A comprehensive study has examined the association between handgrip strength and all-cause mortality risk across diverse populations. Handgrip strength, a readily measurable indicator of overall physical function and muscle mass, has emerged as a significant predictor of health outcomes and longevity. The research synthesizes evidence demonstrating that individuals with lower handgrip strength face substantially elevated mortality risks compared to those with stronger grip measurements. This finding holds importance across multiple age groups and demographic segments, suggesting handgrip strength serves as a valuable biomarker for assessing general health status and disease vulnerability. The association persists even after accounting for other established risk factors, indicating independent prognostic value. These findings underscore the clinical relevance of incorporating handgrip strength assessments into routine health evaluations and mortality risk stratification. The research has significant implications for identifying high-risk populations requiring targeted interventions to improve muscular strength and overall health outcomes. This work supports the integration of simple, non-invasive grip strength testing into preventive healthcare protocols and suggests potential benefits of strength-focused intervention programs in reducing mortality risk among vulnerable populations.

This study examines the relationship between serum albumin levels and peritonitis risk in peritoneal dialysis patients within a renal program. Peritonitis, an infection of the peritoneal membrane, remains a significant complication in peritoneal dialysis treatment, and understanding risk factors is crucial for patient outcomes. The research analyzes data from peritoneal dialysis patients to determine whether serum albumin concentrations correlate with increased peritonitis susceptibility. Lower serum albumin levels, which indicate malnutrition and compromised protein status, emerged as a notable risk factor for developing peritonitis in this patient population. These findings highlight the importance of nutritional assessment and management in peritoneal dialysis care, suggesting that maintaining adequate serum albumin levels may help reduce infection complications. The study contributes to existing evidence that nutritional status plays a significant role in infection prevention among dialysis patients, with potential implications for clinical practice guidelines and patient care protocols in renal programs.

Peritonitis represents a serious complication for peritoneal dialysis (PD) patients. This multicenter cohort study evaluated six inflammatory indices derived from routine complete blood count parameters—pan-immune inflammatory value (PIV), systemic immune-inflammatory index (SII), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-monocyte ratio (PMR)—to identify the strongest predictor of PD-associated peritonitis (PDAP). Analyzing data from 2,036 PD patients across ten centers, researchers found that 147 patients (7.22%) developed peritonitis during follow-up. Among the indices examined, PIV, SII, and PLR demonstrated significant nonlinear associations with peritonitis risk, with adjusted hazard ratios of 2.004, 2.144, and 2.063 respectively. These three markers achieved adjusted C-indices ranging from 0.67 to 0.70, indicating moderate discriminative ability. While elevated levels of PIV, SII, and PLR independently predicted higher peritonitis risk, their clinical significance lies in providing cost-effective, routine-based risk stratification tools that could help identify patients requiring closer monitoring or preventive interventions.

This research article examines patients' experiences and decision-making quality regarding dialysis modality selection following shared decision-making interventions. Published in BMC Nephrology in August 2020, the study investigates how collaborative approaches between healthcare providers and patients influence treatment choices for end-stage renal disease. The research evaluates patient satisfaction, confidence in decisions, and the overall quality of the decision-making process when patients actively participate in selecting between different dialysis options such as hemodialysis and peritoneal dialysis. By analyzing patient experiences post-intervention, the study provides insights into whether shared decision-making frameworks improve outcomes and patient empowerment in renal care. This matters significantly because dialysis modality selection directly impacts patient quality of life, treatment adherence, and clinical outcomes. Understanding how shared decision-making affects patient confidence and satisfaction helps healthcare systems optimize counseling approaches and ensure patients make informed choices aligned with their personal values and circumstances, ultimately improving kidney disease management and patient-centered care delivery.

The International Society for Peritoneal Dialysis (ISPD) has released comprehensive recommendations addressing catheter-related infections, a significant clinical concern in peritoneal dialysis patients. These guidelines provide evidence-based strategies for preventing, diagnosing, and managing infections associated with peritoneal dialysis catheters, which represent a major cause of technique failure and patient morbidity in this population. The recommendations cover essential aspects including proper catheter insertion techniques, exit-site care protocols, and antimicrobial prophylaxis strategies to reduce infection incidence. The document offers clinicians standardized approaches to infection management, encompassing both peritonitis and exit-site infections through detailed diagnostic criteria and treatment algorithms. By establishing clear clinical pathways and best practices, these ISPD recommendations aim to improve patient outcomes, reduce hospitalization rates, and enhance the sustainability of peritoneal dialysis as a renal replacement therapy. Implementation of these guidelines is critical for nephrology teams and dialysis centers seeking to optimize treatment efficacy and patient safety while maintaining the quality of life benefits associated with home-based peritoneal dialysis programs.

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.