[Dialysis as a system integrated into nephrology care (project no. 3 of the Italian Society of Nephrology) - president's letter].

The nephrology, dialysis and transplant system is facing considerable changes, many of them fear-provoking. The fear is not only related to changes in the working activities, but to the fact that these changes are perceived as being driven by purely economic laws in an attempt to save money. This generates a sense of uncertainty, which is never constructive. Chronic dialysis seems to be at particular risk. Nephrologists fear that dialysis will be undervalued as merely a routine technical procedure. The disappearance of chronic dialysis from the nephrology department is felt as a weakening of the system, leading ultimately to its incorporation into the broader system of internal medicine. In order to gain insight into the possible new organization of nephrology and dialysis activities, the Italian Society of Nephrology has launched a study titled ''Dialysis as a System Integrated into Nephrology Care'' in collaboration with CERGAS-Bocconi University of Economics, the Center for the Management of Health Care, and CUSAS-University of Florence. The study is aimed at comparing, by on-site investigation, different approaches to the management of nephrology and dialysis care offered in five centers representative of various Italian regions. Its final objective is to find ways to reconcile patients' needs with financial considerations. The Italian Society foresees the need for a strong coordination among various, apparently heterogeneous activities (from outpatient clinic to chronic dialysis care, kidney transplantation and follow-up of transplant recipients). Instead of moving towards a fragmented whole of individual entities, the care for kidney patients has to be perceived as a service devoted to a single disease entity which requires the activation of the entire service network. The nephrologist should have the responsibility for the entire process for the benefit of the patient.