Peritoneal Dialysis in Italy: the 8th GPDP-SIN Census 2022 - 2nd Part: the Centers.

Objectives. The results are presented of the 8th National Census (Cs-22) of the Peritoneal Dialysis Project Group of the Italian Society of Nephrology relating to the characteristics of the Centers in Italy which used PD in 2022. Materials and methods. The 227 non-pediatric centers which used Peritoneal Dialysis (PD) in 2022 took part. The data requested were sent in aggregate form. For the first time, the resources available and training were investigated as well as home visits. The Centers have been divided into Quartiles according to the number of prevalent PD patients at 31/12/2022. Results. Centers with a smaller PD program (<9 pts) are characterized by 1. smaller overall size - 2. fewer personnel (doctors/nurses) dedicated to PD - 3. greater recourse to external personnel for training - 4. Less incremental prescription and evaluation of peritoneal permeability - 5. higher drop-out to HD in particular for choice/impossibility to continue and for adequacy/catheter-related issues. A lower peritonitis rate was recorded in Centers with a more extensive PD program (≥25 pts). Home visits are carried out regularly by a small minority of Centers. Conclusions. The analysis shows an association between size of Center PD program and available resources, PD modality and outcome.

Role of the Opinions of the Nephrologist and Structural Factors in Dialysis Modality Selection. Results of a Peritoneal Dialysis Study Group Questionnaire.

Background. The use of PD depends on economic, structural and organizational factors. The nephrologist's opinion is that peritoneal dialysis is less used than it shold be. In Italy, PD is not carried out in private Centers, but neither is it in around one third of Public Centers. The aim of this study was to investigate the opinions of nephrologists on PD in Public Centers only, thereby nullifying the influence of the economic factors. Materials and Methods. The investigation was carried out by means of an online questionnaire (Qs) via mail, and during meetings and Congresses in 2006-07. The Qs investigated the characteristics of the Centers, the nephrologists interviewed, and opinions on the various aspects of the choice of Renal Replacement Therapy Renal Replacement Therapy (RRT) (26 questions). Responses were received from 454 nephrologists in 270 public Centers. Among these, 205 centers (370 Qs) report PD (PD-YES), 36 (42 Qs) do not (PD-NO) and 29 (42 Qs) do not use it but send patients selected for PD to other Centers (PD-TRANSF). Results. The PD-NO and PD-TRANSF Centers are significantly smaller, with greater availability of beds. In the PD-YES Centers the presence of a pre-dialysis pathway, early referral and nurses dedicated solely to PD are associated with a higher use of PD. The nephrologists in the PD-NO Centers rate PD more negatively in terms of both clinical and non-clinical factors. The belief that more than 40% of patients can do either PD or HD differs among the nephrologists in the PD-YES (74.3%), PD-TRANSF (45.2%) and PD-NO (28.6%) Centers. Likewise, the belief that PD can be used as a first treatment in more than 30% of cases differs among the nephrologists in PD-YES (49.2%), PD-TRANSF (33.3%) and PD-NO (14.3%) Centers. Conclusions. The use of PD in Public Centers is conditioned by both structural and organizational factors, and by the opinions of nephrologists on the use and effectiveness of the technique.

Peritoneal Dialysis in Italy: the 8th GPDP-SIN census 2022

Objectives. The results are reported here of the 8th National Census (Cs-22) of Peritoneal Dialysis in Italy, carried out in 2022-23 by the Italian Society of Nephrology's Peritoneal Dialysis Project Group and relating to 2022. Methods. The Census was conducted in the 227 non pediatric centers which performed Peritoneal Dialysis (PD) in 2022. The results have been compared with the previous Censuses carried out since 2005. Results. Incidence: in 2022, 1350 patients (CAPD=52.1%) started on PD (1st treatment for ESRD). PD was started incrementally by 35.3% in 136 Centers. The catheter was placed exclusively by a Nephrologist in 17.0% of known cases. Prevalence: there were 4152 (CAPD=43.4%) patients on PD on 31/12/2022, with 21.1% of prevalent patients on assisted PD (family member caregiver: 86.3%). Out: in 2022 the PD drop-out rate (ep/100 pt-yrs) was: 11.7 to HD; 10.1 death, down; 7.5 Tx. The main cause of transfer to HD remains peritonitis (23.5%), although its reduction over the years is confirmed (Cs-05: 37.9%). Peritonitis/EPS: the incidence of peritonitis in 2022 was 0.176 ep/pt-yr (696 episodes). The incidence of new cases of EPS fell in 2021-22 (7 cases). Other results: the number of Centers using 3.86% for the peritoneal equilibration test (PET) (57.7%) increased. PD for heart failure continues to be used in 44 Centers (66 pts). Conclusions. Cs-22 confirms PD's good results in Italy.

Increase of continuous treatments and regional citrate anticoagulation during renal replacement therapy in the ICUs of the North-West of Italy from 2007 to 2015.

BACKGROUND: Few reports have addressed the change in renal replacement therapy (RRT) management in the Intensive care Units (ICUs) over the years in western countries. This study aims to assess the trend of dialytic practice in a 4.5-million population-based study of the northwest of Italy. METHODS: A nine-year survey covering all the RRT provided in the ICUs. Consultant nephrologists of the 26 Nephrology and Dialysis centers reported their activities in the years 2007, 2009, 2012, and 2015. RESULTS: From 2007 to 2015 the patients treated increased from 1042 to 1139, and the incidence of RRT from 254 to 263 cases/10^6 inhabitants. The workload for dialysis center was higher in the larger hub hospitals. RRT for acute kidney injury (AKI), continuation of treatment in chronically dialyzed patients, or extrarenal indications accounted for about the stable rate of 70, 25 and 5% of all RRT sessions, respectively. Continuous modality days increased from 2731 days (39.5%) in 2007 to 5076 (70.6%) in 2015, when the continuous+prolonged treatment days were 6880/7196 (95.6% of total days). As to RRT timing, in 2015 only the classical clinical criteria, and no K-DIGO stage were adopted by most Centers. As to RRT interruption, in 2015 urine volume was the first criterion. Implementation of citrate anticoagulation (RCA) for RRT patients significantly increased from 2.8% in 2007 to 30.9% in 2015, when it was applied in all 26 Centers. CONCLUSIONS: From 2007 to 2015, current practice has changed towards shared protocols, with increasing continuous modality and RCA implementation.

Peritoneal dialysis training performed remotely: results and comparison with Home Training.

OBJECTIVES: Traditional training (Home Training) in peritoneal dialysis (PD) is based on the physical presence of nurse and patient/caregiver. These "space-time" constraints can influence the training's duration, methodology and results. A remote caregiving system (Videodialysis) in our Center has proved to be effective and safe in remotely guiding patients/caregivers with cognitive/psychological barriers to self-care-PD. Since 08/01/2016, to overcome the limitations of Home Training, Videodialysis has also been used to carry out remote patients/caregivers training (Video Training). Retrospective comparison between Video Training (08/01/2016-05/31/2020) and Home Training (01/01/2014-07/31/2016). METHODS: Following initial home-visit Video Training is performed via telemedicine from the Center, whereas Home Training is carried out at the patient's home. Only first trainings for all incident PD patients/caregivers were considered. The following patients were excluded: 9 in nursing homes, 13 kept on Videodialysis due to barriers to self-care, 6 uncompleted procedures, 4 other. Total duration, home visits, exchanges/procedures, peritonitis, technique survival were compared between Home Training and Video Training. RESULTS: 46 trainings were considered (median; IQR): 21 Home Training (CAPD/APD: 11/10) in 17 patients (74.3 years (58.8-78.0; assisted PD: 64.7%) and 25 Video Training (CAPD/APD: 8/17) in 21 patients (65.9 years (56.9-76.4) N.S.; assisted PD: 52.4%). Duration (days): Home Training: CAPD 4.0 (4.0-5.5); APD 8.0 (5.3-10.5); Video Training: CAPD 4.5 (3.8-5.0) (N.S.); APD 8.0 (6.0-13.0) (N.S.). Home-visit (number): Home Training: CAPD 9.0 (7.0-10.0); APD 11.0 (7.8-15.5); Video Training: CAPD 2.0 (2.0-3.5) (p < 0.001); APD 5.0 (4.0-6.0) (p < 0.001). Peritonitis (episodes): Home Training: 5 (Follow-up: 471 pts/months); Video Training: 0 (Follow-up 280 pts/months). 2-Year technique survival. Home Training: 56.3%; Video Training: 76.9% (N.S.). CONCLUSIONS: Video Training is as effective as Home Training, while significantly reducing the number of home visits.

Peritoneal videodialysis: first Italian audit.

Conceived and developed since 2001 at the Alba Center, Videodialysis (VD) was used initially to prevent dropout in prevalent PD patients by guiding them in performing dialysis (VD-Caregiver). Subsequently, its use was extended to the clinical follow-up of critical patients (VD-Clinical), problems relating to transport to the Center (VD-Transport), and since 2016 for training/retraining all patients (VD-Training). Since 2017 other Centers have employed VD using modalities analyzed in this paper. Methods: the paper reports the findings of an Audit (February 2021) of the Centers using VD on 31-12-2020. The Centers provided the following information: the characteristics of the patients using VD; the main and secondary reasons for using VD, considering nursing home (VD-NH) patients separately; VD outcomes: duration, drop-out, peritonitis, patient/caregiver satisfaction (minimum: 1 - maximum: 10). Results: VD, which began between 09-2017 and 12-2019, has been used in 6 Centers for 54 patients at 31-12-2020 (age:71.8±12.6 years - M:53.7% - CAPD:61.1% - Assisted PD:70.3%). The most frequent reason has been VD-Training (70.4%), followed by VD-Caregiver (16.7%), VD-NH (7.4%), VD-Clinical (3.7%), and VD-Transport (1.9%), with differences between Centers. VD-Training is used most with self-care patients (93.8% - p<0.05), while with patients on Assisted PD it is associated with secondary reasons (95.7% - p<0.02). VD-Training (duration: 1-4 weeks) has always been completed successfully. No peritonitis was reported; satisfaction was 8.4±1.4. Conclusion: videodialysis is a flexible, effective, safe, and valued tool that can be employed using various modalities depending on the choice of the Center and the complexity of the patient.

[Peritoneal Dialysis in Italy: the 7th GSDP-SIN census 2019].

Objectives: Analysis of the results of the 7th National Census (Cs-19) of Peritoneal Dialysis in Italy, conducted in 2020-21 by the Peritoneal Dialysis Project Group of the Italian Society of Nephrology, for the year 2019. Materials and methods: The data was initially collected using specially designed software, which after entering the data of individual patients allows the aggregate extraction of the necessary information. The difficulties due to the COVID pandemic made it necessary to also use the traditional on-line questionnaire used previously. Of the 237 Centers envisaged, 198 responded, of which 177 with complete data for HD also in 2016. Results: Overall incidence and prevalence (31/12/2019) were respectively 1,363 (CAPD/APD = 741/622) and 3,922 (CAPD/APD = 1,857 / 2,065) patients. The percentage incidence and prevalence (177 Centers) decreased compared to 2016, respectively, from 23.8% to 22.1% and from 17.3% to 16.6%. 31.4% started PD incrementally in 60.3% of the Centers. The catheter is placed by the Nephrologist alone in 19.7%. Assisted PD is used by 24.5% of the prevalent patients, mostly (83.8%) by a family member. In 2019, the exit from PD (ep/100 years-pts: 11.6 in HD; 8.9 death; 6.0 Tx) is decreasing for all causes. The main cause of transfer to HD remains peritonitis (26.8%). The incidence of peritonitis in 2019 dropped further to 0.190 ep/year-pts as well as the incidence of new cases of EPS (0.103 ep/100 years-pts). Conclusions: The Cs-19 confirms the good results of the DP in Italy.

Videodialysis: a pilot experience of telecare for assisted peritoneal dialysis.

BACKGROUND: We report our experience with Videodialysis (VD), a new telemedicine system created in our Center to overcome physical, cognitive and psychological barriers to PD. METHODS: We analyzed the technical and clinical care results of VD in the period from 01/01/2009 to 12/31/2018. RESULTS: The VD components are: a Remote Station at the patient's home (video camera, monitor, microphone, technological connectivity box), and a Control Station in the Center (PC with high resolution monitor, webcam, speakerphone) with software that manages 6 audio-video connections simultaneously as well as the Remote Station video cameras. In 2015 a second model of VD was designed to further improve ease of transport, installation, user interface, software functionality and connectivity. VD proved to be highly reliable during 21,000 connections, and easy to use by patients/caregivers without technological skills. During the observational period, 107 patients started PD; of these 77 had barriers to PD: in 15 we overcame the barriers by VD-Assisted PD and in 62 we used other modalities of Assisted PD. During a follow-up of 285 months on VD-Assisted, 5 patients died, 3 were transferred to HD (UFF; leakage; onset of barriers insurmountable with VD), 3 to traditional Assisted PD and 4 remained on VD-Assisted PD. Peritonitis incidence in VD-Assisted PD was 1/84.2 pt/mths, not significantly different to that of the patients not using VD. Sense of confidence was the aspect most highly-appreciated by VD-Assisted PD patients. CONCLUSIONS: VD-Assisted PD is a reliable, safe system which requires no technological know-how and it is easy to use when self-care is not possible due to physical, cognitive or psychological barriers.

[Peritoneal Dialysis in Italy: the 6th GSDP-SIN census 2016].

OBJECTIVES: We report here the results of the 6th National Census (Cs-16) of Peritoneal Dialysis in Italy, carried out in 2017-18 by the Italian Society of Nephrology's Peritoneal Dialysis Study Group and relating to 2016. METHODS: The Census was conducted using an on-line questionnaire administered to the 237 non pediatric centers which did perform Peritoneal Dialysis (PD) in 2016. The results have been compared with the previous Censuses carried out since 2005. RESULTS: Incidence: In 2016, 1,595 patients (CAPD=56.1%) started on PD (1st treatment for ESRD) and 4,607 on hemodialysis (HD). PD was started incrementally by 32.5% in 144 Centers. 15.6% were late referrals, and 5.1% began within 48-72 hours of insertion. The catheter was positioned exclusively by a Nephrologist in 24.3% of cases. Prevalence: Patients on PD on 31/12/2016 were 4,607 (CAPD=46.6%), with 22.2% of prevalent patients on assisted PD (family member caregiver: 80.5%). Out: In 2016, PD dropout rate (ep/100 pt-yrs: 12.5 to HD; 11.8 death; 7.0 Tx) has not changed. The main cause of transfer to HD remains peritonitis (23.8%), although it is still decreasing (Cs-05: 37.9%). Peritonitis/EPS: The incidence of peritonitis in 2016 was 0.211 ep/pt-yr (939 episodes). The incidence of new cases of EPS in 2015-16 is diminishing too (16 cases=0.176 ep/100 pt-yrs). Other results: In 2016 the number of Centers using 3.86% for the peritoneal equilibration test (PET) (49.8%) increased, and the Centers carrying out home visits diminished (51.5%). CONCLUSIONS: Cs-16 confirms that PD in Italy is having good results.

[PD in Italy: the 5th GSDP-SIN Census 2014].

OBJECTIVES: To know PD modalities and results in Italy. METHODS: The Census was carried out by means of an on-line questionnaire in ALL the 225 non-pediatric public centers which PERFORMED PD in 2014. The results were compared with those of previous Censuses (2005:Cs-05; 2008:Cs-08; 2010:Cs-10; 2012:Cs-12). RESULTS: Incidence. In 2014 PD was begun (first treatment for ESRD) by 1,652 pts (CAPD: 57.2%) and HD by 4,442 pts (%PD-incidence= Cs-14: 27,1%; Cs-12: 23.4%; Cs-10: 23.3%; Cs-08: 22.8%; Cs-05: 24.2%). For the first time Incremental PD does not increase (Cs-14: 27,5%; Cs-12: 28,8%; Cs-10: 22,8%; Cs-08: 18,3%; Cs-05: 11,9%). Prevalence. At 31/12/2014 there were 4,480 patients on PD (CAPD: 46.9%) (%PD-prevalence= Cs-14: Cs-12: 17.1%; Cs-10: 16.6%; Cs-08: 16.7%; Cs-05:16.8%; p=NS), 24.3% of whom were on assisted PD (family members: 83.6%; paid caregivers: 11.5%; nurses: 1.1%; NH: 2.8%). Out. In 2014 there was no change in the PD drop-out rate (32.0 ep/100yrs-pt) (death: 502; transplant: 329; switch to HD: 528 pts). The main reason for transferring to HD remained peritonitis (24.8%). Choice (9.3%) and impossibility to continue PD (15.2%) are increasing. Peritonitis. The peritonitis rate (953 episodes) was 0.224 ep/yrs-pt. The incidence of new cases of EPS in 2013-14 (39 cases=0.444 ep/100yrs-pt) is decreasing (2011-12= 0.505; 2009-10= 0.529; 2004-08= 0.701 ep/100-yrs-pt). Other results. Compared to 2012, in 2014 the number of Centers using 3.86% for PET increased (41.3%) (Cs-12: 30.8%; Cs-10: 15.6%; p <0.001), while the number carrying out home visits (59.6%) remained unchanged (56.3% in 2012, 59.4% in 2010). CONCLUSION: Cs-14 confirms the extensive use, stability and good results of PD in Italy. Incremental PD and assisted PD are unchanged, peritonitis are decreased and EPS remains a rare event. PET-3.86% is increasingly used.

[Peritoneal Dialysis in Italy: the fourth GSDP-SIN census 2012].

OBJECTIVE: To know PD modalities and results in Italy. METHODS: The Census was carried out by means of an on-line questionnaire in all the 224 non-pediatric public centers which performed PD in 2012. The results were compared with those of previous Censuses. RESULTS: Incidence. In 2012 PD was begun (first treatment for ESRD) by 1,433 pts (CAPD: 54.3%) and HD by 4,700 pts (%PD-incidence= Cs-12: 23.4%; Cs-10: 23.3%; Cs-08: 22.8%; Cs-05: 24.2%; p=NS), with a further increase in incremental PD (Cs-12: 28.8%; Cs-10: 22.8%; Cs-08: 18.3%; Cs-05: 11.9%; p-0.001). Prevalence. At 31/12/12 there were 4,299 patients on PD (CAPD: 46.1%) (%PD-prevalence= Cs-12: 17.1%; Cs-10: 16.6%; Cs-08: 16.7%; Cs-05:16.8%; p=NS), 24.5% of whom were on assisted PD (family members: 82.3%; paid caregivers: 12.4%; nurses: 0.7%; NH: 3.0%). Out. In 2012 there was no change in the PD drop-out rate (30.9 ep/100yrs-pt) (death: 481; transplant: 290; switch to HD: 511 pts). The main reason for transferring to HD remained peritonitis (28.2%). Peritonitis. The peritonitis rate (1,179 episodes) was 0.284 ep/yrs-pt. EPS. The incidence of new cases of EPS in 2011-12 (43 cases=0.505 ep/100yrs-pt) remained unchanged (2009-10= 0.529; 2004-08= 0.701 ep/100-yrs-pt). Other results. Compared to 2010, in 2012 the number of Centers using 3.86% for PET increased (30.8% vs 15.6%-p-0.001), while the number carrying out home visits remained unchanged (56.3 vs 59.4%). CONCLUSIONS: Cs-12 confirms the extensive use, stability and good results of PD in Italy. Incremental PD is on the increase. EPS remains a rare event.

Incremental start to PD as experienced in Italy: results of censuses carried out from 2005 to 2014.

BACKGROUND: It is not known how widely used in Italy an incremental start to in peritoneal dialysis (Incr-PD) is. METHODS: By analyzing the peritoneal dialysis (PD) censuses conducted by the PD Study Group (GSDP-SIN) for the years 2005, 2008, 2010, 2012 and 2014 in all the Centers performing PD in Italy, the use of Incr-PD, i.e. continuous ambulatory peritoneal dialysis (CAPD) with 1 or 2 exchanges/day or automated peritoneal dialysis (APD) with 3-4 sessions/week, was examined among incident PD patients. RESULTS: In 2014 PD was started in Italy by 1,652 patients, 455 (27.5%) of whom incrementally (Incr-CAPD 82.2% vs. Incr-APD 17.8%). Incr-PD was used in 53.5% of the 225 Centers. The number of patients and of Centers using Incr-DP increased constantly over the years up to 2012 (in 2005 Incr-PD was used in 33.4% of Centers, and in 11.9% of patients). The use of Incr-PD was greater in Centers with a more extensive PD program and greater use of PD in general. The most widely-used modality in Incr-PD was CAPD. CONCLUSIONS: Incr-PD is used in Italy in a large number of incident PD patients. The reasons for this increase need to be clarified, as current adequacy targets are based on full-dose studies with a very low glomerular filtration rate (GFR).

[Census of the renal and dialysis units by Italian Society of Nephrology: nephrologist's workload for renal patient assistance in Italy (2014-2015)]. / Censimento a cura della Società Italiana di Nefrologia delle strutture nefrologiche e della loro attività in Italia nel 2014-2015: il lavoro del nefrologo.

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.

[Census of the renal and dialysis units by Italian Society of Nephrology: structure and organization for renal patient assistance in Italy (2014-2015)]. / Censimento a cura della Società Italiana di Nefrologia delle strutture nefrologiche e delle loro attività in Italia nel 2014-2015: l'organizzazione.

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.

Peritoneal ultrafiltration in congestive heart failure-findings reported from its application in clinical practice: a systematic review.

INTRODUCTION: Peritoneal ultrafiltration (PUF) is proposed in the long-term treatment of congestive heart insufficiency. However, the data in literature available at present do not allow for conclusive meta-analysis. OBJECTIVE/MATERIALS AND METHODS: A systematic review of the literature (MEDLINE-EMBASE, 01/01/2003-31/12/2013, studies with ≥4 patients, adults, non-ESRD) to highlight which patients PUF has been used in, how and with what results. RESULTS: Consideration was given to 14 papers for a total of 471 patients. (1) Characteristics of the patients. Average age 71.6 years; diabetes mellitus (DM) 47%; New York Heart Association (NYHA) class III 38.9%-class IV 59.8%; ischemic cardiopathy 67.8%; mean LVEF 35%. (2) PUF modality. Only continuous ambulatory peritoneal dialysis (CAPD) in ten studies, only APD in two studies, both in two studies. Overall CAPD was used in 56.2% of the pts. A single exchange of icodextrin was used to treat 51% of patients on CAPD. The volume of ultrafiltration obtained varied between 390 and 1,180 ml/die. (3) Effects of PUF. Significant improvement in NYHA class and reduction in hospitalizations. Survival at 12 months varying between 47 and 95%. Mortality seems to be associated with DM, higher basal glomerular filtration rate, less change in ejection fraction after PUF and less use of ICOs. LIMITATION: The main limitation of the selected studies, mostly retrospective and with a limited number of patients, remains the lack of clarity and uniformity of the selection criteria used. For this reason extrapolations about survival require extreme caution and are not currently possible. CONCLUSIONS: PUF improves symptomatology and reduces hospitalizations.

[Trend in PD in non-pediatric public centers in Italy: results of the 2010 GSDP-SIN census and comparison with the 2008 and 2005 censuses]. / Andamento della DP in Italia nei centri pubblici non pediatrici: Risultati del censimento GSDP-SIN 2010 e confronto con i censimenti 2008 e 2005.

The 2010 Italian Society of Nephrology Peritoneal Dialysis Study Group (GSPD-SIN) census (Cs-10) involved the 224 Centers performing PD in Italy. PD was used as 1st treatment in 23.3% (1429/4695) of pts (Cs-08:22.8%; Cs-05:24.2%), with 53.4% of them using CAPD. The use of incremental CAPD increased in Cs-10 (Cs-10:35.3%; Cs-08:25.7%; Cs-05:13.6%; p<0.0001). The number of prevalent pts was 4,222 (Cs-10:16.6%; Cs-08:16.6%; Cs-05:16.8%; p=NS), 45.7% of whom were on CAPD; 24.4% (Cs-08:21.8%; p<0.05) required assistance (family member:80.6%; caregiver:12.6%; nurse: 3.0%; RSA:3.4%). In Cs-10 the PD out rate (1,354 pts, of whom ep/100pt-yrs for drop-out: 12.4; death: 12.9; Tx: 7.5) was not different to previous years. The peritonitis rate was 0.30 ep/yr/pt, 18.5% of which with negative culture. There were 44 episodes of EPS in the period 2009-10 (0.53 ep/100yrs); while in the previous 5-year period there were 146 (0.70 ep/100pt-yrs). PET is performed by 98% of the centers, mostly using 2.27% (70.5%). Home visits are carried out by 59.1% of the centers. If regular (8.9% of the centers), they are associated with fewer ep/mth of peritonitis (61.2 vs 38.8) and lower drop-out (8.6 vs 12.8 ep/100 pt/yr - p<0.05) Cs-10 confirms the good results PD is having in the Centers that use it. Incremental CAPD and assisted PD are increasing. EPS remains a rare event. Standard PET is the most frequently-used evaluation of the peritoneal membrane. Though home visits are associated with lower peritonitis and drop-out rates, they are carried out regularly by a minority of the Centers.

[Incremental peritoneal dialysis - conclusions]. / La DP incrementale - conclusioni.

Peritoneal dialysis (PD) adequacy, defined as the sum of renal clearance and peritoneal clearance with a minimum Kt/V target of 1.70, can be achieved with incremental dialysis (Incr-PD), which should therefore not be confused with early dialysis. The Peritoneal Dialysis Study Group census data show that the use of Incr-PD is widespread in Italy and has increased over the years. In 2010 Incr-PD was used in 50% of the centers performing peritoneal dialysis (PD), against 38.5% in 2008 and 29.2% in 2005. The use of PD is also significantly higher in these centers than in those not using Incr-PD (27.5% vs 21.4%; p<0.001). Despite the widespread use of Incr-PD, there is no evidence in the literature showing significantly different clinical results between starting PD incrementally or on full-dose. However, some data suggest a benefit of Incr-PD in that it favors the choice of PD and is associated with a better quality of life. This method allows for the dialysis adequacy and ultrafiltration targets indicated by the current guidelines to be achieved easily without the risk of underdialysis. In view of the frequent errors in the collection of diuresis and of the progressive reduction over time of residual renal function (RRF), frequent RRF monitoring is necessary so that the dialysis dose can be adjusted. Furthermore, dialysis adequacy should always be measured by collection of the dialysate.