Treatment Optimization and Standard of Care Adherence in CKD Primary Care: the TOSCA-CKD project

Background. Effective collaboration between general practitioners (GPs) and nephrologists is crucial for optimizing the management of chronic kidney disease (CKD). The TOSCA-CKD project (Treatment Optimization and Standard of Care Adherence in CKD Primary Care) aimed to evaluate the implementation of guidelines and the use of nephroprotective therapies in primary care. Methods. Clinical data were collected from the medical records of GPs across 12 Italian regions. The data were analyzed at baseline (T0) and after 6 months (T6) of collaboration with nephrologists. During this observational period, GPs were involved in remote education programs, which included expert-led webinars and clinical case-based learning. Results. A total of 76 GPs and 9 nephrologists were involved in the study, evaluating a cohort of 124,759 patients. There was an increase of 23.3% in the uACR test from T0 to T6 (3.0% vs. 3.7%; p < 0.001). Similarly, there was an increase of 15.2% in the use of eGFR from T0 to T6 (29.7% vs. 34.2%; p < 0.001). The rate of CKD diagnosis increased by 17.5% among patients with eGFR < 60 mL/min/1.73 m² (from 4% to 4.7%) and by 40% among patients with ACR > 30 mg/g (from 0.5% to 0.7%). The use of ACEi/ARBs remained stable at approximately 50%, while the treatment with SGLT2i, the new standard of care according to the current CKD guidelines, increased by 29.8% (from 4.7% to 6.1%). Conclusions. The TOSCA-CKD project demonstrated that GPs' remote educational program and a structured co-management approach significantly enhanced the early identification and improved the management of CKD in primary care.