30-Second Takeaway
- Incorporating structured patient-reported outcomes at dialysis start improves short-term mortality prediction beyond standard clinical models.
- Moderate low-protein diets with support appear feasible in advanced CKD and associate with slower progression and fewer dialysis starts.
- Using more acceptable-quality deceased donor kidneys for older candidates is projected to reduce waitlist deaths at low incremental cost.
Week ending January 31, 2026
Focused Updates in CKD Progression, Transplant Access, and Glomerular Disease
Patient-Reported Outcomes Sharpen 2-Year Mortality Prediction in Incident Dialysis
In three incident dialysis cohorts (NECOSAD, EQUAL, NECOSAD 65+), adding patient-reported outcomes improved 2-year mortality prediction beyond clinical variables alone. Base models showed good discrimination (AUCs 0.699–0.806), which increased to 0.746–0.878 after incorporating PROs, with better calibration and Brier scores. Mental and physical component scores and overall symptom burden were the most consistently informative PROs across cohorts. These findings support routine, structured PRO collection at dialysis initiation to refine risk stratification and guide intensity of follow-up and counseling.
Dual Anti-GBM and Anti-TBM Disease Mimicking Diabetic Nephropathy
An elderly woman with diabetes developed rapidly progressive renal failure with hematuria and significant proteinuria requiring dialysis. The atypical course for diabetic nephropathy prompted serologic testing and kidney biopsy, revealing concurrent anti-GBM disease and anti-tubular basement membrane interstitial nephritis. Aggressive immunosuppression and plasma exchange led to marked renal recovery and dialysis independence. The case underscores the importance of biopsy in diabetics with rapid decline and atypical urinary findings to uncover treatable pathology.
Optimizing Kidney Transplant Use in Older ESKD Patients
This Kidney International review synthesizes evidence for selecting older ESKD patients most likely to benefit from kidney transplantation. It emphasizes data-driven assessment of comorbidity, frailty, and competing mortality risks to distinguish clear beneficiaries from those with limited net gain. Preemptive or expedited transplantation is highlighted to minimize dialysis exposure and associated morbidity in older adults. Kidneys from older or high KDPI donors show satisfactory outcomes in older recipients, supporting broader organ acceptance in this population.
More Acceptable-Quality Deceased Donor Kidneys for Older Candidates are Cost-Effective
A microsimulation of 100,000 synthetic candidates aged 65 years or older modeled higher deceased donor transplant rates using acceptable-quality kidneys. Increasing the transplant rate by 25% was estimated to avert 141 waiting list deaths per 10,000 candidates. This strategy cost about $8100 per QALY gained and was frequently cost saving from health care sector perspectives. At willingness-to-pay thresholds of at least $40,000 per QALY, a 25% increase in deceased donor transplantation was preferred in all sensitivity analyses.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.