Immunity plays a crucial role in fighting cancer, but tumours can evade the immune system and proliferate and metastasize. Enhancing immune responses is a new challenge in anticancer therapies. In this context, efficacy data are accumulating on immune checkpoint inhibitors and adjuvant therapies for various types of advanced-stage solid tumours. Unfortunately, immune-related adverse events are common. Although infrequent, renal toxicity may occur via several mechanisms and may require temporary or permanent drug suspension, renal biopsy, and/or immunosuppressive treatment. This short review aims to provide a practical approach to the multidisciplinary management of cancer patients with renal toxicity during treatment with immune checkpoint inhibitors.

Hyperphosphatemia is a common complication in advanced chronic kidney disease and contributes to cardiovascular morbidity and mortality. The present narrative review focuses on the management of phosphatemia in uremic patients receiving peritoneal dialysis. These patients frequently develop hyperphosphatemia since phosphate anion behaves as a middle-size molecule despite its low molecular weight. Accordingly, patient transporter characteristics and peritoneal dialysis modalities and prescriptions remarkably influence serum phosphate control. Given that phosphate peritoneal removal is often insufficient, especially in lower transporters, patients are often prescribed phosphate binders whose use in peritoneal dialysis is primarily based on clinical trials conducted in hemodialysis because very few studies have been performed solely in peritoneal dialysis populations. A crucial role in phosphate control among peritoneal dialysis patients is played by diet, which must help in reducing phosphorous intake while preventing malnutrition. Moreover, residual renal function, which is preserved in most peritoneal dialysis patients, significantly contributes to maintaining phosphate balance. The inadequate serum phosphate control observed in many patients on peritoneal dialysis highlights the need for large and well-designed clinical trials including exclusively peritoneal dialysis patients to evaluate the effects of a multiple therapeutic approach on serum phosphate control and on hard clinical outcomes in this high-risk population.

The hemodialysis population has progressively aged over the past two decades; in several settings, adults aged ≥75 years represent one of the fastest-growing populations receiving dialysis. Frailty, characterized by reduced physiological reserve and heightened vulnerability to stressors, has emerged as a critical determinant of outcomes and is commonly assessed using validated instruments such as the Fried Frailty Phenotype or the Clinical Frailty Scale (CFS). Reported frailty prevalence in hemodialysis varies widely (approximately 20% to >80%), largely depending on the assessment instrument and the population studied, with consistently higher prevalence in older cohorts. It is consistently associated with older age, female sex, diabetes, lower serum albumin, cardiovascular disease, longer dialysis vintage, and lower physical activity. Compared with non-frail patients, frail hemodialysis patients have a substantially higher risk of death (approximately two-fold in pooled analyses). Seminal trials and large observational programs that shaped hemodialysis targets underrepresented very old, frail, and highly comorbid patients, limiting generalizability. In frail older adults with limited life expectancy and substantial comorbidity burden, standard thrice-weekly schedules, higher ultrafiltration intensity, and a uniform ‘fistula-first’ approach may increase treatment burden without clear proportional gains in patient-centered outcomes. This review examines evidence supporting individualized hemodialysis strategies in frail older adults. As the dialysis population continues to age, proficiency in goal-concordant, personalized prescribing is increasingly important for nephrologists and dialysis teams.

Background/Objectives: Diet is a modifiable determinant of kidney health, and sex differences in kidney physiology support sex-specific evaluation of dietary patterns. We examined the association of Planetary Health Diet Index (PHDI) adherence with cystatin C-based eGFR decline, and its modification by sex, in US adults aged 50 years and older. Methods: We analyzed 2126 Health and Retirement Study participants (950 men, 1176 women) with diet assessed by food frequency questionnaire in 2013 and cystatin C-based eGFR measured in 2012 and 2016. Survey-weighted regression models, adjusted for baseline eGFR and for demographic, socioeconomic, lifestyle and clinical covariates, related PHDI to eGFR change and to a ≥30% relative eGFR decline; sex interaction was tested on the multiplicative and additive scales. Results: PHDI adherence was nonsignificantly associated with lower eGFR decline (β per 10-point increment 0.218; 95% CI −0.065 to 0.466). Among women, each 10-point-higher score was associated with slower eGFR decline (β 0.355; 95% CI 0.029 to 0.681; p = 0.034) and 20% lower odds of ≥30% eGFR decline (OR 0.799; 95% CI 0.687 to 0.930; p = 0.005); no significant association was observed in men (β 0.080; 95% CI −0.294 to 0.454; OR 1.080; 95% CI 0.901 to 1.295). Sex modified the association with ≥30% eGFR decline on both a multiplicative (p = 0.002) and additive scale (p < 0.001). Conclusions: PHDI adherence was associated with slower kidney function decline in women aged 50 years and older, with non-significant effect in men. Sex merits consideration as a biological modifier when plant-forward diets are evaluated as potentially nephroprotective strategies.

1. 1.1. Focal segmental glomerulosclerosis (FSGS) is a histological pattern common to several distinct diseases. Segmental sclerosis of the glomerular tuft, variably accompanied by hyalinosis and p...