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A new study reports the seroprevalence of SARS-CoV-2 antibodies among a cross-section of patients on haemodialysis and uses these data to estimate seroprevalence in the general US population. Although this study demonstrates the potential of monitoring infectious disease prevalence in dialysis populations, the findings should be interpreted with caution.
Recent clinical trials demonstrated that sodium–glucose co-transporter 2 inhibitors can reduce hospitalization for heart failure and improve hard kidney end points in patients with and without type 2 diabetes mellitus. These observations consolidate the view that organ protection is independent of blood glucose control and mitigation of traditional risk factors.
A new study examined post-mortem kidney tissue from 63 patients with COVID-19. The results suggest that SARS-CoV-2 has kidney tropism, including the ability to replicate in kidney cells, and that kidney transduction by SARS-CoV-2 is associated with shorter survival time and increased incidence of acute kidney injury.
Timing of dialysis initiation in critically ill patients is controversial. The STARRT-AKI trial reports that an accelerated initiation strategy did not improve 90-day survival and increased dialysis dependency compared with a standard approach in which patients had greater fluid accumulation and metabolic complications at initiation but 38% avoided dialysis.
A new study uses the OpenSAFELY health analytics platform to identify risk factors for COVID-19 mortality. This analysis, which includes data for more than 17 million people in the UK, suggests that patients with chronic kidney disease are at higher risk than those with other known risk factors, including chronic heart and lung disease.
The generation of local immune responses in organs requires a coordinated effort, not just from immune cells, but also from ‘structural’ cells such as epithelial cells, endothelial cells and fibroblasts. New insights gained from profiling these cells across organs in the mouse emphasizes the important contribution of this structural cell network to organ immunity.
Long-term immunosuppression in transplant recipients is associated with important adverse effects including increased risk of infection and malignancy. New data from the ONE Study suggests that use of cell-based medicinal products containing regulatory immune cells is a potentially useful therapeutic strategy to enable minimization of immunosuppression in these patients.
The mechanism underlying glomerular filtration barrier selectivity has not been resolved. A new study that reports an inverse correlation between slit diaphragm density and proteinuria in a genetic mouse model of focal segmental glomerulosclerosis suggests that podocytes function to compress the glomerular basement membrane (GBM) and that failure of this process results in GBM stretching and increased permeability.
Clinical trials of sodium–glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP1) receptor agonists have shown beneficial effects of these agents on kidney outcomes in patients with type 2 diabetes mellitus. Two new cohort studies now demonstrate that these findings are generalizable to the broad range of patients seen in clinical practice.
New data suggest that plasma soluble urokinase receptor (suPAR) might be a predictive biomarker and potential therapeutic target for acute kidney injury (AKI). However, many questions remain regarding the potential of suPAR to inform clinical decision making, identify patients for enrolment in clinical trials and add to the understanding of AKI pathogenesis.
A recent metabolite genome-wide association study (mGWAS) investigated the relationship between genetic factors and the urine metabolome in kidney disease. The findings demonstrate that mGWAS hold promise for identifying novel genetic factors involved in adsorption, distribution, metabolism and excretion of metabolites and pharmaceuticals, as well as biomarkers for disease progression.
The PEXIVAS clinical trial demonstrated that, in patients with anti-neutrophil cytoplasmic autoantibody-associated vasculitis (AAV), adjuvant plasma exchange did not reduce the risk of all-cause mortality or end-stage kidney disease and a reduced dose of glucocorticoids was not inferior to standard dosing. These findings might warrant a change in standard AAV therapy.
Paradoxically, elevated BMI is a recognized positive prognostic factor in renal cell carcinoma (RCC). A recent investigation of the transcriptomic signatures of RCC tumours and peritumoural tissues suggests potential biological mechanisms underlying this effect. However, the clinical utility of BMI in the context of RCC remains uncertain.
Routinely collected data from electronic health records (EHRs) could potentially be used to facilitate clinical trials. Use of computational phenotypes shows promise for detecting trial-eligible paediatric patients; however, moving from EHR identification to recruitment requires consideration of legal, ethical and logistical challenges.
The KALM-1 randomized double-blind placebo-controlled phase III trial showed that intravenous difelikefalin, a selective κ-opioid receptor agonist, significantly reduces itch intensity in haemodialysis patients with uraemic pruritus. However, 49% of difelikefalin-treated patients showed no improvement. In light of the increasing number of patients with end-stage renal disease, additional treatments are sorely needed.
