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Aim: This study aimed to describe the epidemiology of kidney replacement therapy (KRT) in Aotearoa New Zealand and assess the impact of residential location on access to kidney transplantation. Methods: AcceSS and Equity in Transplantation (ASSET), a health‐linked data platform, was used to identify people commencing KRT in New Zealand from 2006 to 2019 and analyse regional epidemiology. Health services were classified as 'transplanting', 'intermediate' or 'remote' depending on their degree of separation from a transplant centre. Multiple logistic regression modelling was used to assess the predictors of deceased donor waitlisting or living donor transplantation within 6 months after starting KRT. Web‐based mapping software was used to develop interactive geospatial maps. Results: The cohort was 7704 people newly starting KRT. Living in an intermediate [odds ratio (OR): 0.73 (95% confidence interval (CI): 0.61–0.88)] or remote [OR: 0.38 (95% CI: 0.27–0.54)) region and Māori (OR: 0.35 (95% CI: 0.28–0.44)], Pacific [OR: 0.32 (95% CI: 0.24–0.42)) and Asian (OR: 0.66 (95% CI: 0.50–0.87)] ethnicity were associated with a decreased likelihood of timely waitlisting or transplantation. Regional maps can be explored here. Conclusion: There is marked geospatial and ethnic variation in the epidemiology of kidney failure and access to kidney transplantation across New Zealand. Geospatial mapping of kidney failure epidemiology and transplantation outcomes can provide opportunities to direct resources towards populations at greatest need. [ABSTRACT FROM AUTHOR]

Aim: Determining specific causes of allograft failure allows a focus on understanding and treating these conditions. Previous studies highlight chronic antibody‐mediated rejection as a leading cause of late allograft failure. We sought to define causes of allograft failure in a large cohort of kidney transplant recipients across multiple centres in Australia and New Zealand, including cases previously attributed to chronic allograft nephropathy (CAN). Methods: All death‐censored allograft failures at 9 participating centres between 1 January 2014 to 31 December 2018 were included. Available clinical and biopsy data were reviewed and the "most likely" cause assigned. Results: There were 642 death‐censored allograft failures in the study period. Of these, 495 (77.1%) had an informative biopsy performed a median of 13.4 months (IQR 2.5–39.1 months) prior to allograft failure. Rejection of any type was the leading cause of allograft failure (47.5%), comprised chiefly of chronic antibody‐mediated rejection (37.4%) and chronic T‐cell mediated rejection (6.4%). Other leading causes were undifferentiated interstitial fibrosis and tubular atrophy (10.8%), late medical and surgical complications (8.1%) and recurrent or de novo glomerulonephritis (7.0%). Polyoma viral nephropathy and calcineurin inhibitor toxicity each contributed to <2%. Causes of allograft failure previously attributed to CAN (n = 419, 65.3%) had a similar distribution to the overall cohort, with 43.9% attributed to chronic antibody‐mediated rejection. Conclusion: To prolong allograft survival, improved strategies are needed to curtail alloimmune responses. Greater understanding of the causes of undifferentiated interstitial fibrosis and tubular atrophy and potential treatments would also be of considerable benefit. Summary at a Glance: In a multicentre, 5‐year, cross‐sectional analysis, rejection, particularly chronic antibody mediated rejection was the leading cause of allograft failure. Further efforts to prevent allo‐immune injury are therefore needed. Interstitial fibrosis and tubular atrophy not due to rejection was also common and requires further exploration into causation and prevention. [ABSTRACT FROM AUTHOR]

Aim: Editors‐in‐Chief (EiC) play a key role as gatekeepers in academic medicine, often shaping research agendas. Women have historically been underrepresented in editorial leadership roles in academic medicine. The purpose of this study was to examine gender representation among EiC of contemporary transplantation and nephrology journals. Methods: This cross‐sectional study evaluated gender disparities among EiC of transplantation and nephrology medical journals. The study population was drawn from journals in two subject categories (1) 'Transplantation' and (2) 'Urology and Nephrology' in the 2023 Journal Citation Reports. Binary gender classification (woman/man) was determined by the names/pronouns used to describe the EiC on the journal or institutional webpage. The primary outcome was the proportion of women EiC. Secondary outcome was the proportion of women EiC based on journal topic, location and metrics. Descriptive statistics were used. Gender differences were compared using students t‐test or Fisher's exact test. Results: A total of 79 EiC were identified of which 16 (20%) were women and 63 (80%) were men (p <.001). Transplantation and nephrology journals had 21% and 20% women EiC, respectively. The proportion of women to men EiC was not impacted by journal category (p =.93), journal location (p =.61), journal impact factor (p =.71) or quartile (p =.59). Conclusion: There was a disparity in gender representation in EiC in nephrology and transplantation journals, with men holding 80% of all positions. These findings, among growing evidence of gender disparity, highlight a need for targeted efforts to promote gender equity in academic medicine. [ABSTRACT FROM AUTHOR]

Background Quality-of-life is an essential outcome for clinical care. Both chronic kidney disease (CKD) and diabetes have been associated with poorer quality-of-life. The combined impact of having both diseases is less well understood. As diabetes is the most common cause of CKD, it is imperative that we deepen our understanding of their joint impact. Methods This was a prospective, longitudinal cohort study of community-based Australians aged ≥25 years who participated in the Australian Diabetes, Obesity and Lifestyle study. Quality-of-life was measured by physical component summary (PCS) and mental component summary sub-scores of the Short Form (36) Health Survey. Univariate and multivariate linear mixed effect regressions were performed. Results Of the 11 081 participants with quality-of-life measurements at baseline, 1112 had CKD, 1001 had diabetes and of these 271 had both. Of the 1112 with CKD 421 had Stage 1, 314 had Stage 2, 346 had Stage 3 and 31 had Stages 4/5. Adjusted linear mixed effect models showed baseline PCS was lower for those with both CKD and diabetes compared with either disease alone (P < 0.001). Longitudinal analysis demonstrated a more rapid decline in PCS in those with both diseases. Conclusions The combination of CKD and diabetes has a powerful adverse impact on quality-of-life, and participants with both diseases had significantly poorer quality-of-life than those with one condition. [ABSTRACT FROM AUTHOR]

Aim: Assessing the impact of interventions on the patient experience requires measures that are plausibly responsive to change. In a community cohort of people with and without chronic kidney disease (CKD) markers at baseline, we aimed to evaluate change in commonly used measures of quality of life (QOL) over the passage of 5 years. Methods: Included were 6400 participants in the Australian Diabetes, Obesity and Lifestyle (AusDiab) surveys with baseline and 5‐year CKD and QOL measures. Changes in SF‐6D utility, and the Medical Outcomes Study 36‐Item Short Form (SF‐36) physical (PCS) and mental (MCS) component summary scores, were evaluated with regression analyses according to the baseline presence of reduced estimated glomerular filtration rate (eGFR) (CKD‐Epidemiology Collaboration eGFR ≤60 m/min per 1.73 m2) or albuminuria (urine albumin:creatinine ratio ≥3.4 mg/mmol). Results: At baseline, eGFR was reduced in 2.4% of participants and 5.1% had albuminuria. Participants with reduced eGFR had a lower SF‐6D and PCS, and those with albuminuria a lower PCS, compared with those without, but the differences were explained by known confounders. MCS scores were not affected by the presence of reduced eGFR or albuminuria. Over 5 years all groups exhibited stable SF‐6D and MCS scores but declining unadjusted PCS scores. PCS decline was greater for those with reduced eGFR, and remained significant after adjustment (−2.7 (−4.1 to −1.3) vs. −0.8 (−1.1 to −0.6, P < 0.01). Analyses according to CKD stages were essentially unchanged. Conclusion: Utility and mental QOL appears stable over 5 years, unaffected by time or markers of CKD health. Physical QOL appeared to deteriorate with time, especially for those with CKD, making it a more likely candidate assessment measure for intervention and health service evaluations. Summary at a Glance: Based on Australian Diabetes, Obesity and Lifestyle (AusDiab) surveys with baseline and 5‐year chronic kidney disease (CKD) and quality‐of‐life (QOL) measures, the authors found that physical QOL deteriorates with time, especially for those with CKD, making it a more likely candidate assessment measure for intervention and health service evaluations. [ABSTRACT FROM AUTHOR]

Competing Interests: The authors declare no funding or conflicts of interest.

Globally, females are ∼30% more likely to have pre-dialysis chronic kidney disease (CKD) than males for reasons that are not fully understood. CKD is associated with numerous adverse health outcomes which makes understanding and working to eradicating sex based disparities in CKD prevalence essential. This review maps both what is known, and what is unknown, about the way sex and gender impacts (1) the epidemiology and risk factors for CKD including age, diabetes, hypertension, obesity, smoking, and cerebrovascular disease, and (2) the complications from CKD including kidney disease progression, cardiovascular disease, CKD mineral and bone disorders, anaemia, quality-of-life, cancer and mortality. This mapping can be used to guide future research., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Competing Interests: S.J. Chadban reports consultancy agreements with CSL; reports receiving research funding from Baxter payments made to the hospital, CSL, and Novartis; reports receiving honoraria from AstraZeneca and Novartis; and reports being a scientific advisor or member of CSL and Novartis. All remaining authors have nothing to disclose.

Background: Transplant recipients experience excess cardiac mortality. We compared circulatory death rates in Australian and New Zealand kidney transplant recipients to the general population and identified risk factors for circulatory death in kidney transplant recipients., Methods: The primary cause of death for kidney transplant recipients aged ≥18 was established through ICD-10-AM codes using data linkage between the Australia and New Zealand dialysis and transplant registry and national death registers. We estimated standardized mortality ratios (SMRs) and developed a Fine-Gray competing risks model to determine risk factors for cardiac mortality., Results: Of 5089 deaths in 16 329 kidney transplant recipients (158 325 person-years), 918 (18%) were cardiac. An increased risk of circulatory death was associated with older age (P < 0.001), male sex (P < 0.001), longer dialysis duration (P = 0.004), earlier era of transplantation (P < 0.001), ever graft failure (P < 0.001), known coronary artery disease (P = 0.002), and kidney failure from diabetes or hypertension (P < 0.001). The cardiac SMR was 5.4 [95% confidence interval (CI): 5.0-5.8], falling from 8.0 (95% CI: 4.9-13.1) in 1988 to 5.3 (95% CI: 4.0-7.0) in 2013 (P < 0.001). Females, particularly young ones, had significantly higher relative cardiac mortality than men. In recipients aged 40 years, the cardiac SMR was 26.5 (95% CI: 15.0-46.6) in females and 7.5 (95% CI: 5.0-11.1) for males., Conclusions: Cardiac risks remain elevated in kidney transplant recipients and may be under-recognized, and prevention and treatment interventions less accessed, less effective or even harmful in female recipients., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)