Scientific community and society articles within Nature Reviews Nephrology

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  • Comment |

    Clinical algorithms that are used to guide medical decision-making often include sex as a variable. However, binary considerations of sex and/or gender might introduce bias due to potentially inaccurate assumptions about sex and gender-specific physiology, hormones and exposures. An equity-focused approach to sex and gender is essential when using clinical algorithms to ensure health equity across populations.

    • Dinushika Mohottige
    • , Samira Farouk
    •  & Selma Feldman Witchel

  • Comment |

    Global inequities and inequalities, human and health-care crises, transplantation successes in the face of limited organ availability, and desperate donors and recipients underlie the backstory of organ trafficking, namely the exploitation of the most vulnerable. Despite the framework set out by the Declaration of Istanbul for the ethical donation and transplantation of organs, organ trafficking remains a global challenge.

    • Thomas F. Mueller
    •  & Sanjay Nagral

  • Comment |

    All patients with kidney disease have the right to have a say in their own clinical care, the provision of health services and research into kidney disease. Patient empowerment and advocacy, especially for those whose views are seldom heard, can be enhanced by working together in communities.

    • Miranda Scanlon

  • Comment |

    Overcoming barriers to deliver high-quality care requires an assessment of the contribution of each barrier within a local context. Tools to identify early disease, knowledge of best therapies, access to care providers and medications, and an accountable and integrated health-care system are essential elements of quality care. Education of patients, providers and policy makers in conjunction with advocacy efforts and national policy frameworks are required to deliver high-quality care worldwide.

    • Adeera Levin

  • Year in Review |

    The next generation of artificial intelligence (AI)-enabled nephrology will leverage generalist models that link diverse multimodal patient data with the linguistic and emergent capabilities of large language models. In 2023, advances in AI that linked novel unstructured data with physiological and clinical characteristics moved the field closer to realizing this vision.

    • Benjamin Shickel
    •  & Azra Bihorac

  • Comment |

    Individuals who are members of multiple marginalized populations experience multiple axes of oppression and discrimination. Such intersectional discrimination can have interactive, negative effects on all aspects of life, including health. To achieve health equity, intersectional-discrimination-induced kidney harms must be examined, measured and mitigated.

    • Elle Lett
    • , Carmen H. Logie
    •  & Dinushika Mohottige

  • World View |

    Mentoring is an essential component of scientific leadership and can have a profound impact on the development and life course of the mentee. Isi Ero-Tolliver, Dean of the School of Science at Hampton University, describes the life-changing and long-lasting effects of mentorship and why it is important to invest time and effort in mentoring.

    • Isi Ero-Tolliver

  • Viewpoint |

    Transgender persons can face a number of barriers in accessing primary and specialist care that is equitable, inclusive and appropriate for their needs. In this Viewpoint, commissioned to recognize Pride, five researchers with expertise across different disciplines, including nephrology, endocrinology, public health, psychology and sociology, provide their perspectives on key considerations that are required to achieve optimal primary and nephrology care for transgender individuals, including barriers to care and how these might be overcome to ensure that the provision of care is inclusive and safe.

    • Sofia B. Ahmed
    • , Lauren B. Beach
    •  & Cameron T. Whitley

  • Comment |

    Specific policies embedded in organ and tissue donation and transplantation systems discriminate against sexual orientation- and gender identity-diverse populations, restricting or excluding the use of donated organs and tissues. Revision of these policies is needed to promote equity and increase the supply of high-quality organs and tissues for those who need them.

    • Murdoch Leeies
    • , Emily Christie
    •  & David Collister

  • Comment |

    The advancement of women to leadership positions in nephrology lags behind that of men by several metrics. Proactive, intentional approaches, including mentorship and sponsorship, family-friendly policies, career development in hard and soft skills, combatting bias and use of transparent institutional metrics of women’s advancement, are required to address this disparity.

    • Lisa M. Curtis

  • Comment |

    Blockchains enable secure data storage, the verification of data origin and accurate registration of changes in information over time. The widespread adoption of blockchain in nephrology could affect clinical practice and research by enhancing the quality of electronic health records and datasets.

    • Tamas Szili-Torok
    • , Daan Kremer
    •  & Martin H. de Borst

  • Comment |

    Access to essential medical care can be compromised by social disruptions (such as riots and labour strikes), armed conflict and natural disasters, including extreme weather events. A successful response to such events requires forward planning, preparation and rehearsal with involvement of health-care systems, professionals, patients and their support networks. Following execution of the response, after-action evaluation is required to improve future responses.

    • Jeffrey B. Kopp
    • , Kenneth Lempert
    •  & Kristen Finne

  • Comment |

    Indigenous Māori experience inequitably high rates of kidney failure and lower rates of kidney transplant, pre-emptive procedures and home dialysis when compared to the New Zealand population as a whole. Prevention strategies in primary care, cultural safety training and routine clinical audit for renal practitioners alongside Indigenous people in governance, management and the clinical workforce would greatly improve Māori outcomes.

    • David Tipene-Leach
    •  & Rachael Walker

  • Editorial |

    June marks Pride Month — an event that aims to recognize and celebrate LGBTQ+ communities worldwide. However, it also provides an opportunity to highlight the challenges that LGBTQ+ colleagues and nephrology patients continue to face, and the need to address health inequities.

  • Comment |

    Sexual and/or gender minority health-care workers are subject to the heteronormativity and cisnormativity of society and often face open discrimination. Empowering these individuals to bring their full, authentic selves to work so that they can serve their patients and institutions with the totality of their strengths requires institutes and cisgender or straight allies to support LGBTQ+ communities by creating a culture of inclusivity and enacting progressive policies.

    • Mackenzie H. Holmberg
    • , Suzanne G. Martin
    •  & Mitchell R. Lunn

  • Comment |

    The COVID-19 pandemic has highlighted the vital role of vaccination in preventing life-threatening diseases and improving global health. Understanding and addressing the concerns of vaccine-hesitant individuals, including those with chronic diseases, is key to increasing vaccine acceptance and uptake.

    • Eve Dubé
    •  & Noni E. MacDonald

  • Comment |

    Dominant narratives that describe the power of individual-level resilience underplay the long-lasting consequences of structural violence and perpetuate harms to historically marginalized patients and communities. It is time to update our approaches and narratives by addressing the root causes of inequities through redress and collective resistance to create the equitable conditions needed for communities to thrive.

    • Karthik Sivashanker
    •  & Cheri Couillard

  • News & Views |

    Concerns regarding the incorrect use of race as a biological construct and the resulting negative effect on health equity have led to reconsideration of the inclusion of race in equations for estimating glomerular filtration rate. Now, two studies report that cystatin-C-based equations can accurately estimate glomerular filtration rate independent of race.

    • Bessie A. Young

  • Comment |

    Growing patient empowerment and the deluge of health information and misinformation have highlighted the importance of health literacy. Unfortunately, public information and literacy programmes often fail to counter the effect of misinformation. Successfully countering misinformation presents distinctive challenges beyond patient education, and may require trust built on collaborative patient–clinician relationships.

    • Peter J. Schulz
    •  & Kent Nakamoto

  • Year in Review |

    The dramatic increase in advocacy and scholarly work on the impact of structural racism on health inequities that began in 2020 has been sustained in the past year. In response to the call for action on these issues, the nephrology community has developed policy-based mitigation strategies and continues to examine our role in promoting health equity and justice in the care of patients with kidney disease.

    • Dinushika Mohottige
    •  & Keisha Gibson

  • Review Article |

    Here, the authors discuss how structural racism underlies many of the health disparities that affect individuals from minority racial groups. They also examine how the use of race coefficients in estimated glomerular filtration rate equations might contribute to health inequities in Black patients with kidney disease.

    • Nwamaka D. Eneanya
    • , L. Ebony Boulware
    •  & Keith C. Norris

  • World View |

    As witnesses to the health consequences of social discrimination, clinicians are uniquely positioned to build coalitions of stakeholders to address inequities and drive change. Such civic engagement is needed to ensure that all populations are given the opportunity to thrive.

    • Lilia Cervantes

  • Roadmap |

    Organ transplantation improves patient survival and quality of life and has a major beneficial impact on public health and the socio-economic burden of organ failure. This Roadmap presents an outline of the challenges to increasing transplantation rates and proposes 12 key areas along with specific measures that should be considered to promote transplantation.

    • Raymond Vanholder
    • , Beatriz Domínguez-Gil
    •  & Gabriel C. Oniscu

  • Year in Review |

    The COVID-19 pandemic and the Movement for Black Lives have focused attention on racial disparities in kidney health outcomes. In 2020, kidney professionals highlighted threats posed by racism and other negative social drivers of kidney health, and proposed solutions to address these issues through scholarship and advocacy for social justice.

    • O. N. Ray Bignall II
    •  & Deidra C. Crews

  • World View |

    Millions of people in under-privileged regions of the world continue to drink heavily polluted water and die from diarrhoea-related acute kidney injury whilst world super-powers continue to offer military aid to these regions. This gun aid must convert into water aid.

    • Sampson Antwi

  • Consensus Statement
    | Open Access

    COVID-19-associated AKI (COVID-19 AKI) is associated with high mortality and is an independent risk factor for all-cause in-hospital death in patients with COVID-19. This Consensus Statement from the Acute Disease Quality Initiative provides recommendations for the diagnosis, prevention and management of COVID-19 AKI and for areas of future research, with the aim of improving understanding of the underlying processes and outcomes for patients with COVID-19 AKI.

    • Mitra K. Nadim
    • , Lui G. Forni
    •  & John A. Kellum

  • Comment |

    Chronic kidney disease (CKD) is a rapidly growing public health problem, especially in disadvantaged populations. Major political interventions are required to mitigate the social and socioeconomic inequities that contribute to the development and progression of CKD and its disproportionate impact on low and middle-income countries.

    • M. R. Moosa
    •  & K. C. Norris

  • Comment |

    Public policy for kidney replacement therapy eludes most low- and middle-income countries owing to the seemingly low number of cases and high cost. Countries such as Thailand have shown that public health authorities can effectively provide treatment and elevate health care for populations by overcoming some common challenges.

    • Yot Teerawattananon
    • , Kriang Tungsanga
    •  & Saudamini Dabak

  • Comment |

    The COVID-19 pandemic has placed a tremendous strain on sustaining the clinical research enterprise and will also likely affect key study outcomes; these effects must be considered during data analysis and interpretation. Nevertheless, the responses to the pandemic have also introduced innovations that will advance the conduct of clinical research.

    • Katherine R. Tuttle

  • Comment |

    Growing genomic knowledge has provided immense insight into the aetiology and mechanisms of kidney diseases but raises ethical issues that risk the successful implementation of genomic medicine. We highlight such issues in two contexts: the return of individual genetic results from nephrology research and preimplantation genetic diagnosis for heritable kidney diseases.

    • Maya Sabatello
    •  & Hila Milo Rasouly

  • Comment |

    The need for innovation in dialysis is long overdue. As past and present users of dialysis we are fully aware of the limitations of current dialysis modalities. The time for complacency is over — developers must engage with dialysors to ensure that our needs are met so that we can live the best life possible. Let us share our dream for devices that will enable us to enjoy life.

    • Nieltje Gedney
    • , Wim Sipma
    •  & Henning Søndergaard

  • Comment |

    Peritoneal dialysis and haemodialysis are lifesaving but intrusive treatments that are associated with high morbidity and mortality. Despite the considerable time patients with kidney failure spend tied to their life-saving therapies, relatively few vital signs are monitored. Smart, unobtrusive approaches to track clinical parameters could help to individualize treatments and improve patient outcomes.

    • Fokko P. Wieringa
    •  & Jeroen P. Kooman

  • Editorial |

    The increasing volumes of biological and clinical data have the potential to greatly enhance our understanding of the processes underlying kidney function and disease. However, maximizing outputs from these data requires a collaborative and open approach to data sharing that can only be achieved through united efforts by researchers, funders and publishers.

  • Comment |

    A critical need exists for innovations in education that increase the recruitment of high school students from diverse backgrounds into the biomedical research workforce. Aspirnaut is one model that addresses this challenge.

    • Julie K. Hudson
    •  & Billy G. Hudson

  • Comment |

    To advance kidney discovery, our community is driven to maximize the utility of genomic data that we all generate. We can best accomplish this through excellence in appropriately incorporating publicly available genomic data into our research efforts and by enthusiastically embracing widespread data sharing in a manner that facilitates its broad use.

    • Matthew G. Sampson
    •  & Hyun Min Kang

  • News & Views |

    In the USA, mortality among patients with chronic kidney disease (CKD) and end-stage renal disease has declined over the past two decades. By contrast, new data indicate that the rate of CKD-associated deaths is increasing worldwide. This important finding highlights CKD as a major contributor to global morbidity and mortality.

    • Connie M. Rhee
    •  & Csaba P. Kovesdy

  • News & Views |

    'Chronic kidney disease (CKD) in disadvantaged populations' is the focus of World Kidney Day 2015. In this article, we discuss the disproportionate burden of CKD in disadvantaged communities as well as approaches to ensure the provision of appropriate renal care across socioeconomic and ethnic groups.

    • Guillermo Garcia-Garcia
    •  & Vivekanand Jha

  • Science and Society |

    Implementation of programmes for dialysis, transplantation and renal-disease screening in developing countries is a complex and challenging task. Here, the authors provide the perspective of their efforts to implement renal care in Haiti. They focus on the importance of collaboration, education and partnership building, rather than on technological issues.

    • Brian D. Remillard
    • , Jean H. Buteau
    •  & Philip Cléophat

  • News & Views |

    It is now accepted that climate change is occurring as a result of human activity and that it will have potentially devastating effects on health. Nephrologists are likely to see a changing spectrum of disease as a consequence of climate change and are ideally placed to lead mitigating strategies in health-care provision.

    • Charles Tomson
    •  & Andrew Connor

  • Review Article |

    The number of candidates awaiting kidney transplantation has grown substantially over the past few decades, but the number of available organs has increased only modestly. Barring any notable progress in technology, improving the fate of transplant candidates will rely heavily on increasing the pool of available donor organs. This Review outlines prominent proposed interventions that may increase the deceased kidney donor pool and discusses issues concerning their implementation and effectiveness.

    • Jesse D. Schold
    •  & Dorry L. Segev

  • Opinion |

    The Declaration of Istanbul on Organ Trafficking and Transplant Tourism was formulated at an international meeting held in 2008 with the aim of promoting the welfare of living organ donors in the context of improved global organ transplantation practice. In this Perspectives article, Danovitch and Al-Mousawi provide an update on this endeavor, specifically discussing promulgation of the Declaration, how it has been put into action and legislative changes that have since come into effect.

    • Gabriel M. Danovitch
    •  & Mustafa Al-Mousawi

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