NDT Advance Access originally published online on November 26, 2007
Nephrology Dialysis Transplantation 2008 23(2):621-626; doi:10.1093/ndt/gfm636
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Clinical policies on the management of chronic kidney disease patients in Italy
1Department of Nephrology, Ospedale A. Manzoni, Lecco 23900, Italy, 2Nephrology, Hypertension and Renal Transplantation Unit and CNR-IBIM, Ospedali Riuniti, 89125 Reggio Cal, Italy and 3Italian Society of Nephrology—SIR-SIN Study Group, Italy
Correspondence and offprint requests to: Francesco Locatelli, Department of Nephrology, Ospedale A. Manzoni, via Dell’Eremo 9/11-Lecco 23900, Italy. Tel: +39-0341-489-850; Fax: +39-0341-489-860; E-mail: f.locatelli{at}ospedale.lecco.it
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Abstract |
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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 
40% of cases.
Conclusion. This survey in Italy highlights important deviations of clinical policies at the centre level from guideline recommendations.
Keywords: chronic kidney disease; guidelines; Italy; management
4FL and CZ contributed equally to this manuscript.
5Investigators of the SIR-SIN study (‘Studio Italiano indicatori di Risultato multipli – epidemiologia dell’insufficienza renale cronica in Italia’ della Società Italiana di Nefrologia, ‘Italian study on multiple predictors of outcome – epidemiology of chronic renal insufficiency in Italy’ sponsored by the Italian Society of Nephrology) are listed in the appendix.
Received for publication: 16. 7.07
Accepted in revised form: 20. 8.07