A global rise in the prevalence of patients with chronic kidney disease (CKD) with end-stage kidney disease (ESKD) has led to a considerable and increasing burden to health systems, patients, and society. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are proven to reduce incidence of cardio-renal outcomes, including onset of ESKD. Recent post hoc analyses of SGLT2 inhibitor trials extrapolate substantial delays in the average time to ESKD over a patient\'s lifetime. In this article, we explore the possible real-world effects of such a delay by considering the available evidence reporting outcomes following onset of ESKD. From the patient perspective, a delay in reaching ESKD could substantially improve health-related quality of life and result in additional life years without the need for kidney replacement therapies, a target relevant to all CKD subpopulations. Furthermore, should a patient initiate dialysis at an older age as a result of CKD progression, the time spent in receipt of dialysis, and therefore associated healthcare costs, may also be reduced. A delay in progression may also lead to changes in the management of ESKD, such as increased election of conservative care in preference to dialysis, particularly in elderly populations. For younger patients with CKD, those who reach ESKD while employed face considerable work impairment and productivity loss, as may families and care partners of working age. Therefore, a delay to the onset of ESKD will reduce the proportion of their working lives affected by productivity losses or unemployment due to medical reasons. In conclusion, optimised treatment of CKD may lead to a shift in treatment options, but proper and timely implementation is essential for the realisation of improved outcomes.

Research has evidenced that purpose in life helps to minimise the strains of providing informal care to a significant other, but little is known about whether this psychological resource influences the paths from stressors to the health outcomes of family caregiving and through which mechanisms it can exert this protective effect. This study aimed to explore the moderating role of purpose in life on the (mediated through adaptive coping) relationship between caregiver burden and psychological distress in haemodialysis caregivers. A cross-sectional study was conducted with a convenience sample of family caregivers (n = 173; M = 55.9, SD = 15.6 years old) of adults undergoing haemodialysis. A moderated-mediation model was computed to explore the interaction effects of purpose in life on the path between burden and distress, having adaptive coping behaviours as parallel mediators. Results showed that purpose in life had a buffering effect on the mediated (through acceptance coping) relationship between burden and distress (index of partial moderated-mediation: bsimple = -0.029, 95% bootstrap confidence interval (CI) [-0.070, -0.002]), and that this conditional effect was lowest at high levels of the moderator (at +1SD: bsimple = 0.038, SE = 0.026, 95% bootstrap CI [0.001, 0.098]). Use of emotional support (F(1,159) = 4.395, p = 0.038) and positive reframing (F(1,159) = 5.648, p = 0.019) also mediated this path. This study expands knowledge about the modifiable internal resources through which purpose in life can help promote psychosocial adjustment to the haemodialysis caregiving process. Mental health promotion initiatives aimed at this population need to consider combining different intervention approaches to foster purpose in life and train adaptive (and flexible) coping skills.

UNASSIGNED: Published literature suggests that sleep duration and quality may be affected in adults with chronic kidney disease. However, the relationship between these two entities remains a matter of debate. The objective of this systematic review and meta-analysis is to assess the effect of sleep duration and quality on chronic kidney disease.
UNASSIGNED: A systematic review of the Medline/PubMed, Embase, Cochrane Library, and CINAHL databases was conducted for articles pertaining to the association between sleep duration and quality on chronic kidney disease. The main outcome was the hazard/risk ratio of chronic kidney disease in patients of varying sleep durations and quality.
UNASSIGNED: In total, 42 studies (2 613 971 patients) with a mean age of 43.55 ± 14.01 years were included in the meta-analysis. Compared with a reference range of 7 to 8 hours of sleep, short sleep durations of ≤4 hours (RR 1.41, 95% CI: 1.16 to 1.71, P < 0.01), ≤5 hours (RR 1.46, 95% CI: 1.22 to 1.76, P < 0.01), ≤6 hours (RR 1.18, 95% CI: 1.09 to 1.29, P < 0.01), and ≤7 hours (RR 1.19, 95% CI: 1.12 to 1.28, P < 0.01) were significantly associated with an increased risk of incident chronic kidney disease. Long sleep durations of ≥8 hours (RR 1.15, 95% CI: 1.03 to 1.28, P < 0.01) and ≥9 hours (RR 1.46, 95% CI: 1.28 to 1.68, P < 0.01) were also significantly associated with an increased risk of incident chronic kidney disease. Meta-regression did not find any significant effect of age, gender, geographical region, and BMI and an association with sleep duration and risk of incident chronic kidney disease.
UNASSIGNED: Both short and long sleep durations were significantly associated with a higher risk of chronic kidney disease. Interventions targeted toward achieving an optimal duration of sleep may reduce the risk of incident chronic kidney disease.

BACKGROUND: Children with established kidney failure may have additional medical conditions influencing kidney care and outcomes. This cross-sectional study aimed to examine the prevalence of co-existing diseases captured in the electronic hospital record compared to UK Renal Registry (UKRR) data and differences in coding.
METHODS: The study population comprised children aged < 18 years receiving kidney replacement therapy (KRT) in England and Wales on 31/12/2016. Comorbidity data at KRT start was examined in the hospital record and compared to UKRR data. Agreement was assessed by the kappa statistic. Associations between patient and clinical factors and likelihood of coding were examined using multivariable logistic regression.
RESULTS: A total of 869 children (62.5% male) had data linkage for inclusion. UKRR records generally reported a higher prevalence of co-existing disease than electronic health records; congenital, non-kidney disease was most commonly reported across both datasets. The highest sensitivity in the hospital record was seen for congenital heart disease (odds ratio (OR) 0.65, 95% confidence interval (CI) 0.51, 0.78) and malignancy (OR 0.63, 95% CI 0.41, 0.85). At best, moderate agreement (kappa ≥ 0.41) was seen between the datasets. Factors associated with higher odds of coding in hospital records included age, while kidney disease and a higher number of comorbidities were associated with lower odds of coding.
CONCLUSIONS: Health records generally under-reported co-existing disease compared to registry data with fair-moderate agreement between datasets. Electronic health records offer a non-selective overview of co-existing disease facilitating audit and research, but registry processes are still required to capture paediatric-specific variables pertinent to kidney disease.

BACKGROUND: Childhood-onset lupus nephritis (cLN) is a severe form of systemic lupus erythematosus (SLE) with high morbidity and mortality. The impact of long-term exposure to fine particulate matter (PM2.5) on adverse outcomes in cLN remains unclear.
METHODS: We combined a 19-years cLN cohort from seven provinces in China with high-resolution PM2.5 dataset from 2001 to 2020, investigating the association between long-term exposure to PM2.5 and its constituents (sulfate, nitrate, organic matter, black carbon, ammonium) with the risk of death and kidney failure, analyzed with multiple variables Cox models. We also evaluated the association between 3-year average PM2.5 exposure before study entry and baseline SLE disease activity index (SLEDAI) scores using linear regression models.
RESULTS: Each 10 μg/m3 increase in annual average PM2.5 exposure was associated with an increased risk of death and kidney failure (HR = 1.58, 95 % CI: 1.24-2.02). Black carbon showed the strongest association (HR = 2.14, 95 % CI: 1.47-3.12). Higher 3-year average exposures to PM2.5 and its constituents were significantly associated with higher baseline SLEDAI scores.
CONCLUSIONS: These findings highlight the significant role of environmental pollutants in cLN progression and emphasize the need for strategies to mitigate exposure to harmful PM2.5 constituents, particularly in vulnerable pediatric populations.

BACKGROUND: Chronic kidney disease (CKD) and its associated complications, such as anemia and secondary hyperparathyroidism (SHPT), pose significant challenges to global healthcare systems. This study explores the demographic and clinical characteristics of 284 kidney failure (KF) patients undergoing hemodialysis, in an effort to shed light on the possible association between anemia and SHPT. A proven connection between the two could theoretically influence the management plans for CKD patients, with the hopes of achieving lower morbidity and/or mortality in this patient group.
METHODS: A retrospective, cross-sectional, real-world data analytical study was conducted at a hemodialysis center in Tbilisi, Georgia, encompassing a sample size of n = 284 patients on maintenance hemodialysis. The data analyzed was extracted from patients\' medical records.
RESULTS: According to our results, the prevalence of anemia was strikingly high at 82.04%, underlining its substantial burden within this patient population. Our analysis revealed a notable systemic association between anemia and SHPT, particularly when considering hemodialysis vintage. However, our final analysis model revealed no statistically significant association between anemia and intact parathyroid hormone (iPTH) levels.  Conclusion: Our study revealed a significant systemic relationship between anemia and SHPT when hemodialysis duration was considered, despite initial analyses showing no direct association. Future research should focus on longitudinal and multi-center studies to better understand this relationship, aiming to enhance the care and management of CKD patients on hemodialysis.

BACKGROUND: Young adults living with kidney failure make decisions to select a kidney replacement therapy choice in partnership with healthcare professionals. However, little is known about how they experience kidney replacement therapy treatment decision-making and the impact this has on their well-being.
OBJECTIVE: To explore young adults living with kidney failure experiences of treatment decision-making. The treatment decision-making investigated is about the choice of dialysis and/or kidney transplant options.
METHODS: A qualitative interpretive hermeneutic phenomenology study.
METHODS: Purposeful sampling was used to recruit young adults with kidney failure from social media, electronic media such as local kidney group websites and word of mouth. Semistructured interviews were conducted with (n = 18) participants aged 18-30 years.
METHODS: Inductive analysis of the data were performed using Braun and Clarke\'s thematic analysis framework.
RESULTS: The five themes generated were (1) awareness and anticipation of future kidney replacement therapy decision; (2) health information and education; (3) engaging in decision-making, support and choices; (4) implementation of kidney replacement therapy and transitioning into the new normal life and (5) the impact of decision-making and choice on well-being.
CONCLUSIONS: Decision-making significantly affected young adults\' psychosocial and mental well-being. Young adults had unmet informational and decisional needs and struggled to cope due to lack of support. A four-talk model, with an implement talk phase added to the existing three-talk (team talk, option talk, decision talk) shared decision-making model, would promote a focus on the implementation of choice and support the transitioning from previous life to long-term dependence on treatment.

OBJECTIVE: It is unclear whether kidney transplant candidates with diabetes have equitable transplantation opportunities or have divergent survival probabilities stratified by kidney replacement therapy. The aim of this study was to investigate these two issues using national transplant registry data in the UK.
METHODS: A cohort study was undertaken of prospectively collected registry data of all wait-listed people with kidney failure receiving dialysis in the UK. All people listed for their first kidney-alone transplant between 2000 and 2019 were included. Stratification was done for cause of kidney failure. Primary outcome was all-cause mortality. Time-to-death from listing was analysed using adjusted non-proportional hazard Cox regression models, with transplantation handled as a time-dependent covariate.
RESULTS: A total of 47,917 wait-listed people with kidney failure formed the total study cohort, of whom 6594 (13.8%) had diabetes classified as cause of kidney failure. People with kidney failure with diabetes comprised 27.6% of the cohort (n=3681/13,359) that did not proceed to transplantation vs only 8.4% (n=2913/34,558) of the cohort that received a transplant (p<0.001). Kidney transplant candidates with diabetes were more likely to be older, of male sex and of ethnic minority background compared with those without diabetes. In an adjusted analysis, compared with remaining on dialysis, any kidney transplant provided survival benefit for wait-listed kidney transplant candidates regardless of diabetes as cause of kidney failure (RR 0.26 [95% CI 0.25, 0.27], p<0.001).
CONCLUSIONS: Kidney transplant candidates with diabetes have a lower chance of transplantation despite better survival after kidney transplantation vs remaining on dialysis. The reasons for this require further investigation to ensure equal transplantation opportunities.

UNASSIGNED: Living with kidney failure can interfere with life participation (ie, participation in valued life activities). Life participation has recently been identified as a top-priority health outcome of people on peritoneal dialysis therapy, but it is a relatively unexplored topic in peritoneal dialysis.
UNASSIGNED: The objective is to describe the interventions that have been used to promote life participation in the peritoneal dialysis population and highlight research gaps warranting further investigation.
UNASSIGNED: A scoping review was conducted according to the Joanna Briggs Institute methodology.
UNASSIGNED: Six electronic databases (MEDLINE [OVID], EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, CINAHL Plus, SCOPUS) were searched.
UNASSIGNED: Adults aged 18+ years on peritoneal dialysis therapy.
UNASSIGNED: Any dedicated scale or subscale that measured life participation as an isolated outcome.
UNASSIGNED: Title/abstract screening was completed independently after adequate inter-rater reliability (kappa > 0.8) was achieved among reviewers. Full-text review and data extraction were conducted in duplicate. Extracted data were analyzed using counts, percentages, and narrative synthesis to describe patterns in the literature.
UNASSIGNED: After identifying 13 874 results, 17 studies met eligibility criteria. Eight studies were conducted within the past 5 years, with China as the most common study location. Only 2 studies investigated life participation as a primary study outcome. Eight studies targeted personal-physical barriers to life participation, 8 targeted multiple barriers, and 1 targeted an environmental-institutional barrier. Life participation was assessed within a subdomain of a broader quality of life assessment (The Kidney Disease Quality of Life [KDQOL]-36 or the 36-Item Short-Form Health Survey [SF-36]) in 11 studies. The majority of assessments captured life participation in all major domains of participation (self-care, work, and leisure).
UNASSIGNED: Eligibility screening at title/abstract stage was not performed in duplicate; articles not available in English were excluded.
UNASSIGNED: Life participation has infrequently been prioritized as a health outcome in peritoneal dialysis (PD). Interventions have been narrow in focus given the range of challenges faced by people on PD and the holistic approaches used in other clinical populations. Future research should prioritize life participation as a key health outcome in PD and investigate the impact of interventions that address cognitive, affective, and environmental barriers to participation.
UNASSIGNED: Vivre avec l’insuffisance rénale peut entraver la participation à la vie (c.-à-d., la participation aux activités significatives du quotidien). La participation à la vie a récemment été identifiée comme un résultat de santé prioritaire pour les personnes sous dialyse péritonéale. Pourtant, elle demeure un sujet relativement inexploré en contexte de dialyse péritonéale (DP).
UNASSIGNED: Décrire les interventions utilisées pour promouvoir la participation à la vie dans une population sous dialyse péritonéale et mettre en évidence les lacunes de la recherche qui justifieraient une étude plus approfondie.
UNASSIGNED: Un examen de la portée a été effectué selon la méthodologie de l’Institut Joanna Briggs.
UNASSIGNED: Consultation de six bases de données électroniques (MEDLINE [OVID], embase, PsycINFO, Cochrane Central Register of Controlled Trials, CINAHL plus et SCOPUS).
UNASSIGNED: Des adultes (18 ans et plus) sous dialyse péritonéale.
UNASSIGNED: Toute échelle ou sous-échelle dédiée mesurant la participation à la vie comme un résultat isolé.
UNASSIGNED: La sélection du titre ou du résumé des articles a été effectuée de façon indépendante une fois la valeur adéquate de fiabilité inter-évaluateurs (kappa > 0,8) atteinte parmi les évaluateurs. L’examen du texte intégral et l’extraction des données ont été effectués en double. L’analyse des données extraites a été réalisée à l’aide de dénombrements, de pourcentages et de synthèses narratives afin de décrire les tendances dans la littérature.
UNASSIGNED: Des 13 874 résultats répertoriés, seules 17 études répondaient aux critères d’admissibilité. Huit études avaient été menées dans les cinq dernières années, le plus souvent en Chine. Seules deux études avaient examiné la participation à la vie comme critère de jugement principal. Huit études ciblaient les obstacles personnels-physiques à la participation à la vie, huit ciblaient les obstacles multiples et une seule ciblait les obstacles environnementaux-institutionnels. La participation à la vie avait été évaluée dans un sous-domaine d’une évaluation plus large de la qualité de vie (KDQOL-36 ou SF-36) dans onze des études retenues. La majorité des évaluations portaient sur la participation à la vie dans tous les domaines principaux (soins personnels, travail et loisirs).
UNASSIGNED: La vérification de l’admissibilité à l’étape de la sélection des titres ou résumés n’a pas été effectuée en double; les articles non disponibles en anglais ont été exclus.
UNASSIGNED: La participation à la vie a rarement été considérée comme un résultat de santé prioritaire en DP. Les interventions ont été limitées, compte tenu de l’éventail des défis auxquels sont confrontées les personnes sous DP et des approches holistiques utilisées dans d’autres populations cliniques. Les recherches futures devraient accorder la priorité à la participation à la vie comme résultat clé de la santé des personnes sous DP et étudier l’effet des interventions qui s’attaquent aux obstacles cognitifs, affectifs et environnementaux qui entravent la participation à la vie.

UNASSIGNED: Secondary hyperparathyroidism (sHPT) is particularly severe in rapidly growing infants in dialysis. Although cinacalcet is effective and licensed in dialysis in children aged >3 years, its efficacy and safety for children aged <3 years is unknown.
UNASSIGNED: We identified 26 children aged <3 years who were on dialysis and treated with cinacalcet between 2009 and 2021 in 8 European pediatric centers.
UNASSIGNED: Median (interquartile range) age at the start of cinacalcet was 18 (interquartile range: 11-27) months, serum parathyroid hormone (PTH) was 792 (411-1397) pg/ml, corresponding to 11.6 (5.9-19.8) times the upper limit of normal (ULN). Serum calcium was 2.56 (2.43-2.75) mmol/l, and serum phosphate 1.47 (1.16-1.71) mmol/l. Serum 25-OH vitamin D (25-OHD) was 70 (60-89) nmol/l, 3 children were vitamin D deficient (<50 nmol/l). The initial cinacalcet dose was 0.4 (0.2-0.8) mg/kg/d and the maximum dose was 1.1 (0.6-1.2) mg/kg/d. The median follow-up under cinacalcet was 1.2 (0.7-2.0) years. PTH decreased to 4.3 (2.2-7.8) times the ULN after 6 months, to 2.0 (1.0-5.3) times ULN after 12 months, and to 1.6 (0.5-3.4) times thereafter (P = 0.017/0.003/<0.0001, log-transformed PTH). Seven of the 26 infants developed 10 hypocalcemic episodes <2.10 mmol/l. Oral calcium intake was 84% (66%-117%) of recommended nutrient intake at start, 100% (64%-142%) at 3 months and declined to 78% (65%-102%) at 12 months of therapy. Three children developed clinical signs of precocious puberty.
UNASSIGNED: Cinacalcet efficiently controlled severe sHPT in children aged <3 years and was associated with hypocalcemic episodes (similar to what is observed in older children) and precious puberty, thereby mandating meticulous control of calcium (considering nutrition, supplementation, and dialysate) and endocrine changes.