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  • The fibrogenic niche is a unique tissue microenvironment that promotes fibroblast activation in organ fibrosis. This Review discusses the composition, function and mechanisms of action of the fibrogenic niche in kidney fibrosis, as well as the potential implications of the fibrogenic niche hypothesis for the future diagnosis and treatment of kidney diseases.

    • Li Li
    • Haiyan Fu
    • Youhua Liu
    Review Article
  • Salt substitution — the partial replacement of sodium with potassium in table salt — is emerging as a powerful public health strategy to reduce hypertension and related diseases. Here, we explore whether salt substitution is suitable for people with kidney disease by weighing the potential cardiorenal benefits against the risk of hyperkalaemia.

    • Ewout J. Hoorn
    • Matti Marklund
    • Jason H. Y. Wu
    Comment
  • The cyclic GMP–AMP synthase (cGAS)–stimulator of interferon genes (STING) pathway not only is involved in host defence against infection but can lead to immune dysregulation. Here, the authors examine the biology and biochemistry of cGAS–STING and discuss its role in disease and potential approaches to therapeutic targeting.

    • Sladjana Skopelja-Gardner
    • Jie An
    • Keith B. Elkon
    Review Article
  • Hypoxia-dependent changes in cellular metabolism have important implications for the effective functioning of multiple immune cell subtypes. This Review describes the inputs that shape the hypoxic response in individual cell types and contexts, and the implications of this response for cellular metabolism and associated alterations in immune cell function.

    • Cormac T. Taylor
    • Carsten C. Scholz
    Review Article
  • Meaningful involvement of patients in clinical trial design could lead to improvements in participant recruitment and retention, the uptake of the tested intervention and the impact of the findings. Here, the authors discuss the involvement of patients at all stages of trial design.

    • Allison Tong
    • Nicole Scholes-Robertson
    • Jonathan C. Craig
    Review Article
  • In this Review, the authors discuss the roles of extracellular vesicles in kidney physiology and disease as well as the beneficial effects of stem cell-derived extracellular vesicles in preclinical models of acute kidney injury and chronic kidney disease. They also highlight current and future clinical applications of extracellular vesicles in kidney diseases.

    • Cristina Grange
    • Benedetta Bussolati
    Review Article
  • The devastating effects of war are far-reaching and particularly affect people with kidney disease. The Ukrainian conflict has highlighted problems encountered in the provision of support for this vulnerable group. On the basis of these and previous experiences in massive disasters, we propose a sustainable action plan to prepare for similar logistical challenges in future conflicts.

    • Raymond Vanholder
    • Anja De Weggheleire
    • Rukshana Shroff
    Comment
  • Chronic kidney disease is associated with an increased risk of cardiovascular disease, such as heart failure. Here, the authors examine myocardial metabolic remodelling in chronic kidney disease, including changes in energy substrate use, mitochondrial dysfunction and the role of cardiotonic steroids, and discuss potential metabolic therapies.

    • Nikayla Patel
    • Muhammad Magdi Yaqoob
    • Dunja Aksentijevic
    Review Article
  • 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.

    Editorial
  • A post hoc analysis of the COAPT trial suggests that transcatheter mitral valve repair for secondary mitral regurgitation is efficacious in patients with heart failure and chronic kidney disease. The intervention also reduced the risk of kidney failure, raising hypotheses regarding the mechanisms that link heart failure and loss of kidney function.

    • Wendy McCallum
    • Mark J. Sarnak
    News & Views