Nephrology

NSF risk with contemporary gadolinium contrast is extremely low in advanced CKD and ESRD

This TriNetX cohort included 73,022 adults with stage 4–5 CKD or ESRD receiving contemporary gadolinium-based contrast agents from 2010–2025. After propensity matching, possible NSF codes occurred in 0.05% of advanced CKD/ESRD patients and 0.05% of controls (RR 1.00, 95% CI 0.63–1.59). NSF-confounder codes were similarly rare and not increased versus controls, and risk did not differ for group II or macrocyclic agents. These data indicate that modern GBCAs confer an exceedingly low NSF signal even in advanced CKD and ESRD. Nephrologists can generally clear necessary contrast-enhanced MRI using contemporary agents, focusing on overall risk–benefit rather than NSF alone. 1

Structured approach to resistant hypertension in CKD with updated targets and sequencing

This review outlines current targets and treatment hierarchy for resistant hypertension in CKD. Office BP <140/90 mmHg is recommended for most, with <130/80 mmHg preferred in albuminuria, diabetes, high cardiovascular risk, or transplant recipients. Systolic BP <120 mmHg is discouraged because of concern for renal hypoperfusion and adverse cardiovascular outcomes. Initial management is optimized triple therapy with a renin–angiotensin blocker, calcium channel blocker, and diuretic, plus beta-blockers for cardiac comorbidities. For uncontrolled BP, spironolactone is preferred when eGFR ≥30, while chlorthalidone is suitable in more advanced CKD, and centrally acting agents are alternatives. Adjuncts include SGLT2 inhibitors, non-steroidal MRAs, GLP-1 receptor agonists, endothelin antagonists, renal denervation, and targeted revascularization in high-risk renovascular disease. 2

Robot-assisted living-donor kidney transplant lowers complications with preserved graft outcomes

This multicenter retrospective study compared robot-assisted kidney transplantation (RAKT) with open kidney transplantation (OKT) from living donors in 733 ESKD patients. Propensity matching yielded 306 RAKT and 306 OKT recipients with similar baseline characteristics. RAKT had shorter vascular anastomosis times but longer total operative and rewarming times than OKT. Early overall and Clavien-Dindo ≥3 complications were significantly lower after RAKT, and RAKT independently predicted fewer early complications and reinterventions. Dialysis-free, graft, reintervention-free, and overall survival were similar between approaches, supporting RAKT as a lower-morbidity option where expertise exists. 3