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This Commission aims to resolve the current dialysis policy challenges in Thailand and generate lessons for the global kidney community by drawing on empirical evidence, systems thinking and multidisciplinary expertise to generate policy goals and recommendations.

An abrupt policy change in 2022 — allowing patients to choose between peritoneal dialysis or hemodialysis — created severe unintended consequences for the Thai health system. A multidisciplinary commission found that interacting factors in the system were overlooked and that future dialysis policies must integrate more-diverse evidence and stakeholder views, prioritizing care quality and ethics while balancing equity and sustainability.

Estimates from the Global Burden of Disease study reveal declines in chronic respiratory disease mortality between 1990 and 2023—especially during the COVID-19 pandemic—but the burdens on people affected remain substantial.

Chronic care manages long-term, progressive conditions, while acute care handles short-term ones. Here, authors show chronic conditions account for most of the global health burden, with 68% of DALYs and 93% of YLDs attributed to chronic care needs.

Announced in this Comment and in collaboration with Nature Medicine is the convening of the Access to Dialysis in Low- and Middle-Income Countries Commission, which will explore Thailand’s experiences with changing its dialysis coverage policy, offering lessons for other countries with universal health coverage systems.

Community-acquired acute kidney injury (AKI) has a varied aetiology and is prevalent in developing tropical countries. In this Review, the authors discuss the main causes of community-acquired AKI in tropical countries and the effect of climate and socioeconomic factors on disease prevalence. The authors also discuss future strategies to reduce the burden of AKI in the tropics.

A new study reports that in 2010–2019, mortality owing to non-communicable diseases continued to decline in the majority of countries worldwide. However, the data also highlight major disparities between countries and a widespread slowing of progress in reducing mortality compared to the previous decade.

Here, the ASN-ERA-EDTA-ISN Joint Working Group on Ethical Issues in Nephrology highlights ten areas of ethical concern as priority challenges that require collaborative action and discusses the need for development of ethical training and guidance tools to manage these issues.

Could the shortage of transplantable kidneys in the developed world be reduced by allowing willing individuals to sell their organs? To answer this question, the authors examine the outcomes of patients who have received paid kidneys, and the financial compensation and postoperative care received by their donors. Adoption of commercial kidney transplantation in the Western world would have inevitable knock-on effects in developing countries, they argue.

A new study suggests that low-cost generic statins are cost-effective for primary prevention of cardiovascular disease in high-risk but not in low-risk subgroups of patients with mild-to-moderate chronic kidney disease (CKD). The cost-effectiveness of statins is markedly reduced in patients with progressive CKD and in those at high-risk of drug-related adverse events.

Fine-scale geospatial mapping of overweight and wasting (two components of the double burden of malnutrition) in 105 LMICs shows that overweight has increased from 5.2% in 2000 to 6.0% in children under 5 in 2017. Although overall wasting decreased over the same period, most countries are not on track to meet the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025.

Two trials of low-glucose-containing peritoneal dialysis regimen in patients with diabetes mellitus show that although this strategy improved glycaemic control, it was associated with increased risk of serious adverse events and mortality. These studies suggest caution is needed when evaluating effectiveness using surrogate measures and awareness of confounding factors is important.

'Chronic kidney disease (CKD) in disadvantaged populations' is the focus of World Kidney Day 2015. In this article, we discuss the disproportionate burden of CKD in disadvantaged communities as well as approaches to ensure the provision of appropriate renal care across socioeconomic and ethnic groups.

Despite uncertainty in the KDIGO guidelines, new research has shown that they can accurately identify acute kidney injury in critically ill patients who have a high risk of mortality. Future refinements to AKI definitions will require biomarkers, and robust assessments in prospective studies.

Although progress in the coverage of routine measles vaccination in children in low- and middle-income countries was made during 2000–2019, many countries remain far from the goal of 80% coverage in all districts by 2019.

The coronavirus disease 2019 (COVID-19) pandemic poses important challenges to the care of patients with immune-mediated kidney diseases and to kidney transplant recipients. Here, we discuss the management of immunosuppression for these patients during the pandemic and suggest potential approaches that could be considered in the absence of validated strategies.

Progress towards the Sustainable Development Goals depends on population health in all countries. Implementation research is crucial for generating evidence on how to sustainably embed effective clinical interventions in health systems and local delivery mechanisms, thereby improving their likelihood of success, and informing policy change to improve population health.

In a first of its kind assessment in cardiovascular research, we assessed whether pooled cardiovascular expertise could accurately predict efficacy and tolerability for both a novel and an established treatment option. A survey was administered prior to the publication of the QUARTET (A Quadruple UltrA-low-dose tReatment for hypErTension) trial. QUARTET was a multicentre, double-blind, parallel-group, trial that randomised participants to initial treatment with either monotherapy or an ultra-low dose quadruple single pill combination for 12 weeks. Survey participants were asked to predict blood pressure (BP) at 12 weeks and 52 weeks for both groups.

Addressing the burden of non-communicable diseases is a global public health priority. In this joint Consensus Statement, the American Society of Nephrology, the European Renal Association and the International Society of Nephrology highlight the need to recognize kidney disease as a key driver of premature mortality, in addition to other non-communicable diseases already prioritized by the World Health Organization.

In this Review, the authors focus on kidney involvement in Chagas disease, filariasis, leishmaniasis, malaria and schistosomiasis. They describe the epidemiology, clinical features, mechanisms of kidney injury and renal pathological aspects of these diseases.

Membranous nephropathy is a glomerular disease that is the most frequent cause of nephrotic syndrome in adults. This Primer reviews the epidemiology, pathophysiology, diagnosis and management of this disease and discusses how to improve long-term renal prognosis and quality of life.

In this Review, the authors summarize the challenges associated with the care of patients with kidney disease during the COVID-19 pandemic. They describe the major challenges and missed opportunities, global inequalities in health care, and offer a framework for future pandemic preparedness.

The use of peritoneal dialysis (PD) can be advantageous compared with haemodialysis treatment, although several barriers limit its broad implementation. This review examines the epidemiology of peritoneal dialysis (PD) outcomes, including clinical, patient-reported and surrogate PD outcomes.

This Review examines the epidemiology of haemodialysis outcomes — clinical, patient-reported and surrogate outcomes — across world regions and populations, including vulnerable individuals. The authors also discuss the current status of monitoring and reporting of haemodialysis outcomes and potential strategies for improvement.