Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia最新文献

{"title":"Cost Analysis for Home and Home-Assisted Renal Replacement Therapy Compared to In-Centre Hemodialysis.","authors":"Lorenzo Aterini, Gian Marco Caselli, Costanza Gaudio, Sonia Salvestrini, Gianna Bucci, Paola Becherelli, Elio Di Marcantonio, Laura Fortunato, Filippo Maria Fani, Chiara Merciai, Giuseppina Rosso, Nicoletta Scopetani, Emanuele D'Arpino, Franca Agrippino, Sandro Signorini, Alberto Rosati","doi":"10.69097/43-03-2026-05","DOIUrl":"https://doi.org/10.69097/43-03-2026-05","url":null,"abstract":"<p><p><b>Introduction.</b> Chronic kidney disease (CKD) is a prevalent condition which may require dialysis; the most common form of this is facility-based haemodialysis. This study aims to provide cost estimates for in-centre haemodialysis/haemodiafiltration compared with home-based peritoneal dialysis and haemodialysis, with or without healthcare staff assistance. <b>Methods.</b> A cost analysis was conducted at the Nephrology and Dialysis Units of San Giovanni di Dio Hospital (Florence, Italy) for the following procedures: high- and low-flux bicarbonate HD (39.95.4), HDF (39.95.7), APD (54.98.1), CAPD (54.98.2), and daily home HD for at least 12 hours/week (39.95.O). Costs were calculated on a monthly basis and included direct medical costs, indirect costs, healthcare personnel costs, and patient transportation costs. <b>Results.</b> In-centre bicarbonate hemodialysis and hemodiafiltration showed a monthly cost of €4672 and €4766, respectively. CAPD and APD monthly costs were €1613 and €2080 without, and €4454 and €3774, respectively, with healthcare assistance. Home hemodialysis monthly costs were €2225 and €4049 in case of healthcare assistance. <b>Discussion.</b> Home-based dialysis modalities, including assisted treatments, demonstrated overall cost competitiveness compared with in-centre hemodialysis. These findings support the potential economic sustainability of expanding home dialysis programs within the healthcare system.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Only By Uniting Mind and Hand Can We Shape the World: The Challenge of Interventional Nephrology].","authors":"Luca Nardelli","doi":"10.69097/43-03-2026-06","DOIUrl":"https://doi.org/10.69097/43-03-2026-06","url":null,"abstract":"<p><p>Interventional nephrology has progressively emerged as a discipline aimed at integrating clinical management with procedural expertise in the care of patients with kidney disease. Since the 1980s, particularly in the United States, nephrologists began reclaiming diagnostic and therapeutic procedures that were historically conceived within the field of nephrology but had gradually been delegated to other specialties. Early experiences demonstrated that nephrologists could perform procedures such as vascular access creation and maintenance, central venous catheter placement, renal biopsy, and peritoneal dialysis catheter insertion with high success rates, low complication rates, and high patient satisfaction. Italy has historically played a pioneering role in this field. Early national surveys and international studies, including the Dialysis Outcomes and Practice Patterns Study 1, documented exceptionally high rates of native arteriovenous fistulas (AVFs) and very low use of central venous catheters (CVCs), largely attributable to the direct involvement of nephrologists in vascular access planning and creation. However, more recent data reveal a gradual shift in practice. Over the past two decades, the prevalence of AVFs has declined while the use of CVCs has increased, accompanied by a progressive transfer of procedural responsibilities to other specialists. A similar trend has been observed in the management of peritoneal dialysis access, where nephrologists have become less frequently involved in catheter placement. Despite these changes, Italy still retains significant technical and cultural expertise in interventional nephrology. Strengthening this field may require coordinated educational and organizational strategies, including the establishment of structured training programs, certification pathways, and dedicated procedural centers. The creation of a national \"Academy\" for interventional nephrology and the development of hub-and-spoke organizational models could support the formation of a new generation of nephrologists capable of combining clinical reasoning with procedural skills, ultimately improving patient care and enhancing the attractiveness of the specialty.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Proliferative Glomerulonephritis with Monoclonal Immunoglobulin Deposits (PGNMID) Associated with Marginal Zone B-cell Lymphoma: A Case of MGRS in a Patient with Nephrotic Syndrome and Rapidly Progressive Renal Failure].","authors":"Luca Visconti, Sebastiano Calimeri, Guido Gembillo, Valeria Tranchida, Domenico Ferrara, Fabrizio Accardi, Marco Raimondi, Epifanio Di Natale","doi":"10.69097/43-03-2026-10","DOIUrl":"10.69097/43-03-2026-10","url":null,"abstract":"<p><p>Monoclonal gammopathies of renal significance constitute a heterogeneous spectrum of nephropathies characterised by renal deposition of monoclonal immunoglobulins or their fragments, produced by clonal proliferation of B lymphocytes or plasma cells, in the absence of diagnostic criteria for symptomatic multiple myeloma or overt lymphoma. In recent years, the growing recognition of these nosological entities has highlighted how early diagnosis and the implementation of clone-directed therapeutic strategies can significantly alter the natural history of the disease and improve long-term renal outcomes. Within this complex classification, proliferative glomerulonephritis with monoclonal immunoglobulin deposits is an exceptionally rare histological diagnosis, typically burdened by an unfavourable renal prognosis and a high risk of progression to end-stage renal disease. The peculiarity of this entity lies in the granular non organised deposition of monoclonal immunoglobulins at the glomerular level, which triggers an endocapillary and/or mesangial proliferative process with consequent impairment of filtration function. We present the clinical case of a 65-year-old male patient who developed overt nephrotic syndrome associated with rapidly progressive renal failure. Renal biopsy revealed PGNMID in the context of MGRS underlying marginal zone B-cell lymphoma. The patient underwent combination treatment with high-dose corticosteroids and rituximab, achieving an excellent clinical response characterised by complete remission of the nephrotic syndrome and normalisation of renal function. This case highlights the importance of a multidisciplinary diagnostic approach in MGRS and the potential benefit of clone-targeted therapies in the management of PGNMID, even in the presence of acute deterioration of renal function.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Twenty years of experience of incremental peritoneal dialysis in Italy.","authors":"Anna Giuliani, Mathias Zeiler, Marco Heidempergher, Stefania Maxia, Loris Neri","doi":"","DOIUrl":"","url":null,"abstract":"<p><p><b>Introduction.</b> Incremental peritoneal dialysis (Incr-PD) is a strategy to start PD when residual renal function is preserved. <b>Methods.</b> We describe the Incr-PD practice across the last 20 years based on the 9th Italian PD Census utilizing a standardized definition of Incr-PD for both CAPD and APD (≤2 exchanges/day, ≤4 sessions/week). <b>Results.</b> In 2024, 1398 patients started PD, 40.2% on Incr-PD. 73.8% of the dialysis centers used Incr-PD. Incr-PD increased from 11.9% in 2010 to 40.2 % in 2024. This is due to both the increase in the number of centers which started to use it (29.2% in 2005 to 73.8% in 2024), and in the number of patients treated with this modality in centers already confident with this modality (33.4% in 2005 vs 50.9% in 2024). Most of Incr-PD patients started with CAPD (84.5%) while APD was the preferred modality when full-PD is prescribed as first PD modality (64.7%). Regarding incremental CAPD, 62.5% of physicians start with one exchange, while 37.4% use two. In the latter case, only 26.2% prescribe two continuous exchanges with \"the abdomen always full\". Incr-PD centers have higher incidence (21.7% vs 15.1%, p < 0.01) and prevalence (16.9% vs 12%, p < 0.01) of PD patients compared with those not using it. <b>Conclusions.</b> The trend confirms the success of Incr-PD, mostly in the form of CAPD. The increased Nephrologist's confidence with Incr-PD allowed the expansion of this PD modality which is the mainstay of dialysis personalization.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 Suppl 86","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148420486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peritoneal dialysis in patients with heart failure - The Italian reality based on the Census 2024 of the Peritoneal Dialysis Project Group of the Italian Society of Nephrology.","authors":"Matthias Zeiler, Anna Giuliani, Marco Heidempergher, Stefania Maxia, Loris Neri","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Peritoneal dialysis has shown to reduce days of hospitalization, NYHA functional class and to improve slightly left ventricular ejection fraction in heart failure patients. For the first time, the nationwide 2024 Census of the Peritoneal Dialysis Project Group of the Italian Society of Nephrology is able to analyze and to compare heart failure patients treated by peritoneal dialysis to a time matched cohort of chronic kidney disease patients under peritoneal dialysis. The census data of 170 Italian dialysis centers are presented. 1063 patients started peritoneal dialysis for kidney disease whereas 47 patients for heart failure, resulting in a prevalence of 3371 kidney disease patients and 72 heart failure patients in 2024. Heart failure patients presented higher age and male prevalence. CAPD was mainly used as dialysis start modality in heart failure patients (78.7%) with incremental dialysis prescription more often applied and assisted dialysis more often needed. Mean duration of peritoneal dialysis was 31.3 months in kidney disease patients, whereas 17.6 months in heart failure patients, mainly due to a 4-fold increased risk of death. The peritonitis risk was lower in heart failure patients with 0.097 episodes / patient-year compared to 0.166 episodes / patient-year in kidney disease patients. The census results confirm that peritoneal dialysis for heart failure is a feasible time-limited therapeutic opportunity for a known high-risk population of mostly elderly, male and frail patients requiring assisted dialysis.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 Suppl 86","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148420435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assisted peritoneal dialysis in Italy: evaluation of the census reports from 2008 to 2024.","authors":"Marco Heidempergher, Matthias Zeiler, Anna Giuliani, Stefania Maxia, Loris Neri","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Assisted peritoneal dialysis (PD) is an important option for frail patients with advanced age, comorbidities, and reduced autonomy who face barriers to self-managed home dialysis. This study evaluates the current use of assisted PD in Italy using data from the 2024 Italian Peritoneal Dialysis Census and compares findings with previous surveys conducted since 2008. Data were collected from 228 dialysis centers, with 221 centers providing information on assisted PD, covering 4,229 prevalent PD patients. Assisted PD was reported in 904 patients (21.4%). Family members were the main caregivers (86.2%), followed by paid caregivers (8.1%), institutional staff (2.9%), and nursing home personnel (2.8%). Over time, the proportion of assisted PD remained stable between 21% and 25%, with no significant change in caregiver distribution. Centers applying assisted PD were larger, had higher PD prevalence, and managed more PD patients compared with centers not using assisted PD. Geographic variability was observed, with the highest prevalence in island regions. Only a small proportion of patients in nursing homes were treated with PD compared to hemodialysis, highlighting organizational and staffing barriers. These findings show that assisted PD in Italy has remained stable over the past two decades and is predominantly based on family caregiving, unlike Northern European countries where professional home care predominates. The limited use of institutional and nursing home support suggests unmet needs and potential areas for improvement. Economic incentives, regional support programs, and telemedicine may help expand assisted PD access and promote home-based dialysis in frail populations.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 Suppl 86","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148420460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Rufus of Ephesus, On gout].","authors":"Natale Gaspare De Santo, Luca De Santo, Carmela Bisaccia","doi":"10.69097/43-02-2026-13","DOIUrl":"10.69097/43-02-2026-13","url":null,"abstract":"<p><p><b>Aims.</b> For a study on the timeline of gout from the Corpus Hippocraticum to the Renaissance, encompassing some 26 authors, we have focussed on a Latin manuscript - \"De podagra\" - of the Middle Ages (posthumous edition dated to the 7th-8th century AD) of Rufus of Ephesus (98-117 AD), during the reign of Trajan. A multipurpose study has been devised to 1) translate into English and Italian the Medieval Latin treatise of the 7th-8th century AD of Rufus of Ephesus on \"De podagra\"; 2) define the role of Rufus in the historical timeline of gout from the Corpus Hippocraticum to the Renaissance ; 3) analyze causes, clinical presentations and therapy of acute attacks and chronic gout; and 4) identify the plant-based remedies described therein. Neither an English nor an Italian translation of \"De podagra\", nor the identification of the plants described therein, has been attempted before. <b>Methods.</b> Plants were identified taking into account methods used for studies on Dioscorides and Galen. <b>Results.</b> The findings highlight the originality of Rufus of Ephesus's clinical approach to therapy and the vast knowledge of diseases treated by plants. <b>Conclusion.</b> Rufus of Ephesus, the third most famous figure in medicine after Hippocrates and Galen, celebrated for his studies in obstetrics, gynecology, pediatrics, and neurology, a gouty physician, left a personal mark in the history of gout by making full use of his clinical skills that had been maximized by the severe apprenticeship in anatomy and in the Corpus Hippocraticum.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Dialisi peritoneale: perché il futuro della nefrologia passa da casa].","authors":"Laura Cosmai, Loris Neri","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[General Assembly on Peritoneal Dialysis: Present and Near Future of the \"Dominant\" Dialysis Modality].","authors":"Luca De Nicola","doi":"10.69097/43-01-2026-02","DOIUrl":"https://doi.org/10.69097/43-01-2026-02","url":null,"abstract":"","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Outcome Analysis of the Outpatient Pathway for Advanced Kidney Disease (MaReA): Focus on Dependent Patients].","authors":"S Di Stante, F Bari, D Colasuonno, P Cutrì, G D'Onofrio, L Lionte, L Lucarelli, S Mambelli, A P Rinaldi, S Silvestrini, V Sirolli, M Signoracci, M Di Luca","doi":"10.69097/43-02-2026-06","DOIUrl":"10.69097/43-02-2026-06","url":null,"abstract":"<p><p><b>Introduction.</b> Chronic Kidney Disease (CKD) represents a global health challenge. The Advanced Kidney Disease Outpatient Program (MaReA) is an organizational model that prepares patients for renal replacement therapy (RRT), promoting informed choice and timely initiation of treatment. Peritoneal dialysis (PD) is a home-based therapy that offers greater autonomy, but its applicability depends on several factors. <b>Objective.</b> The purpose of this study is to analyze the outcomes of a MaReA program, with a specific focus on assessing suitability for PD, patient autonomy, and the role of the caregiver. <b>Materials and Methods.</b> A retrospective analysis was conducted on a cohort of patients with CKD stage 5 enrolled in the MaReA program. The analysis focused on suitability for PD, the outcome of the program for eligible patients, the degree of autonomy achieved, and the availability and type of caregiver for dependent patients. <b>Results.</b> The evaluation showed that 61.2% of patients were deemed eligible for PD. Among eligible patients who completed the program, a high rate of PD adoption was observed. For the proportion of dependent patients, the presence of a caregiver is essential. <b>Conclusions.</b> The MaReA program is an effective tool for identifying candidates for PD and adequately preparing them. Caregivers play a critical role in accessing home care for a subpopulation of frail patients. It is necessary to develop support strategies and implement telemedicine and assisted peritoneal dialysis programs to expand access to PD.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"43 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}