Cutting hospital beds for people with kidney disease, very little home dialysis, nephrologists used to cover shifts in other departments, closed territorial nephrological clinics. All this is leading the treatment of chronic kidney diseases to be a suffering sector, in which at least 350 specialists are missing, due to scheduling problems and blockage of turnover. This is the cry of alarm that comes from nephrologists, gathered at the conference promoted by the Italian Kidney Foundation (Fir), which saw clinicians, administrators and patients confront each other to take stock of the challenges in the post pandemic. About 6 million people in Italy suffer from kidney disease and their number is growing together with the increase of ver 75 years and the spread of risk conditions such as hypertension, obesity and diabetes. “A patient who is well looked after on an outpatient basis has many possibilities of preventing or delaying dialysis and this avoids the patient the inconvenience of going to the hospital three times a week for a ‘blood wash’ and saves resources. The paradox is that today we have drugs that make it possible to delay the entry of patients into dialysis, but we do not have enough professionals to follow them”, explains Massimo Morosetti, president of Fir. At the base, programming and organization problems and a lack of attention to the theme, crushed by the pandemic. “Many dialysis centers – continues Morosetti – have difficulty guaranteeing activities due to a lack of specialists: we have about 2,800 nephrologists in service in Italy in public health, at least 350 are missing. Specialization grants have increased but we will see the benefits in 4 years, while in the meantime they retire without generational change”. Home dialysis is struggling to take hold, which in Italy does not exceed 10% compared to 40% in other countries, while Lazio is at 7%. “Doing it at home – explains Roberto Costanzi, president of the Kidney Disease Association – allows the Health Service to save money but the regional contributions to do it are not enough to cover the costs incurred by families”.
Cnt, 2,000 kidney transplants a year in Italy, 6,500 waiting
Although kidney transplantation saves resources compared to dialysis, as well as improving the quality of life of patients, waiting times are still very long. “In Italy the waiting list for a kidney includes more or less permanently 6,500 people, and therefore the 2,000 transplants that we manage to do every year do not meet the needs for the treatment of terminal renal failure”. This was explained by Massimo Cardillo, director general of the National Transplant Center, speaking at the conference organized in Rome by the Italian Kidney Foundation (Fir). There are two ways to go. “The first – said Cardillo – is to promote the culture of donation as much as possible, asking citizens to express their consent to the withdrawal after death while still alive. On average, over 30% of those who express themselves do so with an opposition, and this is a problem that can be overcome with correct information.The second way is living donor kidney transplantation, which must become a routine solution and, in cases that allow it, the first option for those who have not yet started dialysis In the rest of Europe there are countries that have reached remarkable levels”. “Lazio has an excellent transplant network, but the level of donations needs to be improved: we have 33% of oppositions, higher than the national average”, explained Mariano Feccia, Director of the Lazio Regional Transplant Center. Hemodialysis should be plan B with respect to transplantation. “But the average time before being placed on the waiting list to receive a kidney, in some regions such as Lazio, is 12 months”, explains Massimo Morosetti, president of Fir. Furthermore, from the point of view of assistance, concludes Morosetti, “the structuring and recognition of regional nephrology networks to connect dialysis centers with hospital structures is lacking in Italy, with a view to a hub and spoke organization, such as for heart attack and stroke. This path, to date, is left to the good will of the professional”.