title: [Integrated local management regarding patients suffering from the initial stage of chronic renal failure: NephroCare group pilot experience].
abstract: BACKGROUND
  Early diagnosis of the initial stage of chronic renal failure (CRF) is a highly important factor for reducing morbidity and mortality in patients suffering from this pathology. It delays their undergoing hemodialysis (HD) treatment and prevents its complications. This is a well known problem, and the wrong approach causes the so-called late referral phenomenon. Undoubtedly general practitioners (GPs), can, first, identify at an early stage, patients suffering from this syndrome, as they are the first point of contact for patients at risk (for example, diabetic and hypertensive patients). Furthermore, patients very often turn to their GP for various reasons, even those who are 'apparently in good conditions of health'. This study aimed to implement, through NephroCare and the Cooperatives of General Practitioners, 'Progetto Leonardo' and 'Cumae', the evidence that local cooperation between GPs and nephrologists can be effective.
  
  
  METHODS
  In a localized geographical area (Pozzuoli, Bacoli-Monte di Procida), NephroCare organized meetings with GPs, and doctors belonging to the cooperatives, aimed at creating interaction and discussion concerning the etiology and pathogenesis of kidney diseases that lead to CRF, its complications, prevention and management. Screening of 46277 patients, with a 2-yr follow-up was carried out to identify the two categories at risk, diabetics and hypertensives with creatinine (Cr) >1.5 mg/dL.
  
  
  RESULTS
  The screening identified among 7403 hypertensives and 2501 diabetics two groups of, respectively, 274 and 192 patients with Cr >1.5 mg/dL. All patients screened were invited to talk to a nephrologist, who shared, together with the GP, the decision concerning diagnosis and care.
  
  
  CONCLUSIONS
  The outcomes of the project highlighted the importance of cooperation between GPs and nephrologists to implement the integrated management of patients, increasingly elderly, suffering from CRF. This was achieved because the nephrologists belonged to the same regional area as the patients and were thoroughly dedicated to the project. In times of reduced economic resources, a possible correct approach is facing the 'late referral' problem and, consequently, easier and better management of patient care and cost rationalization can be solved by the intervention of nephrologists working in local clinics. In the future, this will always guarantee continuous care for patients suffering from this pathology.
authors.affiliation: Coordinatore Clinico e Scientifico NephroCare-FME. Italy. attilio.dibenedetto@fmc-ag.com
authors.forename: A
authors.initials: A
authors.lastname: Di Benedetto
authors.forename: D
authors.initials: D
authors.lastname: Adinolfi
authors.forename: C
authors.initials: C
authors.lastname: Fariello
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D010865:Pilot Projects; D012017:Referral and Consultation; D013997:Time Factors