Peritoneal dialysis-related peritonitis (PDRP) remains a significant cause of technical failure and mortality. Hematologic inflammatory indices (HIIs) have previously been associated with the incidence of peritonitis and long-term outcomes in peritoneal dialysis. Their prognostic usefulness in acute PDRP remains unclear. This study evaluated the relationship between HIIs and clinical outcomes in acute PDRP.

Peritoneal dialysis (PD) represents a significant advancement in renal replacement therapy, offering patients greater autonomy in managing their kidney disease treatment. This resource from Vantive Empowers highlights the practical implementation of PD as a home-based therapeutic option. The key advantage of peritoneal dialysis performed at home is the substantial improvement in patient quality of life, providing increased flexibility, freedom, and independence compared to traditional in-center dialysis regimens. By eliminating the need for frequent hospital or clinic visits, home-based PD allows patients to integrate their treatment seamlessly into daily routines. The mechanism relies on the peritoneal membrane's natural filtration capacity to remove waste and excess fluid from the body. This approach addresses a critical need in nephrology care by reducing treatment burden on patients while maintaining clinical efficacy. Vantive Empowers' educational initiative emphasizes the importance of patient awareness regarding available dialysis modalities, empowering individuals with kidney disease to make informed decisions about their treatment preferences and ultimately enhance their overall well-being and life satisfaction during long-term dialysis management.

Nefrología, the official journal of the Spanish Society of Nephrology, publishes peer-reviewed research on nephrology, hypertension, dialysis, and kidney transplantation in English and Spanish. Operating as a Diamond Open Access publication with no author fees or reader charges, the journal adheres to standards established by the International Committee of Medical Journal Editors and the Committee on Publication Ethics, with editorial operations managed by Elsevier while content decisions remain with the Spanish Society of Nephrology. The journal addresses peritoneal fibrosis, a critical complication causing ultrafiltration failure and treatment discontinuation in long-term peritoneal dialysis patients, for which no effective early diagnostic tools currently exist. The underlying pathophysiological mechanisms involve mesothelial-mesenchymal transition, chronic inflammation, pathological angiogenesis, hypoxia, metabolic disturbances, oxidative stress and ferroptosis, and renin-angiotensin-aldosterone system activation. Key pathways include a positive feedback loop between TGF-β1/Smad and inflammatory NF-κB signaling, hypoxia-driven HIF-1α/VEGF linking angiogenesis to fibrosis, and metabolic dysregulation introducing epigenetic factors. The journal explores emerging non-invasive biomarkers in ascites to enable earlier disease detection and intervention in peritoneal dialysis patients.

Peritoneal dialysis-associated peritonitis (PDAP) represents a serious complication of peritoneal dialysis, a primary renal replacement therapy for end-stage renal disease patients. This case report from Shantou University Medical College documents the successful treatment of a 62-year-old male with recurrent PDAP caused by the uncommon pathogen Coxiella burnetii, identified through metagenomic next-generation sequencing (mNGS) of peritoneal fluid. The patient had failed to respond to empirical antibiotic therapy with meropenem and the meropenem/vancomycin combination. Treatment with intravenous omadacycline, administered at 100 mg daily following a 200 mg loading dose as part of a multi-agent regimen, resulted in hemodynamic stabilization within 48 hours and progressive normalization of inflammatory markers including procalcitonin, C-reactive protein, and effluent white blood cell counts. The patient achieved complete recovery, was discharged, and remained relapse-free during three months of follow-up. While the case involved multiple confounding factors including concurrent broad-spectrum antibiotics and polymicrobial infection, the findings suggest omadacycline may offer a promising alternative therapeutic option for Coxiella burnetii infections in PDAP patients. The case underscores the critical importance of precise pathogen identification in managing treatment-resistant peritoneal dialysis complications.

This article examines risk perception and management practices associated with peritoneal dialysis waste disposal. Peritoneal dialysis, a vital renal replacement therapy, generates significant medical waste requiring proper handling and disposal. The study investigates how healthcare professionals and patients perceive biological and chemical hazards inherent in dialysate waste streams and contaminated materials. Understanding these risk perceptions is critical for developing effective waste management protocols, ensuring compliance with environmental regulations, and protecting public health. The research contributes to establishing best practices that balance clinical efficiency with environmental stewardship and occupational safety in nephrology care settings.

Based on The Principles of Biomedical Ethics by Beauchamp and Childress, this study analyzed the perspective of healthcare professionals on the follow-up of patients undergoing conservative treatment for Chronic Kidney Disease until the choice of Renal Replacement Therapy. This was conducted through a cross-sectional, descriptive study involving interviews with 63 professionals working in outpatient clinics of four nephrology specialist training centers in Rio de Janeiro, between March and September 2022. The results are presented in two thematic areas: Patient follow-up and Informed Consent. We conclude that the process is not based on the patient’s choice and that the patient is dependent on the availability of healthcare services and the professional's guidance regarding options. It is important to develop knowledge about the options available to empower patients to become autonomous and capable of seeking access to the treatments they need.

Initiation of emergency dialysis, often requiring temporary catheter owing to unprepared definitive vascular access, is associated with infectious and vascular complications and suggests advanced chronic kidney disease (CKD) care gaps. Previous studies focused on kidney failure or dialysis timing. This study aimed to predict initiation of emergency dialysis using machine learning and baseline data.

This qualitative study examines Veterans' preparedness for critical dialysis and vascular access decisions through semi-structured interviews conducted with 22 participants between October 2022 and July 2023. The predominantly male, African American cohort demonstrated insufficient knowledge regarding dialysis modalities and vascular access options. Three primary themes emerged: inadequate and untimely information delivery, necessity for coordinated team-based communication, and concerns about dialysis-related quality of life impacts. Findings indicate Veterans desire earlier engagement and more effective provider communication throughout the decision-making process. The research advocates for implementing interdisciplinary care teams to strengthen communication pathways and facilitate informed shared decision-making, ultimately improving outcomes for Veterans requiring dialysis therapy.

Steady concentration peritoneal dialysis (PD) is a novel method of increasing ultrafiltration (UF) that uses a device connected to a standard PD catheter to ...

Engineered live biotherapeutic products (eLBPs) represent an emerging class of programmable microbial therapies capable of sensing and responding to host physiology. Advances in microbiome science and synthetic biology have driven the development of engineered bacteria that deliver therapeutic molecules, modulate host metabolism, or detect disease-associated signals. In this review, we summarize recent progress in the development of eLBPs across diverse disease indications, including inflammatory diseases, metabolic disorders, cancer, and infectious diseases. We highlight key factors that drive successful eLBP design, including chassis selection, methods for DNA delivery, approaches for tuning therapeutic expression, and genetic systems for biocontainment. Although early clinical studies demonstrate promising safety profiles, challenges remain in achieving predictable colonization, durable therapeutic activity, and robust biocontainment in vivo. By synthesizing advances across these areas, we propose a framework for the rational design of next-generation eLBPs that can more reliably translate from experimental systems to clinical application.

Escherichia coli demonstrates remarkable pathogenic versatility, functioning as both a harmless commensal bacterium and a virulent urinary tract pathogen. This comprehensive review examines the molecular mechanisms and environmental factors that enable E. coli to transition between these distinct roles. The article explores the genetic and phenotypic switches that activate virulence factors, allowing benign intestinal bacteria to invade and establish infections in the urinary system. Understanding these transformation pathways is critical for developing targeted therapeutic interventions and improving infection prevention strategies. This open-access research contributes valuable insights into bacterial pathogenesis and host-pathogen interactions relevant to infectious disease management.

A retrospective study found that more than 60% of patients with chronic kidney disease (CKD) stages 4 and 5 who received structured predialysis education chose peritoneal dialysis (PD), with over half ultimately starting this home-based treatment.

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.