Missing Opportunity for Nephroprotective Therapy in Patients With Non-Dialysis CKD Under Stable Nephrology Care

Introduction.Awareness of implementation of guideline-directed nephroprotective therapy (GDNT) is an essential preliminary step to optimize implementation of nephroprotective strategies in non-dialysis CKD (ND-CKD).However, no updated information on this issue is available in the setting of nephrology clinics. Methods.In this multicenter prospective study we collected data of 4,523 patients with ND-CKD, either stage 3-5 or 1-2 with ACR>30 mg/g, followed in 30 Italian nephrology clinics in two visits with a 6-month interval between May/2024-May/2025 to evaluate current phenotypes of patients under tertiary nephrology care, and management of the two major modifiable determinants of renal risk, hypertension and albumin-creatinine ratio (ACR), including therapeutic inertia. Results.The cohort was characterized by a severe cardiorenal risk profile: men 65%, age 7114y, diabetes 40%, cardiovascular disease 40%, eGFR 3419 mL/min/1.73m 2 , ACR 70 mg/g .At month-6 visit, in patients with and without diabetes, home and office blood pressure (OBP) were above target in about 70% patients, with high prevalence of sustained (62%) and resistant (23%) hypertension.Among patients with uncontrolled OBP, 43% and 33% of nondiabetic and diabetic patients were prescribed 2 BP lowering drugs.ACR>30 mg/g persisted in 61% of nondiabetic and 64% of diabetic patients with frequent occurrence of therapeutic inertia for antialbuminuric agents at month-6: 85% for RAS inhibitors, 90% for gliflozins, and, among patients with diabetes, 92% for GLP1-RA and 96% for finerenone.Conclusions.The large majority of patients with ND-CKD currently followed in Italian renal clinics is characterized by a severe risk profile that is paradoxically associated with remarkable therapeutic inertia for traditional and innovative GDNT.

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Kidney International Reports
Published
2026-04-01
DOI
https://doi.org/10.1016/j.ekir.2026.106541
Primary Topic
Chronic Kidney Disease and Diabetes
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article
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article

Missing Opportunity for Nephroprotective Therapy in Patients With Non-Dialysis CKD Under Stable Nephrology Care

Filippo Aucella, C Saviano, Michele Provenzano, Pasqualina Acconcia et al.
Kidney International Reports
Chronic Kidney Disease and Diabetes
article

Missing Opportunity for Nephroprotective Therapy in Patients With Non-Dialysis CKD Under Stable Nephrology Care

Filippo Aucella, C Saviano, Michele Provenzano, Pasqualina Acconcia, Roberto Minutolo, Roberta Aliotta, Maurizio Gallieni, Maura Ravera, Michela Tedesco, Luigi Vernaglione, Gaetano La Manna, Grazia Portale, Marco Gregori, Flavia Capaccio, Ida Molfino, Gianfranca Cabiddu, Martina Tedesco, Vincenzo Bellizzi, Alessandro Capitanini, Vittorio Sirolli, Chiara Summaria, Adamasco Cupisti, Yuri Battaglia, Anna Maria Ferrigno, Marcellino Corvinelli, Mario Bonomini, Luca Della Volpe, Stefania Caira, Giovanni Stallone, Irene Torrisi, Federica Mescia, Felicia Cuzzola, Sabrina Caruso, Maria Teresa Farina, Cataldo Abaterusso, Alessandra Spinelli, Mariadelina Simeoni, Valeria Vezzani, Federico Alberici, Laura Cosmai, Pietro Manuel Ferraro, Pietro Cirillo, Angelo Ferrantelli, Lucia Argentiero, Miriam DI Nunzio, Silvia Porreca, Lucio Polese, Gianpaolo Reboldi, Giuseppe Leonardi, Felice Nappi, Chiara Ruotolo, Luca De Nicola, Roberta Arena, Alessandro Mascolo, Chiara Casuscelli, Bianca Lo Giudice, Lorenzo Nolletti, Francesco Zingone, Marco Heidempergher, Carmelita Marcantoni, Giuseppe Pezzi, M. Calderone, Simone Di Lorenzo, Ciro Esposito, Mario Cozzolino, Giuseppe Castellano, Francesco Ravelli, Davide Morisco, Dario Troise Barbara Infante, Chiara Cuffaro, Domenica Biasi, Loreto Gesualdo, Stefania Maxia, Simone Di Pace, Irene Capelli, Giuseppe Grandaliano, Fiorella Iorio, Sara Masotto, Emanuele Marini, Alessia Guarino, Clorinda Rossi, Giuseppe Scarimbolo, Mariagrazia Arcidiacono, Antonio Pisani, Domenico Santoro
article en

Abstract

Introduction.Awareness of implementation of guideline-directed nephroprotective therapy (GDNT) is an essential preliminary step to optimize implementation of nephroprotective strategies in non-dialysis CKD (ND-CKD).However, no updated information on this issue is available in the setting of nephrology clinics. Methods.In this multicenter prospective study we collected data of 4,523 patients with ND-CKD, either stage 3-5 or 1-2 with ACR>30 mg/g, followed in 30 Italian nephrology clinics in two visits with a 6-month interval between May/2024-May/2025 to evaluate current phenotypes of patients under tertiary nephrology care, and management of the two major modifiable determinants of renal risk, hypertension and albumin-creatinine ratio (ACR), including therapeutic inertia. Results.The cohort was characterized by a severe cardiorenal risk profile: men 65%, age 7114y, diabetes 40%, cardiovascular disease 40%, eGFR 3419 mL/min/1.73m 2 , ACR 70 mg/g .At month-6 visit, in patients with and without diabetes, home and office blood pressure (OBP) were above target in about 70% patients, with high prevalence of sustained (62%) and resistant (23%) hypertension.Among patients with uncontrolled OBP, 43% and 33% of nondiabetic and diabetic patients were prescribed 2 BP lowering drugs.ACR>30 mg/g persisted in 61% of nondiabetic and 64% of diabetic patients with frequent occurrence of therapeutic inertia for antialbuminuric agents at month-6: 85% for RAS inhibitors, 90% for gliflozins, and, among patients with diabetes, 92% for GLP1-RA and 96% for finerenone.Conclusions.The large majority of patients with ND-CKD currently followed in Italian renal clinics is characterized by a severe risk profile that is paradoxically associated with remarkable therapeutic inertia for traditional and innovative GDNT.

Kidney International Reports
University of Foggia (IT), University of Pisa (IT), University of Messina (IT), AOL (United States) (US), University of Cagliari (IT), University of Campania "Luigi Vanvitelli" (IT), University of Pavia (IT), University of Perugia (IT), Casa Sollievo della Sofferenza (IT), Villa Maria Hospital (UG), Agostino Gemelli University Polyclinic (IT), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), Brescia University (US), University of Chieti-Pescara (IT), Ospedale Antonio Cardarelli (IT), Istituti Clinici Scientifici Maugeri (IT), Azienda Ospedaliera Universitaria Integrata Verona (IT), Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT), Ospedale A. Perrino (IT), Casa di Cura Villa Garda (IT), Federico II University Hospital (IT), Azienda USL di Bologna (IT), Presidio Ospedaliero (IT), University of Campania "Luigi Vanvitelli" (IT), Ospedale Castelfranco Veneto (IT), Azienda di Rilievo Nazionale ed Alta Specializzazione (IT), Ospedale Policlinico San Martino (IT), Ospedale Sant'Anna (IT), Azienda Usl Toscana Centro (IT), ASST Fatebenefratelli Sacco (IT), University of Calabria (IT), University of Bari Aldo Moro (IT), University of Naples Federico II (IT), University of Brescia (IT), University of Bologna (IT)
Amgen, AstraZeneca, GlaxoSmithKline, Novartis, Sanofi, Alexion Pharmaceuticals, Amicus Therapeutics, Novo Nordisk, Astellas Pharma, Swedish Orphan Biovitrum, California State Library
Openalex Percentile: Top 25%
Chronic Kidney Disease and Diabetes
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