title: Vascular access scenario in Italy: evolution and comparison by two surveys (1998-2013).
abstract: OBJECTIVE
  Dialysis settings have generally improved over the last decades, but the vascular access setting did not see significant advances and experienced a progressive worsening in epidemiology and clinical features. The aim of the study was to describe and compare evolution of vascular access in Italy over time.
  
  
  METHODS
  A national survey implemented in Italy last year is presented and compared to a previous survey performed in 1998. Present survey collected data from almost 50% of centers involved in vascular access.
  
  
  RESULTS
  The nephrologist participates in the management of vascular access in 97% of centers. Almost 40% of centers declare more than 40% of central venous catheters (CVCs) at first dialysis with maximum value being 60%. Prevalence of CVCs is greater than 20% in chronic prevalent patients in 38.8% of centers. According to the 2013 survey, CVCs account for 51.6% of procedures, while arteriovenous fistulae (AVF) and prostheses represent 42.4% and 6%, respectively. Nephrologists perform 73% of procedures on CVCs.From 1998 to 2013, a sharp increase in CVC prevalence was seen, in both incident and prevalent dialysis patients. This activity, mostly due to CVC management, is almost completely carried by nephrologists.
  
  
  CONCLUSIONS
  The variability in CVC utilization among centers suggests the lack of a shared policy in patients and access coupling. Quantitative criteria should be used to reduce inappropriate strategy in vascular access creation. Since this activity in Italy is organized at a local level without a shared organizational model, we should inquire whether a system managed so well in the past should now be rebuilt on the model of organ transplantation.
authors.affiliation: Nefrologia Area Nord, Carpi (MO), AUSL Modena, Modena - Italy.|Nephrology, Dialysis and Renal Transplantation, University Hospital, Modena - Italy.|Vascular Access Study Group, Italian Society of Nephrology, Roma - Italy.
authors.forename: Decenzio
authors.initials: D
authors.lastname: Bonucchi
authors.affiliation: Nephrology, Dialysis and Renal Transplantation, University Hospital, Modena - Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Palmieri
authors.affiliation: Nefrologia Area Nord, Carpi (MO), AUSL Modena, Modena - Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Arletti
authors.affiliation: Nephrology, Dialysis and Renal Transplantation, University Hospital, Modena - Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Cappelli
authors.affiliation: Vascular Access Study Group, Italian Society of Nephrology, Roma - Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Lomonte
authors.affiliation: Vascular Access Study Group, Italian Society of Nephrology, Roma - Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Lodi
authors.affiliation: Vascular Access Study Group, Italian Society of Nephrology, Roma - Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Meola
authors.affiliation: Vascular Access Study Group, Italian Society of Nephrology, Roma - Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Spina
authors.affiliation: Vascular Access Study Group, Italian Society of Nephrology, Roma - Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Napoli
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000706:statistics & numerical data / Q000639:trends*; D019917:Blood Vessel Prosthesis Implantation / Q000706:statistics & numerical data / Q000639:trends*; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data / Q000639:trends*; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000639:trends*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D009398:Nephrology / Q000639:trends*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D015995:Prevalence; D006435:Renal Dialysis / Q000639:trends*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D013997:Time Factors