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


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.


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


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.


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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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