December 2023
KDIGO Allograft Controversies Conference Report Publishes in Kidney International
 
The publication is based on the KDIGO Controversies Conference on Challenges in Management of the Kidney Allograft: From Decline to Failure, held virtually in March 2022. The conference brought together global experts to delve into the complexities of kidney allograft management and explore topics such as ascertaining prognosis and kidney failure trajectory; identifying optimal immunosuppression strategies, managing medical and psychological complications in transplant recipients; and preparing for ensuing kidney replacement therapy (i.e., return to dialysis, retransplantation, or supportive care). Michelle A. Josephson, MD (University of Chicago, United States) and Martin Zeier, MD (Heidelberg University, Germany) co-chaired the conference.
 
The comprehensive report, available for public access in Kidney International and on the KDIGO website, encapsulates key findings and observations from the conference, sheds light on challenges in managing kidney allografts, and identifies strategies to address declining kidney function and coping with kidney allograft decline or failure. The report highlights the critical role of early detection, proactive intervention, and personalized immunosuppressive care in minimizing the risk of rejection and mitigating long-term adverse effects.
“Identifying patients with a failing allograft is challenging, and there are limited prognostication tools that support a clinician’s judgment or improve shared decision-making,” said Dr. Josephson. “Yet the importance of identifying these patients and starting early discussions is paramount for the patient’s psychological well-being and medical care. More time is key to preparing for potential graft failure through preemptive transplantation, optimal dialysis access, or referral for supportive care.”
 
“While there is transformative potential in precision medicine to reshape patient outcomes, further research is needed for better identification, tools, and holistic management strategies,” said Dr. Zeier. “Accurate prognostication tools, although not yet widely available, are enormously valuable for defining allograft survival trajectories and the likelihood of allograft failure. Regardless of the tools available, coordination of care and communication among teams are essential to maximizing the availability of options for patients while being mindful of their values, preferences, and needs.”
 
KDIGO Holds Controversies Conference on Maintaining Kidney Health and Preventing CKD
KDIGO held the Controversies Conference on Maintaining Kidney Health and Preventing Chronic Kidney Disease (CKD) this December in Rome, Italy, bringing together a consortium of global experts across disciplines to explore the current state of knowledge and strategies for CKD prevention across a lifetime. The conference was co-chaired by Alberto Ortiz, MD (Spain) and Katherine Tuttle, MD (United States).

"The spotlight has long been on managing CKD progression and kidney failure, with much less attention on maintaining kidney health and preventing kidney disease," said Dr. Ortiz. "We're at a critical juncture where a shift in focus from reactive to proactive kidney care is imperative."
 
The conference breakout groups focused on defining CKD prevention, identifying high-risk populations, effective strategies for implementation, and assessing available evidence on interventions to prevent kidney disease. Interventions included SGLT2 inhibitors, GLP-1 receptor agonists, and anti-inflammatory therapies that show potential to prevent, delay, or even reverse CKD. Attendees examined studies that showed the ability of these interventions to significantly reduce the decline in kidney function and even induce remission of albuminuria.

"Recent data reveals that interventions applied before the onset or in early CKD stages could maintain kidney health effectively," said Dr. Tuttle. "The emergence of treatments showing promise in preventing CKD onset or progression represents a paradigm shift. It's crucial to evaluate their effectiveness and integrate them into clinical practice."

The conference will result in a publication that will include observations for therapeutic management, areas for future research, and ideas for understanding and implementing effective preventive measures for CKD.

"Defining what constitutes successful primary prevention interventions and their measurable impact will be pivotal in redefining our approach to kidney health,” said Dr. Ortiz.
KDIGO Holds First Workshop on the Nurse’s Role in Managing the Symptoms of People Receiving Dialysis
KDIGO held its first nursing workshop, which centered on empowering nephrology nurses to identify and manage symptoms experienced by individuals undergoing dialysis. The workshop was held in Rome, Italy, in December and was co-chaired by Paul Bennett (Australia), a nephrology nurse and researcher, and Maddy Warren (United Kingdom), a consultancy director and long-term solo home dialyser.

Building on the foundational principles established during the KDIGO Controversies Conference on Symptom-Based Complications in Dialysis, the workshop was a collaborative effort involving nephrology nurses, dialysis patients, psychologists, researchers, nephrologists, and representatives from dialysis providers. The workshop addressed fundamental strategies required to advance the pivotal role of nurses in addressing symptoms associated with kidney failure and dialysis treatment. Central to the discussion were strategies to identify, prioritize, and manage symptoms, such as itch and fatigue, which are prevalent challenges among dialysis patients.

"Nephrology nurses play an integral role in the holistic care of dialysis patients," said Professor Bennett. "Nurses’ enhanced involvement in symptom identification and management is vital to improving patient well-being and outcomes. By KDIGO providing global guidance, tools and resources to support nurses we aim to decrease the symptom burden and  improve the quality of life for individuals undergoing dialysis treatment worldwide."

Participants engaged in conversations that included patients' expectations from nurses for managing their symptoms, the incorporation of symptom assessment into nursing care, tailored approaches for home dialysis patients, communication strategies, utility of structured peer support, education for nurses, barriers in symptom identification, and cultural considerations influencing symptom reporting.

Discussions addressed how assessment information should be documented and shared within multidisciplinary teams, nurse-led strategies for evaluating implementation effectiveness, appropriate reassessment protocols, advocating for improvements, and expanded roles for nurses in addressing gaps in symptom management. The workshop will result in a publication that aims to inform and shape future practices for symptom management in dialysis care.

"This workshop highlighted how important it is to harness nephrology nurses’ breadth of knowledge and strong, trusting relationships with people on dialysis, to better understand and amplify their role in the management of common dialysis symptoms,” said Ms. Warren. “The ethos of collaboration and partnership in this workshop will we hope create outputs that will help elevate standards in dialysis care for everybody.”
KDIGO, The Global Learning Collective, and Medtelligence Announce Expanded Partnership
KDIGO has expanded its collaboration with The Global Learning Collaborative (GLC) and Medtelligence to improve patient outcomes through professional education for healthcare providers. KDIGO continues to grow its Conversations in Nephrology Podcast, which serves as a resource for clinicians caring for individuals with kidney disease.  This podcast involves long-time collaborators Medtelligence and ReachMD, two organizations that have partnered with KDIGO throughout the history of the podcast program. The podcasts feature renowned global experts who address a wide range of topics and the latest scientific information available — from Acute Kidney Injury (AKI) to Early Identification and Intervention of Chronic Kidney Disease (CKD). In addition, the organizations are excited to announce a collaboration for developing and distributing CME activities to advance clinician knowledge and competence in the care of patients with kidney disease. 

ReachMD is a technology platform that helps healthcare professionals discover, participate in, and share medical education and clinical information through on-demand programming and broadcasts. Medtelligence conducts live and enduring medical education (CME) and independent medical education. 

“KDIGO is excited to continue our partnership with Medtelligence and ReachMD,” said KDIGO Chief Executive Officer, John Davis. “Their experienced teams have helped KDIGO to produce high-quality, easily accessible podcasts and expand our reach in the process. Our shared aim is to enable clinicians to easily access the latest science and clinical recommendations.”  

“Medtelligence specializes in clinician education, and KDIGO content is ideal for our network,” said Medtelligence President, Rob Braun. “We are dedicated to creating the highest quality, evidence-based CME initiatives with the primary goal of improving healthcare for patients by sharing research, knowledge, and clinical practice skills. We are delighted to work with an organization like KDIGO with similar objectives and organizational priorities.”  

“ReachMD maintains a library of more than 10,000 medical broadcasts featuring clinical research, medical practice, disease management, and patient care strategies,” said ReachMD President, Dik Barsamian. “We are excited to provide our award-winning, data-centric platform to help KDIGO produce and distribute these important podcasts.” 
New Resources
Synopsis of the KDIGO 2022 Hepatitis C Guideline

Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C in Chronic Kidney Disease: Synopsis of KDIGO 2022 Clinical Practice Guideline is now available in Annals of Internal Medicine. The Guideline was co-chaired by Michel Jadoul, MD (Belgium), and Paul Martin, MD (United States).

The 2022 Hepatitis C in CKD Guideline addresses new evidence that has accumulated in several areas, including the role of additional direct-acting antiviral regimens in treating patients with hepatitis C virus (HCV) and CKD G1-G5 or CKD G5D, including kidney transplant recipients. The guideline also addresses studies attesting to the efficacy and safety of kidney transplantation from donors with HCV to recipients who are HCV negative, and the role of kidney biopsy in managing HCV-associated glomerulonephritis. Read the Synopsis.
Recording of the ISN-KDIGO Webinar on Symptom-Based Complications in Dialysis

The recording of the ISN-KDIGO Webinar on Symptom-Based Complications in Dialysis is now available on the KDIGO YouTube channel and the ISN Academy.

The webinar features the Co-Chairs from the KDIGO Symptom-Based Complications in Dialysis Controversies Conference, Raj Mehrotra, MD (United States), and Edwina Brown, MD (United Kingdom). The webinar also features conference attendee and patient, Dawn Edwards (United States). Watch the recording.
Recording of The Africa Healthcare Network Fireside Chat, "Novel Anemia Therapies in Chronic Kidney Disease"

The recording is now available of The Africa Healthcare Network's Fireside Chat Number 143, “Novel Anemia Therapies in Chronic Kidney Disease.”

This webinar took place on November 23, 2023, and featured Lucia Del Vecchio, MD (Italy), a Steering Committee member of the KDIGO 2021 Novel Anemia Therapies Controversies Conference. Watch the recording.
Recording of The KDIGO AKI Guideline Update at the XVII National Russian Dialysis Society Conference

The Update of the KDIGO AKI Guideline Guideline was presented by Marlies Ostermann, MD (United Kingdom) on November 17, 2023, at the XVII National Russian Dialysis Society Conference and XXIII International CME Course. Dr. Ostermann is a co-chair of the forthcoming KDIGO AKI Guideline Update. KDIGO would like to thank Elena Zakharova, MD (Russia) for providing Russian subtitles for this video. Watch the recording.
About KDIGO

KDIGO is a Belgian foundation committed to developing and implementing nephrology guidelines that improve outcomes for people with kidney disease on a global basis. KDIGO is independent, volunteer-led, self-managed, and accountable to the public and the people it serves.