Introduction: Awareness of the implementation of guideline-directed nephroprotective therapy is an essential preliminary step to optimize implementation of nephroprotective strategies in nondialysis chronic kidney disease (CKD) (ND-CKD). However, updated information on this issue is lacking in the setting of nephrology clinics. Methods: In this multicenter prospective study, we collected data from 4523 patients with ND-CKD, either stage 3 to 5 or 1 and 2 with urinary albumin-to-creatinine ratio (ACR) > 30 mg/g, followed up in 30 Italian nephrology clinics. Patients were evaluated at 2 visits with a 6-month interval between May 2024 and May 2025. The aim was to evaluate the current phenotype of patients under tertiary nephrology care and the management of the 2 major modifiable determinants of renal risk, hypertension and ACR, including therapeutic inertia. Results: The cohort was characterized by a severe cardiorenal risk profile: men comprised 65% of the cohort, mean age was 71 ± 14 years, diabetes was present in 40%, cardiovascular disease in 40%, estimated glomerular filtration rate (eGFR) was 34 ± 19 ml/min per 1.73 m2, and ACR was 70 mg/g (interquartile range: 11–350). At the 6-month visit, in patients with and without diabetes, home and office blood pressure (BP) were above target in about 70% of patients, with a high prevalence of sustained (62%) and resistant (23%) hypertension. Among patients with uncontrolled office BP, 33% and 43% of patients with and without diabetes, respectively, were prescribed ≤ 2 BP-lowering drugs. ACR > 30 mg/g persisted in 61% of nondiabetic and 64% of patients with diabetes. Therapeutic inertia for antialbuminuric agents at month 6 was frequent: 85% for renin-angiotensin system (RAS) inhibitors and 90% for gliflozins. Among patients with diabetes, therapeutic inertia was 92% for glucagon-like peptide-1 receptor agonists (GLP1-RAs) and 96% for finerenone. Conclusion: The large majority of patients with ND-CKD currently followed up in Italian renal clinics are characterized by a severe risk profile that is paradoxically associated with remarkable therapeutic inertia for both traditional and innovative guideline-directed nephroprotective therapy.
Missing Opportunity for Nephroprotective Therapy in Patients With Non-Dialysis CKD Under Stable Nephrology Care / L. De Nicola, C. Ruotolo, G. La Manna, V. Bellizzi, L. Gesualdo, F. Nappi, P.M. Ferraro, C. Marcantoni, D. Santoro, G. Stallone, A. Pisani, C. Abaterusso, A. Cupisti, L. Vernaglione, M. Ravera, M. Cozzolino, M. Gallieni, F. Alberici, M. Corvinelli, Y. Battaglia, A. Capitanini, F. Aucella, G. Castellano, M. Simeoni, M. Provenzano, M. Bonomini, G. Reboldi, A. Ferrantelli, C. Esposito, G. Cabiddu, G. Grandaliano, R. Minutolo, L. Gesualdo, P. Cirillo, A. Mascolo, S. Porreca, G. Scarimbolo, D. Morisco, S. Di Pace, G. La Manna, I. Capelli, M. Di Nunzio, F. Alberici, F. Mescia, F. Ravelli, M. Tedesco, M. Gregori, L. Vernaglione, F. Capaccio, M.T. Farina, D. Biasi, G. Leonardi, M. Arcidiacono, L. Argentiero, A. Spinelli, G. Cabiddu, S. Maxia, S. Caira, M. Corvinelli, L. Polese, V. Bellizzi, C. Saviano, I. Molfino, P. Acconcia, C. Marcantoni, S. Di Lorenzo, I. Torrisi, R. Aliotta, G. Portale, M. Bonomini, B. Lo Giudice, E. Marini, L. Nolletti, V. Vezzani, V. Sirolli, M. Provenzano, C. Summaria, F. Iorio, F. Zingone, G. Pezzi, R. Arena, G. Stallone, D.T. Barbara Infante, M. Ravera, D. Santoro, C. Casuscelli, M. Calderone, F. Cuzzola, M. Gallieni, L. Della Volpe, M. Tedesco, A. Guarino, L. Cosmai, M. Heidempergher, S. Caruso, M. Cozzolino, S. Masotto, A.M. Ferrigno, C. Rossi, C. Cuffaro, G. Castellano, S. Vettoretti, L. De Nicola, R. Minutolo, P.T. Ambrosino, S. Andriella, D. Cesarano, A. D'Ambra, F. Marzano, C. Nardelli, C. Ruotolo, A. Pisani, F. Esposito, M. Saggese, G. Della Corte, M. Simeoni, D. Loffredo, A. Savino, F. Nappi, C. Clienti, A. La Verde, A. Ferrantelli, C. Esposito, M. Arazzi, V. Esposito, F. Sangregorio, G. Reboldi, S. Battistoni, N. Lommano, M. Burdese, Y. Battaglia, F. Baciga, M. Erlati, V. Brunelli, A. Cupisti, D. Giannese, C. D'Alessandro, V. Panichi, A. Capitanini, A.C. Piluso, D. Curi, E. Romoli, V. Miniello, B. Xhaferi, G. Grandaliano, V. D'Ambrosio, F. Aucella, R. Grifa, M. Nardella, P.Y. Aurora Del Mar, C. Abaterusso, M. Beltrami, M. Guizzo, R. Lazzarin, M. Protti, C. Ungaro, P.M. Ferraro, I. Squarzoni, A. Spasiano, F. Bonetti. - In: KIDNEY INTERNATIONAL REPORTS. - ISSN 2468-0249. - 11:6(2026 Jun), pp. 106541.1-106541.13. [10.1016/j.ekir.2026.106541]
Missing Opportunity for Nephroprotective Therapy in Patients With Non-Dialysis CKD Under Stable Nephrology Care
M. Cozzolino;M. Gallieni;G. Castellano;M. Gallieni;M. Cozzolino;C. Rossi;C. Cuffaro;G. Castellano;
2026
Abstract
Introduction: Awareness of the implementation of guideline-directed nephroprotective therapy is an essential preliminary step to optimize implementation of nephroprotective strategies in nondialysis chronic kidney disease (CKD) (ND-CKD). However, updated information on this issue is lacking in the setting of nephrology clinics. Methods: In this multicenter prospective study, we collected data from 4523 patients with ND-CKD, either stage 3 to 5 or 1 and 2 with urinary albumin-to-creatinine ratio (ACR) > 30 mg/g, followed up in 30 Italian nephrology clinics. Patients were evaluated at 2 visits with a 6-month interval between May 2024 and May 2025. The aim was to evaluate the current phenotype of patients under tertiary nephrology care and the management of the 2 major modifiable determinants of renal risk, hypertension and ACR, including therapeutic inertia. Results: The cohort was characterized by a severe cardiorenal risk profile: men comprised 65% of the cohort, mean age was 71 ± 14 years, diabetes was present in 40%, cardiovascular disease in 40%, estimated glomerular filtration rate (eGFR) was 34 ± 19 ml/min per 1.73 m2, and ACR was 70 mg/g (interquartile range: 11–350). At the 6-month visit, in patients with and without diabetes, home and office blood pressure (BP) were above target in about 70% of patients, with a high prevalence of sustained (62%) and resistant (23%) hypertension. Among patients with uncontrolled office BP, 33% and 43% of patients with and without diabetes, respectively, were prescribed ≤ 2 BP-lowering drugs. ACR > 30 mg/g persisted in 61% of nondiabetic and 64% of patients with diabetes. Therapeutic inertia for antialbuminuric agents at month 6 was frequent: 85% for renin-angiotensin system (RAS) inhibitors and 90% for gliflozins. Among patients with diabetes, therapeutic inertia was 92% for glucagon-like peptide-1 receptor agonists (GLP1-RAs) and 96% for finerenone. Conclusion: The large majority of patients with ND-CKD currently followed up in Italian renal clinics are characterized by a severe risk profile that is paradoxically associated with remarkable therapeutic inertia for both traditional and innovative guideline-directed nephroprotective therapy.
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