Dialysis in Lombardy from 1992 to 2011. Analysis of the data of the Lombardy Registry of Dialysis and Transplantation

: The Lombardy Registry of Dialysis and Transplantation collects annual data on patient flow and treatment options from all dialysis units operating in the Lombardy region. We analyzed the data gathered from 1992 to 2011, looking for trends in incidence, prevalence and treatment modalities. Data were collected by questionnaire from 1992 to 2006, and from 2007 by means of a web page. The number of incident and prevalent patients increased progressively from 1992 to 2011 (+98% and +58%, respectively), while the incidence and prevalence per million population rose only in the first decade due to the parallel population increase. The first dialysis treatment was hemodialysis in most patients, with an HD/PD ratio rising from 2.96 to the current value of 5.15. The hospital-based versus outpatient treatment ratio also steadily increased from 1.12 to 1.48. The total increase in the number of prevalent patients in the last 10 years is to be ascribed to in-hospital HD patients (+1082) and almost entirely to hemodiafiltration (+1043), while peritoneal dialysis was used by a decreasing number of patients: patients on CAPD decreased by 424 units, as patients on APD increased by only 257 units. Our analysis shows a steady increase in patients on dialysis, which is increasingly delivered in hospital, using more complex and expensive techniques. These trends call for a further analysis requiring individual data, which will be available through the Lombardic Network of Nephrology.