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Interventional nephrology in Italy: Past achievements, present challenges, and future directions
Luca Nardelli1,2, Antonio Scalamogna3, Federico Alberici1,4
1Nephrology Unit, ASST Spedali Civili di Brescia, Brescia, Italy.
The Journal of Vascular Access
|July 15, 2026
Summary
Interventional nephrology in Italy, once a leader in dialysis access procedures performed by nephrologists, is seeing a decline in direct involvement. Revitalization efforts focus on training and collaboration to restore procedural skills.
Area of Science:
- Nephrology
- Interventional Nephrology
- Medical Procedures
Background:
- Italy historically led interventional nephrology, with nephrologists performing dialysis access and ultrasound-guided procedures.
- High rates of native arteriovenous fistula use were linked to nephrologists' procedural involvement.
Purpose of the Study:
- To review the historical evolution, current status, and future outlook of interventional nephrology in Italy.
- To analyze the factors contributing to the changing role of nephrologists in procedural care.
Main Methods:
- Narrative review of historical data, national surveys, and international registry information.
- Analysis of trends in dialysis access creation and procedural involvement by nephrologists.
Main Results:
- A gradual decline in nephrologists' direct procedural involvement is observed.
- There is increasing reliance on central venous catheters and other specialties for dialysis access procedures.
- Factors include healthcare system changes, workforce issues, and evolving patient demographics.
Conclusions:
- Despite challenges, Italian nephrology possesses technical expertise and organizational capacity.
- Strengthening training, education, and collaborative networks is crucial for revitalizing procedural skills.
- Reintegrating procedural competencies can enhance dialysis access care and redefine the specialty's identity.
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