Advance Access publication xx xx xxxx Original Article

Background. Recent studies have indicated that the imple-mentation of international guidelines for the management of renal patients is suboptimal in Italy. The Italian Society of Nephrology (SIN) decided to undertake a multicentre study to obtain a clear picture of clinical policies on chronic kidney disease (CKD) in Italy. Methods. A 76-item structured questionnaire, designed to evaluate the organization of clinical care, was administered to the director of each participating centre, within the con-text of a large observational trial in 100 Italian nephrology centres, collecting information on newly diagnosed CKD patients (K/DOQI stage 3–5) on conservative treatment. This paper reports the questionnaire results related to man-agement of anaemia and bone metabolism disorders; as-sessment of renal function; creation of a vascular access for dialysis and referral of patients to a nephrologist. Results. Clinical policies at the centre level deviated from guideline recommendations in 70 % (timing of vascular ac-cess creation) to 25 % (assessment of iron deficiency) of centres. Assessment of renal function differed from the recommended approach in 30 % of centres; clinical policies related to anaemia and bone disease did not coincide with guideline standards in 50 and 40 % of centres, respectively. Directors of renal unit estimates indicate that the creation of a vascular access occurs very late in 38 % of patients and that referral to a nephrologist is late in ∼40 % of cases. Conclusion. This survey in Italy highlights important devi-ations of clinical policies at the centre level from guideline recommendations