title: Clinical management of nondialysis patients with chronic kidney disease: a retrospective observational study. Data from the SONDA study (Survey Of Non-Dialysis outpAtients).
abstract: BACKGROUND
  A lack of awareness of chronic kidney disease (CKD) often results in delayed diagnosis and inadequate treatment.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Nephrology and Dialysis Department, 'G.B. Grassi' Hospital, Ostia Lido, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Morosetti
authors.forename: Antonio
authors.initials: A
authors.lastname: Gorini
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Costanzo
authors.forename: Silvia
authors.initials: S
authors.lastname: Cipriani
authors.forename: Sara
authors.initials: S
authors.lastname: Dominijanni
authors.forename: Colin G
authors.initials: CG
authors.lastname: Egan
authors.forename: Laura
authors.initials: L
authors.lastname: Zappalà
authors.forename: Umberto
authors.initials: U
authors.lastname: di Luzio Paparatti
keywords: chronic kidney disease; metabolic bone disorders; predialysis; renal failure
references.citation: J Nephrol. 2012 Jul-Aug;25(4):523-32
references.pmid: 21956766
references.citation: G Ital Nefrol. 2003 Sep-Oct;20  Suppl 24:S61-82
references.pmid: 14666504
references.citation: Kidney Int. 2005 Sep;68(3):1337-43
references.pmid: 16105069
references.citation: Nephrol Dial Transplant. 2001;16 Suppl 2:7-11
references.pmid: 11369842
references.citation: Clin J Am Soc Nephrol. 2008 Jan;3(1):133-8
references.pmid: 18045862
references.citation: Am J Kidney Dis. 2008 Sep;52(3):444-53
references.pmid: 18468747
references.citation: Ann Intern Med. 2012 Jun 5;156(11):785-95, W-270, W-271, W-272, W-273, W-274, W-275, W-276, W-277,
references.pmid: 22312131
references.citation: Clin J Am Soc Nephrol. 2007 Sep;2(5):938-46
references.pmid: 17724278
references.citation: Clin J Am Soc Nephrol. 2009 Jul;4(7):1176-82
references.pmid: 19423567
references.citation: Nephrol Dial Transplant. 2001;16 Suppl 7:61-4
references.pmid: 11590260
references.citation: Nephrol Dial Transplant. 2009 Feb;24(2):348-54
references.pmid: 19037082
references.citation: Kidney Int. 2011 Jul;80(1):93-104
references.pmid: 21289597
references.citation: Nephrol Dial Transplant. 1999 Jan;14(1):129-36
references.pmid: 10052492
references.citation: Clin J Am Soc Nephrol. 2006 Nov;1(6):1205-10
references.pmid: 17699349
references.citation: Kidney Int. 2006 Feb;69(3):538-45
references.pmid: 16395261
references.citation: Clin J Am Soc Nephrol. 2009 Mar;4(3):552-9
references.pmid: 19261821
references.citation: J Am Soc Nephrol. 2001 Dec;12(12):2753-2758
references.pmid: 11729245
references.citation: J Am Soc Nephrol. 2002 Jun;13(6):1635-44
references.pmid: 12039993
references.citation: Nephrol Dial Transplant. 2008 Jul;23(7):2162-6
references.pmid: 18469309
references.citation: Nephrol Dial Transplant. 2007 Aug;22(8):2129-32
references.pmid: 17595177
references.citation: J Nephrol. 2011 Mar-Apr;24(2):225-35
references.pmid: 21188680
references.citation: N Engl J Med. 2009 Nov 19;361(21):2019-32
references.pmid: 19880844
references.citation: Kidney Int Suppl. 2009 Aug;(113):S1-130
references.pmid: 19644521
references.citation: Am J Kidney Dis. 2006 May;47(5 Suppl 3):S11-145
references.pmid: 16678659
references.citation: Kidney Int Suppl. 2006 May;(101):S13-8
references.pmid: 16830701
references.citation: Curr Med Res Opin. 2004 Sep;20(9):1501-10
references.pmid: 15383200
references.citation: Am J Kidney Dis. 2001 Dec;38(6):1398-407
references.pmid: 11728982
references.citation: J Am Soc Nephrol. 2007 Dec;18(12):3164-70
references.pmid: 18003781
references.citation: Clin Ther. 2007 Jul;29(7):1524-34
references.pmid: 17825703
references.citation: Nephrol Dial Transplant. 2008 Feb;23(2):621-6
references.pmid: 18039648
references.citation: G Ital Nefrol. 2011 Jul-Aug;28(4):401-7
references.pmid: 21809309