In this prospective cohort of patients with severe and symptomatic ESKD requiring an urgent start of HD or PD owing to uremic syndrome, both modalities offer similar outcomes in terms of mortality, correction of uremia, and technical survival. Authors found that the urgent start of PD is feasible and effective in the short- and long-term compared to HD. Suggesting that the reluctance to use PD as the initial modality in these urgent scenarios requires further consideration and ongoing evaluation.

This retrospective single-center study examined the effects of socioeconomic status on preemptive kidney transplantation in children. Using an individual-level SES measure, HOUSES, generated by linking recipients' address information to publicly available real property data, which they categorized into quartiles, researchers found significantly lower odds of preemptive kidney transplantation in children with lower SES (Q1 HOUSES quartile) compared to children with higher SES (Q2-4 HOUSES quartile) after adjusting for age at kidney failure sex, donor type, insurance type, and the cause of kidney failure.

Patients on dialysis want to discuss their preferences for treatment. The Shared Decision-Making-Renal Supportive Care intervention effectively elicited dialysis patient preferences for end-of-life care. The HIGHWay project updated this intervention to scale it for broader implementation of advance care planning to all patients during their regular dialysis session and to address barriers previously found.

This episode discusses a study that measured objective nocturnal sleep duration of patients on hemodialysis and characterized natural and dialysis-imposed patterns of sleep duration using a commercially available wearable activity tracker.

Data from nearly 16,000 French peritoneal dialysis (PD) patients were analyzed in this large observational study, to understand factors influencing transfers to hemodialysis for different reasons. Nurse-assisted PD was associated with a reduced risk of infection-related transfers in the first 18 months and inadequacy-related transfers after 6 months. Continuous ambulatory PD showed higher mechanical issue risks early on but better outcomes after 18 months. Suboptimal-starters had increased psychosocial-related transfer risks in the first 6 months. These findings suggest that understanding timing-specific risk factors could help implement targeted preventive strategies to maintain patients on PD longer.

A Kidney360 study examined the living kidney donor evaluation process to determine the point at which sex imbalance arises. The authors conducted a single institution retrospective chart review of self-referrals for living donor evaluation between 2009-2022. Exclusion at each stage was recorded and compared between sexes using log binomial regression. Overall, there were 1,861 self-referrals (65.2% females, 34.8% males), resulting in 146 approvals and 125 donations (60.8% females, 39.2% males). The adjusted risk ratios indicated no significant differences in completing workup, having contraindications, being approved for donation, and proceeding with donation. Thus, female overrepresentation stems from a 1.9x higher self-referral rate.

This episode highlights a study that aimed to analyze the time-varying effect of assistance on the risk of PD cessation. This study was conducted using data from the RDPLF of 15675 incident PD patients between 2002 and 2018. Patients treated with assisted PD had a greater risk of death and a lower risk of transfer to HD. However, the protective effect of assisted PD on the risk of transfer to HD was not constant over time; it started between the first 6 to 12 months on PD. Assisted PD programs should be sustainable for at least 6 months to observe their benefits.

In an analysis of patients undergoing kidney transplantation, depression and health related quality of life (HRQOL) were measured using the Beck Depression Inventory-II (BDI-II) and Kidney Disease Quality of Life Short Form Version 1.3 (KDQOL) physical health composite score (PCS) and mental health composite score (MCS) at 3-months and 1-year post-transplantation. Depression and HRQOL improve with KT. While depression improves in all ages, the improvement in HRQOL, especially PCS, is more evident in younger patients. This improvement in depression and HRQOL is sustained until at least 1-year post-KT.

In a Kidney 360 article of 31 patients with native kidney biopsy proven oxalate nephropathy described from the Cleveland Clinic Kidney Biopsy Epidemiology Project, 10 of 31 patients had multifactorial etiologies of oxalate nephropathy, such as enteric hyperoxaluria and excessive precursor intake. 10 of 31 had a single etiology and 11 had risk factors but the etiology was unknown. Key findings included additional diagnoses such as ATN and diabetic kidney disease in 27 of 31 patients, moderate to severe interstitial fibrosis on biopsy at diagnosis in 90% of patients, with 21 of 26 patients with 1 year follow up data being dialysis dependent at 1 year.

Utilizing a multinational collaborative network, a study provided the first systematic description of urinary vacuolar casts in patients with acute or chronic kidney disease. Notably, these casts are not included in most textbooks of urinalysis and/or urine microscopy. The investigators reported that these distinct type of casts are associated with the presence of a glomerular disease and overt proteinuria. Moreover, individuals in which vacuolar casts were identified via urinary sediment microscopy had greater degree of proteinuria and greater percentage of glomerular obsolescence than a control group of patients without vacuolar casts. Further studies will be needed to examine the prognostic value of vacuolar casts.