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Home dialysis therapies are flexible kidney replacement strategies with documented clinical benefits. While the incidence of end-stage kidney disease continues to increase globally, the use of home dialysis remains low in most developed countries. Multiple barriers to providing home dialysis have been noted in the published literature. Among known challenges, gaps in clinician knowledge are potentially addressable with a focused education strategy. Recent national surveys in the United States and Australia have highlighted the need for enhanced home dialysis knowledge especially among nephrologists who have recently completed training. Traditional in-person continuing professional educational programmes have had modest success in promoting home dialysis and are limited by scale and the present global COVID-19 pandemic. We hypothesize that the use of a ‘Hub and Spoke’ model of virtual home dialysis mentorship for nephrologists based on project ECHO would support home dialysis growth. We review the home dialysis literature, known educational gaps and plausible educational interventions to address current limitations in physician education Refereed/Peer-reviewed

BACKGROUND: AKI is a significant complication of coronavirus disease 2019 (COVID-19), with no effective therapy. Niacinamide, a vitamin B3 analogue, has some evidence of efficacy in non-COVID-19-related AKI. The objective of this study is to evaluate the association between niacinamide therapy and outcomes in patients with COVID-19-related AKI. METHODS: We implemented a quasi-experimental design with nonrandom, prospective allocation of niacinamide in 201 hospitalized adult patients, excluding those with baseline eGFR

As nephrologists, we have early on recognized the current coronavirus disease 2019 (COVID-19) pandemic to be particularly threatening to the patients we care for in our clinics. Many observations have shown older patients and those with chronic medical comorbidities to be disproportionately at risk for excess morbidity and mortality due to COVID-19 infection (1,2). As a medical subspecialty, nephrologists not only see the most substantial proportion of patients age ≥80 years but also care for the most complex patient population with the highest number of comorbidities (3). Therefore, extensive discussions have been carried out in our community about the potential fallout of COVID-19 infection and the observed or anticipated adverse outcomes. These adverse outcomes include hospitalizations, critical care admission, ESKD, and death in patient’s kidney disorder (4⇓–6). Further, several reports have shown that a high number of patients with COVID-19 infection experience AKI and may require dialysis, potentially increasing demand for available resources beyond capacity (7⇓–9). Several surge-mitigation protocols and COVID-19–related best practice guidelines are now available to nephrologists (10,11). Moving beyond the surge, however, there is substantial uncertainty about the chronic management of patients with kidney disease in the near-term future. When should we time dialysis access placement? Do we place patients at unnecessary risk for “nosocomial” COVID-19 infection by requiring routine laboratory assessment or dialysis access surveillance for primary prevention? Or do we risk a rise in preventable adverse outcomes by dialing back on care considered not essential and thus, failing to identify early signs of medical complications? Answers to some of these questions were already hotly debated before. The COVID-19 pandemic has considerably increased their complexity and uncertainty. Here, we share the Kaiser Permanente Northern California (KPNC) strategy for population-wide management strategies of patients with kidney …

International audience; BACKGROUND:CSL112 (apolipoprotein A-I [human]) is a plasma-derived apolipoprotein A-I developed for early reduction of cardiovascular risk following an acute myocardial infarction (AMI). The safety of CSL112 among AMI subjects with moderate, stage 3 chronic kidney disease (CKD) is unknown.METHODS:CSL112_2001, a multicenter, placebo-controlled, parallel-group, double-blind, randomized phase 2 trial, enrolled patients with moderate CKD within 7 days following AMI. Enrollment was stratified on the basis of estimated glomerular filtration rate and presence of diabetes requiring treatment. Patients were randomized in a 2:1 ratio to receive 4 weekly infusions of CSL112 6 g or placebo. The co-primary safety end points were renal serious adverse events (SAEs) and acute kidney injury, defined as an increase ≥26.5 μmol/L in baseline serum creatinine for more than 24 hours, during the treatment period.RESULTS:A total of 83 patients were randomized (55 CSL112 vs 28 placebo). No increase in renal SAEs was observed in the CSL112 group compared with placebo (CSL112 = 1 [1.9%], placebo = 4 [14.3%]). Similarly, no increase in acute kidney injury events was observed (CSL112 = 2 [4.0%], placebo = 4 [14.3%]). Rates of other SAEs were similar between groups. CSL112 administration resulted in increases in ApoA-I and cholesterol efflux similar to those observed in patients with AMI and normal renal function or stage 2 CKD enrolled in the ApoA-I Event Reducing in Ischemic Syndromes I trial.CONCLUSIONS:These results demonstrate the acceptable safety of the 6-g dose of CSL112 among AMI subjects with moderate stage 3 CKD and support inclusion of these patients in a phase 3 cardiovascular outcomes trial powered to assess efficacy.

Glomerular kidney disorders account for a significant proportion of chronic kidney disease and end-stage renal disease worldwide. Nevertheless, major obstacles make breakthrough progress in diagnosis and cure an ongoing challenge. Here we report the creation of a “grassroots” initiative that aims to provide new opportunities for nephrologists, pathologists, basic and clinical scientists, patients, and industry partners to collaborate in the field of glomerular kidney disease. Members of the medical community, including trainees, nephrologists, and nephropathologists, can participate in the open-access, Web-based, multidisciplinary clinical video case conferences, which provide “peer-to-peer” exchange of clinical and pathological expertise combined with a formal didactic curriculum. Participants can also join other aspects of the broader initiative. These include the participation in a multisite research study to facilitate enrollment of patients into a longitudinal clinical data and biorepository for glomerular kidney disorders. Items included in this prospective registry include the following: an ontology-based patient medical history, which is regularly updated; interval collection and storage of blood and urine samples; DNA collection; and a contact registry for patients who wish to participate in clinical trials. Participating sites and external scientists can leverage access to the database to pursue genetic, biomarker, epidemiological, and observational clinical effectiveness studies. Patients can independently sign up for a supplementary contact registry to participate in clinical trials if eligible. The broad spectrum of activities within this initiative will foster closer collaboration among trainees, practicing nephrologists, pathologists, and researchers, and may help to overcome some of the barriers to progress in the field of glomerular kidney disease. Keywords: disease registry, glomerular kidney disease, nephrology education, observational clinical studies

With one of the highest mitochondrial densities in the body, the kidneys consume approximately 10% of total oxygen while constituting 0.5% of body mass. Renal respiration is linear to solute extraction, linking oxidative metabolism directly to tubular function. This fundamental role of mitochondria in renal health may become an “Achilles heel” under duress. Acute kidney injury (AKI) related to each major class of stressor - inflammation, ischemia, and toxins - exhibits early and prominent mitochondrial injury. The mitochondrial biogenesis regulator, PPARγ-coactivator-1α (PGC1α), may confer tubular protection against these stressors. Recent work proposes that renal PGC1α directly increases levels of nicotinamide adenine dinucleotide (NAD+), an essential co-factor for energy metabolism that has lately been proposed as an anti-aging factor. This mini-review summarizes recent studies on AKI, PGC1α, and NAD+ that identify a direct mechanism between the regulation of metabolic health and the ability to resist renal stressors.

Long term outcomes of biodegradable polymer drug-eluting stents (BP-DES) compared to durable polymer drug-eluting stents (DP-DES), are not well described. A comprehensive search in clinicalTrials.gov, PubMed, EBSCO, Web of Science, google scholar and Ovid was performed for RCTs comparing BP-DES and

CSL112 is plasma-derived apolipoprotein A-I (apoA-I), currently in development for early reduction of cardiovascular risk after acute myocardial infarction (AMI). The AEGIS-I trial demonstrated renal and hepatic safety and elevations in cholesterol efflux with 4 weekly intravenous infusions of 2g or