The PIRP project (Prevenzione Insufficienza Renale Progressiva): how to integrate hospital and community maintenance treatment for chronic kidney disease.
Aged
Disease Management
Disease Progression
Female
Follow-Up Studies
Forecasting
Glomerular Filtration Rate
/ physiology
Hospitals
Humans
Incidence
Italy
/ epidemiology
Male
Middle Aged
Prognosis
Quality Improvement
Renal Dialysis
/ methods
Renal Insufficiency, Chronic
/ epidemiology
Retrospective Studies
Risk Factors
CKD management
Chronic kidney disease
General Practitioners
Public health intervention
Registries
eGFR
Journal
Journal of nephrology
ISSN: 1724-6059
Titre abrégé: J Nephrol
Pays: Italy
ID NLM: 9012268
Informations de publication
Date de publication:
Jun 2019
Jun 2019
Historique:
received:
05
07
2018
accepted:
14
12
2018
pubmed:
20
1
2019
medline:
15
8
2020
entrez:
20
1
2019
Statut:
ppublish
Résumé
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.
Identifiants
pubmed: 30659519
doi: 10.1007/s40620-018-00570-2
pii: 10.1007/s40620-018-00570-2
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
417-427Références
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])
doi: 10.1371/journal.pone.0158765
pubmed: 27383068
pmcid: 4934905
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
doi: 10.1093/ndt/gfu383
pubmed: 25523453
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
doi: 10.2215/CJN.02400310
pubmed: 20813860
pmcid: 3001778
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
doi: 10.1016/S0140-6736(14)61682-2
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
doi: 10.1007/s40620-015-0239-4
pubmed: 26498295
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
doi: 10.1007/s10198-016-0830-1
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
doi: 10.4415/ANN_17_04_12
pubmed: 29297866
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 139:244–252
doi: 10.7326/0003-4819-139-4-200308190-00006
pubmed: 12965979
Remuzzi G, Ruggenenti P, Perico N (2002) Chronic renal diseases: renoprotective benefits of renin-angiotensin system inhibition. Ann Intern Med 136:604–615
doi: 10.7326/0003-4819-136-8-200204160-00010
pubmed: 11955029
Feehally J, Griffith KE, Lamb EJ et al (2008) Early detection of chronic kidney disease. BMJ 337:a1618
doi: 10.1136/bmj.a1618
pubmed: 18829639
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
doi: 10.1016/j.amjmed.2011.04.026
pubmed: 22017785
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
doi: 10.1053/ajkd.2003.50038
pubmed: 12552491
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 3:1–150
doi: 10.1038/kisup.2012.73
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
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
doi: 10.1007/s40620-016-0338-x
pubmed: 27568307
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 6:883–891
doi: 10.2215/CJN.07810910
pubmed: 21393493
pmcid: 3069383
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
doi: 10.1093/ndt/gft444
pubmed: 24286974
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
doi: 10.1016/j.kint.2018.01.008
pubmed: 29656901
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
doi: 10.1007/s40620-018-0529-8
pubmed: 30187380
pmcid: 6244557
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
doi: 10.2215/CJN.00070109
pubmed: 19541818
pmcid: 2723966
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 42:22–35
doi: 10.1016/S0272-6386(03)00405-0
pubmed: 12830453
Appel LJ, Middleton J, Miller ER et al (2003) The rationale and design of the AASK cohort study. J Am Soc Nephrol 14:S166–S172
doi: 10.1097/01.ASN.0000070081.15137.C0
pubmed: 12819323
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
doi: 10.1291/hypres.31.1101
pubmed: 18716357
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
doi: 10.1093/ndt/gfr456
pubmed: 21862458
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
doi: 10.5301/jn.5000239
pubmed: 23172127
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
doi: 10.1001/jama.2011.451
pubmed: 21482743
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
doi: 10.1053/j.ajkd.2016.07.030
pubmed: 27693260
Italian Society of Nephrology (SIN) (2018) RIDT 2016 preliminary report. http://ridt.sinitaly.org/2018/10/16/report-2016 . Accessed 20 Oct 2018