Kidney and Dialysis

Hypomagnesaemia, a common complication ranging from 20% to over 90%, depending on the diagnostic criteria and population studied, significantly contributes to adverse outcomes, including new-onset diabetes after transplantation, cardiovascular complications, neurological dysfunction and increased infection risk. A total serum magnesium below 0.70 mmol/L is commonly used to define deficiency. In kidney transplant recipients, calcineurin inhibitors downregulate TRPM6 in the distal nephron, leading to early and persistent hypomagnesaemia with links to adverse metabolic and cardiovascular outcomes. Arrhythmia risk rises steeply at total magnesium of <0.50 mmol/L, while neuromuscular irritability and neuropsychiatric symptoms may appear at levels below 0.70 mmol/L. Severe manifestations, such as seizures or tetany, usually occur at ≤0.50 mmol/L and coma at <0.30 mmol/L. Normal ionised magnesium is typically ~0.48–0.65 mmol/L; transplant-specific intervention thresholds remain unvalidated. This narrative review addresses critical diagnostic gaps and explores emerging therapeutic strategies. It highlights three areas: the diagnostic accuracy of ionised magnesium over total magnesium, the critical role of pharmacogenomics in individualising immunosuppression to mitigate tacrolimus-induced hypomagnesaemia and the promising link between gut microbiome modulation and magnesium homeostasis. The implications of these insights are profound: enabling more precise diagnosis and personalised management, reducing the incidence and severity of hypomagnesaemia-related complications, and ultimately supporting more precise diagnosis and personalised management; prospective validation in transplant cohorts is required before outcome claims can be made. This review exposes current diagnostic and therapeutic limitations, advocating for more precise and personalised strategies to address this critical electrolyte imbalance. Identifying hypomagnesaemia as a mechanistically complex and clinically undertreated complication, this review proposes a thematic roadmap that serves as a scientific and clinical framework for advancing personalised electrolyte care in renal transplantation. It is emphasised that while these approaches appear promising, most remain under-evaluated or hypothesis-generating. Addressing hypomagnesaemia through validated thresholds, new research is required to test novel diagnostics and personalised strategies to improve patient and graft outcomes. Full article

Objective: This scoping review synthesized and mapped the breadth of the existing literature on technological resources used to support individuals undergoing hemodialysis treatment. Methods: Following the methodological guidelines of the Joanna Briggs Institute (JBI) for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist, comprehensive searches were conducted across the following databases: MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Scopus, Scientific Electronic Library Online (SciELO), MedicLatina, and the Cochrane Central Register of Controlled Trials, with no time restrictions. Results: Thirty-nine studies conducted between 2003 and 2023 met the inclusion criteria. These studies covered a range of technological innovations developed specifically for hemodialysis treatment, including virtual reality, exergames, websites, and mobile applications. These technologies were designed with diverse objectives: to facilitate physical exercise, optimize dietary and medication management, improve disease adherence and management, and promote self-efficacy and self-care in patients. Conclusions: The review revealed a wide range of technological resources available to hemodialysis patients. These digital solutions show great potential to transform care by promoting more engaged and personalized health practices. Although this study did not directly assess the impact of these technologies, it provides a solid foundation for future investigations that can explore in-depth how such innovations contribute to effective disease management and improvement in clinical outcomes. Full article

Residual kidney function (RKF) plays a crucial role in improving outcomes for dialysis patients. Enhanced middle molecular clearance has been proposed as one of the several benefits of preserved RKF. Most patients who start dialysis retain some residual kidney function, providing a rationale for using incremental dialysis. RKF has been associated with mortality benefit in both peritoneal dialysis (PD) and hemodialysis (HD). It also influences technique longevity and lowers peritonitis rates in patients on PD. In both dialysis modalities, RKF improves volume management and blood pressure control. Additional potential benefits include reduced dietary restrictions, improved nutritional status, better quality of life (QOL), reduced erythropoiesis-stimulating agent (ESA) requirements, lower inflammatory marker levels, and improved bone health. RKF is less frequently measured in HD patients primarily due to the lack of standardized methods and logistical challenges. Several equations for estimating RKF have been proposed, but none are widely adopted in clinical use. Historically, HD was believed to cause a rapid loss of RKF; however, more recent data have challenged this view. Future research should focus on identifying factors that affect RKF, standardizing measurement methods, and developing strategies for preservation. Efforts to preserve RKF should be made for all dialysis patients, regardless of modality. Full article

Several studies have shown an association of fibroblast growth factor-23 (FGF-23), 25-hydroxyvitamin D (25(OH)D), and asymmetric dimethylarginine (ADMA) with the pathogenesis of albuminuria. However, the direct relationship of these biomarkers with albuminuria independent of other risk factors for chronic kidney disease (CKD) remains controversial. FGF-23 and ADMA levels were associated with the progression of CKD, with a cutoff value of ≥100 RU/mL for FGF-23 and 0.69 μmol/L for ADMA. Background/Objectives: To analyze the correlation between FGF-23, 25(OH)D, and ADMA levels and albuminuria. Methods: This was an observational analytic study with a cross-sectional design conducted in patients with CKD with various disease stages (non-dialysis). The output is albuminuria. Statistical analysis was performed using multivariate logistic regression analysis. Results: This study included 107 patients with CKD stages 2–5 with an average age of 57.32 years. Their average FGF-23, vitamin D, ADMA, and uACR levels were 197.75 RU/mL, 23.44 ng/mL, 0.719 µmol/L, and 940 mg/g, respectively. FGF-23 was weakly correlated with uACR (r = 0.252; p = 0.009). Vitamin D was weakly correlated with uACR (r = −0.375; p = 0.000). ADMA was strongly correlated with uACR (r = 0.687; p = 0.00). Multivariate analysis showed an association of ADMA ≥ 0.69 µmol/L (p = 0.000) with albuminuria ≥ 300 mg/g (p = 0.003). Conclusions: ADMA was correlated with the presence of macroalbuminuria, strongly indicating its role in the progression of CKD. Full article

End-stage chronic kidney disease remains a global challenge, with dialysis and transplantation offering only partial or limited solutions. Recent advances in bioengineering have introduced modular strategies that aim to restore kidney function not by replicating the entire organ, but by rebuilding it one segment at a time. Platforms such as kidney organoids, implantable bioartificial kidneys, 3D-bioprinted tissues, and decellularized scaffolds each target specific nephron functions, from filtration to endocrine signaling. This Perspective examines how these technologies can be integrated into interoperable systems that reflect the nephron’s native structure and functional complexity. We assess translational readiness across key benchmarks, including vascular integration, hormonal responsiveness, immune compatibility, and implantability, and discuss the ethical, regulatory, and design considerations that will shape their clinical future. Collectively, these modular strategies offer a pathway toward more personalized, scalable, and physiologically relevant approaches to kidney replacement. Full article

New and emerging technologies are being developed to combat some of the most pressing issues regarding peritoneal dialysis training, delivery, and complication identification. Currently used peritoneal dialysis solutions are high-dextrose concentrated acidic solutions that can cause increased glucose absorption and peritoneal membrane degradation via a combination of pseudohypoxia and inflammation. Supply storage, the portability of the currently available devices, and the reactive approach to peritonitis identification and treatment are amongst the challenges facing peritoneal dialysis providers and patients. Technologic advancement to combat these issues are underway, and it is important that we study them comprehensively prior to widespread implementation. In this work, I discuss some of these advancements and technologies. Full article

Background: Cardiovascular disease is the leading cause of death in chronic kidney disease populations. The risk of major adverse cardiovascular events (MACE) is greater than that of progression to end-stage kidney disease. An exponential increase in mortality risk is associated with declining kidney function. This study aimed to review the current landscape of traditional and novel blood biomarkers in predicting MACE in ESKD patients. Methods: The systematic review was registered on PROSPERO (CRD42024497403). Standard and extensive Cochrane search methods were used. The latest search date was July 2023. Participants were aged ≥18 years with end-stage kidney disease. Descriptive analysis was performed and data was presented in tabular form. The hazard ratio or odds ratio was presented for potential biomarkers discovered. Results: Overall, 14 studies (4965 participants) were included for analysis; 12 focused on participants requiring haemodialysis and 2 on haemodialysis and peritoneal dialysis. The biomarkers analysed were Troponin I (n = 3), Troponin T (n = 3), B-type natriuretic peptide (n = 2), N-Terminal Pro-Brain-Natriuretic Peptide (n = 7), soluble receptors for advanced glycation end products (n = 2), Galectin 3 (n = 4), and the serum-soluble suppression of tumorigenicity-2 (n = 2). Reported study outcomes included all-cause mortality (n = 11), MACE (n = 5), cardiac specific mortality (n = 6), sudden cardiac death (n = 2), and first cardiovascular event (n = 3). Conclusions: This review outlines the potential role of traditional and novel biomarkers in predicting MACE in end-stage kidney disease. Further larger-scale research is required to establish the validity of the study outcomes to develop new methods of cardiovascular risk prediction in this high-risk population. Full article

Despite improvements in kidney transplantation rates, the shortage of donor kidneys remains a critical issue, exacerbated by non-utilization of recovered kidneys due to quality concerns, necessitating advancements in perfusion methods to enhance graft outcomes and usage. Although static cold storage remains the default standard for kidney preservation, newer methods like hypothermic machine perfusion have shown improved outcomes, including reduced delayed graft function and better survival rates. Hypothermic oxygenated machine perfusion and normothermic machine perfusion offer some potential clinical benefits but studies to date have demonstrated mixed results. In the United States, LifePort and the XVIVO’s Kidney Assist Transport are the most popular hypothermic perfusion devices, with NMP devices mostly in trials. Combining perfusion with biomarkers such as mitochondrial flavin mononucleotide, neutrophil gelatinase-associated lipocalin, and osteopontin shows promise in assessing kidney viability and predicting post-transplant outcomes, though further research is also needed. Emphasis on repair biomarkers, such as uromodulin and osteopontin, aims to better predict graft outcomes and develop new therapies. While notable advancements have been made in the use of machine perfusion and viability testing for liver transplantation, additional research with larger sample sizes is essential to substantiate these results and enhance kidney transplantation outcomes. Full article

The prevalence of early non-infectious peritoneal dialysis (PD) catheter complications makes performing PD challenging for patients and difficult for the healthcare team to manage. Three common patient scenarios are presented: catheter flow dysfunction, peri-catheter leaks, and catheter-related abdominal pain. Practice recommendations are integrated into each scenario and tailored to clinical presentation, patient need, and resource availability. The importance of including patients in the decision-making process is emphasized, and examples of how contextual factors modify the proposed approach to complications are given. Full article

The prevalence of end-stage renal disease has surged significantly in recent decades, with an 88% increase reported in the United States between 2002 and 2022. Peritoneal dialysis and home hemodialysis offer numerous advantages over in-center hemodialysis, including improved quality of life, increased treatment flexibility, and reduced healthcare costs. Despite strong preferences among healthcare professionals and the documented benefits of home-based therapies, utilization remains limited in the U.S. One of the many factors that play a role in the underutilization of home therapies is inadequate training and perceived incompetence among nephrology fellows in initiating and managing home dialysis patients. Here in this article, we highlight the current educational gaps in home dialysis training and ways to overcome the barriers. There is a need for a multifaceted approach that includes home dialysis rotations and continuity clinics; a dedicated one-year Home Dialysis Fellowship; and continued medical education through didactics, symposiums, and conferences. Here we emphasize the need for structured, longitudinal programs that combine didactic learning with hands-on clinical in fellowship trainings and the importance of dedicated one-year fellowships in cultivating future leaders and experts in the field. By enhancing training pathways and expanding fellowship opportunities, nephrology education can better equip physicians to meet the growing demand for home dialysis, ultimately improving patient outcomes and advancing public health objectives. Full article

Background: Stress, anxiety and depression are phenomena that often accompany the onset of chronic illness. The development of psychosomatic medicine has led to the study of the influence of other emotional factors, including the presence of anxiety and depression, on a patient’s health status, in addition to quality of life. The aim of this study is to evaluate the relationship between vascular access function and the occurrence of stress, anxiety and depression in haemodialysis patients. Methods: A total of 202 haemodialysis patients were included in the analysis, and the severity of vascular access problems and levels of negative emotions (feelings of stress, anxiety, depression) were assessed using standardised questionnaires (VAQ, HADS-M, PSS-10). Results: The results show that an increase in vascular access function problems correlated with increased levels of stress (r = 0.262; p < 0.001), anxiety (r = 0.456; p < 0.001) and depression (r = 0.391; p < 0.001). Conclusions: The study confirms the significant impact of vascular access quality on patients’ emotional state, highlighting the need to monitor and optimise its functioning to improve the psychological well-being of dialysis patients. Full article

Bloodstream infections are a significant cause of morbidity and mortality among hemodialysis patients. These infections primarily involve Gram-positive bacteria and, less frequently, Gram-negative bacilli. Raoultella ornithinolytica is a Gram-negative bacillus which is known to be a rare opportunistic pathogen. It is found only occasionally in human infections; however, it has been noted as an emerging pathogen. Sepsis caused by this microorganism is very rare. A few cases have been reported among immunocompromised patients or those undergoing invasive procedures. Cases involving urinary catheters or port catheters have also been reported, as well as a single case of a patient on peritoneal dialysis. Here, we present a novel case of Raoultella ornithinolytica bloodstream infection in a patient with chronic renal failure undergoing hemodialysis who was successfully treated. We discuss the microbiology and clinical features of such infections, and consider aspects of treatment. Full article

Chronic kidney disease (CKD) remains a significant global health challenge, with its advanced stages necessitating timely and comprehensive patient education, particularly regarding kidney replacement therapy (KRT). Early initiation of education is crucial, as it enhances patient understanding and supports shared decision-making with healthcare teams, ultimately leading to better health outcomes. Evidence demonstrates that CKD education not only increases disease-specific knowledge, but also confers multiple benefits, including reduced healthcare utilization, greater adoption of self-management, delayed KRT initiation, improved survival, higher adherence to therapies, and increased transplant evaluation. Despite these advantages, a disconnect persists between the educational content desired by patients and what is prioritized by healthcare professionals. Structured educational interventions have been shown to improve patients’ ability to make informed decisions about KRT, with studies indicating that after targeted education, the vast majority of patients can articulate their therapy preferences. Furthermore, national and international guidelines highlight the necessity of embedding patient education as a core component of CKD care to empower patients and improve the quality of life. However, challenges remain, including disparities in access, health literacy, and the consistency of educational delivery. There is currently no standardized approach on how to effectively educate CKD patients. This review provides a comprehensive analysis of all aspects of pre-dialysis education and best practices for advanced CKD patient education. Full article

This review synthesizes current evidence on clinical nursing practices in the management of arteriovenous fistulas (AVFs) among patients undergoing hemodialysis (HD). It investigates the identification of risk factors and elements contributing to AVF dysfunction, emphasizing the crucial role of nursing professionals in maintaining, monitoring, and enhancing the long-term functionality of vascular access. The findings indicate that implementing upper limb exercise protocols can significantly support AVF maturation, enhance hemodynamic parameters, and improve vascular access outcomes. Notably, the review highlights the necessity of continuous education for nurses in AVF management, emphasizing their critical role in the successful preservation and optimization of vascular access, including the promotion of exercise interventions. These insights underscore the importance of equipping nursing staff with current knowledge and skills to improve patient outcomes in HD care. Full article

Resilience, the ability to adapt and thrive in the face of adversity, is an essential yet under-recognized determinant of outcomes in patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD), particularly those undergoing home-based peritoneal dialysis (PD). While studies have shown that PD can enhance autonomy and quality of life compared to in-center hemodialysis (IHD), it also places substantial emotional, physical and self-management demands on patients. Despite this, resilience is rarely assessed or systematically supported in PD care. This narrative review highlights the importance of resilience in CKD and dialysis populations and extends its application to the unique psychosocial challenges faced by PD patients. This review also introduces psychological frameworks of resilience, in particular the GROW model (Good emotions, Reason and purpose, Others and connections, Wellness flexibility), as tools for clinicians to support PD patients in developing optimism, purpose, strong social networks, and emotional adaptability. We also explore how routine, longitudinal assessment of resilience using validated tools can help improve patient well-being, treatment adherence, and long-term outcomes. Full article

Chronic kidney disease (CKD) is prevalent throughout the world, and peritoneal dialysis (PD) has been a growing mode of renal replacement therapy (RRT) for over four decades. Peritoneal dialysis has several advantages in cost, patient satisfaction, and quality of life, despite accounting for only one in ten patients on dialysis in the United States. In spite of some contraindications and barriers to effective PD, the vast majority of renal failure patients are candidates, especially when in a high-volume program with surgical expertise readily available. Reliable access via an intraabdominal PD catheter is paramount for managing end-stage renal disease patients. Surgical approaches for PD catheter insertion have evolved substantially alongside innovations in catheter design. Recent data suggests that the advanced laparoscopic catheter placement offers the best results and long-term survival. However, image-guided fluoroscopic insertion can be performed without general anesthesia, is highly effective, and is growing in usage. Being able to start PD urgently is vital in avoiding hemodialysis (HD) and its complications, and this is a growing theme worldwide, despite slightly higher morbidity. Infectious and mechanical complications are relatively common and are frustrating to PD patients and the physicians who care for them. Peritonitis and exit site infections require antibiotic coverage and sometimes, surgical intervention. Catheter dysfunction is a frequent mechanical issue requiring a multidisciplinary approach: medical treatment, nurse-administered flushing and clot dissolvers, interventional radiology evaluation and wire manipulation, and surgical laparoscopy for catheter salvage. Full article

Asymptomatic bacteriuria (ASB) is a very frequent condition in kidney transplant recipients (KTRs). Guidelines advise against screening and treatment of ASB beyond the first month after renal transplantation. Here, we report the case of a 40-year-old female KTR with untreated ASB complicated with allograft pyelonephritis with urosepsis and acute kidney injury. The reported case highlights that ASB remains a grey area in the management of KTRs (after the first month), and there is a need for new ad hoc studies to identify which patients should be screened and eventually treated. Until new findings are available, it is suggested not to treat KTRs with ASB; however, if ASB is detected, stricter monitoring and non-antibiotic prophylaxis are necessary to favor prevention or prompt therapy of severe urinary tract infections. Full article

Background Socioeconomic factors significantly influence access to kidney transplantation, with socially vulnerable populations experiencing delays in receiving transplants, resulting in prolonged dialysis duration and poorer post-transplant outcomes. This study evaluates the relationship between social vulnerability and disparities in preemptive kidney transplantation using the Social Vulnerability Index (SVI), a composite measure developed by the Centers for Disease Control and Prevention (CDC). Methods Utilizing data from the Scientific Registry of Transplant Recipients (SRTR) from 2012 to 2020, we analyzed 155,424 adult kidney transplant recipients. The primary exposure was SVI, categorized into quartiles, while primary outcomes included preemptive transplant status and dialysis vintage. Multivariable regression models were adjusted for clinical covariates such as age, gender, BMI, diabetes, and peripheral vascular disease. Result Findings indicate that higher social vulnerability is significantly associated with a reduced likelihood of preemptive kidney transplantation (p < 0.0001) and an increased duration of dialysis prior to transplantation. Patients in the highest SVI quartile (0.75–1.00) were more than twice as likely to undergo dialysis before transplantation compared to those in the lowest quartile (OR = 2.21, 95% CI: 1.89–2.57). Similarly, increased SVI was strongly correlated with prolonged dialysis duration (OR = 3.43, 95% CI: 3.31–3.55, p < 0.0001). Conclusions These results highlight the impact of socioeconomic disparities on access to timely kidney transplantation. Addressing social vulnerability factors—such as poverty, education, and healthcare access—may help reduce inequities and improve transplantation outcomes. Future interventions should target high-SVI communities to facilitate earlier transplant access and reduce reliance on prolonged dialysis. Full article