[Only By Uniting Mind and Hand Can We Shape the World: The Challenge of Interventional Nephrology]

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.