Global kidney health

In this plenary Review, Hoste and colleagues describe the global epidemiology of acute kidney injury (AKI). The influence of modifiable and non-modifiable AKI risk factors, delayed diagnosis, variation in diagnostic criteria and disparities in access to health care are also discussed.

The treatment of chronic kidney disease (CKD) and end-stage renal disease (ESRD) is associated with immense societal costs, with particularly high expenditure for renal replacement therapy. This Review addresses the economic aspects of CKD and ESRD with a focus on approaches to prevent the conditions that contribute to CKD and its progression.

In many countries, patient outcomes with peritoneal dialysis are comparable or superior to those with haemodialysis. Here, the authors discuss the changing epidemiology of peritoneal dialysis worldwide, including the remaining country-specific challenges that must be overcome to improve utilization of this cost-effective therapy.

Acute kidney injury (AKI) is a life-threatening complication in critically-ill neonates. This Review explores the evidence that intrauterine growth restriction, premature birth and low birth weight contribute to neonatal AKI, and discusses perinatal and postnatal risk factors that enhance the risk of AKI among neonates.

This Review describes the epidemiology and mechanisms underlying the reciprocal relationship between hepatitis C virus (HCV) infection and chronic kidney disease (CKD). The authors also discuss recommended treatment approaches for patients with HCV infection and CKD, and outline remaining issues in the field.

Exposure to environmental pollutants is a major cause of kidney injury and disease worldwide and is a particular problem in the developing world. In this Review, the authors discuss the different environmental pollutants that affect the kidney, and our understanding of the pathogenic mechanisms of environmental pollutants in kidney injury and disease.

Estimates of the prevalence of chronic kidney disease (CKD) vary widely, both within and between countries. Here, the authors discuss the origins of this variation, particularly issues relating to the use of estimated glomerular filtration rate, and present solutions for tackling the factors responsible.

A growing body of research indicates that sex and gender-specific differences exist in the mechanisms and epidemiology of chronic kidney disease (CKD). Here, the authors describe current understanding of gender and sex differences in the epidemiology, treatment and outcomes of CKD, as well as the possible underlying causes.

Patients who present with chronic kidney disease and diabetes mellitus can have true diabetic kidney disease (DKD), nondiabetic kidney disease (NDKD), or a combination of both DKD and NDKD. Here, Anders and colleagues discuss the mechanisms underlying these entities and how greater appreciation of distinctions between these entities might facilitate the development of new treatments.

Regular physical activity is associated with reduced mortality in the general population and in patients with chronic kidney disease. Here, the authors discuss the importance of physical activity for patients with renal disease and patient-reported barriers and facilitators for physical activity.

Haemodialysis options for undocumented immigrants with end-stage renal disease range from standard of care thrice-weekly treatments to emergency-only haemodialysis. This latter approach is associated with poor patient outcomes and high costs. The time has come for the nephrology community to demand an end to the practice of emergency-only haemodialysis.

The analyses in the 2017 Global Burden of Disease Study demonstrate the growing burden of chronic kidney disease (CKD), mainly driven by population ageing; absolute levels for every CKD metric considered rose significantly, whereas age-standardized rates were fairly stable. The prevalence of key metabolic CKD risk factors, particularly obesity, also show a worrying increase.

Peritoneal dialysis has many advantages over haemodialysis in the treatment of acute kidney injury (AKI) in low-resource settings. One limitation, however, is the availability of commercial dialysis fluid. Following the International Society of Peritoneal Dialysis AKI guidelines, a frontline hospital in Cameroon now shows that locally prepared fluids are safe and effective.

New data highlight the increasing global burden of cardiovascular disease, end-stage renal disease and disability adjusted life years that can be attributed to reduced glomerular filtration rate (GFR). These findings underline the need to evaluate whether screening for chronic kidney disease is effective and if early interventions can reduce the incidence of GFR-attributable adverse events.

A new study of mortality of children on renal replacement therapy in 32 European countries demonstrates that 67% of the variance between countries can be explained by disparities in public health expenditure. Investment in health care is critical and has demonstrable benefits for the most vulnerable populations.

Chronic kidney disease (CKD) is the progressive, irreversible loss of renal function that has many causes and contributing factors. In this Primer, the authors describe the many consequences of CKD and how understanding — and treating — the underlying cause can substantially slow CKD progression.

Innovative solutions are needed to overcome the global disparity in patients awaiting kidney transplantation versus donor organs available. A new study reports a promising new strategy of transplanting kidneys from HCV-infected donors into HCV-uninfected recipients and treating their HCV with direct-acting antivirals post-transplant — recipients achieved HCV cure with excellent one-year kidney allograft function.