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The use of administrative health data was approved by the Ethics Committee of Bocconi University, and all necessary safeguards were in place to ensure patient confidentiality and data security. Given the retrospective nature of the study and the use of deidentified data, informed consent was waived by the ethics committee for the following reasons. Current regulations governing ethics committees in Italy require standard written informed consent at the time of hospitalization for the Ministry of Health to collect anonymized data for the National Hospital Discharge Database. The Italian Ministry of Health allows for the analysis and publication of aggregate results from this anonymized data. Our retrospective, observational study used anonymized data and included only aggregate results, in compliance with the Italian norms covering the use of this secondary data, and therefore we were not required to collect informed consent. We submitted a request for evaluation of the process and the study to the Bocconi University Ethics Committee, providing details regarding the request for the data, the norms governing the use of this type of administrative data for research purposes, and the global informed consent collected at the time of hospitalization, as well as the details regarding the study, provisions taken for data protection and use, and the resulting manuscript draft. The following assessment of the request was received: \u201cOn the 18th of March, 2025, the Ethics Committee of Bocconi University reviewed your research project, whose data have been previously collected (secondary data), and concluded that, according to our rules, the project does not have critical features that would require ethical clearance.\u201d Supporting documents are available upon request.","order":1,"name":"Ethics","label":"Ethics Committee Approval and Consent to Participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Marco Soro is an employee of CSL Vifor, Global Value, Access, and Policy, Rome, Italy. The other authors declare no conflicts of interest relevant to this manuscript beyond the study funding disclosed above.","order":2,"name":"Ethics","label":"Conflicts of Interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"HB: conceptualization, investigation, writing\u2014original draft, methodology, writing\u2014review and editing, and data curation, validation, and analysis. GF: conceptualization, investigation, methodology, validation, and writing\u2014review and editing. CJ: conceptualization, investigation, methodology, validation, and writing\u2014review and editing. MS: funding acquisition and scientific discussions regarding context. FA: conceptualization, investigation, methodology, validation, and writing\u2014review and editing. LQ: conceptualization, investigation, methodology, validation, and writing\u2014review and editing. All authors have read and approved the final version.","order":3,"name":"Ethics","label":"Author Contributions","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Data were obtained from the National Hospital Discharges Database of the Italian Health Ministry, Planning Department. Data are not publicly available but may be requested from the Italian Ministry of Health.","order":4,"name":"Ethics","label":"Data Availability","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Upon request, all statistical code may be made available.","order":5,"name":"Ethics","label":"Code Availability","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":6,"name":"Ethics","label":"Consent for Publication","group":{"name":"EthicsHeading","label":"Declarations"}}]}}