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Thailand’s dialysis policy reform, introduced in 2022, aimed to enable universal access to life-sustaining dialysis, but instead exposed systemic vulnerabilities that undermined dialysis quality, compromised patient safety and threatened sustainability of care. These outcomes highlight three ethical dilemmas — access versus quality, continuity of care, and financial conflicts of interest — and offer powerful insights into the ethical tensions that are shaping kidney care globally.
In this Tools of the Trade article, Nicholas Lucarelli (Computational Microscopy Imaging Lab, directed by Pinaki Sarder) describes the development of FUSION, a cloud-based platform for the integration of histology and spatial -omics data.
Dialysis is among the most cost-intensive health services available; however, its availability is often shaped by competing interests among providers, payers, industry and patients. Thailand’s experience in aligning these interests offers valuable lessons for countries that are striving to expand equitable kidney care within limited fiscal space and progress towards universal health coverage.
Here, the authors discuss how to implement quality-focused dietary strategies for patients with chronic kidney disease. They discuss the principles of dietary balance, variety and moderation, food processing and cooking methods and approaches to enabling successful implementation of quality-focused dietary strategies.
Targeting incretins is emerging as an effective approach to treat cardiovascular–kidney–metabolic syndrome. Here, the authors examine the biological effects of incretins and other metabolic hormones, such as glucagon and amylin, as well as discussing current clinical data demonstrating the organ-protective effects of incretin drugs and their potential underlying mechanisms.
Here, the authors provide guidance on the prevention, diagnosis and management of anticancer therapy nephrotoxicity in adult patients. They also define a research agenda focused on preventing and mitigating anticancer therapy toxicity, maximizing early detection of nephrotoxicity and enabling optimal drug dosing in patients with kidney disease.
In this Perspective, the authors explore the concept of multifactorial chronic kidney disease and examine the different factors that might compromise kidney functional capacity or increase kidney workload throughout the life-course, and how their cumulative effects can lead to chronic kidney disease.
