[The challenge of the peripheral Nephrological Center: an Italian story]

In small peripheral nephrological hospitals it can sometimes be difficult to obtain an early diagnosis and to ensure a state-of-the-art treatment. In the most complex cases, in fact, patients must be transferred to the closest Nephrological Referral Center in order to recover kidney function or improve the chance of survival. Other challenges are represented by the progressive ageing of the population and by the management of oncological patients developing kidney complications, for which it would be desirable to create dedicated clinics. However, small hospitals also offer many advantages, such as better work management, the opportunity to attend many training initiatives and congresses, and the ability to better balance career with family needs. Cooperating in smaller teams and the harmony that develops with the other physicians and nurses allows us to offer the best healthcare to nephropathic patients who live far away from the major Referral Centers. Each peripheral Center can also represent an essential resource for the major Center because it acts as the first point of contact with patients, taking care of identifying the situations that need the attention of the Referral Center and, subsequently, taking charge of the follow-up in conservative or replacement therapy.