Treatment Optimization and Standard of Care Adherence in CKD Primary Care: the TOSCA-CKD project.

<b>Background.</b> Effective collaboration between general practitioners (GPs) and nephrologists is crucial for optimizing the management of chronic kidney disease (CKD). The TOSCA-CKD project (Treatment Optimization and Standard of Care Adherence in CKD Primary Care) aimed to evaluate the implementation of guidelines and the use of nephroprotective therapies in primary care. <b>Methods.</b> Clinical data were collected from the medical records of GPs across 12 Italian regions. The data were analyzed at baseline (T0) and after 6 months (T6) of collaboration with nephrologists. During this observational period, GPs were involved in remote education programs, which included expert-led webinars and clinical case-based learning. <b>Results.</b> A total of 76 GPs and 9 nephrologists were involved in the study, evaluating a cohort of 124,759 patients. There was an increase of 23.3% in the uACR test from T0 to T6 (3.0% vs. 3.7%; p < 0.001). Similarly, there was an increase of 15.2% in the use of eGFR from T0 to T6 (29.7% vs. 34.2%; p < 0.001). The rate of CKD diagnosis increased by 17.5% among patients with eGFR < 60 mL/min/1.73 m² (from 4% to 4.7%) and by 40% among patients with ACR > 30 mg/g (from 0.5% to 0.7%). The use of ACEi/ARBs remained stable at approximately 50%, while the treatment with SGLT2i, the new standard of care according to the current CKD guidelines, increased by 29.8% (from 4.7% to 6.1%). <b>Conclusions.</b> The TOSCA-CKD project demonstrated that GPs' remote educational program and a structured co-management approach significantly enhanced the early identification and improved the management of CKD in primary care.