Nephrology

Advanced practice nurses can improve select patient outcomes in CKD, but organizational impact is unclear

This systematic review included eight randomized trials and one secondary analysis assessing advanced practice nurses (APNs) in CKD care. APN roles were categorized as collaborative management with physicians or leadership of targeted interventions. Positive effects were reported for blood pressure control, renal endpoints, and patient experience, but results varied across studies. No consistent benefit was found for organizational outcomes such as system-level costs or workflow metrics, limiting generalisability. 1

Sirolimus‑coated balloons after angioplasty improved 6‑month AVF circuit patency

In this multicenter randomized trial (n=170), sirolimus‑coated balloons (SCB) increased 6‑month access circuit primary patency to 70.1% versus 56.7% with placebo. At 12 months the ITT difference did not reach significance (37.1% vs 27.7%, P=0.07), but per‑protocol analysis favored SCB (36.4% vs 25.2%, P=0.04). Adverse events were infrequent and there were no deaths within 30 days, but proceduralists were not blinded. SCB appears effective for short‑term patency after successful plain balloon angioplasty in dysfunctional, nonthrombosed AVFs. 2

Diabetic foot ulcers are frequent in dialysis‑dependent ESKD and predict limb loss and mortality

This systematic review synthesised 64 observational studies of DFU in ESKD and dialysis populations. DFU incidence is high and often precedes dialysis; some cohorts suggest risk rises after haemodialysis initiation, especially within two years. Peripheral arterial disease strongly predicts worse limb outcomes and multidisciplinary care improves healing. Observational data link dialysis‑dependent ESKD to higher lower‑extremity amputation risk and high post‑amputation mortality approaching 50% at 2 years and 70% at 5 years. 3