Articles in 2020

Sodium–glucose co-transporter 2 inhibitors offer impressive cardiac and kidney outcome benefits to people with type 2 diabetes mellitus (T2DM). These benefits now appear to extend to people without T2DM, according to three trials published in 2020.

Timely diagnosis and dialytic treatment of acute kidney injury (AKI) came to the forefront at the height of the coronavirus disease 2019 pandemic as admissions surged in intensive care units. Research on early diagnosis, timing of initiation of kidney replacement therapy, and appropriate post-hospitalization patient care remains essential to tackling the burden of AKI.

The COVID-19 pandemic and the Movement for Black Lives have focused attention on racial disparities in kidney health outcomes. In 2020, kidney professionals highlighted threats posed by racism and other negative social drivers of kidney health, and proposed solutions to address these issues through scholarship and advocacy for social justice.

Beyond the need to understand disease mechanisms and develop new therapies, the inequities that deprive individuals of a healthy life must also be addressed to ensure kidney health for all.

In 2020 a number of clinical trials have provided insights into therapeutic approaches for the treatment of anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis and lupus nephritis. Moreover, mechanistic insights have potential to open new therapeutic strategies in the future.

Genetic research in nephrology is rapidly advancing. Key studies published in 2020 demonstrate that genetic findings can provide new tools for patient diagnosis and risk stratification as well as important insights into kidney physiology and disease mechanisms that could potentially lead to novel therapies.

The consequences of the COVID-19 pandemic have been devastating; however, evidence suggests that patients with, or at risk of, kidney disease are disproportionally affected. Patients on dialysis and kidney transplant recipients are at higher risk of adverse outcomes from COVID-19, whereas, conversely, patients with severe COVID-19 are at increased risk of acute kidney injury, with short-term and possibly long-term consequences for nephrological care.

The nephrology community is increasingly being confronted with the challenge of caring for refugees with kidney disease. An urgent need exists for a global registry of these patients as well as consistent guidance for financial, cultural and ethical issues in order to ensure that they receive sustainable and equitable care.

The coronavirus disease 2019 global pandemic has disrupted every economy in the world. Now, more than ever, universal health coverage is needed to protect the world’s most vulnerable individuals, who are not only at very high risk of virus-related disability or death but also of falling into poverty owing to catastrophic health-care spending.

Mitochondrial dysfunction has roles in acute kidney injury, chronic kidney disease and abnormal kidney repair. Here, the authors discuss the role of mitochondrial quality control mechanisms in kidney injury and repair and highlight their potential as therapeutic targets.

A new study reports the seroprevalence of SARS-CoV-2 antibodies among a cross-section of patients on haemodialysis and uses these data to estimate seroprevalence in the general US population. Although this study demonstrates the potential of monitoring infectious disease prevalence in dialysis populations, the findings should be interpreted with caution.

Clinical trials have demonstrated that glucagon-like peptide 1 receptor (GLP1R) agonists have therapeutic benefits beyond glycaemic control. Here, the authors examine the protective effects of incretin-based therapies in patients with diabetic kidney disease and how the immunomodulatory and anti-inflammatory effects of GLP1 might underlie this protection.

Millions of people in under-privileged regions of the world continue to drink heavily polluted water and die from diarrhoea-related acute kidney injury whilst world super-powers continue to offer military aid to these regions. This gun aid must convert into water aid.

Working towards sustainable development is essential to tackle the rise in the global burden of non-communicable diseases, including kidney disease. Five years after the Sustainable Development Goal agenda was set, this Review examines the progress thus far, highlighting future challenges and opportunities, and explores the implications for kidney disease.

Here, the authors describe the mechanisms of ultrafiltration during kidney replacement therapy, the effects of ultrafiltration on cardiovascular physiology and the principles of volume management in critically ill patients. They also discuss potential mechanisms that could underlie the association between ultrafiltration rate and organ dysfunction.