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Background: Given the public health challenge and burden of chronic kidney disease, the Italian Society of Nephrology (SIN) promoted acensusof the renal and dialysis units to analyse structural and human resources, organizational aspects, activities and workload referring to theyear 2014., Methods: An online questionnaire, including 64 items exploring structural and human resources, organization aspects, activities and epidemiological data referred to 2014, was sent to chiefs of any renal or dialysis unit., Results: Renal and dialysis activity was performed by over 2718 physicians (45 pmp). The management of the acute renal failure was one of the most frequent activities in the public renal units (12,206 patients in ICU and 140.00 dialysis sessions). There were performed about 9000 AV fistulas and 1700 central vascular catheters insertions. In the census, there are a lot of data regarding organization, workforce and workload of the renal unit in Italy. The benchmark data derived from this census show interesting comparisons between centres, regions and groups of regions. These data realised the clinical management of renal disease in Italy.

Background: Given the public health challenge and burden of chronic kidney disease, the Italian Society of Nephrology (SIN) promoted a census of the renal and dialysis units to analyse structural and human resources, organizational aspects, activities and workload referring to the year 2014., Methods: An online questionnaire, including 64 items exploring structural and human resources, organization aspects, activities and epidemiological data referred to 2014, was sent to chiefs of any renal or dialysis unit., Results: 615 renal units were identified. From these 615 units, 332 were public renal centres (of which 318 centres answered to the census) and 283 were private dialysis centres (of which 113 centres answered to the census). The results show 6 public renal units pmp. Renal biopsies were 4624 (81 pmp). The nephrology beds are about 41 pmp. There are 7.304 nurses working in HD wards, 1.692 in the nephrology wards and only 613 for outpatients clinics. The benchmark data derived from this census show interesting comparisons between centres, regions and groups of regions. These data realised the clinical management of renal disease in Italy.

In this article, the Italian Society of Nephrology discusses the risks for the Medical Specialty in Nephrology and the possible lack of job opportunities by young nephrologists, that arises from the actions taken in the last years by National and Regional Italian Governments. The article reports the main legislative rules required to access the work system both in public and private hospital. Finally, we examined the different criteria and the standards requested for Regional Accreditation by Italian National Health System, and to obtain reimbursement by private and public providers. These requirements might be useful to guarantee both the specificity of nephrology specialty in the assistance to patients affected by kidney diseases, and a stable and qualified job for young nephrologists.

Contrast-enhanced ultrasound (CEUS) is one of the most interesting and promising clinical applications of imaging and ultrasound. Thanks to the absence of ionizing radiation, the lack of nephrotoxicity and low cost it has the potential to become a reference in imaging of the kidney. This review, besides providing a brief description of the proper methodology, presents possible applications of CEUS in nephrology and urology, including renal ischemia, the differential diagnosis of cystic and solid lesions, follow-up of ablative therapies, kidney trauma, kidney transplant, inflammatory diseases, ischemic nephropathy and vesicoureteral reflux.

Convective therapies can be a good additional option in extracorporeal renal replacement therapy, but so far the clinical evidence in their favor is rather scarce. In this review the results of the most important studies are discussed, grouped by main outcomes: intradialytic cardiovascular stability, beta2-microglobulin, mortality, calcium-phosphorus metabolism, and possible effect on anemia. In general, the use of convective therapies for reimbursement reasons but without any clear clinical benefit is not justified. The fractional division of convective therapies into various subtypes and the use of different levels of convection among centers make their widespread clinical implementation unlikely in the near future. No firm conclusions can be drawn right now and more controlled clinical trials on convective therapies will be needed to clarify their role in renal replacement therapy.

Therapeutic plasma exchange is an extracorporeal plasmapheresis method for removing high-molecular-weight pathogens and toxins from the circulation. It can be indicated in many clinical conditions, both kidney-related and non-kidney-related. This review focuses on clinical trials related to Goodpasture syndrome, thrombotic thrombocytopenic purpura, and acute renal insufficiency due to multiple myeloma. It also discusses the difficulties and opportunities associated with the development of a randomized controlled multicenter study and of a web-based database. Finally, we report a summary of the risks and complications of therapeutic plasma exchange and how we can update the information on their frequency and seriousness by means of a longitudinal prospective multicenter study open to all centers performing the procedure.

The main purpose of statistics in the analysis of clinical and epidemiological studies is to summarize data and information, as well as assess variability, trying to distinguish between chance findings and results that may be replicated upon repetition. Statistical analyses only convey the effect of chance element in data (random error). Statistics cannot control non-sampling errors concerning study design, conduct and methods adopted. At the end of the study, a result is defined statistically significant if the observed difference in the outcome variable is too large to be attributed to chance. A small P value provides evidence against the null hypothesis (of no effect), since data have been observed that would be unlikely if the null hypothesis was true. However, confidence intervals estimate separate the two data dimensions (strength of the relation between exposure and disease, and precision with which the relation is measured), and add to the hypothesis testing useful information for finding interpretation and further research.

The critical appraisal process of available evidence includes the evaluation of clinical importance of the study findings. This should coincide with the minimum worthwhile effect expected by the investigators in the study design and planning. In hard outcome studies it can be quantified by the absolute risk difference between groups and its reciprocal, known as number needed to treat to avoid one adverse event, or benefit (NNTB). The number needed to treat to produce harmful consequences of treatment (NNTH) should also be taken into account. Finally these effect measures, like risks and incidence proportions, are usually rough estimates of the true effects, due to non-complete follow-up of the observations under study. Underlying assumptions and design issues are especially important to assess the clinical relevance of any results.

Background: Every week, approximately 400 liters of water used for dialysate production come into direct contact, through the semi-permeable membrane of the dialyzer, with the dialysis patient's blood stream. Therefore, submitting municipal water to an adequate depuration process before its use for dialysis becomes necessary., Methods: Problems related to the implementation, updating and management of a dialysis water treatment system are analyzed. The results of the most recent multicenter studies on dialysis fluids quality are also reviewed., Results: The best approach to plan, implement and manage a dialysis water treatment system, first, consists of defining the standards of chemical and microbiological water quality. The most diffused and commonly accepted standards are those recommended by the Association for Advancement of Medical Instrumentation (AAMI) and the European Pharmacopea (EP), which allow a maximum bacterial growth of, respectively, 200 CFU/ml and 100 CFU/mL and a maximum endotoxin concentration of 2 IU/mL and 0.25 IU/mL. A modern dialysis water treatment system provides a final purification process, mainly by reverse osmosis (RO), together with different pre-treatment levels and a hydraulic distribution circuit. Therefore, as RO produces water of optimal chemical and microbial quality, all efforts in the dialysis unit must be aimed at keeping this quality as constant as possible over time, by carrying out effective maintenance strategies and system disinfection. Nevertheless, several multicenter studies reported that 7-35% of water samples exceed a bacterial growth of 200 CFU/mL and that 44% of them display endotoxin concentrations >5 IU/mL., Conclusions: The results of multicenter studies indicate that the microbial quality of dialysis fluids is, unfortunately, still an often neglected problem. Evidence of a possible relationship between dialysis fluid contamination and patient morbidity, as well as the availability of systems and machines allowing purity levels that were unimaginable only a few years ago, must be a stimulus for modifying clinical practices and starting the improvement processes aimed at maximally reducing the risk of microbial contamination in the dialysis water, as already done with chemical contamination.