{"title":"Social determinants of chronic kidney disease: from association to clinical and population action.","authors":"Ricardo Silvariño, Laura Sola","doi":"10.1097/MNH.0000000000001201","DOIUrl":"10.1097/MNH.0000000000001201","url":null,"abstract":"<p><strong>Purpose of review: </strong>To synthesize recent evidence on how social determinants -socioeconomic conditions, health system, physical environment, psychosocial factors, life course, structural forces, migration, gender, and population vulnerability - shape the risk, progression, and outcomes of chronic kidney disease (CKD), and to identify clinical and health policy implications.</p><p><strong>Recent findings: </strong>The evidence confirms a consistent and cumulative social gradient: simultaneous exposure to low income, lower education, unemployment, housing insecurity, and barriers to healthcare access is associated with higher CKD prevalence, accelerated progression, and increased all-cause and cardiovascular mortality. At the territorial level, social deprivation explains a significant proportion of the variability in the incidence of kidney failure, partially independent of comorbidities and environmental exposures. Groups affected by structural inequities - migrants, Indigenous populations, rural residents, and women - present persistent barriers in early detection, access to nephrology care, choice of dialysis modality, and transplantation. Environmental factors (pollution, heat, working conditions), together with low health literacy and unmet social needs, amplify these inequalities across the care continuum.</p><p><strong>Summary: </strong>CKD should be understood as a bio-social phenomenon in which risk and access to timely, high-quality care are socially determined. Recent literature advances from the description of inequities toward the identification of critical points in the care trajectory and actionable strategies, including targeted screening, integration with social work, barrier-free communication, and culturally well tolerated approaches.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"641-646"},"PeriodicalIF":3.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148197648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Financial and policy challenges of delivering kidney replacement therapies in resource-limited settings.","authors":"Anukul Ghimire, Olalekan E Ojo, Aminu K Bello","doi":"10.1097/MNH.0000000000001202","DOIUrl":"10.1097/MNH.0000000000001202","url":null,"abstract":"<p><strong>Purpose of review: </strong>The adoption of a resolution to prevent and control kidney disease at the 2025 World Health Assembly has set the stage for the global community to address barriers in providing life-saving kidney replacement therapy (KRT) in low- and middle-income countries (LMICs) and low-income countries (LICs), where many patients still cannot access dialysis and transplantation. This review will highlight the financial and policy challenges in the delivery of KRT in LMICs and LICs.</p><p><strong>Recent findings: </strong>The International Society of Nephrology Global Kidney Health Atlas has highlighted global disparities in financing kidney care in LMICs and LICs, which limits the inclusion of KRT in universal health care coverage plans and leads to suboptimal provision of KRT. Despite transplantation being the most cost-effective modality of KRT, its uptake remains limited and is hindered by various barriers in developing infrastructure and limitations in workforce. In addition, recent geopolitical conflict has introduced complex challenges in delivering care to people needing KRT.</p><p><strong>Summary: </strong>There are various challenges in the successful delivery of KRT in LMICs and LICs. Strategies to optimize financing and provision of KRT, develop transplantation programs, and recruit a capable workforce are needed.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"660-665"},"PeriodicalIF":3.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148216812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
William R Marshall, Smeeta Sinha, Darren Green, Philip A Kalra
{"title":"Integrating the liver into the cardiovascular-kidney-metabolic syndrome: pathophysiology and therapeutic implications.","authors":"William R Marshall, Smeeta Sinha, Darren Green, Philip A Kalra","doi":"10.1097/MNH.0000000000001225","DOIUrl":"10.1097/MNH.0000000000001225","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review examines the mechanistic, epidemiological and therapeutic evidence underpinning liver integration into the cardiovascular-kidney-metabolic (CKM) construct. For the purposes of this review, we use the term cardiovascular-renal-hepatic-metabolic (CRHM) syndrome to denote this expanded framework, acknowledging that consensus nomenclature is yet to be established.</p><p><strong>Recent findings: </strong>Large cohort data confirm that coexistent metabolic dysfunction-associated steatotic liver disease (MASLD) and CKD confer additive, stage-dependent mortality risk exceeding that of either condition alone, with hepatic fibrosis severity, rather than steatosis, the dominant prognostic driver. The past 12-18 months have seen significant therapeutic developments spanning the full CRHM spectrum. Resmetirom, a hepato-selective thyroid hormone receptor-β (THR-β) agonist, received FDA-accelerated approval (March 2024) and European Commission conditional marketing authorization (August 2025) as the first licensed metabolic dysfunction-associated steatohepatitis (MASH)-specific therapy; UK approval is pending. Incretin-based therapies demonstrated efficacy across the full CRHM spectrum: semaglutide in diabetic and non-diabetic kidney disease across FLOW, SELECT, and SMART trials; tirzepatide in obesity-related heart failure with preserved ejection fraction (HFpEF) in SUMMIT. Semaglutide additionally received accelerated FDA approval and EU marketing authorization for MASH following the ESSENCE trial; UK approval for this indication is pending.</p><p><strong>Summary: </strong>The integration of the liver into CKM staging now has implications for how clinicians stratify risk and select therapy. Early identification of MASLD in CKD cohorts using validated noninvasive fibrosis tools should be considered standard practice in high-risk populations.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"666-675"},"PeriodicalIF":3.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Displaced people and kidney health.","authors":"Sanjib Kumar Sharma, Urza Bhattarai, Arun Gautam","doi":"10.1097/MNH.0000000000001219","DOIUrl":"10.1097/MNH.0000000000001219","url":null,"abstract":"<p><strong>Purpose of review: </strong>The number of displaced people worldwide continues to rise because of conflict and disasters-related crises. Kidney disease is increasingly recognized as an important contributor to morbidity among displaced populations, yet it remains under-prioritized in humanitarian responses. This review summarizes current evidence on the burden, risk factors, barriers, and management of kidney disease in displaced settings.</p><p><strong>Recent findings: </strong>Recent literature highlights multiple risk factors linking displacement and kidney disease. Acute kidney injury may result from trauma, dehydration, infections, malnutrition, and environmental exposures, while chronic kidney disease is exacerbated by interrupted care for hypertension and diabetes. Major barriers include disrupted health systems, shortages of dialysis and medications, limited diagnostic capacity, financial constraints, and language and cultural challenges. Reports from Syria, Sudan, Ethiopia, Ukraine, Gaza, and other crisis settings demonstrate substantial treatment interruptions and adverse outcomes among patients requiring dialysis or transplantation.</p><p><strong>Summary: </strong>Kidney health should be integrated into humanitarian and primary healthcare responses for displaced populations. Preparedness planning, continuity of care, community-based screening, tele-nephrology, task-shifting, and international collaboration are essential to reduce preventable kidney-related morbidity and mortality. Future research should strengthen epidemiological data and evaluate scalable models of kidney care in displaced settings.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"655-659"},"PeriodicalIF":3.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Beyond creatinine: biomarkers of kidney recovery after acute kidney injury.","authors":"Grazia Dea Bonelli, Nicholas M Selby","doi":"10.1097/MNH.0000000000001218","DOIUrl":"https://doi.org/10.1097/MNH.0000000000001218","url":null,"abstract":"<p><strong>Purpose of review: </strong>Recovery from acute kidney injury (AKI) is currently assessed via traditional diagnostic tests (i.e. serum creatinine) despite increasing recognition that restoration of kidney function does not necessarily correlate with resolution of underlying injury. This editorial summarizes recent advances in biomarkers of kidney recovery after AKI and their potential role in predicting long-term outcomes.</p><p><strong>Recent findings: </strong>Emerging evidence suggests that AKI recovery is determined by several biological processes, including persistent injury, inflammatory signalling, tubular repair and onset of fibrosis. Biomarkers reflecting these pathways have shown promise in identifying patients at risk of maladaptive recovery and progression to chronic kidney disease (CKD). Albuminuria and urinary CCL14 provide information on ongoing injury and incomplete recovery while soluble TNFR1 and 2, urine MCP-1 and YLK-40 have emerged as markers of persistent inflammation associated with long-term kidney disease progression. Uromodulin and epidermal growth factor may identify adaptive repair whereas markers of extracellular matrix turnover such as endotrophin and PRO-C3 offer insight into fibrotic remodelling.</p><p><strong>Summary: </strong>Contrary to traditional diagnostic tests, novel biomarkers provide mechanistic information and may improve risk stratification after AKI; their integration with imaging and clinical phenotyping represents a promising strategy to better define recovery trajectories and identify therapeutic targets to prevent AKI-to-CKD transition.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":"35 6","pages":"583-588"},"PeriodicalIF":3.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Optimizing care delivery models for persons with chronic kidney disease.","authors":"Sunita Bavanandan, Adrian Liew","doi":"10.1097/MNH.0000000000001222","DOIUrl":"10.1097/MNH.0000000000001222","url":null,"abstract":"<p><strong>Purpose of review: </strong>Chronic kidney disease (CKD) is a growing healthcare burden globally, driven by increasing incidences of diabetes mellitus and hypertension. With an ageing population and attrition of nephrology workforce, managing CKD has become challenging across multiple healthcare settings. Despite increasing availability of novel treatment options with organ-protective benefits for CKD, implementation of guideline directed medical therapy (GDMT) had been sub-optimal due to the rapidity of growing clinical data, clinical inertia and resource limitations. Consequently, it is timely to review how care delivery models of CKD might be optimized.</p><p><strong>Recent findings: </strong>An integrated, multidisciplinary approach, with collaborative framework between primary care physicians, nurses, pharmacists, community health workers and nephrology oversight has demonstrated efficiency in delivering care to CKD patients. Reliance on accessible and low-cost technology have complemented provision of CKD care, especially in low-resource settings. Value-based care models are important in focusing on a patient-centric approach to CKD, with the aim of improving patient satisfaction and clinical outcomes.</p><p><strong>Summary: </strong>Care models for CKD need to evolve to meet the growing needs of the disease burden, i.e. improve screening and diagnosis, increase implementation of GDMT, optimize triaging of specialist care and overcome complexities of clinical care.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"647-654"},"PeriodicalIF":3.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kevin M Bennett, Jennifer R Charlton, Edwin J Baldelomar
{"title":"Are noninvasive measurements of nephron number achievable in humans?","authors":"Kevin M Bennett, Jennifer R Charlton, Edwin J Baldelomar","doi":"10.1097/MNH.0000000000001221","DOIUrl":"10.1097/MNH.0000000000001221","url":null,"abstract":"<p><strong>Purpose of the review: </strong>This review summarizes recent pivotal studies demonstrating the importance of nephron number as a potential clinical marker of kidney health, and highlights technological advances aimed at facilitating the clinical measurement of nephron number in vivo in individuals. Finally, we summarize clinical applications in which measurements of nephron number will likely lead to improved patient care, and discuss challenges to the deployment of technologies to measure nephron number in humans.</p><p><strong>Recent findings: </strong>Recent studies have demonstrated that nephron number is an important determinant of risk of kidney disease, and that it can be used to predict outcomes in large patient cohorts. However, there are currently no clinical tools to measure nephron number noninvasively in humans. Several new technologies have now demonstrated that nephron number can be measured in vivo . With further development, these technologies have the strong potential for translation to general use in humans, suggesting that clinical measurements of nephron number will be available in the near future.</p><p><strong>Summary: </strong>New technologies are now emerging that are likely to enable the noninvasive measurement of nephron number in humans. These technologies are supported by a growing understanding of the importance of nephron number in kidney health and risk of kidney disease.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"614-618"},"PeriodicalIF":3.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13505275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wassim El Amrani, Margo Verbinnen, Björn K I Meijers
{"title":"Advancing dialysis technology to reduce the impact on global warming.","authors":"Wassim El Amrani, Margo Verbinnen, Björn K I Meijers","doi":"10.1097/MNH.0000000000001220","DOIUrl":"10.1097/MNH.0000000000001220","url":null,"abstract":"<p><strong>Purpose of review: </strong>Healthcare significantly impacts global warming, with nephrology and dialysis being major contributors. This has led to the emergence of the green dialysis movement. However, literature summarizing recent advances and providing clear implementation frameworks remains limited.</p><p><strong>Recent findings: </strong>In this narrative review, we explore interventions that reduce the global footprint of dialysis. Through the conceptual framework of the Six W's of Sustainable Dialysis, we aim to facilitate the implementation of green dialysis initiatives by improving knowledge and raising awareness. These include the dialysis population (who?), dialysis modality (what?), in-hospital or home-dialysis (where?), water, waste, and energy consumption (watts). Innovative, sustainable interventions and resource management greatly reduce greenhouse gas emissions. However, there are still important barriers to implementation.</p><p><strong>Summary: </strong>Sustainable dialysis offers an opportunity to align kidney care with broader environmental goals, thereby benefiting both the environment and individuals living with chronic kidney disease.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"589-595"},"PeriodicalIF":3.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The feasibility of telenephrology solutions for rural patients.","authors":"Ifeoma Isabella Ulasi, Ugochi Chika Onu, Chinwuba Kenneth Ijoma","doi":"10.1097/MNH.0000000000001226","DOIUrl":"10.1097/MNH.0000000000001226","url":null,"abstract":"<p><strong>Purpose of review: </strong>Chronic kidney disease (CKD) is a worsening global health problem that disproportionately affects rural populations, especially in low-income and middle-income countries (LMICs). Managing patients with CKD presents significant challenges, including limited access to healthcare. Key contributing factors include geographical barriers, a shortage of nephrology specialists, and insufficient healthcare infrastructure. As CKD is projected to become the fifth leading cause of death by 2040, it is crucial to develop innovative alternatives to the traditional care model to help bridge the gap in care in line with SDG 3.</p><p><strong>Recent findings: </strong>Lessons learned from the COVID-19 pandemic include the successful use of telemedicine-telenephrology for healthcare delivery. However, uptake among underserved populations remains challenging. However, a review of evidence suggests that such challenges are surmountable, as telenephrology has been practised in some resource-constrained remote areas. The results across these populations included shorter waiting times, lower costs, reduced health-related travel, higher overall satisfaction, and lower mortality rates.</p><p><strong>Summary: </strong>These findings portray telenephrology as a technological solution for kidney health inequities. However, government support, digital infrastructure development, bridging of the digital divide, and community engagement are essential.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"626-634"},"PeriodicalIF":3.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joana Gameiro, José Agapito Fonseca, José António Lopes
{"title":"Living after acute kidney injury: understanding the physical and psychosocial consequences.","authors":"Joana Gameiro, José Agapito Fonseca, José António Lopes","doi":"10.1097/MNH.0000000000001200","DOIUrl":"10.1097/MNH.0000000000001200","url":null,"abstract":"<p><strong>Purpose of review: </strong>Acute kidney injury (AKI) is increasingly recognized as a condition with important long-term consequences, beyond kidney specific outcomes. This review addresses the growing population of AKI survivors and the need to better understand outcomes that matter to patients, which are often underrepresented in current care models.</p><p><strong>Recent findings: </strong>Recent studies show that AKI survivors are at increased risk of recurrent AKI, progression to chronic kidney disease, cardiovascular events, rehospitalization, and mortality. Beyond these outcomes, accumulating evidence demonstrates a high burden of persistent physical, psychological, cognitive, and social impairments that significantly affect health-related quality of life. Despite this, structured post-AKI follow-up remains inconsistently implemented, and patient-reported outcomes are rarely incorporated into routine clinical practice or research.</p><p><strong>Summary: </strong>A broader recognition of the multidimensional impact of AKI is needed to improve survivorship care. Integrating patient-centered outcomes into clinical practice and developing structured follow-up strategies may enhance long-term recovery and better align care with patients' needs.</p>","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"605-613"},"PeriodicalIF":3.1,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147971141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}