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Chronic kidney disease and the global public health agenda: an international consensus

  • Anna Francis
  • Meera N. Harhay
  • Vivekanand Jha
Consensus Statement

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  • A toolbox

    A series of articles that aim to explore the tools and techniques that are improving our understanding of renal development, physiology and disease mechanisms as well as contributing to advances in the screening, diagnosis and management of kidney diseases.

  • A kidney puzzle

    This Focus issue examines how tackling the three dimensions of sustainable development — social, economic and environmental — is essential to improving global kidney health.

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    • In this Review, the authors discuss potential pathophenotypes of coexisting chronic kidney disease and pulmonary hypertension, discuss the principles of clinical management of patients with chronic kidney disease or kidney failure and pulmonary hypertension, and outline key areas for further research.

      • Katarina Zeder
      • Edward D. Siew
      • Bradley A. Maron
      Review Article
    • Perturbations in the regulation of gene expression can contribute to disease- and ageing-associated changes in cell physiology. This review describes how the coordination of gene expression within and between cells can be represented through models of the molecular interactions that govern gene expression levels, and how such models can be used to understand age-associated changes in cell physiology.

      • Paula Unger Avila
      • Tsimafei Padvitski
      • Andreas Beyer
      Review Article
    • In this Review, Owen Lyons discusses the diagnosis, epidemiology and pathophysiology of three sleep disorders that commonly affect patients with chronic kidney disease — restless legs syndrome, insomnia and sleep apnoea — and their impact on patient morbidity and mortality.

      • Owen D. Lyons
      Review Article
    • In this Review, the authors summarize the mechanistic rationale for current treatments for podocytopathies and for novel podocyte-targeted therapies. They also discuss potential approaches to regenerate podocytes and to develop podocyte-specific drug delivery systems.

      • Kristin Meliambro
      • John C. He
      • Kirk N. Campbell
      Review Article
    • Spatially resolved transcriptomic technologies enable the mapping of transcripts at single-cell or near single-cell resolution in a multiplex manner. This Review describes current and emerging spatial transcriptomic methods, their applications of relevance to kidney biology and remaining challenges for the field.

      • Sanjay Jain
      • Michael T. Eadon
      Review Article
  • Graft rejection is traditionally attributed to adaptive immune cells that recognize donor-specific alloantigens, with innate immunity having a secondary role. The finding that recipient natural killer cells are activated by the inability of graft endothelial cells to provide HLA-I-mediated inhibitory signals challenges this dogma and introduces the concept of innate rejection.

    • Olivier Thaunat
    Comment
  • Kidneys from older donors might improve the quality of life and survival of patients with kidney failure, yet these organs are often underutilized. Re-framing discussions of organ acceptance from older donors and its benefits over dialysis, especially for older patients and those who cannot tolerate prolonged waiting for transplantation, is urgently needed.

    • Vidya A. Fleetwood
    • Krista L. Lentine
    Comment
  • Centenarians — who are a putative model of healthy longevity — often have a low risk of cardiovascular disease, despite an age-associated decline in kidney function. An understanding of the molecular and cellular underpinnings of health kidney ageing in centenarians may provide clues for the prevention or alleviation of the burden of kidney disease in older populations.

    • Yasumichi Arai
    • Motoko Yanagita
    Comment
  • American Indian and Alaska Native peoples have low life expectancy and a disproportionate disease burden (including of chronic kidney disease), owing to inadequate education, poverty, discrimination and underfunding in the delivery of health services, and healthcare institutions’ lack of appreciation for cultural differences. These broad quality-of-life issues are rooted in economic adversity and poor social conditions.

    • Vallabh O. Shah
    • Tassy Parker
    • Mark L. Unruh
    Comment
  • The increasing prevalence of chronic kidney disease (CKD) is placing a growing burden on healthcare systems, which results in considerable economic and environmental challenges. Sustainable CKD care and optimization of patient outcomes requires a new approach to the organization of healthcare systems, in which home monitoring will have a pivotal role.

    • Sabine H. Josemans
    • Lucas Lindeboom
    • Joris I. Rotmans
    Clinical Outlook
  • The use of cystatin C-inclusive equations will continue to propagate the unnecessary overdiagnosis of chronic kidney disease (CKD) in older people. Cystatin C is less biologically specific for CKD than is serum creatinine, inflates the risks of adverse outcomes compared to measured glomerular filtration rate, and does not establish chronicity at a single time point.

    • Andrew D. Rule
    • Richard J. Glassock
    Comment