Nephrology

Longer hemodialysis treatment time associates with lower mortality and hospitalizations

In 146,127 US in-center hemodialysis patients, longer delivered treatment times were associated with substantially lower all-cause mortality. Compared with 180–194-minute sessions, 240–254 minutes was associated with 27% lower mortality (HR 0.73; 95% CI 0.69–0.76). Intermediate treatment-time groups (195–239 minutes) showed graded mortality reductions of 15%–19% versus the shortest group. Longer treatments were similarly associated with fewer hospitalizations and shorter stays across ultrafiltration volumes and in patients with spKt/V >1.4. 1

Older-adult eGFR equations inflate CKD prevalence with limited prognostic gain

Among 17,686 ASPREE participants (mean age 75 years), BIS1 and EKFC equations yielded eGFR values 12–15 mL/min/1.73 m² lower than CKD-EPI 2021. Using BIS1 or EKFC increased CKD prevalence from 21% to 37%–46%, with most participants reclassified to higher CKD stages. Despite this, long-term risks of reduced disability-free survival, mortality, and MACE were similar in reclassified and nonreclassified groups. Across all equations, excess risk clustered below eGFR 45 mL/min/1.73 m², largely independent of uACR. 2

KDIGO kidney protection bundles cut moderate–severe AKI after major surgery

This IPD meta-analysis pooled four RCTs including 1,851 high-risk surgical patients enriched using renal stress biomarkers. Patients randomized to a KDIGO-based kidney protection strategy received hemodynamic and fluid optimization, nephrotoxin avoidance, close kidney monitoring, and glycemic control. Moderate or severe AKI (KDIGO stage ≥2 within 72 hours) occurred in 17.7% with the bundle vs 27.1% with standard care (OR 0.55; 95% CI 0.44–0.70). Heterogeneity was negligible, and secondary endpoints were broadly similar, though persistent AKI and tubular stress biomarkers tended to improve. 3

Thailand’s patient-choice dialysis reform increased HD use, costs, and early mortality

After Thailand moved from a PD-first to a patient-choice policy in 2022, hemodialysis rapidly became the dominant modality and dialysis incidence increased. Dialysis care shifted toward private providers, with more unplanned dialysis starts and prolonged use of temporary hemodialysis catheters. Program expenditure rose 74% from 2018, reaching USD 452 million in 2024, or 9.3% of the national health budget. All-cause mortality increased, particularly within 90 days of initiation, and postpolicy initiations had higher adjusted mortality risk. 4