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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.

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.

The periodic study of Quality of Life ( QoL) in chronic uremic patients on hemodialysis, is a tool aimed to adapt the approach to the patient, according to the evolving needs. The study sample consisted of 35 subjects (M 65.7% and 34.2 % F), aged 18-84 years (57+16,3) and with an average dialytic age of 6.5 years (+5.3). The tool used was the Multidimensional Inventory for Patient on Hemodialysis (IPPE) which provides a survey for the patients consisting of 24 items to evaluate their degree of agreement/disagreement on a 4-point Lickert scale (false, partially false, partially true, true). The analysis showed that: with respect to the family relationships, criticality was 12.6 %, about the relationship with their body it was 15,8 %, regarding the need to drink it was 22.2%, about the daily life 20.6% and about the perception of their disease it was 7.9 %. Compared to the Index of Global Psychophysical Distress (IPPE), in the sample considered the 67,6% of the patients did not present any problem, the 32.3 % presented a quite critical discomfort and nobody presented any acute critical discomfort. Statistical analysis showed a significant inverse correlation between the IPPE and dialysis age (r = - 0.473, p = 0.005). Although this is a preliminary result of an in-depth understanding of the underlying processes, it may help to identify the factors that, over time, contribute to the patient adaptation to the dialysis treatment, in order to facilitate this process in people who start hemodialysis.

Vascular access (AV) dysfunction is a major cause of morbidity and hospitalisation in hemodialysis population. Despite of guidelines statements which consider native arteriovenous fistula (nAVF) the gold standard, epidemiological studies still show a decline in their prevalence with an increase of central venous catheters (CVC). In this study we compared the activity of two Dialysis Units both characterized by a high prevalence (> 90%) of nAVF, in order to highlight the possible reasons. No collaboration existed between the two centres until the decision to design this work. The "policy" on creation and management of vascular access and organizational models of the two centres were assessed, in particular focusing on surgeons, presence of dedicated nephrologists, preoperatory ultrasound evaluation, follow-up and diagnosis of complications, resort to interventional radiology, complications management, in particular the timing of intervention after AVF thrombosis. Of the two dialysis populations were analysed: age, time on dialysis, coexistence of diabetes and the prevalence of various types of vascular access to 31 December 2007. It was evaluated the AV incidence in the last 4 years. The statistical analysis was performed by T student and Chi square tests. There were no substantial differences in the organizational models of the two centres, which had both a routine ECD use in preoperatory mapping and in monitoring of complications; in case of thrombosis both centres performed surgery within 12-24 hours; in case of stenosis both centres performed the correction, surgical or by angioplasty, within 15 days from the diagnosis. Another common element was the presence of a multidisciplinary team with a interventionist nephrologist, a vascular surgeon and a vascular interventional radiologist, where nephrologist has the coordination role. The data analysis showed a prevalence of nAVF in the two centres of 92.5% and 96.1%, Pescara and Lecce respectively, with a prevalence of forearm nAVF of more than 80% and 90% respectively. The analysis of incident interventions showed high percentage of forearm AVF in case of revisions for complications (stenosis, thrombosis), and a little recourse to proximal AVF and graft.

According to the main guidelines, dialysis adequacy monitoring is fundamental in the management of patients on peritoneal dialysis. In order to avoid mistakes in the calculation of the peritoneal urea and creatinine clearance in patients on dialysis with intermittent techniques, the collection of blood samples about 6 hours after the end of the dialysis session is advised. In fact, because the creatinine and urea values at the end of dialysis (the morning values in NIPD) are the lowest, the resulting clearances could be overestimated. The mean values between the start and the end of the dialysis session are considered the gold standard. However, collecting a blood sample at 2.00 p.m. may be difficult and uncomfortable both for the nurse and the patient. In this paper we present two formulas (the first for urea and the second for creatinine) which, starting from the values at the end of dialysis, predict the values at the beginning of the session and consequently the mean values. The aim of this study was to validate the formulas by evaluating their capability to predict the mean urea and creatinine values when only end-of-dialysis blood sampling was performed. Statistical analysis was carried out using the Bland-Altman test. The two formulas proved able to predict the mean urea and creatinine values; the differences between the measured and calculated values were not statistically significant.