Horizontal gene transfer (HGT) facilitates the dissemination of antibiotic resistance genes (ARGs) through mobile genetic elements (MGEs). A comprehensive ...

This study examined erythropoiesis-stimulating agent (ESA) hyporesponsiveness among 85,259 hemodialysis patients across 24 countries from 2015 to 2021. The research revealed significant variation in hyporesponsiveness prevalence depending on diagnostic criteria used, ranging from 5.2% to 47.9% of patients. Despite receiving higher ESA doses, hyporesponsive patients maintained hemoglobin levels comparable to responsive counterparts. These findings highlight the inconsistency in identifying ESA hyporesponsiveness and suggest the need for standardized diagnostic approaches to optimize treatment strategies and reduce unnecessary medication exposure in kidney disease patients with anemia.

Uremic toxins may worsen endothelial injury by disrupting intercellular connections, highlighting the complex pathogenic environment in CKD. Given these insights, the need for standardized diagnostic thresholds for endothelial dysfunction in geriatric CKD patients is clear. Serum sVE-cadherin emerges as a promising novel biomarker for assessing endothelial health, offering potential for earlier intervention and improved cardiovascular outcomes. It may be a potent indicator of endothelial dysfunction and should be featured in future studies of elderly CKD patients.

Antimicrobial resistance represents a critical global health threat, with the human gut microbiome playing a central role in its development and propagation. The gut microbiota maintains a delicate metabolic balance essential for host protection against pathogenic invasion and metabolic dysfunction. While antibiotics remain vital for treating bacterial infections, their broad ecological impact disrupts this microbial equilibrium, facilitating dysbiosis. The gut serves as a reservoir for antimicrobial resistance genes, collectively termed the resistome, which transfer between bacterial species through horizontal gene transfer mechanisms. This comprehensive review examines gut microbiota composition, antibiotic-induced dysbiosis mechanisms, and the influence of host factors including age, genetics, diet, and immune status on microbiome dynamics and antimicrobial resistance development, while evaluating emerging intervention methods.

Moreover, elevated plasma TMAO levels in patients with chronic kidney disease have been associated with systemic inflammation and gut microbial dysbiosis [112].

This study investigates the mechanisms underlying relapsing peritoneal dialysis-associated peritonitis (PDAP), a significant clinical challenge. Analyzing 31 PDAP patients, researchers employed conventional bacterial culture, 16S rDNA sequencing, and proteomic analysis of peritoneal dialysate samples. The combined diagnostic approach achieved an 83.9% detection rate, surpassing individual methods. Microbiome analysis revealed that relapse stems from both exogenous pathogens and gut-derived bacterial translocation linked to compromised local immunity. Proteomic profiling identified dysregulated biomarkers including decreased CCL28, CD40, and uPA alongside elevated NRTN in relapsing patients. Bioinformatic analysis demonstrated dysregulation in inflammatory, fibrinolytic, and immune clearance pathways. These findings establish peritoneal immune dysregulation as a key driver of relapsing PDAP and position 16S rDNA sequencing as a valuable complementary diagnostic tool, potentially enabling more precise patient management and improved clinical outcomes.

# Professional Summary Every eighteen minutes, a patient joins a kidney transplant waiting list worldwide, while organ supply remains critically constrained. Three-dimensional bioprinting technology—combining stem cell biology, advanced biomaterials, and precision manufacturing—now promises to transform organ scarcity from an intractable humanitarian crisis into a solvable engineering challenge. Harvard's Wyss Institute has demonstrated significant progress through its SWIFT technique, enabling the creation of vascularized kidney tissue essential for transplant viability. By utilizing patient-derived stem cells as biological printing material, this approach could substantially mitigate immune rejection, the leading cause of transplant failure. With over 100,000 Americans currently waiting for kidney transplants and only 20,000 procedures completed annually, this technology represents a watershed moment for transplant medicine. Recent recognition by PMI as a most influential 2024 project underscores the field's accelerating trajectory toward clinical implementation within the coming decade.

Researchers have developed a 3D printed microfluidic chip platform designed to vascularize kidney organoids derived from human induced pluripotent stem cells (hiPSCs). This innovative approach addresses a critical challenge in organ engineering by integrating vascular networks into lab-grown kidney tissues. The 3D printing technology enables precise spatial organization and control of cell culture environments, facilitating the development of functional, vascularized tissue constructs. This advancement holds significant promise for regenerative medicine applications, disease modeling, and potential drug testing platforms, while reducing reliance on traditional animal models in biomedical research.

High-volume post-dilution hemodiafiltration (HVHDF) demonstrates superior preservation of residual kidney function compared to conventional hemodialysis through enhanced hemodynamic stability. This advanced renal replacement therapy technique reduces microinflammatory responses and minimizes nephrotoxic insults to remaining functional nephrons. By maintaining more stable blood pressure and reducing hemodynamic stress, HVHDF creates a less hostile environment for residual renal tissue. The improved convective clearance mechanism of HVHDF also contributes to better removal of uremic toxins and inflammatory mediators. These advantages position HVHDF as a clinically significant option for dialysis patients seeking to extend residual kidney function longevity and potentially improve long-term patient outcomes and quality of life.

This retrospective cohort study examines nutrient density-based dietary indicators in peritoneal dialysis patients, analyzing 794 adults followed for a median of 47 months. Researchers assessed dietary phosphorus, protein, and energy intake using 3-day dietary records collected six months after dialysis initiation, calculating phosphorus-protein, phosphorus-energy, and protein-energy ratios as exposure indicators. The study employed Cox proportional hazards and Fine-Gray competing risk models to evaluate associations with all-cause and cardiovascular mortality. Results demonstrated that the phosphorus-protein ratio exhibited a significant nonlinear association with all-cause mortality among the 412 deaths recorded, including 158 cardiovascular events. Higher phosphorus-protein ratio quintiles compared to the second quintile showed increased mortality risk. These findings suggest that nutrient density-based indicators may provide superior prognostic value compared to absolute nutrient intake for optimizing nutritional management in peritoneal dialysis patients.

Incremental peritoneal dialysis represents an evolving approach to renal replacement therapy that optimizes treatment protocols by gradually increasing dialysate volumes and treatment frequency according to individual patient needs. This comprehensive review examines the historical development of incremental peritoneal dialysis, analyzes its current clinical applications and outcomes, and explores emerging innovations shaping its future. The methodology allows for personalized treatment strategies that may improve patient tolerance, preserve residual kidney function, and enhance quality of life. As nephrology advances, incremental peritoneal dialysis continues to demonstrate significant potential in expanding therapeutic options for end-stage renal disease management, offering promising benefits for diverse patient populations requiring renal replacement therapy.

The Centers for Disease Control and Prevention provides clinical guidance for preventing Clostridioides difficile infection in acute care facilities. The recommendations emphasize isolating patients with suspected or confirmed CDI and implementing contact precautions, including placement in single-patient rooms with dedicated toilets. Healthcare providers should establish nurse-driven protocols for rapid patient isolation and maintain rigorous hand hygiene practices. Additional prevention measures include using dedicated patient-care equipment, performing daily patient bathing with soap and water, and conducting thorough environmental cleaning. The guidance urges facilities to develop comprehensive infrastructure supporting CDI prevention and engage antibiotic stewardship programs. These evidence-based interventions are intended for state and local health departments, hospitals, quality improvement organizations, and other healthcare facilities seeking to reduce CDI transmission and improve patient safety outcomes.

Kidney organoids represent a significant advancement in renal research, functioning as three-dimensional in vitro models that faithfully replicate human kidney structure and function. This comprehensive review examines current technologies for kidney organoid generation and their applications in disease research, drug screening, and personalized therapeutic evaluation. Key developments include vascularization strategies, integration with bioprinting and organ-on-chip platforms, immune microenvironment simulation, and improved long-term culture techniques. The article addresses critical translation challenges including large-scale production, data reproducibility, and regulatory considerations. Emerging convergence with precision medicine, microfluidic systems, and biosensing technologies promises substantial clinical impact. Kidney organoids are positioned to revolutionize nephrology research and accelerate the development of innovative therapeutic solutions for renal diseases.

Peritoneal dialysis represents an alternative renal replacement therapy for kidney failure patients, utilizing the peritoneum as a semi-permeable membrane to filter waste and excess fluids. This home-based treatment offers significant advantages including greater flexibility, independence in scheduling, and the ability to perform more frequent treatments, which promotes better fluid and waste management. Patients also benefit from reduced dietary restrictions and enhanced mobility for travel. However, the treatment requires dedicated daily care routines, comprehensive patient education, and close clinical monitoring to ensure safety and efficacy. Success depends heavily on patient commitment and caregiver involvement in maintaining consistent treatment protocols.

Home dialysis modalities offer significant advantages for patients seeking to maintain employment while undergoing treatment. Unlike in-center hemodialysis, which presents substantial physical and mental challenges and limited scheduling flexibility, home dialysis and peritoneal dialysis enable higher employment rates among incident dialysis patients. Current data demonstrates that full-time employment rates are notably higher for home hemodialysis patients at 14.9% compared to 8.5% for in-center dialysis patients. Healthcare providers are increasingly required to evaluate patients' employment goals and status as part of comprehensive psychosocial assessments. By facilitating access to work-compatible dialysis options, nephrologists and social workers can help patients preserve income, health benefits, and personal dignity while managing their chronic kidney disease.

This study delves into the efficacy of the CloudCath system, designed to monitor turbidity in dialysis effluent and promptly alert users to potential peritonitis-related changes. The investigation, a single-arm, open-label, multicenter study, involved 243 participants utilizing the CloudCath system during peritoneal dialysis. System notifications were intentionally deactivated for participants and investigators who adhered to the standard of care for peritonitis signs and symptoms. The study’s effectiveness endpoints focused on assessing the time lapse between CloudCath system notifications and peritonitis events, employing the criteria established by the International Society of Peritoneal Dialysis (ISPD).

Patients with end-stage renal disease undergoing haemodialysis experience a variety of stressors leading to decreased level of quality of life (QoL). Thus, in this study, we aimed to review the current literature and identify factors affecting the health-related QoL (HRQoL) in these patients.

Dialysis serves as a substitute for the natural function of the kidneys in individuals with kidney failure. The process involves removing waste and excess fluids from the blood, and maintaining a balance of electrolytes. Top nephrologist in Haryana explains types of dialysis and the factors that are needed to look upon for deciding the type of dialysis one needs. There are following types of dialysis:

While mean platelet volume (MPV) is linked to severity and all-cause mortality in patients with sepsis, its association with all-cause mortality and cardiovascular mortality in patients treated with peritoneal dialysis (PD) remains unknown.

Several studies have demonstrated the efficacy and user acceptance of telehealth in managing patients with chronic conditions, including continuous ambulatory peritoneal dialysis (CAPD). However, the rates of telehealth service use in various patient groups have been low and have declined over time, which may affect important health outcomes. Telehealth service use in patients undergoing CAPD has been recognized as a key challenge that needs to be examined further.