From stethoscope to ultrasound: an Italian survey of nephrology ultrasound practice.

BACKGROUND

Ultrasound (US) is an increasingly utilized imaging technique in nephrology,  for diagnostic and interventional applications. In spite of growing interest, its implementation across Italian nephrology centers remains poorly documented. To address this gap, a cross-sectional study was conducted to explore the modalities of the training of expert nephrologists and current practices of diagnostic and interventional US procedures  performed by nephrologists in Italy.

METHODS

We developed a 24-question electronic survey that collected data on (1) participants' background (years in US practice and certification), (2) type of US examinations performed (B-mode US, echo color Doppler studies, echocardiography, arteriovenous fistula [AV] assessment, US in peritoneal dialysis, and contrast-enhanced US), and (3) US-guided interventional procedures (kidney biopsies, central venous catheter [CVC] placements, and AV fistula [AVF] complications).

RESULTS

Questionnaires were returned by 115 nephrology units across Italy. Only 39% of respondents held formal US certification, and 65% stated they wished to attend US courses. Renal and urinary tract US was performed in 90% of respondent centers, followed by AV fistula echo color Doppler in 72%. However, advanced applications such as lung US or echocardiography were carried out in only 32% and 12% of centers, respectively. Regarding US-guided procedures, nephrologists performed CVC placements in 64% of responding centers and kidney biopsies in 37%.

CONCLUSIONS

This survey showed that US is widely used in Italian nephrology centers for renal and urinary tract imaging, AVF assessment, and CVC insertion. However, it also revealed a strong interest among nephrologists in further enhancing their US competencies through structured training programs, which should be promoted to improve the performance and diffusion of US in nephrology care.