Kidney and Dialysis

Background: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is released in response to increased cardiac wall stress and is used as a biomarker for volume overload and heart failure (HF). It is also elevated in atrial fibrillation (AF) and inflammation. However, in hemodialysis (HD) patients, its interpretation is complicated by reduced renal clearance, large fluid shifts between dialysis sessions, and chronic inflammation. Methods: In 123 HD patients, we examined the relationship between NT-proBNP and interdialytic weight gain, HF with preserved ejection fraction (HFpEF), left ventricular systolic dysfunction (LVSD), and AF, as well as the impact of inflammation. Clinical characteristics, laboratory data, and echocardiography (within three months) were evaluated, while serum NT-proBNP and calprotectin levels were measured by ELISA. Results: NT-proBNP showed no association with interdialytic weight gain and did not identify HFpEF. Inflammatory markers (C-reactive protein and calprotectin) correlated positively with NT-proBNP. Multivariable analysis demonstrated that LVSD, AF, and inflammation remained independent predictors of NT-proBNP levels. Although NT-proBNP levels were higher in LVSD, its diagnostic performance was poor (AUC 0.627). In contrast, NT-proBNP was significantly elevated in patients with AF and showed good diagnostic performance (AUC 0.801). Conclusions: In HD patients, NT-proBNP is not correlated with interdialytic weight gain, performs poorly as a marker of LVSD, but may serve as a useful marker of AF. Full article

Background: Hungry bone syndrome (HBS) is a frequent and potentially severe complication following parathyroidectomy in patients with chronic kidney disease (CKD) and secondary (SHPT) or tertiary hyperparathyroidism (THPT). We aimed to identify preoperative risk factors associated with the development of HBS in this population. Methods: We conducted a retrospective cohort study including 99 adult patients with CKD-associated SHPT or THPT who underwent parathyroidectomy at Hospital San Vicente Fundación between 2018 and 2024. HBS was defined as corrected serum calcium <8.5 mg/dL requiring intravenous calcium supplementation for at least 72 h postoperatively. Clinical, biochemical, and histopathological variables were evaluated. Multivariable logistic regression analysis was performed to identify independent predictors of HBS, and model discrimination was assessed using the area under the receiver operating characteristic curve (AUC). Results: Overall, 40.4% of patients developed HBS after parathyroidectomy. Compared with patients without HBS, those with HBS more frequently had preoperative musculoskeletal symptoms (82.5% vs. 32.2%), higher preoperative intact parathyroid hormone levels (2135 vs. 1561 pg/mL), and parathyroid adenoma on histology (57.5% vs. 25.4%). In multivariable analysis, preoperative musculoskeletal symptoms (OR 10.92; 95% CI 2.32–51.43) and parathyroid adenoma (OR 6.16; 95% CI 1.38–27.54) were independently associated with increased risk of HBS. Conversely, higher preoperative calcium levels (OR 0.36; 95% CI 0.16–0.85) and the use of calcitriol or vitamin D receptor activators (OR 0.24; 95% CI 0.07–0.81) were protective factors. The final model demonstrated good discrimination (AUC = 0.86; 95% CI 0.77–0.93). Conclusions: HBS is a common complication after parathyroidectomy in patients with CKD-associated SHPT or THPT. Preoperative musculoskeletal symptoms and parathyroid adenoma were associated with increased risk, whereas higher calcium levels and calcitriol/vitamin D receptor activator use appeared protective. Early identification of high-risk patients may facilitate perioperative risk stratification and targeted management strategies. Full article

Background: IgA nephropathy (IgAN) is the most common primary glomerulonephritis, characterized by immune dysregulation and progressive renal injury. Among immunoregulatory mediators, interleukin-6 (IL-6) and interleukin-27 (IL-27) have been implicated in inflammatory and immune processes; however, their combined role in IgAN remains poorly understood. Methods: In this study, serum levels of IL-6 and IL-27 were measured in 51 patients with biopsy-proven IgAN and 62 healthy controls using enzyme-linked immunosorbent assay (ELISA). Associations with clinical and histopathological parameters, including the Oxford MEST-C classification, were evaluated. Results: Serum IL-27 levels were significantly higher in patients with IgAN compared to controls (p = 0.001), while IL-6 levels did not differ significantly between groups (p = 0.820). A positive correlation between IL-27 and IL-6 levels was observed in the patient group (Spearman’s rho = 0.287, p = 0.044). Higher IL-27 concentrations were associated with the absence of mesangial proliferation (p = 0.021) and erythrocyturia (p < 0.001), and showed a trend toward lower proportions of global and segmental glomerulosclerosis. ROC analysis demonstrated moderate discriminatory ability for IL-27 (AUC = 0.708), while the combined IL-6/IL-27 model showed only modest improvement (AUC = 0.661). Conclusions: Our findings suggest that IL-27 may play a modulatory and potentially protective role in IgAN, possibly through attenuation of IL-6–mediated inflammatory pathways. Full article

Introduction: Chronic kidney disease represents a significant global health burden, with dialysis as the most prevalent modality for end-stage kidney disease (ESKD) treatment. One of the major causes of ESKD is diabetes mellitus. Diabetic patients undergoing dialysis have higher mortality risk so optimal timing for its initiation is critical in maximizing survival and quality of life. This study aimed to explore the mortality risk of early versus late dialysis initiation in ESKD patients with diabetes. Methods: Systematic searches were conducted according to the PRISMA 2020 guidelines on PubMed, Scopus, ProQuest, and several databases through Web of Science up to 20 May 2025 (PROSPERO CRD420251074686). Effect sizes were presented as hazard ratios (HRs) with 95% confidence intervals (CIs) and 95% prediction intervals (PIs), pooled using a restricted maximum likelihood random-effects model. Subgroup and meta-regression analyses were also performed to search for potential confounding variables. Results: Eight studies involving 303,116 patients were included. Two studies defined early and late dialysis initiation using an estimated glomerular filtration rate (eGFR) cut-off of 5.0 mL/min/1.73 m², while the remaining studies used cut-offs ranging from 7.0 to 7.7 mL/min/1.73 m². The pooled hazard ratio (HR) showed no significant difference in the mortality risk between early and late initiation of dialysis in ESKD patients with diabetes mellitus (HR 1.02, 95% CI 0.79–1.31, p = 0.90, I² = 97.87%, 95% PI 0.45–2.32). Sensitivity analysis showed that the pooled HR was robust. Subgroup analysis demonstrated no significant difference in the pooled HR according to different study designs. Meta-regressions also showed that the year of population sampling, mean age, and follow-up duration of mortality risk did not have significant associations with the pooled HR. Conclusions: Early dialysis initiation does not appear to confer a survival benefit in ESKD patients with diabetes mellitus. However, given the limited and heterogeneous evidence, further high-quality studies are needed. We suggest that dialysis initiation in this specific population should be guided by clinical indications. Full article

Dengue remains a major public health problem in tropical and subtropical regions, particularly in Latin America. Acute kidney injury (AKI) is one of the severe complications associated with dengue and has been linked to worse clinical outcomes, including prolonged hospitalization, need for renal replacement therapy, and increased mortality. This review aimed to summarize the available evidence on the epidemiology, pathophysiology, clinical manifestations, diagnosis, management, and prognosis of dengue-associated AKI, while also providing an overview of the literature from Latin America. This manuscript was developed as a narrative review. For the Latin America-specific overview, a focused structured search was conducted in PubMed, ScienceDirect, Cochrane Library, LILACS, and Web of Science, including studies published up to December 2025. The available data suggest that AKI in dengue is multifactorial, involving plasma leakage, renal hypoperfusion, endothelial dysfunction, tubular injury, rhabdomyolysis, thrombotic microangiopathy, and inflammatory renal damage. Clinically, AKI has been associated with oliguria, proteinuria, elevated serum creatinine, renal replacement therapy, and higher mortality. Only four eligible indexed studies from Latin America were identified in our search, all from Brazil, with small sample sizes and incomplete reporting of renal outcomes; however, additional unpublished or non-indexed local data may exist. In summary, dengue-associated AKI is a relevant complication of severe dengue, but the evidence available from Latin America remains limited. These findings highlight the need for improved renal surveillance and standardized reporting in dengue-endemic settings across Latin America. Full article

Granulomatosis with polyangiitis (GPA) is a systemic vasculitis frequently associated with serum anti-neutrophil cytoplasmic antibodies (ANCAs), particularly anti-proteinase 3 (PR3). Multisystem involvement is typical, although disease onset with simultaneous manifestations affecting both the ocular and otorhinolaryngologic systems is rare and poorly reported in the literature. We describe a 65-year-old woman with renal impairment with microscopic hematuria and proteinuria and PR3-positive who developed bilateral otitis leading to sensorineural hearing loss and severe anterior scleritis, with a high suspicion of ANCA-associated vasculitis. Despite immunosuppression therapy, persistently elevated serum anti-PR3 levels in the absence of overt clinical activity prompted further diagnostic evaluation, which revealed previously unrecognized subglottic stenosis (SGS), confirmed by MRI, and fully resolved after anti-CD20 therapy. Concurrent involvement of the upper airways and ocular district as the initial presentation of GPA is unusual and may precede renal involvement by several months. Persistent elevation of PR3 levels in an apparent state of clinical remission may indicate ongoing active disease in other anatomical sites. The integration of laboratory tests, imaging studies, and multidisciplinary assessment is essential for early diagnosis and effective therapeutic management. Full article

Background: Entrustable Professional Activities (EPAs) that transform competencies into distinct, assessable clinical tasks have not yet been developed for US nephrology fellowships. We created and achieved consensus on a set of nephrology-specific EPAs and aligned them with Accreditation Council for Graduate Medical Education (ACGME) competency standards. Methods: This study was conducted within the University of New Mexico nephrology fellowship program. An initial EPA list was generated by the study team using program objectives, a literature review, and clinician insight. Study participants included eight faculty nephrologists and one nephrology fellow, who completed an online-based three-round modified Delphi consensus-building processes. Each EPA was rated on a five-point Likert scale with consensus requiring strict criteria. Finalized EPAs were independently mapped to ACGME nephrology program requirements. Results: Nine study participants (100% response rate) completed all survey rounds. Through iterative consensus, utilizing strict criteria, a final list of 22 distinct EPAs was created, covering 10 core domains of practice including dialysis management, acute kidney injury, chronic kidney disease, electrolyte abnormalities, hypertension, kidney stones, glomerular disease, pregnancy, transplant care, and education. Finalized EPAs were mapped to 38 different ACGME-required sub-competencies, showcasing diversity and applicability to national expectations. Conclusions: We developed the first consensus-based set of EPAs geared for US nephrology fellowship programs, providing a foundation for standardized assessment and curriculum development that could be implemented across nephrology fellowship programs nationally. Full article

Chronic kidney disease–mineral and bone disorder (CKD-MBD) is a major complication of end-stage renal disease and is associated with increased morbidity and mortality. Sclerostin, an osteocyte-derived glycoprotein that inhibits the Wnt/β-catenin signaling pathway, has been implicated in the dysregulation of bone metabolism in dialysis patients. However, comparative data on sclerostin levels and their clinical determinants between hemodialysis (HD) and peritoneal dialysis (PD) patients remain limited, particularly in Southeast Asian populations. This cross-sectional study was conducted at Hue Central Hospital, Vietnam, between June 2023 and January 2026. A total of 89 end-stage renal disease patients were consecutively enrolled (HD: n = 51; PD: n = 38). Median serum sclerostin levels were 584.21 (IQR: 301.18–1479.50) pg/mL in the HD group and 684.21 (IQR: 407.48–940.35) pg/mL in the PD group, with no significant difference between groups (p = 0.839). Serum sclerostin was inversely correlated with PTH in both HD (r = −0.444, p = 0.001) and PD patients (r = −0.341, p = 0.036). In the HD group, total femur BMD showed a significant inverse correlation with sclerostin (r = −0.304, p = 0.030). In multivariable analysis, Log_PTH remained an independent predictor of sclerostin across all three sequential models in the HD group (Model 1: B = −0.340, p = 0.001; Model 2: B = −0.270, p = 0.035; Model 3: B = −0.268, p = 0.039; adjusted R² range: 0.197–0.217) and in the combined HD + PD cohort (Model 1: B = −0.271, p < 0.001; Model 2: B = −0.263, p < 0.001; Model 3: B = −0.249, p = 0.003; adjusted R² range: 0.141–0.158). In the PD subgroup, Log_PTH was significant in Models 1 and 2 but not in Model 3; none of the models reached overall statistical significance (all p ≥ 0.081), and findings should be considered exploratory given the limited sample size. Serum sclerostin levels did not differ significantly between HD and PD patients. PTH was the most consistent independent predictor of sclerostin across dialysis modalities and analytical models, underscoring its central role in CKD-MBD pathophysiology. Larger prospective multicenter studies are warranted to validate these findings and further clarify the clinical utility of sclerostin in dialysis populations. Full article

Malaria remains a leading cause of morbidity and mortality among children in sub-Saharan Africa. Acute kidney injury (AKI) is increasingly recognized as a frequent and severe complication of pediatric severe malaria, yet it remains largely underdiagnosed. This under-recognition is driven by important limitations in current diagnostic approaches. The World Health Organization (WHO) criteria rely on fixed serum creatinine (SCr) thresholds that are poorly adapted to children, whereas Kidney Disease Improving Global Outcomes (KDIGO) criteria require baseline SCr (bSCr) values that are rarely available in low-resource settings. The estimation of bSCr using back-calculation methods is further complicated by population-specific factors, particularly malnutrition, which reduces creatinine generation and may mask kidney injury. In addition, urine output (UO) monitoring is often underutilized despite its diagnostic value, and access to laboratory testing remains limited. Emerging biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, and kidney injury molecule-1 (KIM-1) show promise for early detection and risk stratification but remain insufficiently validated in African pediatric populations. In this narrative review, we highlight key challenges in diagnosing malaria-associated AKI (MAKI) in children and discuss potential strategies to improve early detection in resource-limited settings, with the aim of reducing morbidity and mortality. Full article

Background: Chronic kidney disease-associated pruritus (CKD-aP) is characterised as pruritus in individuals with advanced chronic kidney disease (CKD) without a discernible alternative etiology. This study assessed the prevalence, severity, and effects of CKD-aP on sleep and health-related quality of life (HRQoL) among end-stage kidney disease patients (ESKD) undergoing maintenance hemodialysis (MHD) in an Indian cohort. Methods: This cross-sectional, single-centre study included adults with renal failure undergoing MHD for ≥3 months. The primary outcome was CKD-aP prevalence and its relationship with demographic, clinical, and laboratory variables. Secondary outcomes included CKD-aP severity, characteristics, HRQoL, and sleep quality scores. Statistical analysis was conducted using SPSS v21, with a significance level of p < 0.05. Results: The 12-item Pruritus Severity Scale found mild CKD-aP to be the most common (37% of patients). The 5-D Itch Scale found that patients with moderate-to-severe CKD-aP had longer daily itching (52.9%) with a nonsignificant change over time (p = 0.18), and the back (77.9%) was the most affected site. The Dermatology Life Quality Index revealed that 75.5% of patients had HRQoL impairment. The Skindex-16 found that moderate-to-severe CKD-aP was linked to a greater symptom burden and emotional distress. The Pittsburgh Sleep Quality Index found poorer sleep quality as CKD-aP worsened. Conclusions: CKD-aP is common in patients undergoing hemodialysis and negatively impacts quality of life, emphasizing the need for routine assessment and targeted management. Full article

Chronic kidney disease (CKD) is a major global health burden associated with substantially increased risks of morbidity and mortality. Cardiovascular disease remains the leading cause of death across all stages of CKD. Over the past few decades, several pharmacologic therapies—including renin–angiotensin system inhibitors, sodium–glucose cotransporter-2 inhibitors, mineralocorticoid receptor antagonists, glucagon-like peptide-1 receptor agonists, and lipid-lowering agents—have demonstrated substantial cardio-nephroprotective benefits and are recommended in international guidelines. However, real-world implementation of these therapies remains incomplete, and emerging evidence highlights important sex-based disparities in prescribing patterns. Although CKD is more prevalent in women worldwide, women with CKD are consistently less likely than men to receive guideline-directed cardioprotective and nephroprotective medications. This treatment gap spans both traditional therapies, such as angiotensin-converting enzyme inhibitors and statins, and newer agents with proven outcome benefits. Women are less likely to initiate treatment, less likely to receive high-intensity or target doses, and less likely to achieve recommended blood pressure and lipid goals. Importantly, the presence of CKD attenuates the usual female survival advantage, and the relative excess cardiovascular risk associated with CKD may be particularly pronounced in women. The under-prescription of cardio-renal therapies in women with CKD reflects a complex interplay of factors. These include older age at presentation, higher reported rates of adverse drug reactions, concerns regarding tolerability and safety in advanced kidney disease, therapeutic inertia, underestimation of cardiovascular risk, and persistent underrepresentation of women in clinical trials. Biological differences in pharmacokinetics and pharmacodynamics, as well as structural and system-level barriers, further contribute to inequities in care. Addressing these disparities requires improved risk recognition, sex-informed prescribing practices, enhanced representation of women in clinical research, and implementation strategies that incorporate sex-disaggregated performance metrics. Reducing treatment gaps is essential to improving cardiovascular and renal outcomes and to achieving equitable, precision-based care for women with CKD. Full article

Background: Ischemia-reperfusion injury (IRI) impairs kidney transplants. Diazepam can reduce IRI through peripheral benzodiazepine receptors. We aimed to evaluate the effect of diazepam premedication on the IRI of the rat kidney. Methods: Fourteen days after unilateral nephrectomy, male Sprague-Dawley rats underwent a 45 min sole kidney ischemia. Sixty minutes prior to ischemia, the animals were randomly assigned to a subcutaneous injection of 0.75 mg diazepam (n = 28) or 0.5 mL 0.9% NaCl (n = 31). Results: After 48 h, serum creatinine of diazepam-administered rats was lower and creatinine clearance was higher than in controls (119.8 ± 73.3 vs. 217.5 ± 105.3 µmol/L, p < 0.01 and 0.14 ± 0.07 vs. 0.08 ± 0.05 mL/min/100 g BM, p < 0.01, respectively). Moreover, the former had lower urinary losses of sodium and potassium (fractional excretions of 1.24 ± 1.39% vs. 2.87 ± 3.66%, p = 0.02 and 111.1 ± 95.7% vs. 199.0 ± 143.3%, p < 0.01, respectively). After 7 days, diazepam-treated rats remained superior vs. controls, regarding serum creatinine (53.7 ± 12.7 vs. 77.6 ± 21.3 µmol/L, p < 0.01), creatinine clearance (0.22 ± 0.08 vs. 0.17 ± 0.06 mL/min/100 g BM, p < 0.01), potassium sparing (50.2 ± 31.7% vs. 73.4 ± 38.7% excretion, p < 0.01), and renal edema (1.92 ± 0.45 vs. 2.30 ± 0.61 g of kidney mass, p < 0.01). Furthermore, their 24 h proteinuria was marginally reduced (4.03 ± 2.62 vs. 5.06 ± 2.74 mg, p = 0.06). Conclusions: Administration of diazepam preceding renal ischemia attenuates subsequent kidney injury in rats. Benzodiazepines may be beneficial prior to kidney transplantation. Full article

Eryptosis is a programmed cellular death that leads to the removal of defective red blood cells (RBCs). It is driven by convergent intracellular pathways centered on cytosolic Ca²⁺ overload, ceramide formation, caspase and calpain activation, disruption of membrane phospholipid asymmetry, and the externalization of phosphatidylserine on the cell surface, which marks the cell for clearance by macrophages. In hemodialysis (HD), intermittent extracorporeal circulation exposes erythrocytes to mechanical stress, bio-incompatible membrane surfaces, and rapid osmotic and ionic shifts. Experimental evidence indicates that osmotic shock induces eryptosis through synergistic Ca²⁺ influx and sphingomyelinase-dependent ceramide generation, providing a mechanistic framework for intradialytic erythrocyte injury. Clinical studies report heterogeneous eryptotic responses during HD, reflecting the balance between toxin removal and procedure-related stress. In contrast, peritoneal dialysis (PD) imposes sustained exposure to hyperosmolar, glucose-based solutions and is strongly influenced by inflammation and residual kidney function. Clinical and experimental data consistently demonstrate increased eryptosis in PD patients, with marked amplification during peritonitis and close associations with inflammatory mediators. This review integrates mechanistic and clinical evidence on eryptosis in HD and PD, highlights modality-specific triggers converging on shared downstream pathways and discusses translational implications and research priorities for improving dialysis biocompatibility and anemia management. Full article

Background/Objectives: Candidates with cardiometabolic risk are considered for living kidney donation more frequently because of the global organ shortage. The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines introduced individualized risk assessment based on composite donor profiles rather than categorical exclusion, but the long-term implications of accepting donors with potential risk factors require careful evaluation. This review synthesizes current evidence on outcomes of living kidney donors with obesity, prediabetes, hypertension, and smoking. Methods: A literature search was conducted in PubMed/MEDLINE for studies published between 1 January 2000 and 28 February 2026, including cohort studies, registry analyses, meta-analyses, and clinical guidelines evaluating living kidney donors with obesity, smoking, prediabetes, or hypertension. Priority was given to large cohorts with long-term follow-up. Over 70 publications were included in the final synthesis. Findings were synthesized narratively by risk factors and outcomes. Results: Obesity was associated with an 86% increased end-stage kidney disease (ESKD) risk and 32% increased 20-year mortality. Central adiposity measures outperformed body mass index (BMI) for predicting estimated glomerular filtration rate (eGFR) decline. Post-donation weight gain increased the risk for developing hypertension and diabetes. Smoking conferred a 7.5-fold chronic kidney disease (CKD) risk, with impaired compensatory renal adaptation after donation. Prediabetic donors showed comparable outcomes to normoglycemic donors, with 57.8% reverting to normoglycemia at 10 years. Pre-donation hypertension increased 15-year ESKD risk 3-fold, but absolute risk remained low. At 15 years post-donation, over 50% of the donors developed hypertension. Glucagon-like peptide-1 (GLP-1) receptor agonists reduce diabetes progression by 73–94% in at-risk populations, but prospective studies in donors are lacking. Conclusions: Each risk factor carries quantifiable risks for individualized stratification. These risk factors usually coexist and interact. Refinement of risk prediction models, strategies for metabolic optimization and prospective evaluation of emerging pharmacologic therapies are key priorities. Full article

Randomized controlled trials (RCTs) are the gold standard for evaluating the efficacy and safety of medical interventions. However, the interpretation of their results is often obscured by an overreliance on relative measures of effect, such as relative risk reduction (RRR) and hazard ratios (HRs). While statistically robust, these measures may mislead clinicians and patients when used in isolation. This article provides a methodological framework for the comprehensive interpretation of treatment effects in RCTs, emphasizing the importance of integrating absolute measures such as absolute risk reduction (ARR), number needed to treat (NNT), annualized NNT (aNNT), and number needed to harm (NNH). Additionally, we explore the conceptual differences between risk-based and rate-based measures, the clinical implications of time-to-event analyses, and the utility of composite metrics such as the likelihood of being helped or harmed (LHH). By adopting a multidimensional approach to effect estimation, researchers and clinicians can enhance the translation of statistical findings into meaningful clinical decisions. This approach also facilitates communication with patients. Full article

Gender medicine represents a key paradigm for advancing equitable and effective healthcare by systematically integrating sex- and gender-related differences into medical research and clinical practice. Despite regulatory efforts and international guidelines, significant gaps persist in the consideration of sex and gender across medical disciplines, including nephrology. Biological factors—including genetic, hormonal, and metabolic differences—interact with social, cultural, and environmental determinants to influence chronic kidney disease (CKD) susceptibility, clinical presentation, progression, and response to therapy. Insufficient consideration of sex and gender contributes to persistent disparities in CKD progression, cardiovascular outcomes, access to kidney transplantation, adverse drug reactions, dialysis outcomes, and pregnancy-related kidney complications. This narrative review outlines the historical development of gender medicine and critically appraises its relevance and unresolved challenges in kidney disease, with a focus on sex-specific differences in selected conditions, including autosomal dominant polycystic kidney disease, glomerular diseases, acute kidney injury, and pregnancy-associated kidney disorders. Integrating sex- and gender-informed approaches into nephrology is not merely an ethical requirement but a scientific necessity to improve risk stratification, personalize therapeutic strategies, and promote truly equitable and effective kidney care. Full article

Social determinants of health (SDoH) are non-medical factors shaped by the socioeconomic status of individuals or communities that influence the onset and progression of diseases and affect their outcomes. We have narratively analyzed the most important findings relating chronic kidney disease (CKD) and SDoH, evaluating the following items: (i) medical care and social determinants of health, (ii) socioeconomic risk for kidney disease at the individual level and (iii) socioeconomic risk for kidney disease at the population level. SDoH can be categorized by how they influence a person’s daily life. Individual factors include personal lifestyle choices such as smoking habits, alcohol consumption, and how a patient spends their non-working time. Community factors include structural elements such as average household income, educational attainment, employment rates, and the quality of the surrounding physical environment. Research consistently shows that a low socioeconomic status is a primary driver of poor clinical outcomes. While healthcare systems vary globally, the negative impact of socioeconomic deprivation on CKD patients remains a constant. Disadvantaged patients experience a faster loss of renal function, and there is a significantly higher incidence of cardiovascular events and mortality compared to those with financial stability. Financial hardship often leads to a “double burden,” where the struggle to afford care triggers a decline in both physical health and mental well-being. To improve patient care, it is essential to raise awareness among healthcare providers regarding the profound impact of these social factors. More precise data and thorough research are needed to fully understand these associations and develop targeted interventions. Full article

Background: Chronic Kidney Disease-associated Pruritus (CKD-aP) is a frequent, debilitating, and often underestimated symptom in clinical practice, with significant impacts on quality of life, sleep, mental health, and therapeutic adherence. This study aimed to develop a structured, person-centered nursing care overview for the management of CKD-aP. Methods: A comprehensive narrative review of the recent scientific literature on CKD-aP was conducted, adapting the conceptual domains of the European Specialist Nurses Organisation (ESNO) Common Training Framework (CTF) to nephrology nursing practice. The theoretical model guiding the work was Virginia Henderson’s paradigm, selected for its consistency with care models focused on promoting independence and meeting fundamental human needs. The study would answer the main research question “Which nursing evidence, tools, and strategies can support integrated, patient-centered management of CKD-aP?”. Results: A structured nursing care process was developed, articulated in sequential phases (assessment, problem definition, planning, intervention, and re-evaluation), visually represented in an operational flowchart and supported by validated clinical tools. The model emphasizes the nurse’s role in the multidimensional management of the symptom, incorporating educational, relational, therapeutic, and coordination-focused interventions. Conclusions: This proposal contributes to nephrology nursing practice by providing a theoretical and practical framework to standardize the management of CKD-aP. It promotes a holistic, evidence-based approach tailored to individual care needs, establishing a foundation for future clinical, educational, and research developments. Full article