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Background: Lymphopaenia is commonly observed in autoimmune diseases, where it has been associated with disease activity or prognosis. However, in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) only a few small-scale studies have been targeted towards this issue. Research has not yet focused on AAV with renal involvement (AAV-RI). Thus the aim of this study was to analyse the association between lymphocyte counts and outcomes in a large cohort of AAV-RI patients., Methods: We used the Maine-Anjou AAV registry that retrospectively gathers data on consecutive patients affected by AAV in four French nephrology centres, recorded since January 2000. We analysed clinical, biological and histological data at diagnosis of AAV-RI. Risk factors for end-stage kidney disease (ESKD) were analysed. Event-free survival was also assessed., Results: Among the 145 patients included in the study, those with lymphopaenia at diagnosis had a lower renal function at baseline [estimated glomerular filtration rate (eGFR) 13 versus 26 mL/min; P = 0.002] and were more likely to require kidney replacement therapy (51% versus 25%; P = 0.003). Lymphopaenia was correlated with histological lesions and especially with the percentage of sclerotic glomeruli (P = 0.0027). ESKD-free survival was lower in lymphopaenic patients (P < 0.0001). In multivariate Cox analysis, lymphopaenia was an independent risk factor for ESKD [hazard ratio 4.47 (95% confidence interval 2.06-9.72), P < 0.001]., Conclusions: Lymphopaenia correlates with the severity of AAV glomerulonephritis at diagnosis and predicts poor renal outcome. In this view, lymphopaenia could be used as a simple and cost-effective biomarker to assess renal prognosis at AAV-RI diagnosis., (© The Author(s) 2021. Published by Oxford University Press on behalf of ERA-EDTA.)

Central venous catheterization plays an important role in patients with end-stage renal disease undergoing hemodialysis. Placement of a right subclavian hemodialysis catheter was complicated by looping and entrapment of the guidewire. Computed tomographic and three-dimensional scans were essential in locating and determining that the guidewire was outside the vessel., (Copyright © 2012 Elsevier Inc. All rights reserved.)

The Italian Registry of Dialysis and Transplantation (RIDT) was born in 1996 under the aegis of the Italian Society of Nephrology, and it is organized as a federation of regional registries. This study aimed to completely revise the epidemiological data collected during the first 5 yrs (1996-2001) of RIDT activity to evaluate the trends of the main epidemiological features. During this period, regional registries were not always able to assure complete and exhaustive information according to RIDT requirements, owing to different levels of organization and functioning. To avoid any possible error in data analysis, information inadequately assessed was refused. The incidence of end-stage renal disease (ESRD) patients on renal replacement therapy (RRT) in Italy has increased from 114 pmp in 1996 to 139 pmp in 2001, that means an increase of 3.5%/yr, corresponding to 5718 patients during 1996 and 8000 patients during 2001. Primary renal diseases (according to the EDTA) in incident ESRD patients are vascular and diabetic nephropathy. Main dialysis modality in incident patients was hemodialysis (HD) (85%), while peritoneal dialysis (PD) was only 15%; pre-emptive transplantation was a very unusual modality. The prevalence of ESRD patients at 31 December was 693 pmp in 1996 and 827 pmp in 2001; among dialysis patients, the corresponding rates were 575 pmp and 657 pmp, respectively. Consequently, the number of dialyzed patients increased, respectively, from 28892 to 37919. The prevalent dialysis modality was bicarbonate dialysis in 74% of cases, followed by hemodiafiltration (HDF) in 15%, continuous ambulatory peritoneal dialysis (CAPD) in 7% and APD in 3%. The gross mortality rate in dialyzed patients was stable during this period, at approximately 14%, the main causes of death being cardiovascular diseases and cachexia.

Background: Late referral (LR) to the nephrologist of patients with progressing chronic kidney disease (CKD) has numerous deleterious effects and is observed in many countries. The contributing factors associated with LR are controversial and poorly defined. We hypothesized that these factors might be better identified by analysing patients starting dialysis in three distinct European countries within the same area., Method: The referral and progression of kidney failure patterns were analysed with demographic, clinical and biological data in 279 non-selected consecutive patients starting dialysis in eight centres of three adjacent regions in France, Italy and Switzerland., Results: Early referral (>6 months before the start of dialysis) was seen in 200 patients (71.6%), intermediate referral (1-6 months) in 42 (15.1%) and LR (<1 month) in 37 (13.3%). However inter-centre variations were between 2 and 19% for LR and 6-50% for combined late and intermediate referral. There were no differences at the national levels, but LR was more frequent in the large city centres than in the private or regional structures, with 31 out of 169 (18.3%), two out of 55 (5.4%) and four out of 55 (7.3%), respectively, of their patients (P<0.01). By multivariate analysis, it appears that, besides the presence of an active cancer and the CKD progression rate, the centre structure and the referring physician (primary care physicians and nephrologists are less responsible for LR than other medical specialists) play a significant role in the practice of LR., Conclusions: Within a dialysis cohort spread over adjacent regions of three countries, LR has the same global distribution pattern, indicating that different health and social security systems do not play a major role in inducing or preventing this practice. The contributing factors for LR that were identified are the type of the referring physician and the structure of the dialysis unit. Both factors are potential targets for an educational and collaborative approach.

Background: Clinical and therapeutic characteristics of chronic dialysis patients vary widely at national and/or regional levels. Their increased cardiovascular (CV) mortality is not explained by traditional cardiovascular disease (CVD) risk factors only. Therefore, this study aimed to investigate and compare the characteristics of patients starting dialysis in a homogeneous Alpin region and possibly to identify new biological parameters (phenotypes or genotypes), which eould be responsible for the increased CVD seen in end-stage renal disease (ESRD) patients., Methods: A cohort of 279 non-selected consecutive patients entering a dialysis program was prospectively investigated in eight centers of three adjacent regions in France, Italy and Switzerland. In addition to the usual demographic, clinical and biological data, we analyzed at study entry the blood levels of homocysteine, lipoprotein(a) (Lp(a)) and antioxidized low density lipoprotein (LDL) antibodies, vitamin B12 status, Lp(a) and haptoglobin phenotypes, methylenetetrahydrofolate reductase (MTHFR), angiotensin-converting enzyme (ACE), allele epsilon E4 of apolipoprotein (ApoE4) and plasminogen activator inhibitor-1 (PAI-1) genetic polymorphism., Results: At entry, 90.3% of patients were hypertensive, 30% had type 2 diabetes mellitus and 17.6% were current smokers; 42% of patients had already experienced at least one CV event: peripheral artery disease (26% of the cohort), coronary artery disease (22%) or ischemic cerebro-vascular disease (16%). Forty-two patients had had > or =2 CV events or documented atherosclerotic localizations. Anemia was not optimally treated: mean hemoglobin (Hb) was at 97.7 g/L and, while overall 62% of patients received erythropoietin (EPO) prior to dialysis, large national differences were observed. Compared to the reference population, ESRD patients exhibited increased homocysteinemia, Lp(a) levels and ApoE4 allele prevalence. Conversely, the distribution of Lp(a) phenotype, MTHFR TT, ACE DD and PAI-1 4G/4G was equivalent to that of the reference population. In addition, none of the analyzed phenotypical or genotypical parameters, except for the haptoglobin 2.2 phenotype, could be associated with the existence of a previous adverse CV event., Conclusions: (1) The clinical characteristics of the ESRD patients entering dialysis in our region were comparable to the currently observed dialysis populations in most European countries with the deleterious role of advancing age, diabetes, previous CVD, smoking and hypertension evident (2). Except for anemia therapy, there were no regional or national differences observed at dialysis start. (3) An analysis of the phenotypic and genotypic CV risk factors demonstrated differences with the reference population only for hyperhomocysteinemia, Lp(a) and ApoE4 allele prevalence, with no notable differences among the participating centers.

Background: Long-term survivors are living evidence of the goals and limits of renal replacement therapy (RRT)., Methods: A cross-sectional study was performed on all cases (188 patients) with RRT follow-up >/=20 years in Piemonte, northern Italy (4 350 000 inhabitants, 22 dialysis centres). Study included revision of clinical charts and assessment of functional (Karnofsky scale, Ks) and nutritional status (subjective global assessment, SGA). According to treatment history, patients were sorted into three groups: group 1, 56 patients always on dialysis; group 2, 40 patients on dialysis with previous graft; group 3, 92 grafted patients., Results: Age differed between group 1 and groups 2 and 3 (59.5+/-11.5 vs 51.5+/-7.9 and 51.0+/-9.0 years; P=0.001). Prevalence of comorbidity was higher in groups 1 and 2 (94.6% and 95%) compared with group 3 (81.5%), reflecting selection during follow-up. Twenty-two cases (11.7%) had no comorbidity; these patients were younger (44.3+/-8.5 years) and 17 out of 22 had a functioning graft. The most common comorbidities were vasculopathy (73.4%), bone disease (72.9%) and cardiopathy (33.5%). Severe visual impairment was a common problem (18%), with a higher prevalence in patients with cardiovascular comorbidity (32%). Severe depression was found in 13.3% of cases. Despite comorbidity, functional scores (Ks) were good (higher in group 3 (88.1+/-15) than in groups 1 and 2 (67.9+/-21.9 and 75.5+/-18, respectively); P=0.000) and 64% of patients were well nourished. The combination of cardiovascular comorbidity, bone disease and visual impairment may reflect the premature ageing of RRT patients., Conclusion: Despite the high prevalence of comorbidity, long-term follow-up may promote good clinical conditions at least in some patients, highlighting the therapeutic potentials of dialysis in an era of reconsideration of open acceptance of RRT.

The rate of the clinical adoption of the so-called pre-emptive transplantation is widely different among countries. In North America it represents 25 % of the total living donor transplantations; in Norway and Sweden it is 15 % and 9 %, respectively, of all grafts performed; in Italy it is less than 1%, whilst in countries like Austria, Germany and Ireland pre-emptive transplantation is nonexistent. Some concern on this type of transplantation was raised in the Seventies and were mainly based on the evidence that uraemia has an immunosuppressive effect, which could be weaker in the pre-dialysis period. Several clinical observations in the pre- cyclosporin era supported this assumption. Starting from the Eighties, however, several studies have demonstrated that pre-emptive transplantation may yield better recipient and graft survival. Moreover, a recent retrospective study, based on higher than 8000 living donor grafts that included both treated and untreated by long-term dialysis before transplantation, showed in the pre-emptive cohort a 52 % reduction in graft losses after the first year and also a lower incidence of acute rejections. Among the advantages of pre-emptive transplantation we find better rehabilitation and especially a lower risk of job loss. The risk of poorer patient compliance, as initially pointed out, has no longer been reported and can be overcome by adequate psychological preparation of the patient. Most centres performing pre-emptive transplantation favour the use of living donor because of the general shortage of cadaver kidney vs. the increasing number of dialysed patients on the waiting list. Nevertheless, in special circumstances (national programs with short waiting lists, uremic type I diabetics, children, primary type I hyperoxaluria), some AA also recommend the use of the cadaver donor.

Background: Therapeutic compliance is fundamental on dialysis; however following a therapy requires a prior understanding of it. Aim of the study was to assess the need and interest for information on dialysis efficiency and to prepare a dedicated teaching tool., Methods: 72 patients, on hemodialysis in two limited-care satellite units, were given a questionnaire testing knowledge and interest on dialysis efficiency. In a subsequent second phase, following patients' suggestions, a cartoon book was prepared and opinions recorded., Results: 63 patients' returned the questionnaire. 79.4% had basic knowledge on routine blood tests, 30.1% were aware of their specific meaning. All patients asked for further information, preferring books to other media. The book "Kt/V as cartoon" was distributed; 71.2% read it, 93% scored it as good-very good. In the Unit employing flexible dialysis schedules, 22/42 patients increased dialysis time., Conclusions: Despite insufficient knowledge on dialysis efficiency, patient interest is high. An educational program is feasible and may also give practical results, such as self-increase in dialysis time.

Therapeutic compliance and patient education are presently considered crucial parts of end-stage renal disease (ESRD) therapy. In the center where Italian home and self-care dialysis treatment started, an education program was designed as multi-step pathway--following patients from chronic renal failure to dialysis and eventual graft--employing lessons, booklets, and books. Each step was validated in various subsets of patients. Lessons involved two hours of informal discussion on the main aspects of ESRD and renal replacement therapy (RRT); booklets were created from tape recordings of the lessons. Patient participation was good, with 28 of 33 patients on charge in the center for 6 months or more taking part in more than one lesson in 1999. In 16 of 16 patients who answered a questionnaire after two lessons, expressed opinion was "good" to "fair." All asked for further material. With regard to books, 500 copies of the book What does dialysis mean? were given out in the region; this book was validated in 22 patients on peritoneal dialysis (PD) and 18 on hemodialysis (HD). It helped patients to accept dialysis in 65% of cases and to comprehend it in 90%. Four thousand copies of the book Stories, containing 18 interviews on transplantation, were printed, and this book was validated in 21 patients on self-care and 35 on hospital dialysis (potential candidates for graft). Of 56 patients, 53 asked for further material; 19 changed their initial opinion (10 choose transplantation, despite initial skepticism; 9 put off transplantation, despite initial acceptance). On a local scale, the program led 12 of 18 new patients, who followed at least part of the program, to choose self-dialysis (PD, home, and self-care dialysis).

Background: It is not known whether smoking increases the risk of end-stage renal failure (ESRF) in patients with primary renal disease., Methods: We performed a retrospective multicenter case-control study including 582 patients from nine centers in Germany, Italy and Austria. The diseases investigated were IgA glomerulonephritis (IgA-GN) as a model of inflammatory renal disease and autosomal dominant polycystic kidney disease (ADPKD) as a model of non-inflammatory renal disease. Cases were patients who had progressed to ESRF and controls were patients who were not in ESRF, that is, whose serum-creatinine failed to progress to >3 mg/dl during the observation period and who did not require renal replacement therapy. Matching for renal disease (IgA-GN, ADPKD), gender, age at renal death and region of residence resulted in 102 individually matched pairs (IgA-GN N = 54, ADPKD N = 48). Multiple conditional logistic regression was used to estimate adjusted odds ratios for independent tobacco effects., Results: In men (matched pairs: IgA-GN N = 44, ADPKD N = 28), a significant dose-dependent increase of the risk to progress to ESRF was found (non-adjusted). The baseline risk was defined as <5 pack-years (PY): (i) 5 to 15 PY, odds ratio 3.5 (95% CI 1.3 to 9.6), P = 0.017; (ii) >15 PY = 5.8 (2.0 to 17), P = 0.001. Systolic blood pressure, ACE inhibitor treatment and age at diagnosis emerged as potential confounders. After adjustment, the risk for ESRF in men with >5 PY was highly increased for patients without ACE inhibitor treatment [10.1 (2.3 to 45), P = 0.002] but not with ACE inhibitor treatment [1.4 (0.3 to 7.1), P = 0.65]., Conclusion: Smoking increases the risk of ESRF in men with inflammatory and non-inflammatory renal disease.

The parameters used at present by the Piedmont Dialysis and Transplant Register to evaluate rehabilitation and quality of life of the dialyzed patients have been useful in the past, but they will no longer be so in the future, as the typology of the dialyzed patient is changing: the mean age is increasing, patients with high-risk conditions as vasculopathy and diabetes are widely accepted to the treatment. Thus, rehabilitation has to be evaluated not only from a social and professional viewpoint, but also as "illness situation" and "quality of life" and this can be done using the Karnofsky scale and the test of Spitzer: our Register needs to be implemented in the future by such evaluations, to go on giving us useful information about rehabilitation of the dialyzed patients.

A multicentre trial (11 nephrology centres) was carried out to test the effects of ibopamine, an orally active dopamine-like drug, on the progression of chronic renal failure. For a 2-year period 189 chronic renal failure patients (serum creatinine level 1.5-4.0 mg/dl) were observed. They were homogeneous for basic nephropathy, degree of residual renal function, blood pressure, and proteinuria. The patients were randomly divided into two groups: 96 took ibopamine at a dosage of 100 mg/day (group A) and 93 served as controls (group B). All were on a low-protein diet (mean 0.8 g/kg body weight). By the end of the observation period, the rate of decrease of the renal function indexes in time proved significantly slower (1.8 times) in group A than in group B. The survival curves for renal function (pre-established end points were creatinine level increases equal to or > 20% and equal to or > 40% of the basal values) proved significantly better (p < 0.02 and p < 0.002 respectively) in group A than in group B. The mean plasma creatinine values rose by 17% in group A and by 36% in group B. The creatinine clearance decreased by 5% in treated patients and by 14% in the controls. Statistical analysis ruled out any possible centre effect. The trial suggests that low-dosage ibopamine administration may be used as a valid and safe pharmacological adjunct for retarding the progression of renal failure in patients with mild or moderate chronic renal impairment.

Analysis of long-term dialysis results is the cornerstone of renal replacement therapy evaluation. Elderly patients may be considered a crucial cohort, since subtle differences may be enhanced in a population of lower life expectancy. The aim of the study was an analysis, from the Piedmont Registry of Dialysis and Transplantation, of the results obtained in 1981-1992 (northern Italy, about 4,400,000 inhabitants, 21 dialysis centres, open acceptance since mid-1970s) in patients aged > or = 65 years (475 patients started treatment in 1981-1985, 1026 in 1986-1992). As a first treatment, during the 12 years considered acetate haemodialysis decreased sharply; bicarbonate haemodialysis is currently the standard treatment (68%). Peritoneal dialysis is stable (21%), and haemodiafiltration is increasing (8%). Shifts between treatments are frequent: 15% of elderly patients changed treatment at least once in 1991-1992. Nephroangiosclerosis/ischaemic renal disease, undefined causes and diabetes mellitus are the major causes of end-stage renal disease; 57.3% of patients have high risk conditions in addition to age. In this cohort of patients, mean age of new cases starting dialysis significantly increased in 1986-1992 (72.7 +/- 5.4 years) versus 1981-1985 (71.3 +/- 4.5; P < 0.001). Despite this, survival at 2 years increased significantly from 54.6% in the period 1981-1985 to 59% in the period 1986-1992 (P < 0.05). Even in an ageing dialysis population, therefore, choice of an open dialysis system with easy changes among treatments allowed improvement of survival results; further technical advances may help in maintaining present trends.

Automated peritoneal dialysis (APD) is currently considered as one of the most attractive home treatments for uremic patients. However, relevant costs and the presence of a dialysis machine prevent a wider diffusion of this technique. In this work we discuss the results obtained in 42 patients (12 females, 30 males) treated by two dialysis units of the Piedmont Region. Patients' characteristics. Eighty-three percent of the females and 66.5% of the males are under 65 years of age; glomerulo-nephritis and nephroangiosclerosis account for the most frequent renal diseases (28.5 each); a high risk condition is recorded in 52.5% of cases. Twenty-two patients were transferred to APD from CAPD (patient's request in 59% of cases, clinical problems in the remaining). RESULTS. Forty-five percent of cases are working full or part-time, 12% are not caring for self. Peritonitis rate accounts for 1 episode every 42 patient-months. Biochemical control is satisfactorily achieved (mean values: urea 137.8 mg/dl, creatinine 11 mg/dl, calcium 10.2 mg/dl, phosphate 5.7 mg/dl, albumin 4.3 g/dl, cholesterol 234 mg/dl, triglycerides 195 mg/dl). Technical assistance was requested on average once every 16 months of treatment. CONCLUSION. Negative drawbacks of APD, mainly related to elevated costs and technical complexity, are fully counterbalanced by satisfactory social and clinical rehabilitation, wider indications to peritoneal dialysis with respect to CAPD, lower rates of peritonitis and limited technical needs.

In recent years, the availability of large epidemiological series allowed identification of biochemical outcome markers in the dialysis population. Interest towards albumin and cholesterol levels is motivated by their easy availability and by the presence of a strong short-term effect on mortality and morbidity. The aim of the study was an analysis of the relationship between albumin and cholesterol levels at start of dialysis and mortality (gross mortality and Kaplan Meier survival curves). Data were obtained from the Piedmont Regional Registry of Dialysis and Transplantation (Northern Italy Region, about 4,400,000 inhab, 20 Dialysis Centers, open acceptance since mid '70, yearly information on 100% of patients) in the period 1981-1990 (4734 patients on file). Only non diabetic patients with follow-up > = 1 month, who started treatment in the Region, were selected. Patients with renal function recovery were excluded. Albumin levels were dichotomized at 3.5 g/dl. Cholesterol was stratified into 3 levels (< 150, 150-250, > or = 300 mg/dl). The choice of dividing the study into 2 periods (1980-1985 vs 1986-1990) is due to the fact that 1984 has been the year of switch from acetate to bicarbonate dialysis. Prevalence of albumin and cholesterol under the normal range (22% and 15%) is low and rises with age and presence of high risk conditions. A a good correlation with the risk of death of these biochemical markers (stronger for albumin at least in the short term) was observed. No correlations are found with risk of death and elevated cholesterol levels (low number of cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Prevalence of diabetic patients on dialysis is often considered a marker of overall acceptance rate for dialysis; however, even when acceptance policy is open, incidence of diabetic patients varies widely. Epidemiological differences of diabetes incidence all over the world partly explain the discrepancies. Incidence of diabetic patients accepted for dialysis (1981 to 82: 6 p.m.p.; 1989 to 90: 11.5 p.m.p.) differs according to age and sex in the setting analyzed (Piedmont, Northern Italian region, about 4,400,000 inhabitants, 20 dialysis centers, open acceptance since the mid-70s, yearly information on 100% of patients, gathered by a Dialysis and Transplantation Registry). Patterns changed remarkably during the 10 years considered (1981 to 90). Incidence was higher in males (10.4 p.m.p. in the period 1981 to 90), with a peak at ages 60 to 69. Incidence remained relatively stable in the younger patients, but increased in the elderly, mainly in males, rising from 6.23 in 1981 to 82 to 12.88 p.m.p. in 1989 to 90 (males, all ages). In conclusion, the demographic characteristics of diabetic patients with ESRD accepted for dialysis is changing. The stability of incidence of younger patients reassures about the open acceptance policy, at least in these ages. The increase in the elderly probably reflects the longer lifespan of diabetic patients in the overall population. The possibility of a hidden preselection must be further assessed. Future provisions of dialysis needs must take into account the trend towards an increase of this high risk, elderly population.

Four thousand hemofiltrations have been performed in 22 patients with low tolerance to conventional hemodialysis (20 cases), and severe arterial hypertension (2 cases). In comparison with hemodialysis, hemofiltration had a low incidence of intradialytic collapses, vomit and cramps, and allowed a better state of well-being during interdialytic periods. In hypertensive patients hemofiltration has accomplished a better control of arterial pressure and pharmacotherapy has been reduced. In this study, we report the data concerning metabolism, electrolytes, acid-base balance during our experience utilizing bicarbonate in the replacement fluid. Our experience further supports the impression that hemofiltration may have some advantages in patients with low tolerance to conventional dialysis and/or severe dislipemia and hypertension. The possibility to reduce dialysis duration to 3 hrs, stimulates further application of this new treatment in a wider number of patients on RDT.

To evaluate the immunological state in chronic renal insufficiency, the Authors studied cellular and humoral immunity in 292 patients with chronic renal failure. They were divided into 3 groups: 1) 37 with creatinine clearance between 50 and 20 ml/min; 2) 57 with creatinine clearance between 20 and 8 ml/min; 3) 178 treated by hemodialysis. In vivo and in vitro tests, that is DNCB, PPD skin tests, spontaneous, active and EAC rosettes, surface membrane immunoglobulin test, complement (C3, C4) and serum immunoglobulins were taken as markers of the immune response. Cell-mediated immunity was found to be significantly impaired in patients with terminal renal insufficiency or on hemodialysis and also markedly reduced in patients with non-terminal renal insufficiency. Humoral immunity produced less significant results: the B lymphocyte count and serum immunoglobulins were normal; only C3 levels were found below normal range. Thus it would seem that cell-mediated immunodeficiency appears in an early stage of chronic renal failure and that hemodialysis does not improve this deficiency.

Numerical and functional markers of peripheral lymphocytes were adopted to study the influence of cimetidine on the immune response in immunocom-promized patients. Twenty-three patients on regular dialysis treatment, who had been given cimetidine (400 mg daily) for peptic ulcer, were studied during a follow-up of 3 months. Thirty healthy people served as controls for the study of the immunological parameters, i.e. DNCB and PPD skin tests, E-rosetting assays, monoclonal antibodies to T-cells, membrane immunoglobulins for the B-cells, serum immunoglobulins and complement. Before therapy was started CMI was impaired in all patients, with a significant reduction in the E-rosette count (P less than 0.01) and depressed DTH (DNCB, PPD). The number of active E-rosettes and OKT4 subsets increased slightly during the period of treatment, though this finding was not confirmed by functional in vivo tests. No change was observed in the B-lymphocyte count and in serum immunoglobulins or complement. The fact that treatment with cimetidine does not seem to influence the immune response in patients on RDT, may suggest that this therapy does not restore the principal immunopathological disorder of these patients, and further justifies its use in patients awaiting renal transplantation or in those who have been given transplant.

The Piedmont planning for the prevention and treatment of chronic uremia started in 1976, with the purpose to extending full treatment of the whole region, through the development of home and self care dialysis and intensive use of hospital short dialysis. Hospital dialysis would be reserved either for new treatments or complicated or uncooperative patients. Thank to an intensive exploitation of the existing hospital centers, a 68.7% increment in the number of treated patients was achieved and costs were kept down to a limited acceptable range. With the development of home and self care dialysis, 27% of the patients were located in out-of-hospital centers, and 17% at home. The Piedmont planning concerned itself with the patients' data collected by the Regional Registry under the following items: a) characteristics of dialysis population; b) the present modes of treatment; c) the number of patients apt to varying treatments and renal transplantation; d) the epidemiology of uremia causing nephropathies. At the present time results are only preliminary. Nevertheless, the first observations showed a long and difficult work with good possibilities of success for computerized facilities in the field of dialysis, particularly in respect to regional areas which in the reformed Health Service are now considered to be operating as autonomous.