Atrial fibrillation (AF) is common among patients with kidney failure on hemodialysis (KF). We studied the outcomes of apixaban initiation, compared with no initiation of any oral anticoagulation (OAC), among patients with KF and newly-diagnosed AF.

Thrombotic microangiopathies (TMAs) are severe endotheliopathies that can arise in pregnancy and require early recognition. Complement-mediated (C-)TMA should be differentiated from other endotheliopathies of pregnancy, as treatment differs. Here, we report on a case of a pregnant woman with acute kidney injury requiring hemodialysis due to C-TMA on the background of a pathogenic C3 variant at 28 weeks of gestation. Low soluble Fms-like tyrosine kinase-1 to placental growth factor (sFlt1/PlGF) ratio excluded preeclampsia. Eculizumab was started and therapeutic drug monitoring was applied for optimal dosing. Despite prolonged hemodialysis, fetal well-being was preserved and delivery was safely postponed till 34 weeks of gestation, resulting in a healthy neonate. We also separately report on sFlt1/PlGF ratios measured in a cohort of 11 patients with TMA and coexisting pregnancy. Ten (91%) out of 11 patients had low sFlt1/PlGF ratios, excluding preeclampsia. Thus, successful pregnancy in women with C-TMA can occur, and sFlt1/PlGF ratios may aid in clarifying the diagnosis and appropriate treatment.

Starting dialysis is challenging for both patients and their informal caregivers. Caregivers help patients adapt and adhere to treatment by providing practical and emotional support, but these responsibilities can take a considerable toll on them. As little is known about how caregiver experiences evolve after dialysis initiation, we aimed to: 1) assess the trajectory of experiences and health-related quality of life (HRQoL) of caregivers of patients on dialysis during the first year of dialysis, 2) assess whether differences in these trajectories exist between caregivers of home dialysis patients and those of in-center hemodialysis (ICHD) patients, and 3) explore in which domains caregivers desire support over time.

Living kidney donors (LKDs) perceive gaps in care along their donation journeys, such as poor coordination and communication between providers. Better integration of their primary care providers (PCPs) in their donation journey can help address these gaps. We sought to capture the perspectives of Canadian PCPs to understand the challenges they perceive when caring for LKDs and their recommendations to address them.

Evidence is limited regarding the associations of non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease (MAFLD) with the development of nephrolithiasis. This study aimed to assess the associations of NAFLD and MAFLD with the risk of incident nephrolithiasis, using data from two cohort studies conducted in China and UK.

Adults receiving maintenance hemodialysis (HD) frequently report pain, yet detailed descriptions of pain in this population are lacking. This study examines pain locations, characteristics, and associations with other symptoms in adults receiving HD.

There are limited real-world data describing the cardiovascular benefits of glucagon-like-peptide-1 receptor agonists (GLP1RAs) across the spectrum of chronic kidney disease (CKD) severity. The objective of this study was to evaluate the association of GLP1RAs with major adverse cardiovascular events in comparison to dipeptidyl peptidase-4 (DPP-4) inhibitors in the setting of CKD.

Medicare Advantage (MA) enrollment among patients receiving dialysis has surged following the 21 Century Cures Act, which lifted prior restrictions on enrollment. As MA becomes the plurality payer for dialysis, understanding its implications for patients, providers, and policymakers is critical. MA offers out-of-pocket spending caps and additional services not covered under fee-for-service (FFS) Medicare. Some plans also prioritize care coordination, which may improve patient outcomes. However, concerns remain regarding limited provider networks, prior authorization barriers, and disparities in access to medications and transplants. The increasing shift to MA also challenges value-based care models, as most quality measures and payment models for patients receiving dialysis are limited to FFS Medicare. Although research examining the benefits and downsides of MA is paramount, comparing MA and FFS Medicare is complicated by selection bias and incomplete or inaccessible data. To ensure that increasing enrollment into MA has not harmed patients, policymakers must enhance data fidelity and transparency, strengthen regulatory oversight, and align financial incentives across populations to safeguard access to high-quality care for patients receiving dialysis.

Detection and management of depression have special considerations in people with kidney disease. Screening should be done every 6-12 months using a self-reported questionnaire. Clinicians should rule out symptoms from medical conditions such as dialysis inadequacy or hypothyroidism and confirm the presence of sadness or anhedonia. Sertraline has shown limited efficacy and an increased risk for adverse effects such as gastrointestinal symptoms, so cautious, gradual dose titration is warranted. Cognitive behavioral therapy has potential benefit for depressive symptoms in people with kidney disease. Current trials are evaluating behavioral activation therapy. Physical activity has many benefits and likely improves depression.

Skin disorders occur commonly in patients with chronic kidney disease (CKD) and may greatly impact their quality of life. These skin disorders have varying underlying pathophysiologies, but there are a few common mechanisms including the accumulation of uremic solutes, metabolic disturbances, and inflammation. Pruritus in the setting of CKD (CKD-associated pruritus or CKD-aP), acquired perforating disorder (APD), calcinosis cutis, calciphylaxis, cutaneous lupus, and vasculitis are skin disorders often occurring in association with kidney disease and with which clinicians should be familiar. CKD-aP is reported to have a prevalence of 40% among patients receiving dialysis and 20% with earlier stages of CKD. Acquired perforating disorder (APD) is a skin disorder seen commonly in patients with diabetes mellitus and kidney failure that presents typically with crater-shaped nodular eruptions with a central hyperkeratosis. Calcinosis cutis is a skin disorder that occurs when calcium salts deposit into skin and subcutaneous tissues. Calciphylaxis is a rare cutaneous vasculopathy characterized by microvascular calcium deposition and thrombosis leading to tissue ischemia and subsequent skin necrosis. Lupus erythematosus and the vasculitides are systemic disorders with distinct skin manifestations that may offer clues as to the underlying disorder.