OBJECTIVES: Chronic kidney disease (CKD) represents a major public health concern with a great economic burden. The aim of the study is to estimate the mean annual social cost of a patient with CKD by stage (IV and V pre-dialyses) and cost component in Italy. METHODS: The cross sectional study included all adult outpatients that were in charge of the 14 main Hospital Centers in the Tuscany Region during 7 week. Direct medical costs have been estimated using tariff for laboratory test, diagnostic exams, visits and hospitalization and price for drugs. Non medical costs included the cost of diet, patients and caregivers travel expenses, formal and informal care. The loss of productivity of patients and caregivers have been estimated as indirect costs using the human capital approach. Costs are expressed as mean (± standard deviation) in Euro 2012. RESULTS: