title: The MAURO study: baseline characteristics and compliance with guidelines targets.
abstract: BACKGROUND
  The Multiple Intervention and Audit in Renal Diseases to Optimize Care (MAURO) study was a cluster randomized controlled trial in 22 renal clinics which aimed to assess the efficacy of a multimodal quality improvement intervention to increase compliance with guideline recommendations for prevention of chronic kidney disease (CKD) progression and cardiovascular (CV) complications. The trial aimed to test whether this multimodal intervention improved adherence to recommended targets for a series of surrogate indicators relevant to blood pressure (BP) control, sodium intake, proteinuria, dyslipidemia, anemia and calcium-phosphate alterations. The trial also tested whether the same intervention slowed CKD progression and prevented CV complications in CKD patients.
  
  
  METHODS
  Twenty-two renal clinics were randomized to 2 arms: an intervention arm applying a multimethod quality improvement intervention and a control arm providing standard care. Surrogate indicators were measured to evaluate blood pressure (BP) control, sodium intake, proteinuria, dyslipidemia, anemia and calcium-phosphate alterations.
  
  
  RESULTS
  Notwithstanding the fact that the vast majority of patients enrolled in this study (95%) were being treated with antihypertensive drugs, BP goals at baseline (specific for proteinuria level and diabetes) were met only in 45% of nonproteinuric patients and in just 14% and 18% of proteinuric and diabetic patients, respectively. The use of diuretics in hypertensive patients was less than what was needed, and about 80% of patients showed a salt excretion >100 mmol/24 hours. Total and low-density lipoprotein cholesterol levels were out of target in over 40% of patients, but only about 60% of these were on statins. A large majority of CKD patients were obese or overweight. The proportion of smokers was relatively small (13%), and 37% of patients had quit smoking, indicating patients' awareness of the health risks of smoking.
  
  
  CONCLUSIONS
  In our cohort, management of modifiable risk factors for CKD progression and CV disease could be substantially improved.
authors.affiliation: Nephrology, Dialysis and Transplantation Unit, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Leonardis
authors.forename: Francesca
authors.initials: F
authors.lastname: Mallamaci
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Enia
authors.forename: Maurizio
authors.initials: M
authors.lastname: Postorino
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tripepi
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
mesh_terms: D000368:Aged; D000740:Anemia / Q000453:epidemiology / Q000628:therapy; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D002118:Calcium / Q000097:blood; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D016009:Chi-Square Distribution; D018450:Disease Progression; D050171:Dyslipidemias / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007558:Italy / Q000453:epidemiology; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000453:epidemiology / Q000628:therapy; D010710:Phosphates / Q000097:blood; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011507:Proteinuria / Q000453:epidemiology / Q000628:therapy; D058996:Quality Improvement; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D016540:Smoking Cessation; D012982:Sodium, Dietary / Q000008:administration & dosage; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers; D000960:Hypolipidemic Agents; D008055:Lipids; D010710:Phosphates; D012982:Sodium, Dietary; D002118:Calcium