World Kidney Day

Increased awareness of chronic kidney disease among the general public is required to facilitate action to improve kidney health. An integrated approach involving mass media campaigns, primary health-care interventions and advocacy is needed to draw attention to chronic kidney disease and shift the focus from kidney failure to achieve a public health perspective on this disease.

Living with chronic kidney disease (CKD) is not easy, and patients must adopt lifestyle changes that can be difficult. Owing to the complexities of the disease, patients must be supported to improve their understanding of CKD and to enable them to make informed decisions about the management of their disease.

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.

Chronic kidney disease is a major public health problem that is associated with excessive morbidity, mortality and healthcare costs. However, limited clinician awareness of chronic kidney disease is universally identified as a key barrier to care. A concerted effort is urgently needed to address the knowledge gaps of primary care providers.

Insomnia is common among patients on maintenance haemodialysis and may be exacerbated by the challenges of the COVID pandemic. However, data on the efficacy of insomnia interventions in this population are limited. Efforts are needed to address this important problem and increase access to insomnia interventions for patients on haemodialysis.

Regular physical activity can help people to live well with kidney disease, yet the promotion, funding, level of interest, and general support of physical activity remains poor. Novel high-quality approaches to increase physical activity must be considered, and practical means of scaling up effective interventions at the population level are required.

Older adults receiving dialysis commonly experience poor quality of life. A cyclical process of quality of life assessment, needs assessment and individualized care plans should be implemented to integrate quality of life into care planning. Improvements in health-care delivery and interpersonal communication are needed to prioritize quality of life.

The 2020 World Kidney Day campaign highlights the importance of prevention of chronic kidney disease. Various strategies and therapies are available to prevent disease before its onset (primary prevention), during early disease stages (secondary prevention) and for effective management of established disease to prevent dialysis (tertiary prevention).

Unpleasant symptoms — arising as a consequence of disease processes, comorbid conditions, therapeutics and lifestyle regimens — adversely affect the quality of life and life participation of patients with chronic kidney disease (CKD). This Perspective examines the concept and scope of symptom burden in CKD, theoretical frameworks and validated tools for symptom appraisal, and strategies with which to support patients actively through the identification and targeting of unpleasant symptoms.

This Review examines the concept of kidney lifespan and how increases in haemodynamic and metabolic demands in the kidney can lead to nephron overload, which is a common feature of progressive kidney disease and therefore represents a therapeutic target.

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.

Loss of muscle protein is a deleterious consequence of chronic kidney disease (CKD) that results in decreased muscle strength and function. This Review summarizes the cellular mechanisms that lead to reductions in muscle protein in patients with CKD and highlights commonalities with other catabolic conditions such as cancer and diabetes.

Pain management in patients with haemodialysis-dependent kidney failure might involve the use of opioids. This Review discusses the safe implementation of opioid therapy in these patients, including specific pharmacological considerations, drug choice and opioid use monitoring.

To quote Nelson Mandela, “education is the most powerful weapon which you can use to change the world”. Education and training have changed the world of nephrology in Africa for many patients and their physicians, but most low- and middle-income countries still lack access to affordable therapies for kidney disease.

The clinical course of diabetic kidney disease can follow different trajectories of albuminuria and glomerular filtration rate. In this Review, the authors discuss these trajectories and their underlying factors, as well as their correlation with histopathological changes in the kidney and patient outcomes.

Interruptions to dialysis services in resource-limited settings, like India, amidst the COVID-19 pandemic has highlighted our ill-preparedness. We need alternative plans to safeguard the provision of this life-sustaining treatment and protect our vulnerable patients.

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.

Ameliorating the inequitable burden of kidney disease that is experienced by Aboriginal and Torres Strait Islander peoples is an achievable goal. Genuine and committed partnerships between the Australian government, health-care providers and Aboriginal and Torres Strait Islander peoples are imperative to maximize the success of health equity initiatives.

Venezuela is going through a humanitarian crisis that has severely impacted all programmes of kidney replacement therapy — dialysis coverage has decreased markedly, particularly in small towns and rural areas, and almost all peritoneal dialysis and deceased donor organ procurement for kidney transplantation have been discontinued.

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.

Working towards sustainable development is essential to tackle the rise in the global burden of non-communicable diseases, including kidney disease. Five years after the Sustainable Development Goal agenda was set, this Review examines the progress thus far, highlighting future challenges and opportunities, and explores the implications for kidney disease.

Many children die from preventable and/or treatable kidney disease in low-resource settings. Here, the authors examine strategies to improve the care of these children, including the need to invest in disease prevention and early detection, promote disease awareness and education, and adapt treatments to expand provision.

Here, the authors discuss the mechanisms by which food and specific nutrients could affect the uraemic phenotype in chronic kidney disease (CKD). They suggest that a food-as-medicine approach could potentially be used to prevent and treat CKD and its complications.

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.

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.

Emerging evidence suggests that plant-based diets could help to prevent chronic kidney disease (CKD), manage its symptoms and metabolic complications and delay disease progression. Here, the authors discuss the potential risks and benefits of these diets in patients with CKD, as well as implementation strategies and knowledge gaps.

Capasso and colleagues provide an overview of cognitive dysfunction resulting from CKD, including mild cognitive impairment and dementia. CKD-associated cognitive impairment seems to be caused by the effects of uraemic neurotoxins and kidney neurotrophins on specific neurons and regions of the brain.

Here, the authors review drivers of fibrogenesis, including epithelial cell injury, inflammation, regeneration pathways and factors that promote the AKI-to-CKD transition. They discuss direct targeting of fibrotic pathways and therapeutic approaches that have reportedly decreased kidney fibrosis in preclinical and/or clinical studies.

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.