30-Second Takeaway
- Incremental twice-weekly hemodiafiltration appears as safe as thrice-weekly initiation for patients with preserved residual kidney function.
- Short-course cotrimoxazole around rituximab infusions substantially lowers infections in glomerulonephritis without added serious toxicity.
- Kidneys from active hepatitis B–infected donors can be selectively used in HBV-negative recipients with vaccination and antiviral strategies.
- Furosemide stress testing in high-risk PICU patients sharpens prediction of severe AKI and near-term need for RRT.
- New IgA nephropathy strategies target complement and APRIL, while risk tools refine decisions for older CKD patients.
Week ending December 27, 2025
Dialysis initiation, infection prevention, transplant expansion, and emerging therapeutics: concise updates for nephrologists
Incremental twice-weekly hemodiafiltration matches thrice-weekly outcomes at dialysis initiation
Incident dialysis patients with urea clearance ≥2.5 ml/min were randomized to incremental twice-weekly versus conventional thrice-weekly hemodiafiltration. Over 12 months, decline in GFR, residual kidney function, hospitalizations, mortality, and anuria did not differ between groups. Quality-of-life scores modestly favored incremental therapy at 6 months, especially disease burden, but this advantage attenuated by 12 months. Patients on incremental hemodiafiltration had far fewer sessions per year (69.1 vs 122.6), implying major resource and time savings.
Brief cotrimoxazole prophylaxis cuts infections after rituximab in glomerulonephritis
In 150 rituximab-treated glomerulonephritis patients, 1-week cotrimoxazole courses after each infusion were compared with no prophylaxis. Infections occurred in 7 cotrimoxazole-treated versus 16 control patients over 180 days, with lower incidence density in the prophylaxis group. Cotrimoxazole reduced cumulative infection risk (HR 0.39; 95% CI 0.17–0.88) and lowered infection-related mortality. Short-course prophylaxis did not increase serious adverse events attributed to cotrimoxazole, despite the single-center open-label design.
Using kidneys from active hepatitis B–infected donors into HBV-negative recipients appears feasible with precautions
This meta-analysis synthesized 20 cohorts including 600 HBsAg-negative kidney recipients transplanted from donors with active hepatitis B infection. Overall HBV transmission was 4.0%, mostly transient low-level viremia without sustained infection. Transmission risk rose to 16.0% when all donors were NAT positive, but was very low in living-donor and surface-antibody–positive recipients. Three HBV-related deaths occurred, all in recipients who did not receive posttransplant antiviral prophylaxis, underscoring the importance of prophylaxis.
References
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Additional Reads
Optional additional studies from this edition.