Pesce Francesco, Bruno Giacomo Matteo, Colombo Giorgio Lorenzo, Di Matteo Sergio, Maurizi Anna Rita, Mongelli Valentina, Mele Silvia, Narici Lavinia, Bianchi Stefano, Bonomini Mario, Castellano Giuseppe, De Nicola Luca, Gambaro Giovanni, Grandaliano Giuseppe, La Manna Gaetano, Pani Antonello, Ranghino Andrea, Gesualdo Loreto
Division of Renal Medicine, "Fatebenefratelli Isola Tiberina-Gemelli Isola", Rome, 00186, Italy.
Department of Drug Sciences, University of Pavia, Pavia, Italy.
Clinicoecon Outcomes Res. 2024 Aug 5;16:547-555. doi: 10.2147/CEOR.S470728. eCollection 2024.
The underdiagnosis of chronic kidney disease (CKD) remains a significant public health concern. The Early chroNic kiDney disease pOint of caRe Screening (ENDORSE) project aimed to evaluate the clinical and economic implications of a targeted training intervention for general practitioners (GPs) to enhance CKD awareness and early diagnosis.
Data on estimated Glomerular Filtration Rate (eGFR) and Urinary Albumin-Creatinine Ratio (uACR) were collected by 53 Italian GPs from 112,178 patients at baseline and after six months. The intervention involved six months of hybrid training provided by 11 nephrologists, which included formal lectures, instant messaging support, and joint visits for complex cases.
The results demonstrated a substantial increase in the use of eGFR (+44.7%) and uACR (+95.2%) tests. This led to a 128.9% rise in the number of individuals screened for CKD using the KDIGO classification, resulting in a 62% increase in CKD diagnoses. The intervention's impact was particularly notable in high-risk groups, including patients with type 2 diabetes, hypertension, and heart failure.
A budget impact analysis projected cumulative five-year savings of €1.7 million for the study cohort. When these findings were extrapolated to the entire Italian CKD population, potential savings were estimated at €106.6 million, highlighting significant cost savings for the national health service. The clinical simulation assumed that early diagnosed CKD patients would be treated according to current indications for dapagliflozin, which slows disease progression.
The ENDORSE model demonstrated that targeted training for GPs can significantly improve early CKD detection, leading to better patient outcomes and considerable economic benefits. This approach shows promise for broader implementation to address the underdiagnosis of CKD on a national and potentially international scale.
慢性肾脏病（CKD）的诊断不足仍然是一个重大的公共卫生问题。早期慢性肾脏病初级保健筛查（ENDORSE）项目旨在评估针对全科医生（GPs）的定向培训干预措施对提高CKD知晓率和早期诊断的临床及经济影响。
53名意大利全科医生收集了112,178名患者在基线期和六个月后的估计肾小球滤过率（eGFR）和尿白蛋白肌酐比值（uACR）数据。干预措施包括由11名肾病专家提供的为期六个月的混合培训，其中包括正式讲座、即时通讯支持以及针对复杂病例的联合出诊。
结果显示，eGFR检测的使用量大幅增加（+44.7%），uACR检测的使用量增加了95.2%。这使得使用KDIGO分类法筛查CKD的人数增加了128.9%，CKD诊断数量增加了62%。该干预措施在高危人群中影响尤为显著，包括2型糖尿病、高血压和心力衰竭患者。
预算影响分析预计，该研究队列在五年内累计节省170万欧元。将这些结果外推至整个意大利CKD人群时，预计潜在节省金额为1.066亿欧元，凸显了对国家卫生服务的显著成本节约。临床模拟假设，早期诊断的CKD患者将根据目前达格列净的适应证进行治疗，该药可减缓疾病进展。
ENDORSE模式表明，针对全科医生的定向培训可显著改善CKD的早期检测，带来更好的患者预后和可观的经济效益。这种方法有望在全国乃至国际范围内更广泛地实施，以解决CKD诊断不足的问题。
