[Epidemiology and prognosis of chronic kidney disease in Italy]. / Epidemiologia e prognosi della malattia renale cronica in Italia.

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.

[Limitations of blood pressure target in non-dialysis chronic kidney disease: a question of method?]. / Limiti del target pressorio nell'insufficienza renale cronica non-dialitica: una questione di metodo?

International guidelines recommend to reduce blood pressure (BP) levels below 130/80 mmHg in non-dialysis chronic kidney disease (CKD) patients. However, this BP target has not been validated by randomized controlled trials and is mainly driven by data obtained in observational and post-hoc analyses suggesting that it improves the renal and, to some extent, cardiovascular prognosis. The inconclusive results on the prognostic role of the BP target in patients with CKD might also relate to the limited ability of office BP readings to adequately stratify the global risk of this population. In fact, alterations of the pressure profile (such as white-coat hypertension) and nighttime hypertension are common in CKD patients. Recent studies have demonstrated that ambulatory blood pressure monitoring (ABPM) is superior to clinic BP measurements in predicting renal death and cardiovascular events. Therefore, while waiting for the results from the ongoing randomized Systolic Blood Pressure Intervention Trial (SPRINT) comparing the effect on cardiorenal prognosis of two BP target levels, the more widespread use of ABPM is desirable in CKD patients.