Background

Cardiovascular disease (CVD) prevalence is high in industrialised countries (Fig. 1) (1), presenting a significant societal and economic burden. Early detection of CVD risk factors may prevent related complications, including chronic kidney disease (CKD) (Fig.2) (2-3-4). The most important cardiovascular (CV) risk factors are hypertension, smoking, diabetes, lifestyle - related obesity, and overhydration (Fig.3) (5). Prevention and management of fluid overload could reduce incidence of secondary hypertension and left ventricular hypertrophy (LVH). We report the results of a screening program in an apparently healthy population evaluating blood pressure, waist circumference and Body Mass Index (BMI) measurements.

Methods In 2013 and 2014 “Prevention Races” (6) were organized in Naples and Salerno by Federico II, University, Campus 3S (7) and Sportform to promote sport, health and solidarity (Fig.4). During the sports events, participants and spectators were evaluated by different specialists free of charge including a nephrological screening for cardiovascular risk factors. (Fig.5-6) The following parameters were assessed: blood pressure, weight, height, waist circumference, BMI and body composition to determine hydration and nutritional status in terms of lean and fat body mass. Lean and Fat Tissue Indexes and overhydration were evaluated by Body Composition Monitor (Fresenius Medical Care, Bad Homburg, Germany), using multi-frequency bioimpedance spectroscopy at 50 different frequencies between 5 and 1000 KHz. Results are reported as means and standard deviations or percentages for continuous and cathegorial variables, respectively.

Fig. 4: Naples 2014 Prevention Race in Plebiscito Square

Fig. 5-6: NephroCare Team doctors and nurses providing information and free health check to the people during Naples and Salerno 2014 Prevention Races

Results 701 subjects were evaluated: 269 (38.5%) were male; mean age was 51.8 ( 15.5) years, 39 (5.6%) had dyslipidemia, 29 (4.2%) were diabetic, 99 (14.2%) were hypertensive, 271 (39.3%) were overhydrated, 9 (1.3%) had heart disease, 15 (2.1%) had hypothyroidism, 9 (1.3%) had CKD. Mean systolic blood pressure was 127.1 ( 19.3) mmHg and diastolic blood pressure was 75.9 ( 10.8) mmHg. Table 1 reports mean systolic anddiastolic blood pressures and proportions of patients with overhydration by age group. Subjects evaluated had the following BMI levels: <20 kg/sm: 21 (3%); 20-24 kg/sm: 248 (35.4%); 25-29 kg/sm: 266 (37.9%); and ≥ 29 kg/sm: 163 (23.3%). Mean waist circumference was 92.8 ( 15.7) cm. According tonormal distribution adjusted by age and gender, 487 (70.8%) had a Lean Tissue Index (LTI) in a normal range (N), 36 (5.2%) had an LTI greater than N, 165 (24%) had an LTI below N. 550 (79.9%) had a Fat Tissue Index (FTI) in a normal range, 119 (17.3%) had an FTI greater than N, 19 (2.8%) had an FTI below N. Distribution by age group is reported in Table 2.

References

1. World Health Organization: http://www.who.int/chp/chronic_disease_report/en/ 2. Foley R.N., Parfrey P.S., Sarnak M.J. Clinical epidemiology of cardiovascular disease in chronic renal disease. AJKD (1998) 32, Suppl 3: S112-S119. 3. De Jager D.J., Grootendorst D.C., Jager K.F. et al. Cardiovascular and non cardiovascular mortality among patients starting dialysis. JAMA (2009) 302 (16): 1782-1789. ERA-EDTA Registry, 1994-2007. 4. Di Benedetto A., Marcelli D., D’Andrea et al. Risk factors and underlying cardiovascular diseases in incident ESRD patients. J Nephrol (2005) 18:592-598. 5. Wizemann V., Wabel P., Chamney P. et al. The mortality risk of overhydration in haemodialysis patients - Nephrol Dial Transplant (2009) 24: 1574-1. 6. Di Benedetto A., Ciotola A., Cerino F., Colao A., Marcelli D., Canaud B. Prevention Run:opportunity for Chronic Kidney Disease preventive measures- ASN 2014 Congress Proceedings. 7. Campus 3S: www.campus3s.it

Conclusion

In a large sample of apparently healthy people evaluated in the occasion of non-competitive sports events, a relevant proportion of subjects with cardiovascular related risk factors like obesity, dyslipidemia, hypertension, and diabetes was detected. The evaluation of body composition is important also in the general population for the correct classification in terms of fat body mass and overhydration.

Fig 1: Projected death by cause, all ages, WHO 20051

Fig 2: Cardiovascular risk factors proportion at admission on dialisis4

Fig 3: Cardiovascular mortality and ROH<15% vs ROH>15%5

Di Benedetto A.*, Ciotola A.*, Cerino F.*, Colao A.**, Marcelli D.***, Canaud B.*** *NephroCare Italy, Naples, Italy - **Università Federico II, Dipartimento di Medicina Clinica e Chirurgia, Naples, Italy - ***Fresenius Medical Care, Bad Homburg, Germany

Fi 1 P j t d d th b ll WHO 20051

Tab. 1: Mean systolic and diastolic blood pressure and patients with overhydration by age group

Tab. 2: LTI, FTI and waist circumference by age group.

CARDIOVASCULAR AND CHRONIC KIDNEY DISEASE RISK FACTORS SCREENING IN AN APPARENTLY HEALTHY POPULATION

Partecipating researchers A. Di Benedetto - A. Ciotola – D. Bonanno - V. Di Stasio - A. Pizzo - A. Nappa – P. Olivieri - F. Miano - V. Neiviller – M. Avella – M. Paglia – A. Vigorito - A.Amendola