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.
|Titolo:||Clinical policies on the management of chronic kidney disease patients in Italy|
|Autori interni:||GALLIENI, MAURIZIO ALBERTO|
|Parole Chiave:||Chronic kidney disease; Guidelines; Italy; Management|
|Data di pubblicazione:||2008|
|Digital Object Identifier (DOI):||10.1093/ndt/gfm636|
|Appare nelle tipologie:||01 - Articolo su periodico|