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 / F.Locatelli ; C.Zoccali; P. Acciarri ; MA. Menegato; E. Ancarani; V. Andreucci; A. Antonelli; MR. Auricchio; A. Balducci; A. Bassi ; G. Battaglia ; G. Bellingheri ; A. Beltrame ; M. Biagini ; L. Bonfante ; 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; T. Cicchetti; G. Concas ; M. Concetti ; F. Conte ; M. Conti ; Coratelli P; MM. Corti ; R. Costanzo ; A. Dal Canton; L. D'Apice ; S. David. - In: NEPHROLOGY DIALYSIS TRANSPLANTATION. - ISSN 1460-2385. - 23(2008), pp. 621-626. [10.1093/ndt/gfm636]

CLINICAL POLICIES ON THE MANAGEMENT OF CHRONIC KIDNEY DISEASE PATIENTS IN ITALY

DAVID, Salvatore
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.
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