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  • Kidney disease is an underappreciated medical complication of anorexia nervosa. Further research is needed to clarify the mechanisms that drive kidney disease in patients who restrict caloric intake or engage in purging. Education and awareness are also needed, because kidney disease is often under-recognized by these patients and their clinicians.

    • Leah Puckett
    • Shoshana Mehler
    • Philip Mehler
  • 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
  • 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
  • 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
  • Advancing kidney health justice for all requires the kidney-care community to embrace gender-affirming care across the life course, including inclusion of gender minority individuals in research, thoughtful attention to sexual-orientation and gender-identity data collection, as well as the promotion of policies and practices that protect and provide comprehensive care to all patients.

    • Han E. Eckenrode
    • Joseph T. Flynn
    • Dinushika Mohottige
  • People with chronic diseases are at high risk of becoming innocent victims of the Russian–Ukrainian war, owing to interruption of their health care. More than 10 million Ukrainian people have left their homes and almost 5 million have left the country. Provision of kidney care for these refugees is an emerging challenge.

    • Giorgina B. Piccoli
    • Giuliano Brunori
    • Kamyar Kalantar-Zadeh
  • People who identify as sexual and/or gender minority individuals face unique and challenging inequities in access to health care. They experience bias, discrimination and underinsurance, which limits their access to high-quality care (including for kidney disease). These inequities must be addressed through the provision of safe and inclusive environments, improved identification of disparities and the creation of a pipeline of equity-focused leaders.

    • Juan D. Salcedo-Betancourt
    • Samira S. Farouk
    • Yuvaram N. V. Reddy
  • 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
  • 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
  • Decades of research have revealed that nephron number is a crucial determinant of kidney health. However, a lack of appropriate tools has limited these studies to ex vivo analyses. For the first time, techniques are emerging that might enable the use of functional nephron number as a biomarker in living humans.

    • Kevin M. Bennett
    • Edwin J. Baldelomar
    • Jennifer R. Charlton
  • 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
  • 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.

    • Annemiek Dorgelo
    • Tom A. J. Oostrom
  • 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.

    • John D. Ortiz
  • 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
  • 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.

    • Aminu K. Bello
    • David W. Johnson
  • Vaccination against SARS-CoV-2 seems to be safe in patients with immunity-mediated kidney disease, although their immunological responses to vaccination are impaired. Further strategies, including the administration of additional vaccine doses and passive immunization with long-acting monoclonal antibodies, might increase protection in this vulnerable patient group.

    • Maria Prendecki
    • Michelle Willicombe
    • Stephen P. McAdoo
  • Patients receiving dialysis are at high risk of contracting SARS-CoV-2 and developing severe COVID-19. Established SARS-CoV-2 vaccination schemes might lack efficacy in these patients and a personalized approach is therefore necessary. Importantly, given the enhanced infection risks associated with dialysis, current vaccines do not replace non-pharmacological measures to prevent infection.

    • Benjamin Wilde
    • Johannes Korth
    • Andreas Kribben
  • Kidney transplant recipients receive therapeutic immunosuppression that impairs their immune responses to the COVID-19 mRNA vaccine. For this reason, this vulnerable patient population is insufficiently protected by the standard two-dose COVID-19 vaccination programme and requires a specific follow-up to guide personalization of an intensified vaccination approach.

    • Sophie Caillard
    • Olivier Thaunat
  • Kidney involvement is common in patients with acute SARS-CoV-2 infection, and subclinical inflammation and injury may persist for many months, resulting in a progressive decline in kidney function that leads to chronic kidney disease. Continued research is imperative to understand these long-term sequelae and identify interventions to mitigate them.

    • Sachin Yende
    • Chirag R. Parikh