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The PIRP project (Prevenzione Insufficienza Renale Progressiva): how to integrate hospital and community maintenance treatment for chronic kidney disease

  • Antonio SantoroEmail author
  • Dino Gibertoni
  • Paola Rucci
  • Elena Mancini
  • Decenzio Bonucchi
  • Andrea Buscaroli
  • Anselmo Campagna
  • Gianni Cappelli
  • Salvatore David
  • Maria Cristina Gregorini
  • Gaetano La Manna
  • Giovanni Mosconi
  • Angelo Rigotti
  • Roberto Scarpioni
  • Alda Storari
  • Marcora Mandreoli
Original Article
  • 39 Downloads

Abstract

Chronic kidney disease (CKD) represents a global health burden with great economic impact on healthcare and therefore it requires appropriate interventions by Health Care Systems. The PIRP (Prevenzione Insufficienza Renale Progressiva) project is endorsed and funded by the Emilia-Romagna Regional Health Board and involves all the Nephrology Units of the Emilia-Romagna Region (Italy). The project has a predominantly clinical purpose and is expected to bring about a continuous quality improvement in the treatment of patients with CKD. Its aims are to intercept patients in an early phase of CKD, to delay their illness progression and to prevent cardiovascular complications. An integrated care pathway involving nephrologists, general practitioners (GPs) and other specialists has been created to identify patients to whom ambulatory care targeted on effective, efficient pharmaceutical and dietary treatment as well as on lifestyle modifications is subsequently provided. With the cooperation of GPs, in its 13 years of activity the project identified and followed up more than 25,000 CKD patients, who attended the Nephrology units with more than 100,000 visits. The effects of a closer and joint monitoring of CKD patients by GPs and nephrologists can be quantified by the reduction of the mean annual GFR decline (average annual CKD-EPI change: − 0.34 ml/min), and by the decrease in the overall incidence of patients who annually started dialysis in the Emilia-Romagna Region, that dropped from 218.6 (× million) in 2006 to 197.5 (× million) in 2016, corresponding to about 100 cases.

Keywords

Chronic kidney disease Registries General Practitioners eGFR CKD management Public health intervention 

Notes

Compliance with ethical standards

Ethical statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Hill NR, Fatoba ST, Oke JL et al (2016) Global prevalence of chronic kidney disease: a systematic review and meta-analysis. PLoS One 11:e0158765 (5524 [pii]) CrossRefGoogle Scholar
  2. 2.
    De Nicola L, Donfrancesco C, Minutolo R et al (2015) Prevalence and cardiovascular risk profile of chronic kidney disease in Italy: results of the 2008–12 National Health Examination Survey. Nephrol Dial Transplant 30:806–814.  https://doi.org/10.1093/ndt/gfu383 CrossRefGoogle Scholar
  3. 3.
    Gambaro G, Yabarek T, Graziani MS et al (2010) Prevalence of CKD in northeastern Italy: results of the INCIPE study and comparison with NHANES. Clin J Am Soc Nephrol 5:1946–1953.  https://doi.org/10.2215/CJN.02400310 CrossRefGoogle Scholar
  4. 4.
    GBD 2013 Mortality and Causes of Death Collaborators (2015) Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 385:117–171.  https://doi.org/10.1016/S0140-6736(14)61682-2 CrossRefGoogle Scholar
  5. 5.
    Gibertoni D, Mandreoli M, Rucci P et al (2016) Excess mortality attributable to chronic kidney disease. Results from the PIRP project. J Nephrol 29:663–671.  https://doi.org/10.1007/s40620-015-0239-4 CrossRefGoogle Scholar
  6. 6.
    Turchetti G, Bellelli S, Amato M et al (2017) The social cost of chronic kidney disease in Italy. Eur J Heal Econ 18:847–858.  https://doi.org/10.1007/s10198-016-0830-1 CrossRefGoogle Scholar
  7. 7.
    Vaccaro CM, Sopranzi F (2017) A comparison between the costs of dialysis treatments in Marche Region, Italy: Macerata and Tolentino hospitals. Ann Ist Super Sanita 53:344–349.  https://doi.org/10.4415/ANN_17_04_12 Google Scholar
  8. 8.
    Jafar TH, Stark PC, Schmid CH et al (2003) Progression of chronic kidney disease: the role of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition: a patient-level meta-analysis. Ann Intern Med 139:244–252CrossRefGoogle Scholar
  9. 9.
    Remuzzi G, Ruggenenti P, Perico N (2002) Chronic renal diseases: renoprotective benefits of renin-angiotensin system inhibition. Ann Intern Med 136:604–615CrossRefGoogle Scholar
  10. 10.
    Feehally J, Griffith KE, Lamb EJ et al (2008) Early detection of chronic kidney disease. BMJ 337:a1618CrossRefGoogle Scholar
  11. 11.
    Smart NA, Titus TT (2011) Outcomes of early versus late nephrology referral in chronic kidney disease: a systematic review. Am J Med 124:1073–1080.e2.  https://doi.org/10.1016/j.amjmed.2011.04.026 CrossRefGoogle Scholar
  12. 12.
    Stack AG (2003) Impact of timing of nephrology referral and pre-ESRD care on mortality risk among new ESRD patients in the United States. Am J Kidney Dis 41:310–318.  https://doi.org/10.1053/ajkd.2003.50038 CrossRefGoogle Scholar
  13. 13.
    Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group (2013) KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 3:1–150CrossRefGoogle Scholar
  14. 14.
    Servizio Statistica Regione Emilia-Romagna (2018) Emilia-Romagna region demographic indicators. https://public.tableau.com/profile/servizio.statistica.regione.emilia.romagna#!/vizhome/IndicatoridemograficiRER_0/Dashboard1. Accessed 20 Feb 2018
  15. 15.
    Bellizzi V, Conte G, Borrelli S et al (2017) Controversial issues in CKD clinical practice: position statement of the CKD-treatment working group of the Italian Society of Nephrology. J Nephrol 30:159–170.  https://doi.org/10.1007/s40620-016-0338-x CrossRefGoogle Scholar
  16. 16.
    Bellasi A, Mandreoli M, Baldrati L et al (2011) Chronic kidney disease progression and outcome according to serum phosphorus in mild-to-moderate kidney dysfunction. Clin J Am Soc Nephrol 6:883–891CrossRefGoogle Scholar
  17. 17.
    Rucci P, Mandreoli M, Gibertoni D et al (2014) A clinical stratification tool for chronic kidney disease progression rate based on classification tree analysis. Nephrol Dial Transplant 29:603–610.  https://doi.org/10.1093/ndt/gft444 CrossRefGoogle Scholar
  18. 18.
    Brück K, Jager KJ, Zoccali C et al (2018) Different rates of progression and mortality in patients with chronic kidney disease at outpatient nephrology clinics across Europe. Kidney Int 93:1432–1441.  https://doi.org/10.1016/j.kint.2018.01.008 CrossRefGoogle Scholar
  19. 19.
    Raman M, Green D, Middleton RJ, Kalra PA (2018) Comparing the impact of older age on outcome in chronic kidney disease of different etiologies: a prospective cohort study. J Nephrol.  https://doi.org/10.1007/s40620-018-0529-8 Google Scholar
  20. 20.
    Lash JP, Go AS, Appel LJ et al (2009) Chronic renal insufficiency cohort (CRIC) study: baseline characteristics and associations with kidney function. Clin J Am Soc Nephrol 4:1302–1311.  https://doi.org/10.2215/CJN.00070109 CrossRefGoogle Scholar
  21. 21.
    Brown WW, Peters RM, Ohmit SE et al (2003) Early detection of kidney disease in community settings: the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis 42:22–35CrossRefGoogle Scholar
  22. 22.
    Appel LJ, Middleton J, Miller ER et al (2003) The rationale and design of the AASK cohort study. J Am Soc Nephrol 14:S166–S172CrossRefGoogle Scholar
  23. 23.
    Imai E, Matsuo S, Makino H et al (2008) Chronic Kidney Disease Japan Cohort (CKD-JAC) study: design and methods. Hypertens Res 31:1101–1107.  https://doi.org/10.1291/hypres.31.1101 CrossRefGoogle Scholar
  24. 24.
    Eckardt K-U, Barthlein B, Baid-Agrawal S et al (2012) The German Chronic Kidney Disease (GCKD) study: design and methods. Nephrol Dial Transplant 27:1454–1460.  https://doi.org/10.1093/ndt/gfr456 CrossRefGoogle Scholar
  25. 25.
    Leonardis D, Mallamaci F, Enia G et al (2012) The MAURO study: baseline characteristics and compliance with guidelines targets. J Nephrol 25:1081–1090.  https://doi.org/10.5301/jn.5000239 CrossRefGoogle Scholar
  26. 26.
    Tangri N, Stevens L, Griffith J et al (2011) A predictive model for progression of chronic kidney disease to kidney failure. JAMA 305:1553–1559.  https://doi.org/10.1001/jama.2011.451 CrossRefGoogle Scholar
  27. 27.
    Tangri N, Inker LA, Hiebert B et al (2017) A dynamic predictive model for progression of CKD. Am J Kidney Dis 69:514–520.  https://doi.org/10.1053/j.ajkd.2016.07.030 CrossRefGoogle Scholar
  28. 28.
    Italian Society of Nephrology (SIN) (2018) RIDT 2016 preliminary report. http://ridt.sinitaly.org/2018/10/16/report-2016. Accessed 20 Oct 2018

Copyright information

© Italian Society of Nephrology 2019

Authors and Affiliations

  • Antonio Santoro
    • 1
    Email author
  • Dino Gibertoni
    • 2
  • Paola Rucci
    • 2
  • Elena Mancini
    • 1
  • Decenzio Bonucchi
    • 3
  • Andrea Buscaroli
    • 4
  • Anselmo Campagna
    • 5
  • Gianni Cappelli
    • 6
  • Salvatore David
    • 7
  • Maria Cristina Gregorini
    • 8
  • Gaetano La Manna
    • 9
  • Giovanni Mosconi
    • 10
    • 11
  • Angelo Rigotti
    • 12
  • Roberto Scarpioni
    • 13
  • Alda Storari
    • 14
  • Marcora Mandreoli
    • 15
  1. 1.Nephrology, Dialysis and Hypertension UnitPoliclinico S. Orsola-MalpighiBolognaItaly
  2. 2.Department of Biomedical and Neuromotor SciencesUniversity of BolognaBolognaItaly
  3. 3.SSD Nephrology and DialysisOspedale RamazziniCarpiItaly
  4. 4.Nephrology and Dialysis UnitOspedale S. Maria delle CrociRavennaItaly
  5. 5.Health Policies DepartmentEmilia-Romagna RegionBolognaItaly
  6. 6.Nephrology and Dialysis UnitUniversity Hospital of ModenaModenaItaly
  7. 7.Nephrology and Dialysis UnitOspedale MaggioreParmaItaly
  8. 8.Nephrology and Dialysis UnitArcispedale S. Maria NuovaReggio EmiliaItaly
  9. 9.Nephrology, Dialysis and Transplantation UnitPoliclinico S. Orsola-MalpighiBolognaItaly
  10. 10.Nephrology and Dialysis UnitOspedale Morgagni-PierantoniForlìItaly
  11. 11.Nephrology and Dialysis UnitOspedale M. BufaliniCesenaItaly
  12. 12.Nephrology and DialysisOspedale degli InfermiRiminiItaly
  13. 13.Nephrology and Dialysis UnitOspedale “Guglielmo da Saliceto”PiacenzaItaly
  14. 14.Nephrology and Dialysis UnitArcispedale S. AnnaFerraraItaly
  15. 15.Nephrology and Dialysis UnitOspedale S. Maria della ScalettaImolaItaly

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