Background: The coronavirus disease (COVID) pandemic has resulted in a major disruption in healthcare that has affected several medical and surgical specialties. European and American Vascular Societies have proposed deferring the creation of an elective vascular access (VA) [autologous or prosthetic arteriovenous fistula (AVF) or arteriovenous graft (AVG)] in incident patients on haemodialysis (HD) in the era of the COVID pandemic. The aim of this study is to examine the impact of the COVID pandemic on VA creation and the central venous catheter (CVC)-related hospitalizations and complications in HD patients dialyzed in 16 Spanish HD units of three different regions. Methods: We compared retrospectively two periods of time: the pre-COVID (1 January 2019–11 March 2020) and the COVID era (12 March 2020–30 June 2021) in all HD patients (prevalent and incident) dialyzed in our 16 HD centres. The variables analysed were type of VA (CVC, AVF and AVG) created, percentage of CVC in incident and prevalent HD patients, CVC-related hospitalizations and complications (infection, extrusion, disfunction, catheter removal) and percentage of CVC HD sessions that did not reach the goal of Kt (>45) as a marker of HD adequacy. Results: A total of 1791 VAs for HD were created and 905 patients started HD during the study period. Patients who underwent vascular access surgery during the COVID period compared with pre-COVID period were significantly younger, with a significant decrease in surgical activity to create AVFs and AVGs in older HD patients (>75 and >85 years of age). There was a significant increase in CVC placement (from 59.7% to 69.5%; P < 0.001) from the pre-COVID to the COVID period. During the COVID pandemic, a significantly higher number of patients started HD through a CVC (80.3% versus 69.1%; P < 0.001). The percentage of CVC in prevalent HD patients has not decreased in the 19 months since the start of the pandemic [414 CVC/1058 prevalent patients (39.4%)]. No significant changes were detected in CVC-related hospitalizations between the pre-COVID and COVID periods. In the COVID period, a significant increase in catheter replacement and the percentage of HD session that did not reach the HD dose objective (Kt > 45) was observed. Conclusions: COVID has presented a public health system crisis that has influenced VA for HD, with an increase in CVCs relative to AVFs. A decrease in HD sessions that did not reach the HD dose objective was observed in the COVID period compared with a pre-COVID period.

CC motif chemokine ligand 20 (CCL20), a chemokine involved in immune cell migration through its receptor CCR6, has been implicated in kidney inflammation in crescentic glomerulonephritis and acute kidney injury. However, clinical information for other kidney diseases is scarce. We have analysed CCL20 levels in plasma and urine from patients with diabetic kidney disease (DKD, n = 98) and autosomal dominant polycystic kidney disease (ADPKD, n = 85) treated according to the guidelines and studied their association with baseline characteristics and long-term (median follow-up 4.9 and 7.1 years, respectively) clinical outcomes. Single-cell kidney transcriptomics were mined to identify CCL20-expressing cells. Plasma CCL20 was higher in DKD and ADPKD than in a reference group: median 12.8 (3.5–33.2), 6.0 (1.2–19.2), and 0.0 (0.0–9.0) pg/mL, respectively. Urinary CCL20 was quantifiable in 48% of patients with DKD but not in the reference group. Transcriptomics data support a local kidney source of CCL20. In DKD, plasma CCL20 was higher in early compared to advanced CKD. Urinary CCL20 was higher in patients with A2 albuminuria than in those with other albuminuria categories. In ADPKD, higher plasma and urinary CCL20 levels tended to be associated with lower eGFR, higher albuminuria, and larger kidneys. However, no significant association was found between CCL20 levels and progression to kidney failure or death. In conclusion, CCL20 is increased in biological fluids and locally produced in CKD. While this may point to a potential role in risk stratification, further studies are necessary.

Background/Objectives: Frailty is increasingly recognized as a major determinant of adverse outcomes in patients receiving peritoneal dialysis (PD), yet it is not routinely incorporated into clinical practice. Because PD relies heavily on patient autonomy and self-management, frailty, sarcopenia, malnutrition, and impaired quality of life may compromise both outcomes and technique retention. This study aimed to describe current clinical practices related to frailty-informed assessment in PD units participating in the GCDP network and to identify barriers to implementing a more comprehensive, patient-centered approach. Methods: We conducted a descriptive, observational, cross-sectional study based on a survey distributed to PD units belonging to the Grupo Centro de Diálisis Peritoneal (GCDP), a collaborative network of 24 hospitals across four autonomous communities in Spain. Physicians and nurses completed the questionnaire between January and February 2025. The survey explored seven domains: use of frailty scales, nutritional screening tools, dynamometry, muscle ultrasound, bioimpedance, quality of life instruments, and digital applications for patient follow-up. Results: Twenty of 24 centers completed the survey. Although all units considered frailty clinically relevant, only 11 assessed it at PD initiation and only 5 performed periodic or systematic re-evaluation. Nutritional screening tools were used in 13 centers, most commonly the Malnutrition Inflammation Score. Twelve centers had a dynamometer, though its use was not standardized. All centers used bioimpedance—primarily for hydration assessment—while muscle ultrasound was rarely applied in scheduled follow-up. Only 7 centers assessed quality of life. The main reported barriers were lack of time in routine practice and the absence of specific guidelines and training. Conclusions: Frailty-related assessment across participating GCDP units remains heterogeneous and incompletely implemented despite broad recognition of its clinical relevance. The identified gaps in standardized protocols, training, and integration of assessment tools highlight priorities for future implementation research aimed at incorporating frailty-informed, patient-centered assessment into routine PD care.