BACKGROUND: Recent studies have indicated that the implementation of international guidelines for the management of renal patients is suboptimal in Italy. The Italian Society of Nephrology (SIN) decided to undertake a multicentre study to obtain a clear picture of clinical policies on chronic kidney disease (CKD) in Italy. METHODS: A 76-item structured questionnaire, designed to evaluate the organization of clinical care, was administered to the director of each participating centre, within the context of a large observational trial in 100 Italian nephrology centres, collecting information on newly diagnosed CKD patients (K/DOQI stage 3-5) on conservative treatment. This paper reports the questionnaire results related to management of anaemia and bone metabolism disorders; assessment of renal function; creation of a vascular access for dialysis and referral of patients to a nephrologist. RESULTS: Clinical policies at the centre level deviated from guideline recommendations in 70% (timing of vascular access creation) to 25% (assessment of iron deficiency) of centres. Assessment of renal function differed from the recommended approach in 30% of centres; clinical policies related to anaemia and bone disease did not coincide with guideline standards in 50 and 40% of centres, respectively. Directors of renal unit estimates indicate that the creation of a vascular access occurs very late in 38% of patients and that referral to a nephrologist is late in approximately 40% of cases. CONCLUSION: This survey in Italy highlights important deviations of clinical policies at the centre level from guideline recommendations.
Clinical policies on the management of chronic kidney disease patients in Italy / Locatelli F; Zoccali C; Acciarri P; Menegato MA; Ancarani E; Andreucci V; Antonelli A; Auricchio MR; Balducci A; Bassi A; Battaglia G; Bellingheri G; Beltrame A; Biagini M; Bonfante L; Bonofiglio R; Bonomini M; Borghi M; Brigante M; Buccianti G; Buongiorno E; Cabibbe M; Cancarini G; Capistrano M; Cappelli G; Capuano M; Cascone C; Catizone L; Catucci AE; Cavatorta F; Chiarinotti D; Cicchetti T; Concas G; Concetti M; Conte F; Conti M; Coratelli P; Corti MM; Costanzo R; Dal Canton A; D'Apice L; David S; De Cristofaro V; Deferrari G; Della Grotta F; De Nicola L; De Santo NG; De Simone W; Di Daniele N; Di Giulio S; Di Landro D; Di Luzio V; Di Maggio A; Fagugli R; Farina M; Feriani M; Gallieni M; Gambaro G; Giordano R; Greco S; Grillo C; Huber W; Liuzzo G; Lombardi L; Lopez T; Malberti F; Mancini W; Manenti F; Manisco G; Marrocco A; Matocci G; Merico G; Messa P; Minutolo R; Monardo P; Moriconi L; Murrone P; Nardo A; Naso A; Nobile R; Panarello G; Paone A; Parravano M; Pedrini L; Piazza V; Pistis R; Procida M; Quarello F; Rapisarda F; Ricciardi B; Rindi P; Ronco C; Rotolo U; Russo G; Saraniti A; Sasdelli M; Savica V; Scanziani R; Sidoti A; Spotti D; Stalteri A; Stefoni S; Stella A; Strippoli P; Teatini U; Teodoro C; Tozzo C; Triolo G.. - In: NEPHROLOGY DIALYSIS TRANSPLANTATION. - ISSN 0931-0509. - STAMPA. - 23(2):(2008), pp. 6-621. [10.1093/ndt/gfm636]
Clinical policies on the management of chronic kidney disease patients in Italy.
STEFONI, SERGIO;
2008
Abstract
BACKGROUND: Recent studies have indicated that the implementation of international guidelines for the management of renal patients is suboptimal in Italy. The Italian Society of Nephrology (SIN) decided to undertake a multicentre study to obtain a clear picture of clinical policies on chronic kidney disease (CKD) in Italy. METHODS: A 76-item structured questionnaire, designed to evaluate the organization of clinical care, was administered to the director of each participating centre, within the context of a large observational trial in 100 Italian nephrology centres, collecting information on newly diagnosed CKD patients (K/DOQI stage 3-5) on conservative treatment. This paper reports the questionnaire results related to management of anaemia and bone metabolism disorders; assessment of renal function; creation of a vascular access for dialysis and referral of patients to a nephrologist. RESULTS: Clinical policies at the centre level deviated from guideline recommendations in 70% (timing of vascular access creation) to 25% (assessment of iron deficiency) of centres. Assessment of renal function differed from the recommended approach in 30% of centres; clinical policies related to anaemia and bone disease did not coincide with guideline standards in 50 and 40% of centres, respectively. Directors of renal unit estimates indicate that the creation of a vascular access occurs very late in 38% of patients and that referral to a nephrologist is late in approximately 40% of cases. CONCLUSION: This survey in Italy highlights important deviations of clinical policies at the centre level from guideline recommendations.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
