Bisphenol A (BPA) is a compound that is especially widespread in most commonly used objects due to its multiple uses in the plastic industry. However, several data support the need to restrict its use. In recent years, new implications of BPA on the renal system have been discovered, which denotes the need to expand studies in patients. To this end, a systematic review and a meta-analysis was performed to explore existing literature that examines the BPA-kidney disease paradigm and to determine what and how future studies will need to be carried out. Our systematic review revealed that only few relevant publications have focused on the problem. However, the subsequent meta-analysis revealed that high blood concentrations of BPA could be a factor in developing kidney disease, at least in people with previous pathologies such as diabetes or hypertension. Furthermore, BPA could also represent a risk factor in healthy people whose urinary excretion is higher. Finally, the data analyzed from the NHANES 03-16 cohort provided new evidence on the possible involvement of BPA in kidney disease. Therefore, our results underline the need to carry out a thorough and methodologically homogeneous study, delving into the relationship between urinary and blood BPA, glomerular filtration rate, and urine albumin-to-creatinine ratio, preferably in population groups at risk, and subsequently in the general population, to solve this relevant conundrum with critical potential implications in Public Health.

This cross-sectional study aims to explore the prevalence of protein-energy wasting (PEW) in dialysis patients in Catalonia, Spain, using a new and practical online tool which enables rapid calculation and comparison with other nutritional scores. Methods: A web tool (Nutrendial) was created to introduce different variables and automatically calculate PEW, Malnutrition inflammation Score (MIS) and Subjective Global Assessment (SGA) in 1389 patients (88% in haemodialysis (HD)), 12% in peritoneal dialysis (PD) from different regions of Catalonia. Results: A prevalence of 23.3% (26% HD, 10.2% PD) of PEW was found, with a mean MIS score of 6 and SGA score of C in 7% of the patients. ROC analysis showed MIS as the best nutritional score to diagnose PEW (AUC 0.85). Albumin delivered lower diagnostic precision (AUC 0.77) and sensitivity (66%). A cut off point of 7 (86% sensitivity and 75% specificity) for MIS and 3.7 mg/dL for albumin were found to predict the appearance of PEW in this population. SGA B or C showed an 87% sensitivity and 55% specificity to diagnose PEW. Very low nutritional intervention (14%) was recorded with this tool in patients with PEW. Conclusions: This new online tool facilitated the calculation of PEW, enabling different professionals—including nephrologists, dieticians and nurses—to efficiently obtain insights into the nutritional status of the Catalonian dialysis population and implement the required nutritional interventions. MIS is the score with more sensitivity to diagnose PEW.

Anemia in chronic kidney disease (CKD) remains highly prevalent and is strongly associated with increased cardiovascular morbidity, mortality, and impaired quality of life. The Anemia Working Group of the Spanish Society of Nephrology reviews the KDIGO 2026 anemia guideline, structured into 4 chapters, integrating national epidemiological data and the regulatory framework of the Spanish National Health System to contextualize its implementation. The guideline introduces substantial updates, particularly in iron therapy strategies, the role of hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs), and the systematic assessment of treatment resistance. Iron deficiency is reclassified as 'systemic deficiency' or 'iron-restricted erythropoiesis', reinforcing a proactive intravenous iron approach in hemodialysis, supported by the PIVOTAL trial. Broader thresholds for initiating iron therapy in non-dialysis CKD are proposed, although uncertainties persist regarding upper ferritin and transferrin saturation limits. The guideline emphasizes individualized selection of the administration route and recommends withholding iron during systemic infections. Notably, treatment of marked iron deficiency without anemia is now considered. Erythropoiesis-stimulating agents remain first-line therapy once alternative causes are excluded and iron deficiency corrected. Hemoglobin targets remain < 11.5 g/dL, with individualized initiation between 8.5 and 10 g/dL depending on cardiovascular risk, symptoms, and transfusion needs, with slightly lower thresholds in dialysis (≥9-10 g/dL). The guideline stresses using the lowest effective erythropoiesis-stimulating agent or HIF-PHI dose, with adjustments every 4 weeks. HIF-PHIs, such as roxadustat, are reserved for non-dialysis CKD when erythropoiesis-stimulating agents are unsuitable, given potential risks and limited long-term data. Finally, Patient Blood Management strategies are promoted to reduce transfusions, particularly in kidney transplant candidates. This position statement underscores the importance of adapting international recommendations to Spanish clinical practice, prioritizing safety, individualized care, and shared decision-making.

Bisphenol (BP) compounds are widely present in the environment, primarily due to their use as plastic additives. These substances involve health risks, particularly as endocrine disruptors. While the general population is chronically exposed, patients with end-stage chronic kidney disease undergoing hemodialysis (HD-CKD) represent a particularly vulnerable group. This is due to both impaired renal clearance of circulating BPs and potential contamination from plastic-containing dialyzers used in extracorporeal blood circulation. In this longitudinal study, from the 35 HD-CKD patients initially selected, 25 changed their conventional dialyzers to BPA-free dialyzers for 6 months. Blood serum samples were collected, at baseline and after the intervention, to quantify levels of five BP analogues: Bisphenol A (BPA), Bisphenol AF (BPAF), Bisphenol F (BPF), Bisphenol B (BPB), and Bisphenol S (BPS). Genotoxicity was assessed using the comet assay and the micronucleus test on peripheral white blood cells. Among the analyzed BPs, only BPAF showed a statistically significant reduction when using BPA-free dialyzers. In terms of genotoxicity, a significant decrease was observed only in primary DNA damage (mainly DNA strand breaks), with no notable changes in chromosomal damage. This is the first study to detect multiple BP analogues in HD-CKD patients, beyond BPA, and to associate human exposure to BPs with DNA damage biomarkers. The observed reduction in DNA damage in parallel with decreased BPAF levels highlights the importance of monitoring and minimizing BP exposure of this high-risk population.