Chronic kidney disease for 4 mln in Italy: the importance of ensuring an adequate diet for all
Ensuring the same distribution models and uniform reimbursement criteria throughout the country: these are the demands of patients who represent as much as 7% of the adult population in the country and risk dialysis or transplantation
by Leonardo Loche *, Roberto Costanzi **
It is time to promote equitable and uniform access, throughout the country, to hypoprotein dietary-nutritional therapy (Tdn), recognising its fundamental role in the prevention and conservative treatment of chronic kidney disease (CKD).
L’identikit
Mrc refers to a condition characterised by a progressive and permanent impairment of kidney function. It can be caused by primary kidney disease or by other systemic diseases that also impair kidney function. Mrc represents an independent cardiovascular (cv) risk factor and is frequently associated with other cv risk factors that may, in turn, contribute to the onset of the disease. In the end stage, the only possible treatments are dialysis or renal transplantation.
The numbers
In Italy, Mrc affects around 7% of the adult population, i.e. more than 4 million people, with a slight prevalence in men compared to women. Due to the disease, about 8,000 patients begin renal function replacement therapy (dialysis or transplantation) each year, while about 19,400 follow a hypoproteic diet, to be understood as a true therapy, often integrated with pharmacological treatment, which produces the effect of delaying entry into dialysis, reducing the symptoms of renal failure and maintaining an adequate nutritional status. Specifically, Dietary-Nutritional Therapy (DNT) is mainly based on reducing protein intake, but also provides for adequate caloric intake, controlling sodium and potassium intake, as well as limiting phosphorous intake; it also encourages the consumption of plant-based foods to ensure better control of phosphorous metabolism and acid-base balance.
Aprotein products 'not for everyone'
However, although the high clinical value of Tdn is now established, access to this treatment is still not equally guaranteed throughout the country, due to the different distribution and reimbursement models applied by the individual regions:
- logistical difficulties in supplying aproteic products, available in some regions at distribution centres and hospital facilities, and in other regions in pharmacies - other than community pharmacies - which are sometimes difficult to reach, especially for the most fragile;
