Nephrology

Nurse practitioner CKD clinic improved BP, albuminuria, and guideline therapy use in early CKD

In a prospective cohort of 95 early CKD patients, a nurse-led clinic lowered median urine albumin-creatinine ratio from 32.3 to 12.4 mg/mmol (P < .001). Systolic and diastolic blood pressures fell by 10.1 mmHg and 5.2 mmHg, respectively, with no change in median eGFR. Use of guideline-directed therapies increased (RAAS inhibitors 88.4% vs 76.8%, SGLT2 inhibitors 53.6% vs 28.4%). Patient satisfaction was high among respondents, supporting acceptability in early CKD care. 1

EHR-integrated ML risk prediction did not improve SDM or communication after transplant

In a single-center RCT of 76 kidney transplant recipients with eGFR <30, adding an EHR ML model predicting 1-year graft loss did not increase patient–reported conversations about post-graft-loss options (39% vs 40%). No differences occurred in secondary SDM, relationship, distress, or clinical outcomes over 12 months. Post-trial feedback cited low, variable tool uptake and workflow barriers as likely reasons for neutral results. Passive availability of risk estimates in the EHR alone did not change clinician–patient communication. 2

Organizational supports can enable equitable dialysis delivery and transplant access for immigrants

A 15-year retrospective cohort of 497 incident dialysis patients in Brussels showed peritoneal dialysis use of 25%–30% across groups, including asylum seekers and undocumented immigrants. Age (HR 1.73) and comorbidity (HR 1.62) predicted mortality, while ethnicity did not drive worse outcomes after adjustment. Sub-Saharan African patients had higher transplant access (35%–40% at 10 years; sub-distribution HR 2.13, P = .004). Results suggest clinical and system factors, not migration status, determine outcomes when deliberate structures support care. 3