Real-world management of dialysis-requiring acute kidney injury in Italy: a national survey of nephrology centers.

Authors

Erika Naso, Paolo Fabbrini, Marita Marengo, Marco Fiorentino, Giuseppe Castellano, Vincenzo Cantaluppi, Pasquale Esposito

Published in

Journal of nephrology. Jul 28, 2026. Epub Jul 28, 2026.

Abstract

Dialysis-requiring acute kidney injury (AKI-D) is a frequent and severe in-hospital complication associated with high mortality, long-term kidney sequelae, and substantial resource use. National data on AKI-D impact and service organization in Italy are limited.
We conducted a nationwide, web-based, 20-item survey endorsed by the Italian Society of Nephrology. We assessed care settings (dialysis units and other wards, including intensive care units [ICUs]), kidney replacement therapy (KRT) modalities in ICUs, staffing models, monitoring and anticoagulation strategies, and nephrologists' perspectives on barriers and priorities for improvement.
Fifty-nine centers responded; analyses focused on 57 adult centers. AKI-D represented ∼20% to >60% of dialysis-unit activity. KRT was frequently delivered outside nephrology wards, most often in cardiac intensive care units (94%) and emergency departments (50.8%). In ICUs, nephrologists primarily prescribed KRT in 73.7% of centers; continuous KRT (CKRT) was available in 94.7%, and regional citrate anticoagulation was first-line in 82.5%. Dialysis dose was reassessed daily in 55.2% of centers. Routine antibiotic therapeutic drug monitoring during CKRT was available in 30.3%, and in 22.8% dedicated post-AKI outpatient clinics. Most indicators were similar between center types; however, structured antibiotic therapeutic drug monitoring during CKRT was more frequently available in University and Hub centers than in Spokes (43.5 vs 31.6 vs 7.1%, respectively, P = .031). Respondents highlighted heterogeneous protocols, limited dedicated staffing, and gaps in multidisciplinary coordination.
AKI-D care in Italy is widespread but organizationally heterogeneous across settings, responsibilities, and key operational practices. Standardized pathways, training, and measurable monitoring tools are key priorities for improvement.

PMID:
42517201
Bibliographic data and abstract were imported from PubMed on 28 Jul 2026.

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