[Best practices on peritoneal dialysis: the audit of Lazio Region]. / Best practices in dialisi peritoneale: l'audit della regione Lazio.

The diffusion of peritoneal methodology can not be something out of the real organizational context and the regional directive can not be the only means to encourage the diffusion. There is the need to provide effective and sustainable levels of assistance through a clinical scientific support and sharing of best-practises. On one side, the aim is to provide an aid by the centers with great expertise in the methodology, recognized as reference points; on the other side, to establish the shared K.P.I.s (Key Performance Index), to asses the clinical effectiveness and measure the objectives to be achieved, through a modality of valuation to establish the real applicability. For this purpose, a scientific board was founded, composed by the heads of UU.OO, that provide the peritoneal dialysis, to determine which aspects to investigate and identify factors of supply improvement. The selected method was the clinical audit. The analysis of the 2011 data has allowed us to capture the situation of the peritoneal dialysis in the Lazio Region. The formative procedure has enabled the centers to share and standardize protocols and therapeutic procedures, identify the strengths of peritoneal dialysis in the Lazio Region and define the KPIs through whose compare and monitor the centers over time. The conclusive analysis of the audit has enabled to identify a series of activities to be undertaken together in order to improve the situation of the peritoneal dialysis in the Lazio Region. In the following years, surveys will be carried out to verify the KPIs trend.

Renal artery aneurysm in a solitary kidney.

A 55-year-old hypertensive female was referred for renal artery color Doppler examination because of a suspicion of renovascular hypertension. Renal artery aneurysm was occasionally detected at the distal portion of the artery in the single left kidney, without the presence of stenosis. An aneurysm was confirmed via magnetic resonance angiography and arteriographical examination.

Low-contrast medium doses for ultrasound imaging during renal revascularization by PTA-stenting.

BACKGROUND: To evaluate the incidence of progressive renal damage in patients with chronic renal insufficiency and renal-artery stenosis undergoing percutaneous transluminal angioplasty and stenting (PTA-stenting), color Doppler ultrasound (CDU)-guided, a procedure requiring low-contrast medium doses, or digital subtraction angiography were compared. METHODS: Thirty patients with renal artery stenosis and severe renal insufficiency underwent PTA-stenting for revascularization, 15 patients with CDU guidance and 15 patients with standard selective digital subtraction angiography (SDSA). Serum creatinine (Cr) concentrations were compared in the two groups at 6 days and 12 months after revascularization. RESULTS: The stents were properly positioned and resolved the renal artery stenosis. None of the patients who underwent ultrasound-guided PTA-stenting had significantly increased Cr values (>50% or >1 mg/dL) at 6 days after surgery (95% confidence interval (95% CI), 0-21.8); and none had progressive chronic renal insufficiency at 12 months. Conversely, six of the 15 patients in the group who underwent PTA-stenting with standard SDSA had significantly increased Cr values at 6 days (95% CI, 16.3-67.7) and two patients had progressive chronic renal insufficiency at 12 months. CONCLUSIONS: Our results suggest that PTA-stenting under CDU guidance, a procedure requiring low-contrast medium doses, is suitable for patients with severe renal dysfunction and especially for those with diabetes mellitus undergoing percutaneous renal revascularization.