Controversial Aspects of Peritoneal Dialysis in Italy. Results of the First National Audit of PD

The Census carried out by the Italian Society of Nephrology's Peritoneal Dialysis (PD) Project Group has been following the evolution of PD for 20 years. For the first time, the latest edition in 2024 was followed up by an on-line audit conducted between 28/04/2025 and 09/05/2025. With 185 of the 228 Centers which used PD in 2024 taking part, the Audit investigated a number of questions which are controversial or relatively unexplored: 1) the incremental dialysis prescription in CAPD; 2) empiric peritonitis therapy; 3) the prophylaxis of exit site infections (ESI); 4) types of peritoneal catheter used; 5) the use of telemedicine. There is no consensus on the incremental prescription in CAPD. Most start with a single exchange, and in the event of two exchanges the majority keep the abdomen empty for part of the day. However, 37.4% of the 162 Centers using incremental PD begin from 2+ exchanges, while 26.5% in two-exchange CAPD keep the abdomen always full. A fair degree of variation was also observed regarding the type of catheter used, although 75.7% of the Centers use only one type in their Center. Almost all the Centers follow ISPD recommendations on empiric peritonitis therapy and ESI/TI prophylaxis, the validity of which is confirmed by the constant reduction in the drop-out rate for peritonitis recorded over the last 20 years. Finally, Telemedicine data show the ever-increasing use of this tool, notably Telemonitoring, whereas only a minority of the Centers use Teleassistance - in particular Televisits - which is particularly useful in Assisted PD.