Missing Opportunity for Nephroprotective Therapy in Patients With Non-Dialysis CKD Under Stable Nephrology Care
Year: 2026
Type: article
Study design: Observational Study
Abstract: Introduction: Awareness of the implementation of guideline-directed nephroprotective therapy is an essential preliminary step to optimize implementation of nephroprotective strategies in nondialysis chronic kidney disease (CKD) (ND-CKD). However, updated information on this issue is lacking in the setting of nephrology clinics. Methods: In this multicenter prospective study, we collected data from 4523 patients with ND-CKD, either stage 3 to 5 or 1 and 2 with urinary albumin-to-creatinine ratio (ACR) > 30 mg/g, followed up in 30 Italian nephrology clinics. Patients were evaluated at 2 visits with a 6-month interval between May 2024 and May 2025. The aim was to evaluate the current phenotype of patients under tertiary nephrology care and the management of the 2 major modifiable determinants of renal risk, hypertension and ACR, including therapeutic inertia. Results: , and ACR was 70 mg/g (interquartile range: 11-350). At the 6-month visit, in patients with and without diabetes, home and office blood pressure (BP) were above target in about 70% of patients, with a high prevalence of sustained (62%) and resistant (23%) hypertension. Among patients with uncontrolled office BP, 33% and 43% of patients with and without diabetes, respectively, were prescribed ≤ 2 BP-lowering drugs. ACR > 30 mg/g persisted in 61% of nondiabetic and 64% of patients with diabetes. Therapeutic inertia for antialbuminuric agents at month 6 was frequent: 85% for renin-angiotensin system (RAS) inhibitors and 90% for gliflozins. Among patients with diabetes, therapeutic inertia was 92% for glucagon-like peptide-1 receptor agonists (GLP1-RAs) and 96% for finerenone. Conclusion: The large majority of patients with ND-CKD currently followed up in Italian renal clinics are characterized by a severe risk profile that is paradoxically associated with remarkable therapeutic inertia for both traditional and innovative guideline-directed nephroprotective therapy.
Source: Kidney International Reports
Authors: Luca De Nicola, Chiara Ruotolo, Gaetano La Manna, Vincenzo Bellizzi, Loreto Gesualdo, Felice Nappi, Pietro Manuel Ferraro, Carmelita Marcantoni, Domenico Santoro, Giovanni Stallone, Antonio Pisani, Cataldo Abaterusso, Adamasco Cupisti, Luigi Vernaglione, Maura Ravera, Mario Cozzolino, Maurizio Gallieni, Federico Alberici, Marcellino Corvinelli, Yuri Battaglia, Alessandro Capitanini, Filippo Aucella, Giuseppe Castellano, Mariadelina Simeoni, Michele Provenzano, Mario Bonomini, Gianpaolo Reboldi, Angelo Ferrantelli, Ciro Esposito, Gianfranca Cabiddu, Giuseppe Grandaliano, Roberto Minutolo, Roberto Minutolo, Loreto Gesualdo, Pietro Cirillo, Alessandro Mascolo, Silvia Porreca, Giuseppe Scarimbolo, Davide Morisco, Simone Di Pace, Gaetano La Manna, Irene Capelli, Miriam Di Nunzio, Federico Alberici, Federica Mescia, Francesco Ravelli, Martina Tedesco, Marco Gregori, Luigi Vernaglione, Flavia Capaccio, Maria Teresa Farina, Domenica Biasi, Giuseppe Leonardi, Mariagrazia Arcidiacono, Lucia Argentiero, Alessandra Spinelli, Gianfranca Cabiddu, Stefania Maxia, Stefania Caira, Marcellino Corvinelli, Lucio Polese, Vincenzo Bellizzi, Caterina Saviano, Ida Molfino, Pasqualina Acconcia, Carmelita Marcantoni, Simone Di Lorenzo, Irene Torrisi, Roberta Aliotta, Grazia Portale, Mario Bonomini, Bianca Lo Giudice, Emanuele Marini, Lorenzo Nolletti, Valeria Vezzani, Vittorio Sirolli, Michele Provenzano, Chiara Summaria, Fiorella Iorio, Francesco Zingone, Giuseppe Pezzi, Roberta Arena, Giovanni Stallone, Dario Troise Barbara Infante, Maura Ravera, Domenico Santoro, Chiara Casuscelli, Michela Calderone, Felicia Cuzzola, Maurizio Gallieni, Luca Della Volpe, Michela Tedesco, Alessia Guarino, Laura Cosmai, Marco Heidempergher, Sabrina Caruso, Mario Cozzolino, Sara Masotto, Anna Maria Ferrigno, Clorinda Rossi, Chiara Cuffaro, Giuseppe Castellano, Simone Vettoretti, Luca De Nicola, Roberto Minutolo, Roberto Minutolo, Paolo Tino Ambrosino, Simona Andriella, Davide Cesarano, Annarita D’Ambra, Federica Marzano, Christian Nardelli, Chiara Ruotolo, Antonio Pisani, Fabio Esposito, Michela Saggese, Giuditta della Corte, Mariadelina Simeoni, Davide Loffredo, Angelo Savino, Felice Nappi, Carla Clienti, Antonietta La Verde, Angelo Ferrantelli, Ciro Esposito, Marta Arazzi, Vittoria Esposito, Filippo Sangregorio, Gianpaolo Reboldi, Sara Battistoni, Nicola Lommano, Manuel Burdese, Yuri Battaglia, Federica Baciga, Michela Erlati, Veronica Brunelli, Adamasco Cupisti, Domenico Giannese, Claudia D’Alessandro, Vincenzo Panichi, Alessandro Capitanini, Adriano Carmelo Piluso, Dritan Curi, Elana Romoli, Vincenzo Miniello, Brunilda Xhaferi, Giuseppe Grandaliano, Viola D’Ambrosio, Filippo Aucella, Rachele Grifa, Maria Nardella, Pérez Ys Aurora Del Mar, Cataldo Abaterusso, Michelangelo Beltrami, Marta Guizzo, Roberta Lazzarin, Mariapaola Protti, Claudia Ungaro, Pietro Manuel Ferraro, Isabella Squarzoni, Andrea Spasiano, Francesco Bonetti
Institutions: University of Campania "Luigi Vanvitelli", University of Bologna, University of Bari Aldo Moro, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - San Marco", University of Messina, University of Foggia, Federico II University Hospital, University of Naples Federico II, Ospedale Castelfranco Veneto, University of Pisa, Ospedale A. Perrino, Ospedale Policlinico San Martino, University of Milan, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, ASST Fatebenefratelli Sacco, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, University of Brescia, Ospedale P. Pederzoli – Casa di Cura Privata S.p.a., Azienda Usl Toscana Centro, Casa Sollievo della Sofferenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Calabria, University of Chieti-Pescara, University of Perugia, University of Pavia, Istituti Clinici Scientifici Maugeri, University of Cagliari, Agostino Gemelli University Polyclinic, Istituti di Ricovero e Cura a Carattere Scientifico
Language: English
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,800
OpenAlex ID: W7154425239