Nephrology

Incremental twice-weekly hemodiafiltration matches thrice-weekly outcomes at dialysis initiation

Incident dialysis patients with urea clearance ≥2.5 ml/min were randomized to incremental twice-weekly versus conventional thrice-weekly hemodiafiltration. Over 12 months, decline in GFR, residual kidney function, hospitalizations, mortality, and anuria did not differ between groups. Quality-of-life scores modestly favored incremental therapy at 6 months, especially disease burden, but this advantage attenuated by 12 months. Patients on incremental hemodiafiltration had far fewer sessions per year (69.1 vs 122.6), implying major resource and time savings. 1

Brief cotrimoxazole prophylaxis cuts infections after rituximab in glomerulonephritis

In 150 rituximab-treated glomerulonephritis patients, 1-week cotrimoxazole courses after each infusion were compared with no prophylaxis. Infections occurred in 7 cotrimoxazole-treated versus 16 control patients over 180 days, with lower incidence density in the prophylaxis group. Cotrimoxazole reduced cumulative infection risk (HR 0.39; 95% CI 0.17–0.88) and lowered infection-related mortality. Short-course prophylaxis did not increase serious adverse events attributed to cotrimoxazole, despite the single-center open-label design. 2

Using kidneys from active hepatitis B–infected donors into HBV-negative recipients appears feasible with precautions

This meta-analysis synthesized 20 cohorts including 600 HBsAg-negative kidney recipients transplanted from donors with active hepatitis B infection. Overall HBV transmission was 4.0%, mostly transient low-level viremia without sustained infection. Transmission risk rose to 16.0% when all donors were NAT positive, but was very low in living-donor and surface-antibody–positive recipients. Three HBV-related deaths occurred, all in recipients who did not receive posttransplant antiviral prophylaxis, underscoring the importance of prophylaxis. 3