Chronic kidney disease (CKD) is a complex and multifactorial disease, and one of the most prevalent worldwide. Chronic kidney disease–mineral bone disorders (CKD–MBD) with biochemical and hormonal alterations are part of the complications associated with the progression of CKD. Pathophysiology of CKD–MBD focused on abnormalities in serum levels of several biomarkers (such as FGF-23, klotho, phosphate, calcium, vitamin D, and PTH) which are discussed in this review. We therefore examine the prognostic association between CKD–MBD and the increased risk for cardiovascular events, mortality, and CKD progression to end-stage kidney disease (ESKD). Lastly, we present specific treatments acting on CKD to prevent and treat the complications associated with secondary hyperparathyroidism (SHPT): control of hyperphosphatemia (with dietary restriction, intestinal phosphate binders, and adequate dialysis), the use of calcimimetic agents, vitamin D, and analogues, and the use of bisphosphonates or denosumab in patients with osteoporosis.

Renin–angiotensin–aldosterone system (RAAS) inhibitors are standard care in patients with hypertension, heart failure or chronic kidney disease (CKD). Although we have studied the RAAS for decades, there are still circumstances that remain unclear. In this review, we describe the evolution of the RAAS and pose the question of whether this survival trait is still necessary to humankind in the present age. We elucidate the benefits on cardiovascular health and kidney disease of RAAS inhibition and present promising novel medications. Furthermore, we address why more studies are needed to establish a new standard of care away from generally prescribing ACEi or ARB toward an improved approach to combine drugs tailored to the needs of individual patients.

This study investigated the impact of the fourth COVID-19 pandemic wave on dialysis patients of Romagna territory, assessing the associations of vaccination status with infection risk, clinical severity and mortality. From November 2021 to February 2022, an epidemiological search was conducted on 829 patients under dialysis treatment for at least one month. The data were then analyzed with reference to the general population of the same area. A temporal comparison was also carried out with the previous pandemic waves (from March 2020 to October 2021). The epidemiological evolution over time in the dialysis population and in Romagna citizens replicated the global trend, as the peak of the fourth wave corresponded to the time of maximum diffusion of omicron variant (B.1.1.529). Of 771 prevalent dialysis patients at the beginning of the study, 109 (14.1%) contracted SARS-CoV-2 infection during the 4-month observation period. Vaccine adherence in the dialysis population of the reference area was above 95%. Compared to fully or partially vaccinated subjects, the unvaccinated ones showed a significantly higher proportion of infections (12.5% vs. 27.0% p = 0.0341), a more frequent need for hospitalization (22.2% vs. 50.0%) and a 3.3-fold increased mortality risk. These findings confirm the effectiveness of COVID-19 vaccines in keeping infectious risk under control and ameliorating clinical outcomes in immunocompromised patients.

Poor water treatments and concentrates to prepare dialysis fluids favor bacterial growth-producing pyrogens (e.g., endotoxins) that may cross hemodialysis, particularly high-flux, membranes. This puts hemodialysis patients at risk of acute bacteremia, pyrogenic reactions, long-term complications, loss of residual renal function, and poor nutritional status. Consequently, regulatory bodies worldwide recommend using ultrapure dialysis fluid for routine hemodialysis. Requests are also growing for the online production of sterile non-pyrogenic substitution fluid from ultrapure dialysis fluid. This way, large volumes of infusion solution may be safely and economically produced, enabling more end-stage kidney disease patients to benefit from the greater capacity of hemodiafiltration to remove toxins than purely diffusive hemodialysis treatment. Ultrapure dialysis and substitution fluids are often produced upstream from hemodialyzers by online filtration of standard dialysis fluid through cascades of bacteria- and endotoxin-retentive filters (ETRFs). Commercial ETRFs differ for membranes, operation, performance, duration and maintenance protocols, connection to a dialysis machine, disinfection procedures, and replacement schedule. Although suboptimal ETRF choice may increase treatment costs, the difficulty in gathering comparative information on commercial ETRFs complicates their selection. To aid dialysis centers in selecting the most convenient and suitable ETRF for their needs, herein, relevant characteristics of commercial ETRFs are reported and critically reviewed for a quick yet effective comparison.

Chronic kidney disease (CKD) is a widespread condition with significant cardiovascular risks and a progression to end-stage kidney failure. In recent years, increasing attention has been paid to the role of dietary interventions as a factor capable of influencing disease trajectory. This review summarizes the current observational and interventional evidence on various dietary approaches in patients with CKD and kidney transplants (KTs), including Mediterranean, plant-based, and low-protein diets. A balanced Mediterranean diet, rich in fruits, vegetables, whole grains, fish, and unsaturated fats, shows promises in improving the prognosis for CKD patients. Plant-based diets, which emphasize legumes, vegetables, and grains while minimizing animal protein, improve blood pressure and the glycemic and lipid control. Low-protein diets (LPDs), typically providing less than 0.6 g/kg/day of protein, may reduce the CKD progression and nitrogen burden, further delaying the initiation of dialysis. In conclusion, diets represent a valuable and underutilized therapeutic strategy in the management of CKD and KTs, influencing disease progression and patient outcomes.

Nephrology is an ever-evolving field of medicine. The importance of such a discipline is related to the high clinical impact of kidney disease. In fact, abnormalities of kidney function and/or structure are common in the general population, reaching an overall prevalence of about 10%. More importantly, the onset of kidney damage is related to a strikingly high risk of cardiovascular events, mortality, and progression to kidney failure which, in turn, compromises quality and duration of life. Attempts to comprehend the pathogenesis and molecular mechanisms involved in kidney disease occurrence have prompted the development and implementation of novel drugs in clinical practice with the aim of treating the ‘specific cause’ of kidney disease (including chronic kidney disease, glomerular disease, and genetic kidney disorders) and the main immunological complications following kidney transplantation. Herein, we provide an overview of the principal emerging drug classes with proved efficacy in the context of the aforementioned clinical conditions. This can represent a simplified guide for clinical nephrologists to remind them of the vast and heterogeneous armamentarium of drugs that should be used in the present and the future to improve the management of patients suffering from kidney disease.