social Enterprise, Milan, Lombardy, Italy
• ⁷Sapienza University of Rome, Rome, Lazio, Italy

Background: 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: Results revealed a CKD prevalence ranging from 12.7% (CKD-EPI 2009) to 15.8% (MDRD), 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).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.