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The global nephrology community recognizes the need for a cohesive strategy to address the growing problem of end-stage kidney disease (ESKD). In March 2018, the International Society of Nephrology hosted a summit on integrated ESKD care, including 92 individuals from around the globe with diverse expertise and professional backgrounds. The attendees were from 41 countries, including 16 participants from 11 low- and lower-middle-income countries. The purpose was to develop a strategic plan to improve worldwide access to integrated ESKD care, by identifying and prioritizing key activities across 8 themes: (i) estimates of ESKD burden and treatment coverage, (ii) advocacy, (iii) education and training/workforce, (iv) financing/funding models, (v) ethics, (vi) dialysis, (vii) transplantation, and (viii) conservative care. Action plans with prioritized lists of goals, activities, and key deliverables, and an overarching performance framework were developed for each theme. Examples of these key deliverables include improved data availability, integration of core registry measures and analysis to inform development of health care policy; a framework for advocacy; improved and continued stakeholder engagement; improved workforce training; equitable, efficient, and cost-effective funding models; greater understanding and greater application of ethical principles in practice and policy; definition and application of standards for safe and sustainable dialysis treatment and a set of measurable quality parameters; and integration of dialysis, transplantation, and comprehensive conservative care as ESKD treatment options within the context of overall health priorities. Intended users of the action plans include clinicians, patients and their families, scientists, industry partners, government decision makers, and advocacy organizations. Implementation of this integrated and comprehensive plan is intended to improve quality and access to care and thereby reduce serious health-related suffering of adults and children affected by ESKD worldwide.

This article discusses the challenges of diagnosing acute coronary syndromes (ACS) in hemodialysis (HD) patients. The study aimed to explore the changes in cardiac troponin (cTn) levels during HD with different membranes and treatment modalities. The results showed significant differences in cTn changes depending on the type of membrane used. The data suggests that high-flux HD and MCO may be more effective in reducing troponin levels compared to low-flux HD and HDF. However, further research is needed to confirm these findings and establish a diagnostic algorithm for AMI in HD patients. [Extracted from the article]

This article challenges the concept of a fixed target weight in hemodialysis (HD) patients. The authors conducted a study with 25 HD patients and used bioimpedance spectroscopy (BIS) measurements to analyze fluid status and body composition. They found that the patients' euvolemic body weight varied longitudinally, indicating that target weight might need to be adjusted in individual HD patients. The authors suggest that a soft target weight prescription could be more physiological and potentially reduce complications such as intradialytic hypotension. However, there are limitations to the study, including a small sample size and non-standardized recording of pre-dialysis weight. [Extracted from the article]

Vascular access dysfunction is associated with reduced delivery of dialysis, unplanned admissions, patient symptoms, and loss of access, making assessment of vascular access a fundamental part of routine care in dialysis. Clinical trials to predict the risk of access thrombosis based on accepted reference methods of access performance have been disappointing. Reference methods are time‐consuming, affect the delivery of dialysis, and therefore cannot repeatedly be used with every dialysis session. There is now a new focus on data continuously and regularly collected with every dialysis treatment, directly or indirectly associated with access function, and without interrupting or affecting the delivered dose of dialysis. This narrative review will focus on techniques that can be used continuously or intermittently during dialysis, taking advantage of methods integrated into the dialysis machine and which do not affect the delivery of dialysis. Examples include extracorporeal blood flow, dynamic line pressures, effective clearance, dose of delivered dialysis, and recirculation which are all routinely measured on most modern dialysis machines. Integrated information collected throughout every dialysis session and analyzed by expert systems and machine learning has the potential to improve the identification of accesses at risk of thrombosis. [ABSTRACT FROM AUTHOR]