News & Comment

  • Comment |

    Health-care professionals in general and nephrologists in particular can and should make clear contributions towards achieving the Sustainable Development Goals. This commitment will require changes in patient care, research and education, which should be carried out in collaboration with relevant stakeholders, such as health-care industries.

    • Peter J. Blankestijn
  • Comment |

    The drug development pipeline for kidney diseases is plagued with challenges ranging from an insufficient understanding of disease mechanisms to a lack of robust preclinical models. Bioengineering approaches have the potential to streamline preclinical drug discovery efforts and improve the success of clinical trials for kidney disease.

    • Nanditha Anandakrishnan
    •  & Evren U. Azeloglu
  • News & Views |

    A new study examined post-mortem kidney tissue from 63 patients with COVID-19. The results suggest that SARS-CoV-2 has kidney tropism, including the ability to replicate in kidney cells, and that kidney transduction by SARS-CoV-2 is associated with shorter survival time and increased incidence of acute kidney injury.

    • Anitha Vijayan
    •  & Benjamin D. Humphreys
  • News & Views |

    Timing of dialysis initiation in critically ill patients is controversial. The STARRT-AKI trial reports that an accelerated initiation strategy did not improve 90-day survival and increased dialysis dependency compared with a standard approach in which patients had greater fluid accumulation and metabolic complications at initiation but 38% avoided dialysis.

    • Josée Bouchard
    •  & Ravindra Mehta
  • Comment |

    Interest in the use of haemoperfusion for severe COVID-19 has been spurred by anecdotal reports of its efficacy and expert reviews suggesting theoretical benefits. However, on the basis of the limited current evidence, haemoperfusion remains an experimental therapy that should only be applied within the context of well-designed randomized trials.

    • Edward G. Clark
    • , Swapnil Hiremath
    • , Lauralyn McIntyre
    • , Ron Wald
    • , Gregory L. Hundemer
    •  & Michael Joannidis
  • News & Views |

    A new study uses the OpenSAFELY health analytics platform to identify risk factors for COVID-19 mortality. This analysis, which includes data for more than 17 million people in the UK, suggests that patients with chronic kidney disease are at higher risk than those with other known risk factors, including chronic heart and lung disease.

    • Ron T. Gansevoort
    •  & Luuk B. Hilbrands
  • Comment |

    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.

    • M. R. Moosa
    •  & K. C. Norris
  • Editorial |

    A host of innovative developments in dialysis technologies could potentially transform the field, with benefits for patient outcomes, access to therapy and environmental sustainability.

  • Comment |

    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.

    • Yot Teerawattananon
    • , Kriang Tungsanga
    • , Solange Hakiba
    •  & Saudamini Dabak
  • News & Views |

    The generation of local immune responses in organs requires a coordinated effort, not just from immune cells, but also from ‘structural’ cells such as epithelial cells, endothelial cells and fibroblasts. New insights gained from profiling these cells across organs in the mouse emphasizes the important contribution of this structural cell network to organ immunity.

    • Zewen Kelvin Tuong
    •  & Menna R. Clatworthy
  • Comment |

    Management of kidney transplant recipients requires a sustainable infrastructure that can provide reliable medical care both before and after transplantation. The COVID-19 pandemic has disrupted transplant referral and listing processes, led to decreases in the numbers of transplant procedures and resulted in changes in practice for pre- and post-transplantation management and follow-up.

    • Sami Alasfar
    •  & Robin K. Avery
  • Comment |

    The COVID-19 pandemic has placed a tremendous strain on sustaining the clinical research enterprise and will also likely affect key study outcomes; these effects must be considered during data analysis and interpretation. Nevertheless, the responses to the pandemic have also introduced innovations that will advance the conduct of clinical research.

    • Katherine R. Tuttle
  • Comment |

    Reports of collapsing glomerulopathy in patients of African ancestry and high-risk APOL1 genotype infected with SARS-CoV-2 have emerged during the COVID-19 pandemic. This new entity, which we term COVID-19-associated nephropathy (COVAN), may particularly impact individuals in some regions of the world. Awareness of this potentially ominous complication of COVID-19 must be raised.

    • Juan Carlos Q. Velez
    • , Tiffany Caza
    •  & Christopher P. Larsen
  • Comment |

    Continuous kidney replacement therapy (CKRT) can be a lifesaving intervention for critically ill patients; however, mortality remains high. The adaptation of existing innovations, including anti-clotting measures; cloud-computing for optimized treatment prescribing and therapy monitoring; and real-time sensing of blood and/or filter effluent composition to CKRT devices has the potential to enable personalized care and improve the safety and efficacy of this therapy.

    • Balazs Szamosfalvi
    •  & Lenar Yessayan
  • News & Views |

    Long-term immunosuppression in transplant recipients is associated with important adverse effects including increased risk of infection and malignancy. New data from the ONE Study suggests that use of cell-based medicinal products containing regulatory immune cells is a potentially useful therapeutic strategy to enable minimization of immunosuppression in these patients.

    • James M. Mathew
    •  & Joseph R. Leventhal
  • World View |

    Brazil has been severely affected by the novel coronavirus. At a time when the country needs to concentrate on controlling and fighting the virus, President Bolsonaro has minimized the importance of the pandemic and focused on political battles.

    • Daniela Ponce
  • Comment |

    The most common treatment option worldwide for persons with kidney failure is in-centre haemodialysis; however, this treatment has remained largely unchanged over decades owing to a lack of true patient-centred technological innovation. The development of safe and effective wearable forms of dialysis has the potential to transform the lives of these patients.

    • Jonathan Himmelfarb
    •  & Buddy Ratner
  • News & Views |

    The mechanism underlying glomerular filtration barrier selectivity has not been resolved. A new study that reports an inverse correlation between slit diaphragm density and proteinuria in a genetic mouse model of focal segmental glomerulosclerosis suggests that podocytes function to compress the glomerular basement membrane (GBM) and that failure of this process results in GBM stretching and increased permeability.

    • Marcus J. Moeller
    •  & Arnaldo Chia-Gil
  • Comment |

    Health-care workers involved in the response to the COVID-19 pandemic are often required to work in highly challenging conditions and may therefore be at increased risk of experiencing mental health problems. This Comment sets out a practical approach to protecting the mental health of health-care workers based on contemporary evidence.

    • Neil Greenberg
  • News & Views |

    Clinical trials of sodium–glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP1) receptor agonists have shown beneficial effects of these agents on kidney outcomes in patients with type 2 diabetes mellitus. Two new cohort studies now demonstrate that these findings are generalizable to the broad range of patients seen in clinical practice.

    • Annemarie B. van der Aart-van der Beek
    •  & Hiddo J. L. Heerspink
  • Comment |

    Current dialysis technologies require vast quantities of pure water; however, water is a finite resource and water scarcity is increasing globally. For dialysis to be sustainable, a critical need exists for innovative approaches that address the consumption and wastage of water by dialysis.

    • John W. M. Agar
    •  & Katherine A. Barraclough
  • Comment |

    The coronavirus disease 2019 (COVID-19) pandemic poses important challenges to the care of patients with immune-mediated kidney diseases and to kidney transplant recipients. Here, we discuss the management of immunosuppression for these patients during the pandemic and suggest potential approaches that could be considered in the absence of validated strategies.

    • Andreas Kronbichler
    • , Philipp Gauckler
    • , Martin Windpessl
    • , Jae Il Shin
    • , Vivekanand Jha
    • , Brad H. Rovin
    •  & Rainer Oberbauer
  • Comment |

    An obligation of medical journals is the responsible, professional and expeditious delivery of knowledge from researchers and practitioners to the community. The task of editors, therefore, rests not merely in selecting what to publish, but in judging how it might best be communicated. The challenge of improving descriptions of kidney function and disease in medical publishing was the impetus for a KDIGO consensus conference. The conference goals included standardizing and refining kidney-related nomenclature and developing a glossary to be used by journals.

    • Andrew S. Levey
    • , Kai-Uwe Eckardt
    • , Nijsje M. Dorman
    • , Stacy L. Christiansen
    • , Michael Cheung
    • , Michel Jadoul
    •  & Wolfgang C. Winkelmayer
  • Comment |

    New exposome-based approaches permit omic-scale characterization of the non-genetic contributors to kidney disease. High-resolution mass spectrometry analysis of plasma and urine samples captures a wide range of exogenous and endogenous metabolites that can be used in combination with genetic risk factors to identify new biomarkers of exposure and therapeutic approaches.

    • Tess V. Dupre
    • , Rick G. Schnellmann
    •  & Gary W. Miller
  • Comment |

    Kidney failure is associated with the retention and subsequent accumulation of uraemic toxins, which have detrimental effects on various physiological processes. The removal of these toxins by current dialysis modalities is inadequate, highlighting the need for innovative approaches to enhance their clearance and/or suppress their generation to improve outcomes for patients with kidney disease.

    • Rosalinde Masereeuw
    •  & Marianne C. Verhaar
  • Comment |

    Growing genomic knowledge has provided immense insight into the aetiology and mechanisms of kidney diseases but raises ethical issues that risk the successful implementation of genomic medicine. We highlight such issues in two contexts: the return of individual genetic results from nephrology research and preimplantation genetic diagnosis for heritable kidney diseases.

    • Maya Sabatello
    •  & Hila Milo Rasouly
  • Comment |

    The need for innovation in dialysis is long overdue. As past and present users of dialysis we are fully aware of the limitations of current dialysis modalities. The time for complacency is over — developers must engage with dialysors to ensure that our needs are met so that we can live the best life possible. Let us share our dream for devices that will enable us to enjoy life.

    • Nieltje Gedney
    • , Wim Sipma
    •  & Henning Søndergaard
  • Comment |

    Haemodialysis is a life-saving therapy. However, in comparison with the healthy kidney, it removes only a small fraction of the uraemic toxins produced, does not function continuously and cannot replicate biological kidney functions. Innovations in membrane design hold promise to overcome these limitations with potential to improve patient outcomes.

    • Ilaria Geremia
    •  & Dimitrios Stamatialis
  • Comment |

    Peritoneal dialysis and haemodialysis are lifesaving but intrusive treatments that are associated with high morbidity and mortality. Despite the considerable time patients with kidney failure spend tied to their life-saving therapies, relatively few vital signs are monitored. Smart, unobtrusive approaches to track clinical parameters could help to individualize treatments and improve patient outcomes.

    • Fokko P. Wieringa
    •  & Jeroen P. Kooman
  • Comment |

    Peritoneal dialysis (PD) is the dialysis modality of choice for many regions. The application of innovative technology has led to the development of new PD devices that reduce the environmental and economic costs of the therapy, as well as miniaturized devices that provide greater freedom for patients.

    • Marjorie W. Y. Foo
    •  & Htay Htay
  • Comment |

    The prevalence of direct kidney involvement in novel coronavirus disease (COVID-19) is low, but such involvement is a marker of multiple organ dysfunction and severe disease. Here, we explore potential pathways of kidney damage and discuss the rationale for extracorporeal support with various blood purification strategies in patients who are critically ill with COVID-19.

    • Claudio Ronco
    •  & Thiago Reis
  • News & Views |

    New data suggest that plasma soluble urokinase receptor (suPAR) might be a predictive biomarker and potential therapeutic target for acute kidney injury (AKI). However, many questions remain regarding the potential of suPAR to inform clinical decision making, identify patients for enrolment in clinical trials and add to the understanding of AKI pathogenesis.

    • Sarah Faubel
  • Comment |

    The increasing availability of sequencing has accelerated the discovery of genetic causes of kidney disease, with clear benefits for patients. However, insufficient or contradictory evidence exists for numerous variants that were previously reported to be pathogenic, calling into question some proposed gene–disease associations. Rigorous re-appraisal of evidence is needed to ensure diagnostic accuracy.

    • Daniel P. Gale
    • , Andrew Mallett
    • , Chirag Patel
    • , Tam P. Sneddon
    • , Heidi L. Rehm
    • , Matthew G. Sampson
    •  & Detlef Bockenhauer