The PIRP project (Prevenzione Insufficienza Renale Progressiva): how to integrate hospital and community maintenance treatment for chronic kidney disease

Santoro, Antonio; Gibertoni, Dino; Rucci, Paola; Mancini, Elena; Bonucchi, Decenzio; Buscaroli, Andrea; Campagna, Anselmo; Cappelli, Gianni; David, S.; Gregorini, Maria Cristina; Manna, Gaetano La; Mosconi, Giovanni; Rigotti, Angelo; Scarpioni, Roberto; Storari, Alda; Mandreoli, Marcora

doi:10.1007/s40620-018-00570-2

Cited by 12 publications

(33 citation statements)

References 26 publications

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“…Our results concerning the costs of chronic kidney disease are consistent with other reports showing that, starting from stage 3A, the financial burden of chronic kidney disease increases as renal function declines [40,41]. This supports early identification and clinical interventions for chronic kidney disease in patients with diabetes to delay progression towards end-stage renal failure through optimal management strategies [42].…”

Section: Discussionsupporting

confidence: 91%

Medical Costs of Patients with Type 2 Diabetes in a Single Payer System: A Classification and Regression Tree Analysis

Rucci

Avaldi

Travaglini

et al. 2019

PharmacoEconomics Open

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Background and Objectives Many studies and systematic reviews have estimated the healthcare costs of diabetes using a cost-of-illness approach. However, in the studies based on this approach patients' heterogeneity is rarely taken into account. The aim of this study was to stratify patients with type 2 diabetes into homogeneous cost groups based on demographic and clinical characteristics. Methods We conducted a retrospective cost-of-illness study by linking individual data on health services utilization retrieved from the administrative databases of Emilia-Romagna Region (Italy). Direct medical costs (either all-cause or diabetesrelated) were calculated from the perspective of the regional health service, using tariffs for hospitalizations and outpatient services and the unit costs of prescriptions for drugs. The determinants of costs identified in a generalized linear regression model were used to characterize subgroups of patients with homogeneous costs in a classification and regression tree analysis. Results The study population consisted of a cohort of 101,334 patients with type 2 diabetes, followed up for 1 year, with a mean age of 70.9 years. Age, gender, complications, comorbidities and living area accounted significantly for cost variability. The classification tree identified ten patient subgroups with different costs, ranging from a median of €483 to €39,578. The two subgroups with highest costs comprised dialysis patients, and the largest subgroup (57.9%) comprised patients aged ≥ 65 years without renal, cardiovascular and cerebrovascular complications. Conclusions Classification of patients into homogeneous cost subgroups can be used to improve the management of, and budget allocation for, patients with type 2 diabetes.

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Section: Discussionsupporting

confidence: 91%

Medical Costs of Patients with Type 2 Diabetes in a Single Payer System: A Classification and Regression Tree Analysis

Rucci

Avaldi

Travaglini

et al. 2019

PharmacoEconomics Open

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“…The number of elderly patients on dialysis is increasing in western countries: in the Emilia‐Romagna region of northern Italy, the mean age of incidence ESKD patients in 2017 was 69 years, while 22% of patients were older than 80 years 16 : in our dialysis center in Piacenza, the mean age was 69.2 + 15.3, and more than 35% of patients were older than 75 years of age.…”

Section: Discussionmentioning

confidence: 88%

What can a home hemodialysis program offer to patients in a nursing home setting? A case series and feasibility analysis

Scarpioni

Ricardi

Manini

et al. 2020

Hemodialysis International

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Introduction: Over the last decades, the number of elderly patients on dialysis has rapidly grown on account of increased life expectancy, improved care and reduced mortality rate. Therefore, cooperation between geriatricians and nephrologists has become mandatory for co-managing kidney disease in these patients. Based on renewed interest in home hemodialysis (HHD), elderly patients may benefit from not being transported from their home for therapy. Methods: Here, we report our experience with HHD involving three elderly patients who were followed-up over a 15-months period in a nursing home. Findings: Our experience demonstrates that hospitalization abruptly dropped from 40 days to zero days, the need for erythropoietin stimulating agents (ESAs) diminished, transportation-related costs for home treatments decreased, and quality of life (QoL) improved. This was confirmed by a questionnaire administered to our patients at the start and again after 6 months of HHD which evaluated the Physical Health Component Score (PCS) and the Mental Health Component Score (MCS). Discussion: Home hemodialysis may represent an important way to improve social, mental, and physical recovery, while also eliminating the cost of transportation and the discomfort of abandoning their "homes" and daily habits. Home hemodialysis is an effective alternative to incenter HD or peritoneal dialysis (PD) that should be offered to elderly patients when a home caregiver is not available, nonetheless, nursing assistance is required. Moreover, HHD allows patients to stay at home, thereby avoiding several weekly trips to the dialysis center, and may be useful in reducing infections, especially in times of the COVID-19 pandemic, as demonstrated by our experience.

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“…The study population consists of patients participating in the PIRP project [13], a collaborative network of nephrologists and general practitioners operating in Emilia-Romagna, a region of North-Eastern Italy with 4,351,393 inhabitants (2011 census data, National Institute of Statistics). The study was exempt from approval from the Ethics Committee of Emilia-Romagna.…”

Section: Methodsmentioning

confidence: 99%

Temporal validation of the CT-PIRP prognostic model for mortality and renal replacement therapy initiation in chronic kidney disease patients

Gibertoni

Rucci

Mandreoli³

et al. 2019

BMC Nephrol

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Background A classification tree model (CT-PIRP) was developed in 2013 to predict the annual renal function decline of patients with chronic kidney disease (CKD) participating in the PIRP (Progetto Insufficienza Renale Progressiva) project, which involves thirteen Nephrology Hospital Units in Emilia-Romagna (Italy). This model identified seven subgroups with specific combinations of baseline characteristics that were associated with a differential estimated glomerular filtration rate (eGFR) annual decline, but the model’s ability to predict mortality and renal replacement therapy (RRT) has not been established yet. Methods Survival analysis was used to determine whether CT-PIRP subgroups identified in the derivation cohort ( n = 2265) had different mortality and RRT risks. Temporal validation was performed in a matched cohort ( n = 2051) of subsequently enrolled PIRP patients, in which discrimination and calibration were assessed using Kaplan-Meier survival curves, Cox regression and Fine & Gray competing risk modeling. Results In both cohorts mortality risk was higher for subgroups 3 (proteinuric, low eGFR, high serum phosphate) and lower for subgroups 1 (proteinuric, high eGFR), 4 (non-proteinuric, younger, non-diabetic) and 5 (non-proteinuric, younger, diabetic). Risk of RRT was higher for subgroups 3 and 2 (proteinuric, low eGFR, low serum phosphate), while subgroups 1, 6 (non-proteinuric, old females) and 7 (non-proteinuric, old males) showed lower risk. Calibration was excellent for mortality in all subgroups while for RRT it was overall good except in subgroups 4 and 5. Conclusions The CT-PIRP model is a temporally validated prediction tool for mortality and RRT, based on variables routinely collected, that could assist decision-making regarding the treatment of incident CKD patients. External validation in other CKD populations is needed to determine its generalizability.

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The PIRP project (Prevenzione Insufficienza Renale Progressiva): how to integrate hospital and community maintenance treatment for chronic kidney disease

Cited by 12 publications

References 26 publications

Medical Costs of Patients with Type 2 Diabetes in a Single Payer System: A Classification and Regression Tree Analysis

Medical Costs of Patients with Type 2 Diabetes in a Single Payer System: A Classification and Regression Tree Analysis

What can a home hemodialysis program offer to patients in a nursing home setting? A case series and feasibility analysis

Temporal validation of the CT-PIRP prognostic model for mortality and renal replacement therapy initiation in chronic kidney disease patients

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