Comment in 2021

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  • 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
    Comment
  • 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
    Comment
  • 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
    Comment
  • 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
    Comment
  • 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
    Comment
  • Preparation for health-care transition from paediatric to adult-focused care must continue in young adulthood and requires coordination and an inter-disciplinary approach; however, the implementation of available tools and interventions remains challenging worldwide. Current practices fail to address issues related to patient safety, mental health, respect and equity, even in resource-rich societies.

    • Maria E. Diaz-Gonzalez de Ferris
    • Michael Ted Ferris
    • Guido Filler
    Comment
  • Key differences exist between clinical and research genomics. As genomic testing is adopted in nephrology clinical care, we propose focusing on clinical genomics approaches to obtain genetic diagnoses in order to ensure optimal use of resources and maximum patient benefit.

    • Andrew J. Mallett
    • Nine Knoers
    • Zornitza Stark
    Comment
  • Rationing of scarce health-care resources is distressing. Clinicians therefore require clear guidance, which should be developed systematically and transparently through multi-stakeholder engagement. Rationing is seldom required in high-income settings but is often necessary in low-income settings. Global solidarity and health system strengthening are required to reduce the need for rationing.

    • Mohammed R. Moosa
    • Valerie A. Luyckx
    Comment
  • Living donor kidney transplantation benefits the recipient. However, kidney failure can occur in a small fraction of donors — the risk is not uniform but varies according to donor characteristics. Studies to date have failed to match on important factors, such as era, environment or family history. Long-term studies with well-matched healthy controls are therefore needed.

    • Arthur J. Matas
    • Andrew D. Rule
    Comment
  • Patients with kidney diseases should be prioritized for COVID-19 vaccination and the available data suggest that replication-defective viral-vectored vaccines and mRNA vaccines are safe to use. As vaccine responses are likely to be lower in patients with kidney diseases than in the general population, highly potent vaccines should be preferred.

    • Martin Windpessl
    • Annette Bruchfeld
    • Andreas Kronbichler
    Comment
  • 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.

    • Ezequiel Bellorin-Font
    • Raul G. Carlini
    Comment
  • 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.

    • Daniel Cukor
    • Mark Unruh
    • Rajnish Mehrotra
    Comment
  • 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.

    • Thomas J. Wilkinson
    • Alice C. Smith
    Comment
  • 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.

    • Rasheeda K. Hall
    Comment