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. 2024 Aug 5:16:547-555.
doi: 10.2147/CEOR.S470728. eCollection 2024.

Clinical and Economic Impact of Early Diagnosis of Chronic Kidney Disease in General Practice: The Endorse Study

Francesco Pesce  1 , Giacomo Matteo Bruno  2 , Giorgio Lorenzo Colombo  2 , Sergio Di Matteo  3 , Anna Rita Maurizi  4 , Valentina Mongelli  4 , Silvia Mele  5 , Lavinia Narici  5 , Stefano Bianchi  6 , Mario Bonomini  7 , Giuseppe Castellano  8 , Luca De Nicola  9 , Giovanni Gambaro  10 , Giuseppe Grandaliano  11 , Gaetano La Manna  12 , Antonello Pani  13 , Andrea Ranghino  14 , Loreto Gesualdo  15
Affiliations

Clinical and Economic Impact of Early Diagnosis of Chronic Kidney Disease in General Practice: The Endorse Study

Francesco Pesce et al. Clinicoecon Outcomes Res. .

Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Discussion: 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.

Conclusion: 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.

Keywords: awareness; chronic kidney disease; eGFR; early diagnosis; economic impact; general practice; training intervention; uACR.

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Conflict of interest statement

FP received fees from AstraZeneca and GSK for lectures. LDN received fees from AstraZeneca, Astellas, Bayer and NovoNordisk for lectures and scientific consultations. GG received fees from AstraZeneca, Astellas, Alexion, GSK, Boehringer, Novartis and Bayer for lectures and scientific consultation. MB received fees from Astellas, AstraZeneca, GSK, Nipro and Travere Therapeutics for lectures and scientific consultations. GLM received payment or honoraria for lectures, presentation, speakers bureaus, eduational events - Support for attending meetings or and/or travel from Astellas, Hansa Biopharma, Travere, Vifor, Eli-Lily, GlaxoSmithKline, Alexion, Braun, and Boehringer Ingelheim. LG received research grants from Abionyx, Sanofi; consultancy fees from Baxter, Travere, AstraZeneca, GSK, Novartis, Chinook, Roche, Reata, Nestle, Otsuka, Gilead Science, Bayer, Vifor Fresenius; speaker fees from Bayer and Werfen. The authors report no other conflicts of interest in this work.

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