Kidney360 Podcast

In 11,409 adults with CKD and no prior heart failure, drawn from the NYU MUSE ECG database linked to electronic health records, three standard ECG features — PR interval, corrected QT, and T axis independently predicted new-onset HF hospitalization. Adding them to a clinical model improved discrimination modestly (C-statistic 0.70 to 0.73). HRV parameters from 10-second tracings did not add independent predictive value. The findings support routine ECG as a low-cost adjunct to existing HF risk assessment in CKD, pending external validation.

Sickle cell disease causes accelerated kidney function decline, yet proven GFRpreserving therapies remain elusive. In this two-center, propensity score-matched study of 358 adults with sickle cell disease, RASi use was not associated with a significant difference in the rate of eGFR decline compared with no treatment (−0.15 mL/min/year; 95% CI, −1.67 to +1.36; p = 0.84). This null finding was robust across sensitivity analyses excluding missing albuminuria and low dose RASi. These results highlight the limitations of observational data and underscore the urgent need for prospective randomized trials targeting GFR preservation in sickle cell disease.

This podcast discusses a post hoc analysis of the STOP-ACEi trial, examining whether baseline loop diuretic use modifies the effect of Renin–Angiotensin System Inhibitors in advanced CKD. Among patients not receiving loop diuretics, stopping Renin-angiotensin system inhibitors was associated with lower eGFR at three years and a faster decline in kidney function. In contrast, among patients taking loop diuretics, the decline in eGFR was slower and withdrawal of RAS inhibitors had little effect on eGFR decline. Rates of ESKD and KRT were similar between groups, although mortality appeared higher in patients receiving loop diuretics. Overall, the findings suggest that discontinuing RAS inhibitors may be more harmful in advanced CKD patients who are not taking loop diuretics.

This episode highlights data from a qualitative substudy of the AV Access trial, a randomized controlled trial studying outcomes of older adults who are receiving hemodialysis with a central venous catheter.

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.