[Epidemiology and prognosis of chronic kidney disease in Italy]

Because chronic kidney disease (CKD) is a major public health issue, it is important to make the available epidemiological data widely known for a proper understanding of its social impact, and to identify risk factors that can influence the prognosis of the disease. The data from the CARHES study show in the general population of Italy a prevalence of CKD (stage 1-5) of 8%, less than in other countries, a higher prevalence of proteinuria at early stages (1-2), and a cardiovascular risk profile in CKD patients characterized by metabolic syndrome. The prognosis of CKD is an essential element in clinical practice as it allows to better define the severity of the disease and to determine the most appropriate therapeutic approach. The data from the TABLE study, performed in nephrology care, show that ESRD was more frequent than death before dialysis but not in stage 3; we note that advanced age reduces the progression of renal failure and that the most important among the modifiable risk factors is proteinuria, which has a negative predictive role in stage 3-4 but not stage 5 and which interacts specifically with advanced age. No predictive role was found for hypertension, but this is only apparently surprising; in fact, there is growing evidence of the superior effectiveness of ambulatory blood pressure measurement (ABPM) over office blood pressure measurement. These data, together with the results of some trials, show the need for the more extensive use of ABPM to identify subjects with white-coat hypertension and to better control the circadian blood pressure profile by administering antihypertensive drugs also in the evening.