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Analysis of the factors conditioning the diffusion of peritoneal dialysis in Italy.

BACKGROUND
The diffusion of peritoneal dialysis (PD) in Italy is lower than expected on the basis of indications and contraindications reported in literature.


METHODS
To analyse the factors influencing the use of PD in Italy, we used data from the first National Census of the Italian Society of Nephrology relating to 9773 incident patients (Incid(HD + PD)) in 2004 and 43 293 prevalent patients dialysed in 658 centres at 31/12/2004 (337 public centres, 286 private centres, 12 paediatric centres, 15 research or religious institutions and 8 unspecified).


RESULTS
The percentages on PD of total incident (Inc(PD)%) and prevalent dialysis patients (Prev(PD)%) were 15.9% and 10.3%, respectively with considerable variations from region to region and from centre to centre. The Inc(PD)% was higher in regions with fewer patients on dialysis in private centres. In the private centres, the Inc(PD)% was 0.4%. Of the 325 non-paediatric public centres, 116 (35.7%) do not use PD: compared with the 209 centres which do, these centres have a lower mean Inc(HD + PD) and Prev(HD + PD) per centre (13.0 +/- 12.3 vs 28.6 +/- 18.0 - 51.8 +/- 35.7 vs 117.3 +/- 66.4 patients, P < 0.0001), and more haemodialysis (HD) stations available (3.0 vs 3.5 patients per HD station, P < 0.0001). However, the significant influence of cultural and motivational factors on the use of this method is demonstrated by the fact that it is used by 34% of the smaller non-paediatric public centres, and is not used by 19% of the larger non-pediatric public centres.