CURRENT OPINION IN NEPHROLOGY AND HYPERTENSION

Implementing novel diagnostic and therapeutic strategies to improve population health outcomes and equity in kidney disease, dialysis therapies, and transplantation
Tantisattamo E, Hanna RM and Kalantar-Zadeh K
Incremental hemodialysis transition in veterans and nonveterans with kidney failure
Rhee CM, Kovesdy CP, Unruh M, Crowley S, Geller D, Goldfarb DS, Kraut J, Rastegar M, Rifkin IR and Kalantar-Zadeh K
Initiation of hemodialysis treatment with a thrice-weekly prescription is currently the standard of care irrespective of patients' residual kidney function (RKF), comorbidities, and preferences.
Editorial introductions
Population health strategies for health equity in chronic kidney disease management
Brown CO, Pham PC, Shah A, Dukkipati R, Shen J, Elali I, Dai T, Raff EA and Kalantar-Zadeh K
Chronic kidney disease (CKD) is a widespread health issue, affecting one out of every 10 adults. This prevalence is even higher among vulnerable and underserved populations, including low-income individuals, racial and ethnic minorities, and immigrants. Urban areas such as New York City and Los Angeles County offer municipal safety-net healthcare systems for these groups.
Recent advances in peritoneal dialysis catheter placement: the association between method of insertion, operator, and prior abdominal surgery and outcomes
Quinn RR and Oliver MJ
Peritoneal dialysis (PD) is associated with comparable outcomes to hemodialysis and is much less expensive to provide in most parts of the world. A well functioning PD catheter is required, but complications are frequent, and while there are guidelines for the placement and care of a PD access, they are based on low-quality evidence.
Bringing the end-stage kidney disease life plan home
Shah AD
International equity in access to home dialysis
Iyengar A, Kalyesubula R, Darwish R and Luyckx VA
Discussion of inequalities and inequities in global distribution of and access to home dialysis.
Automation and innovation in home hemodialysis machines
Shamy OE and Sloand JA
In this review, we discuss the timeline of innovation and technologic development in home hemodialysis (HHD) in the United States and the legislative approvals that accompanied them.
Recent advances in the understanding of the peritoneal membrane
Seghers F, Tintillier M and Morelle J
The efficiency of peritoneal dialysis (PD) as a life-sustaining replacement therapy for patients with kidney failure relies on the integrity and function of the peritoneal membrane. Here, we review the most recent advances in the understanding of the peritoneal membrane and its role in PD.
Practicing health equity in kidney care by establishing improved access to timely disease management and kidney replacement therapy options: from providers to patients
Yerram P, Edwards D, Norris KC, Molony D, Kalantar-Zadeh K and Landry DL
The aim of this article is to review the current understanding of disparities in healthcare experienced by people living with kidney disease and emerging approaches to address root causes. Health equity for any disease state is an aspirational goal commonly sought out by the medical community, but all too often lacking the understanding and support required to improve the outcomes of people with complex conditions such as chronic kidney disease (CKD).
Staying home when peritoneal dialysis ends: the integrated home dialysis approach
Pecce A, Belhumeur L and Nadeau-Fredette AC
Home dialysis has been promoted for several years for patients starting dialysis. Although incident use of peritoneal dialysis (PD) and home hemodialysis (HHD) is increasing in several regions, patients on home dialysis remain at high risk of transfer to facility-hemodialysis (HD). The integrated home dialysis model, where patient start dialysis on PD and eventually transition to HHD when PD cannot be optimally continued has gain interest from dialysis stakeholders.
The cardiovascular unphysiology of thrice weekly hemodialysis
Shringi S and Shah AD
This review examines the unphysiological nature of conventional intermittent hemodialysis (IHD) and explores alternative dialysis modalities that more closely mimic natural kidney function. As cardiovascular complications remain a leading cause of morbidity and mortality in dialysis patients, understanding and addressing the limitations of IHD is crucial for improving outcomes.
Evolving indications and management patterns in heart - kidney transplantation
Lang FM and Topkara VK
Dual heart - kidney transplantation (HKT) is an increasingly utilized option for patients with end-stage heart failure and impaired renal function. In 2023, the United Network for Organ Sharing (UNOS) formalized indications for simultaneous heart - kidney transplantation (SHKT) and kidney-after-heart transplantation (KAHT). In light of this landmark effort, we review the evolution in HKT indications, outcomes after SHKT and KAHT in various patient populations, novel considerations in pre and posttransplant management, and areas for future research.
Infection prevention in home dialysis
Al Sahlawi M, Chan CT and Perl J
Among patients with kidney failure, home dialysis modalities, including peritoneal dialysis (PD) and home hemodialysis (HHD) provide several individual and healthcare system benefits over in-center hemodialysis (HD). Infection remains a major source of morbidity and mortality in this population, and a core outcome of critical importance to patients, caregivers, and kidney health professionals. This narrative review provides evidence-based measures for infection prevention among individuals receiving home dialysis, with a particular emphasis on dialysis and access-related infections.
Prospects for gene therapy in polycystic kidney disease
Chakraborty A and Yu ASL
We aim to provide an updated perspective on the recent advancements in gene therapy for polycystic kidney disease (PKD), a genetic disorder with significant morbidity. Given the rapid evolution of gene therapy technologies and their potential for treating inherited diseases, this review explores the therapeutic prospects and challenges in applying these technologies to PKD.
Why protein-energy wasting leads to faster progression of chronic kidney disease
Narasaki Y, Rhee CM, Kalantar-Zadeh K and Rastegar M
Protein-energy wasting (PEW) is increasingly more prevalent as chronic kidney disease (CKD) progresses to more advanced stages. There is a global recognition of the importance of preventing and mitigating PEW in the CKD population not on dialysis given the goal of extending dialysis-free time and delaying dialysis initiation and growing evidence of the clinical consequences of PEW which include the risk of death, hospitalization and clinical conditions such as infections. We reviewed the association of PEW and the malnutrition characteristics indicative of PEW on CKD progression.
Updated diagnostic and therapeutic management for membranous nephropathy
Caravaca-Fontán F, Yandian F and Fervenza FC
Pioneering contributions in membranous nephropathy over the last decade have greatly enhanced our comprehension of its pathogenesis, diagnosis, and treatments, igniting renewed interest in this entity. This review provides an updated perspective on the diagnosis and therapeutic management of membranous nephropathy.
Diagnostic and therapeutic challenges in implementing hypertension management after kidney transplantation
Tantisattamo E, Ferrey AJ, Reddy UG, Redfield RR, Ichii H, Al Ammary F and Lau WL
Evidence for blood pressure (BP) measurement and hypertension management in kidney transplant recipients (KTR) remains lacking.
Social and humanitarian issues in nephrology and hypertension
Abdellatif DA
Chronic kidney disease and hypertension, two widely prevalent conditions worldwide, present an urgent and pressing need for immediate action. The review describes how social conditions and humanitarian issues can influence hypertension and kidney disease.
Built environment and chronic kidney disease: current state and future directions
Kim B, Kanchi R, Titus AR, Grams ME, McAdams-DeMarco MA and Thorpe LE
Despite emerging studies on neighborhood-level risk factors for chronic kidney disease (CKD), our understanding of the causal links between neighborhood characteristics and CKD is limited. In particular, there is a gap in identifying modifiable neighborhood factors, such as the built environment, in preventing CKD, that could be targets for feasible place-based interventions.
Population health strategies for health equity in chronic kidney disease management
Brown CO, Pham PC, Shah A, Dukkipati R, Shen J, Dai T, Raff EA and Kalantar-Zadeh K
Chronic kidney disease (CKD) is a widespread health issue, affecting one out of every 10 adults. This prevalence is even higher among vulnerable and underserved populations, including low-income individuals, racial and ethnic minorities, and immigrants. Urban areas such as New York City and Los Angeles County offer municipal safety-net healthcare systems for these groups.