[Palliative Care in Nephrology: A National Survey]

The demographic and epidemiological transition that Italy has undergone over the past 50 years has made palliative care (PC) essential in situations where active treatment is no longer proportionate. One of the major current and future challenges of palliative care lies in the management of non-oncological chronic diseases, particularly advanced organ failure and dementia. Individuals aged over 70 and 80 represent a significant proportion of the more than 45,000 chronic dialysis patients in Italy. These patients typically present with increased comorbidities, reduced life expectancy and quality of life, and a higher risk of hospitalization and in-hospital mortality. Moreover, older adults in these age groups also constitute the majority of the approximately 15% of patients with end-stage renal disease (ESRD) who continue exclusively with conservative management, never initiating renal replacement therapy. Over the past decade, interest in palliative care within the field of nephrology has grown substantially across the Western world. Decisions to withhold or withdraw dialysis vary widely by region, with higher rates observed in North America and Canada, and lower rates in Southern Europe. The Italian Society of Palliative Care (SICP) published with the Italian Society of Nephrology (SIN) and the Italian Society of Nephrology Nurses (SIAN), ten and six years ago respectively, a consensus document on the integration of palliative care in the management of chronic kidney disease. The objective of this study is to provide a comprehensive overview of the current state of palliative care practices within nephrology units across Italy.