MO492: ‘The Disease Awareness Innovation Network’ (DANTE) Framework for Chronic Kidney Disease Diagnosis
Authors: Pesce Francesco , Pasculli Domenico , Pasculli Giuseppe , Sivo Carmen , Serena Russo Maria , Granata Antonio , Gesualdo Loreto 
Published: May 2022

Abstract

BACKGROUND AND AIMS
The global burden of chronic kidney disease (CKD) is growing, impacting around 10% of the worldwide population becoming the 5th cause of mortality by 2023, with high cost for the health care system (Glassrock et al. 2017). CKD can be identified using two easy and inexpensive tests (eGFR and ACR). Early stages of CKD are generally asymptomatic, hence challenging clinical recommendations for early detection of CKD. Indeed, a high percentage of patients in primary care are undiagnosed (Zilich et al. 2005). As a result, high-risk individuals, such as those with hypertension, diabetes, a family history of renal disease and cardiovascular disease, require targeted and accessible screening. In a study promoted by the Italian Society of Nephrology (SIN) and the Italian Society of General Practitioners (SIMG), 300 general practitioners (GPs) recruited a cohort of ∼500 thousand patients in the general population, showing that creatinine dosage was requested for only 17% of patients (Minutolo et al. 2008). Of this subgroup, 16% were affected by CKD, but only one out of eight patients was actually identified by the GP as nephropathic, with potential harm to the patient due to possible missed diagnosis. Such study highlighted that, in Italy, a nephrological consultation is usually requested only in 5% of patients with overt nephropathy in the conservative phase (eGFR 30–60), whereas the nephrological referral did not exceed 50% in cases of pre-dialysis disease (eGFR 30–15). With a global lack of CKD specialists, enabling GPs and building successful multidisciplinary teams to play a larger role in early detection and management will assist hospitals and health systems to alleviate the burden.

METHOD
An observational pilot study was undertaken between 1 May 2021 and 31 October 2021 in the Apulia region, Italy, within a framework called `The Disease Awareness iNnovaTion nEtwork’ (DANTE). We aimed at evaluating the impact of GPs targeted training by specialized nephrologists towards CKD awareness. A first meeting was set up with GPs in which trained nephrologists illustrated to the GPs the KDIGO CKD guidelines. The differences in terms of proportions between the two groups [baseline time (T0) versus time at 6 months (T6)] were evaluated with Pearson's.

RESULTS
A total of n = 17 854 of patients were enrolled at T0 versus n = 18 661 at T6 from the databases of 17 Apulian GPs who satisfied the entry criterion (having Millewin software installed on their systems). All of the comparisons in terms of percentage patients tested for ACR and eGFR between T0 and T6 resulted in a statistically significant P-value (&lt;.0001) also when stratifying/disease groups (diabetes, hypertension and heart failure, Fig. 1). Patients with eGFR &lt;60 mL/min were found to be 3.8% at T6, hence providing for an increase of detection of + 72.73% after GP CKD training awareness.

CONCLUSION
The DANTE pilot study was the first of its kind ever planned in Apulia. All of the diagnostic tests undertaken did register an increase of at least + 42.59% at T6, with an overall median increase of + 72.73%. Therefore, we can argue that teaching devoted to GPs by nephrologist it is able to improve GPs CKD awareness and increase its early diagnosis, which can slow down the progression of CKD, plus providing for high savings given the large cost gap between the early and late stages of CKD (Jommi et al. 2018).