The European Renal Association (ERA) Registry collects data on patients with kidney failure receiving kidney replacement therapy (KRT). This paper presents a summary of the ERA Registry Annual Report 2023, and focuses specifically on comparisons by age. The complete ERA Registry Annual Report 2023 is available in the Supplementary information. For 2023, data were collected from 34 countries in Europe and countries bordering the Mediterranean Sea. Using these data, incidence and prevalence of KRT, kidney transplantation rates, survival probabilities, and expected remaining lifetimes were calculated. In 2023, the ERA Registry covered 519 million people in the participating countries. The incidence of KRT was 151 per million population (pmp). Among incident patients, 29% were aged ≥75 years, 64% were male, and the most common primary renal disease (PRD) was diabetes mellitus (22%). Most patients (83%) started KRT with haemodialysis (HD), 11% started with peritoneal dialysis (PD), and 6% underwent pre-emptive kidney transplantation. On 31 December 2023, the prevalence of KRT was 1101 pmp. Among prevalent patients, 24% were aged ≥75 years, 62% were male, and the most common PRD was of miscellaneous origin (18%). Moreover, 56% of prevalent patients received HD, 5% received PD, and 39% were living with a functioning graft. In 2023, the kidney transplantation rate was 43 pmp, with 69% of kidneys coming from deceased donors. For patients starting KRT between 2014 and 2018, 5-year survival probability was 51%. The proportions of incident and prevalent patients aged ≥75 varied considerably across European countries. In addition, incident patients aged ≥75 were more often male, and had more often hypertension as PRD compared with younger patients. Only 1% of incident patients aged ≥75 received a pre-emptive kidney transplant, while among prevalent patients of the same age, 22% was living with a functioning graft.

In the collective perception, uraemic patients are often identified as those undergoing dialysis. In reality, however, dialysis patients represent only a small fraction of the total uraemic population. Conservative estimates indicate that one in ten individuals in the industrialized world has some degree of renal dysfunction, meaning that approximately 700 million people are affected [GBD-Chronic Kidney Disease Collaboration. Global, regional, and national burden of Chronic Kidney Disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2020;395:709-33]. These figures have rapidly made chronic kidney disease (CKD)-the correct term for renal failure-a global public health issue, owing both to its unsustainable economic burden for healthcare systems and its high mortality rate, estimated at 2.6 million deaths in 2017 [Saran R, Robinson B, Abbott KC, Bragg-Gresham J, Chen X, Gipson D et al. US Renal Data System 2019 annual data report: epidemiology of kidney disease in the United States. Am J Kidney disease 2020;75:S1-S64]. To mitigate the impact of this true epidemic, new strategies must prioritize early detection and prevention. The first step, however, is conceptual: CKD should no longer be regarded as an exclusively nephrological disorder but as a multisystem condition requiring the attention of internists, cardiologists, diabetologists, and general practitioners alike.

In the field of heart failure, sodium-glucose cotransporter 2 inhibitors (SGLT2-i) have demonstrated robust efficacy and have received a Class I, Level A recommendation for reducing the risk of heart failure hospitalizations and cardiovascular mortality across the entire spectrum of left ventricular ejection fraction. The therapeutic effect occurs early, with the first statistical significance observed as soon as 12-28 days after treatment initiation. Evidence suggests that early introduction during hospitalization may reduce the short-term risk of cardiovascular death or worsening heart failure. SGLT2 inhibitors display a favourable safety and tolerability profile, without an increased incidence of adverse events compared with placebo. Furthermore, they are indicated for the treatment of type 2 diabetes mellitus and chronic kidney disease, irrespective of the presence of heart failure. Therefore, we propose that in patients presenting with signs and/or symptoms of heart failure and elevated natriuretic peptide levels, SGLT2 inhibitors may be initiated even before echocardiographic confirmation of the diagnosis. Given the favourable risk-benefit profile, this approach may help avoid therapeutic delay, which could otherwise be associated with an increased risk of early adverse events, and may ultimately improve prognosis.

Obesity represents a pandemic, independent and modifiable cardiovascular risk factor, distinct from other well-known risk factors such as hypertension, hypercholesterolemia, and diabetes mellitus. The impact of this condition on cardiovascular outcomes is remarkably potentiated when obesity is associated with hypertension. These include the development and progression of left ventricular hypertrophy, endothelial dysfunction, sympathetic activation to the heart and peripheral vessels, impaired arterial distensibility, pro-atherogenic vascular alterations and kidney dysfunction and failure. On the clinical ground these alterations favor the development and progression of cardiovascular complications, such as coronary artery disease, chronic heart failure, life-threatening cardiac arrhythmias cerebrovascular disease and sleep apnea syndrome. In conclusion, the present paper will provide a comprehensive in-depth pathophysiological background, clinical consequences and therapeutic implications of the obesity-related hypertensive phenotype.

Objectives Patients with diabetic kidney disease (DKD) are at increased risk of cognitive impairment, but the underlying alterations in resting-state BOLD-CBF coupling remain unclear. This study aimed to investigate changes in resting-state BOLD-CBF coupling and their associations with clinical characteristics and cognitive function in DKD. Resting-state functional MRI (rs-fMRI) and arterial spin labeling (ASL) were performed in 36 patients with DKD, 36 patients without DKD, and 37 healthy controls. Amplitude of low-frequency fluctuations (ALFF) derived from rs-fMRI and cerebral blood flow (CBF) derived from ASL were used to calculate the ALFF-CBF coupling coefficient, which was used to characterize resting-state BOLD-CBF coupling. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) before MRI examination. Laboratory tests were also performed, and correlations with clinical variables and MoCA scores were analyzed. Compared with the non-DKD group, the DKD group showed significantly reduced resting-state BOLD-CBF coupling in several brain regions. In the DKD group, glycated hemoglobin A1c levels negatively correlated with resting-state BOLD-CBF coupling in the bilateral medial superior frontal gyrus, while hemoglobin levels positively correlated with resting-state BOLD-CBF coupling in multiple brain areas. And resting-state BOLD-CBF coupling in the left hippocampus was linked to MoCA score. DKD patients exhibited more pronounced alterations in resting-state BOLD-CBF coupling compared to non-DKD patients, potentially linked to elevated blood glucose levels.

Familial hypomagnesemia with hypercalciuria and nephrocalcinosis (FHHNC) is a rare genetic disorder characterized by renal magnesium wasting, hypercalciuria, and progressive renal function decline, often culminating in end-stage renal disease (ESRD). This report presents the case of a successful living-donor kidney transplantation from a mother to her 22-year-old son, who was diagnosed with FHHNC. The patient initially exhibited hematuria at age two years, progressing to recurrent nephrolithiasis and hypercalciuria. Genetic analysis at age nine years confirmed FHHNC because of a CLDN-16 gene mutation. The CLDN-16 gene, which codes for claudin-16, is a crucial protein involved in renal magnesium and calcium reabsorption. While both parents and one sibling were identified as heterozygous carriers of the mutation, only the patient experienced severe symptoms. As his renal function progressively declined, ultimately reaching ESRD, a living-donor transplant was deemed necessary. His mother, with normal renal function and no history of nephrolithiasis, was evaluated as a suitable donor. Post-transplantation, the patient demonstrated rapid improvement in renal function, with magnesium levels stabilizing to baseline without supplementation, indicating effective graft function. This case underscores the complexities of managing FHHNC, particularly regarding kidney transplantation options and outcomes. Given the rarity of FHHNC, this report highlights the critical role of genetic diagnosis, family screening, and timely intervention. Additionally, it contributes to the limited literature on post-transplant outcomes in FHHNC, emphasizing the potential for living-donor transplantation to restore renal function and enhance quality of life in affected patients.

Arteriovenous fistula (AVF) failure remains a significant clinical problem for hemodialysis access. It is driven by hemodynamic changes which promote inflammatory responses leading to neointimal hyperplasia and ultimately stenosis. Perivascular wraps have proved to be a promising intervention for mitigating hemodynamics stress. However, the molecular impact of perivascular wraps on the venous wall is not fully understood. This study aims to evaluate the molecular effects of polycaprolactone (PCL) perivascular wraps and PCL wraps embedded with radiopaque bismuth nanoparticles (PCL-Bi) on the outflow vein. Chronic kidney disease (CKD) was induced in female Sprague-Dawley rats through 5/6th nephrectomy. After CKD induction, AVFs were created via end-to-side anastomosis of the external jugular vein to the common carotid artery. The AVFs were treated with either a PCL wrap, a PCL-Bi wrap, or left as unwrapped controls (n = 3 each group). The outflow veins were harvested for bulk RNA sequencing after 8 weeks. Differential expression and pathway enrichment analyses were performed to evaluate differences between the groups. Compared to the unwrapped controls, the PCL-wrapped AVFs showed significant downregulation of pathways related to vascular smooth muscle cell processes, endothelial cell processes, and cell adhesion. Conversely, pathways related to phagocytosis and lysosomal activity were upregulated, reflecting a controlled response to the bioresorbable scaffold. Few differences were observed between the PCL and PCL-Bi wrapped AVFs, demonstrating that the addition of bismuth nanoparticles does not negate the beneficial effects of the PCL scaffold.

End stage renal disease (ESRD) is characterized by irreversible loss of kidney function requiring dialysis or kidney transplant to maintain fluid homeostasis. The integumentary system is known to be affected, and nail changes such as Terry's nails and half-and-half nails are frequently observed. However, the prognostic significance of nail manifestations in this population remains poorly defined. Using the United States Renal Data System, which contains medical claims of all ESRD patients in the US, a retrospective cohort analysis was performed using patients enrolled between 2005 and 2018, allowing for at least a one-year follow-up. A nail change diagnosis was determined using ICD-9 and ICD-10 codes and mortality risk was evaluated using Cox Proportional Hazards (CPH) models. Of the 1,028,817 ESRD subjects included in this analysis, 66,704 (6.5%) subjects had a nail change diagnosis. In the final CPH model, a nail change diagnosis was independently associated with an increased risk of all-cause mortality (HR=1.22; 95% CI 1.20-1.23) after controlling for demographic and clinical risk factors. Despite this association, nail changes are likely underdiagnosed in the ESRD population. Our findings underscore the importance of a comprehensive dermatological evaluation of ESRD patients and recognition of nail changes as a possible prognostic indicator.

Carbapenem-resistant Acinetobacter baumannii (CRAB) is a major cause of hospital-acquired infections but is rarely implicated in community-acquired pneumonia (CAP). We report the case of a 79-year-old woman with stage 3 chronic kidney disease who presented with severe CAP and respiratory failure. Bronchoscopy with bronchoalveolar lavage (BAL) identified CRAB sensitive to tobramycin and levofloxacin but resistant to all Beta-lactams and carbapenems. She was successfully treated with intravenous tobramycin and levofloxacin, followed by oral doxycycline and levofloxacin. Clinical and radiologic resolution was achieved by week 6. This case highlights a rare instance of community-acquired CRAB pneumonia and underscores the importance of BAL-based diagnosis and susceptibility-guided therapy, particularly in high-risk patients.