Clinical management of nondialysis patients with chronic kidney disease: a retrospective observational study. Data from the SONDA study (Survey Of Non-Dialysis outpAtients)

Massimo Morosetti,¹ Antonio Gorini,² Anna Maria Costanzo,² Silvia Cipriani,¹ Sara Dominijanni,¹ Colin G Egan,³ Laura Zappalà,¹ Umberto di Luzio Paparatti<sup>2

1</sup>Nephrology and Dialysis Department, ‘G.B. Grassi’ Hospital, Ostia Lido, Rome, Italy; ²Abbott S.r.l., Campoverde (LT), Rome, Italy; 3Primula Multimedia S.r.l., Pisa, Italy

Background: A lack of awareness of chronic kidney disease (CKD) often results in delayed diagnosis and inadequate treatment.
Purpose: The objective of this study was to assess the therapeutic management and outcome of nondialysis CKD patients.
Methods: Three hundred ninety-seven patients (54.9% males aged 67.5 ± 14.6 years) were retrospectively screened at the Nephrology Department, GB Grassi Hospital, Rome, Italy. After a baseline visit, patient data were collected every 6 months for a total of 24 months. Clinical characteristics were measured at baseline, then the following outcomes were measured every 6 months: staging of CKD, presence of concomitant diseases, treatment and adherence to Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines for anemia management.
Results: Three hundred sixty-eight (92.7%) patients attended at least one visit and 92 (23.2%) patients attended all four visits. Patients were mainly referred to a nephrologist for chronic renal failure (61.7%) or hypertension (42.8%). At baseline, 79.6% of patients had previous hospitalization and 79.1% were receiving antihypertensive medication. Serum creatinine and/or glomerular filtration rate was examined in >90% of patients, whereas parathyroid hormone was rarely examined (5.5%). Vitamin D supplementation was received by 6.5% of patients. The majority of patients were staged at 3 or 4 CKD (32% and 23.9%, respectively) and did not significantly change over time. The use of antithrombotic, antilipidemic and erythropoietin medication increased over the four surveys. The majority of patients (86.8%) achieved hemoglobin K/DOQI target levels.
Conclusion: These findings demonstrate a current lack of attention of CKD and related disorders (mineral metabolism, electrolyte balance, and anemia) at the level of the general practitioner (GP) and non-nephrology specialist, which can result in both delayed referral and inadequate treatment. By increasing both awareness of CKD and the coordinated relationship between GPs and nephrologists, patient clinical and therapeutic outcome may be improved.

Keywords: chronic kidney disease, metabolic bone disorders, predialysis, renal failure