Early identification of kidney disease can protect kidney health, prevent kidney disease progression and related complications, reduce cardiovascular disease risk, and decrease mortality. We must ask “Are your kidneys ok?” using serum creatinine to estimate kidney function and urine albumin to assess for kidney and endothelial damage. Evaluation for causes and risk factors for chronic kidney disease (CKD) includes testing for diabetes and measurement of blood pressure and body mass index. This World Kidney Day we assert that case-finding in high-risk populations, or even population level screening, can decrease the burden of kidney disease globally. Early-stage CKD is asymptomatic and simple to test for, and recent paradigm shifting CKD treatments such as sodium glucose co-transporter-2 inhibitors dramatically improve outcomes and favor the cost-benefit analysis for screening or case-finding programs. Despite this, numerous barriers exist, including resource allocation, health care funding, health care infrastructure, and health care professional and population awareness of kidney disease. Coordinated efforts by major kidney nongovernmental organizations to prioritize the kidney health agenda for governments and aligning early detection efforts with other current programs will maximize efficiencies.

In 2017, Kidney Disease: Improving Global Outcomes (KDIGO) published a Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKDMBD). Since then, new lines of evidence have been published related to evaluating disordered mineral metabolism and bone quality and turnover, identifying and inhibiting vascular calcification, targeting vitamin D levels, and regulating parathyroid hormone. For an in-depth consideration of the new insights, in October 2023, KDIGO held a Controversies Conference on CKD-MBD: Progress and Knowledge Gaps Toward Personalizing Care. Participants concluded that the recommendations in the 2017 CKD-MBD guideline remained largely consistent with the available evidence. However, the framework of the 2017 Guideline, with 3 major sections–biochemical abnormalities in mineral metabolism; bone disease; and vascular calcification–may no longer best reflect currently available evidence related to diagnosis and treatment. Instead, future guideline efforts could consider mineral homeostasis and deranged endocrine systems in adults within a context of 2 clinical syndromes: CKD-associated osteoporosis, encompassing increased fracture risk in patients with CKD; and CKD-associated cardiovascular disease, including vascular calcification and structural abnormalities, such as valvular calcification and left ventricular hypertrophy. Participants emphasized that the complexity of bone and cardiovascular manifestations of CKD-MBD necessitates personalized approaches to management.

Introduction. In recent years, childhood has been recognized as a "window of opportunity" to reduce both the prevalence of cardiovascular diseases (CVD) and their long-term impact on life expectancy and health in adulthood. Children and adolescents with chronic kidney disease (CKD) face a significantly increasing risk of developing CVD later in life. This narrative review aims to highlight the importance of studying dyslipidemia in children and adolescents with CKD and to provide a theoretical foundation for future reseach. The key research questions focus on assessing the prevalence of dyslipidemia, conducting a comparative analysis of clinical practice guidelines, and summarizing the findings of clinical trials evaluating the efficacy and safety of lipid-lowering therapies of this patient population.

Methods. A narrative review was conducted by searching for relevant articles on PubMed and on eLIBRARY.RU Scientific Electronic Library.

Results. The search identified 27 publications including: 11 observational studies; 9 clinical practice guidelines for lipid management in children and adolescents with CKD; and 7 clinical trials evaluating the efficacy and safety of lipid-lowering therapy. A key finding was the use of varying diagnostic criteria in observational studies. In studies that followed standardized diagnostic guidelines, the reported prevalence of dyslipidemia was: 61.5% – 71.8% in patients with CKD G1-G5 without renal replacement therapy; 85.1% in patients on peritoneal dialysis; 76.1% in patients on hemodialysis; 54.2% – 55.5% in post-kidney transplantation. Dyslipidemia was most commonly characterized by elevated triglycerides and reduced high-density lipoprotein (HDL) cholesterol level. Significant inconsistencies were noticed in clinical practical guidelines for lipid management in children and adolescents with CKD, with recommendations generally based on low or very low level of evidence. All clinical trials assessing the efficacy and safety of statins in pediatric CKD patients had notable limitations. However, most studies reported a reduction in major lipid fractions with statin therapy, and no clinically significant adverse effects were observed after short-term treatment courses.

Conclusions. The review confirmes the high prevalence of dyslipidemia in children and adolescents with CKD. Significant inconsistencies in existing clinical practice guidelines and a lack of strong evidence were identified. Currently, nonpharmacological therapy remains the primary focus of both scientific research and clinical practice. To optimize its effectiveness, there is a need to develop educational resources for healthcare professionals and patients.

A direct comparison of the long-term effectiveness of combined interventions in controlled studies is often challenging, if not infeasible due to ethical concerns, due to ethical concerns, including the reluctance to withhold potentially beneficial treatments. This gap can be addressed through pragmatic research or the analysis of large prospectively collected datasets, such as registers. In addition providing valuable outcome assessments, these datasets enable the formation of matched groups for comparison in interventional studies, which, under certain conditions, may serve as a form of quasi-randomization.

This study analyzes data from the renal replacement therapy registry in a large city, covering the period from the transition of dialysis to the compulsory medical insurance system in 2009, ensuring accurate tracking of therapy initiation and outcomes untill the COVID-19 pandemic, which disrupted the stable organization and outcomes of dialysis. The analysis focuses on factors associated to patient survival, particularly those directly related to dialysis and chronic kidney disease syndromes during this period.

The overall five-year survival rate was 60.4%±1.5%. Factors at dialysis initiation associated with adverse outcomes included: age (+1% risk increase per year of age), the underlying disease diagnosis, baseline residual GFR below 5.3 ml/min/1.73 m2 (+41%), or below 3.6 ml/ min/1.73 m2 (+55%), phosphatemia above 1.78 mmol/L (+58%) or below 1,13 mmol/ L (+38%); calcemia outside the target range (+57% risk for low levels, +120% risk for high levels); natremia (above 141 mmol/L (+62%); albuminemia (below 36 g/L (+22%); interdialytic weight gain (+23% for each 1% of body weight increase), and urgent of dialysis initiation. During maintenance dialysis (indicator period – 3th-15th months) adverse outcomes were associated with phosphatemia above 1.78 mmol/l (68% risk increase), calcemia above 2.5 mmol/L (+122% risk) and their interaction, as well as ultrafiltration rate above 8 ml/hour/kg (165% risk increase and higher for more fast ultrafiltration). Additional risk factors include worsening hyperphosphatemia (+72%), deviation in calcemia from target range (+16% risk for downward shifts, +43% risk for upwards shifts) and ultrafiltration rate exceeding 10 ml/hour/kg (+21%). Notably, anemia correction indicators and their trends, under current favorable treatment practice, were not identified as significant risk factors.

Detailed patient data will facilitate the evaluation of intervention impacts on dialysis outcomes by enabling comparison matched historical cohorts.

The prevalence of type 2 diabetes mellitus (DM2) and obesity in pregnant women is increasing, particularly in those of advanced reproductive age. DM2, arterial hypertension (AH), proteinuria, and renal insufficiency significantly elevate the risk of pregnancy complications, including preeclampsia (PE), preterm birth, cesarean section (CS), congenital malformations, neonatal respiratory and metabolic disorders, and accelerated progression of chronic kidney disease in mothers. This article describes a case of unplanned pregnancy in a 45-year-old woman with morbid obesity (BMI 50.39), AH, DM2, extremely high proteinuria (12 g/day), and pregestational serum creatinine 210 μmol/L. The patient declined medical recommendations for pregnancy termination. She was prescribed insulin detemir and aspart, achieving a target HbA1C level below 6%. Acetylsalicylic acid and enoxaparin were administrated to prevent PE and thromboembolic complications. Antihypertensive therapy was adjusted multiple times based on 24-h blood pressure monitoring. By 26 weeks of gestation, the patient received methyldopa, extended-release nifedipine, and bisoprolol. No PE or fetal growth restrictions was observed. At 36 weeks 4 days of gestation, a planned CS was performed due to breech presentation. A female infant with diabetic fetopathy was delivered with weight 3290 g, height 51 cm, Apgar score – 7/8 points. The postpartum period was uneventful, and both mother and child were discharged at eighth day. The infant remains healthy and is developing normally. The mother was resumed nephroprotective therapy but, by her own decision, was lost to follow-up after six months. It is known she began regular hemodialysis 1.5 years postpartum. A favorable obstetric outcome was achieved through multidisciplinary pregnancy management, complication prevention, and strict glycemic and blood pressure control.

The number of patients with end-stage renal disease (ESRD) undergoing programmed hemodialysis remains high worldwide. Over time, the formation of an arteriovenous fistula increases the risks of access loss due to the progression of anastomosis stenosis, stenosis of the diversion vein, and pathology of the major arteries in the upper limb. These factors, individually or in in combination, can lead to adequate hemodialysis and fistula thrombosis.

We present a successful clinical case of treatment of a long-term hemodialysis patient with type 2 diabetes mellitus who developed vascular access pathology leading to critical ischemia of the right upper limb and progression of necrosis of the 3^rd, 4^th and 5^th fingers of the right hand. Given the extent of vascular involvement, the patient’s constitutional characteristics, and associated comorbidities, a minimally invasive intervention was deemed the appropriated course of action. The patient underwent balloon angioplasty with stenting of the diverting vein, as well as endovascular correction of both the subclavian artery and the arteriovenous fistula anastomosis. The patient was discharged on postoperative 4th day in satisfactory condition. A follow-up ultrasound confirmed the proper functioning of the reconstructed vascular segments and the arteriovenous fistula. The patient was referred again on the 47^th day of the postoperative period. On postoperative day 47, the patient was re-evaluated and reported no pain. A necrectomy of the distal phalanx of the 3^rd finger of the right hand was performed, while the 4^th and 5^th fingers showed no signs of trophic changes. Program hemodialysis was successfully continued through the fistula, with no pathology detected in the access zone. The case highlights the safety and efficacy of minimally invasive interventions in managing patients with concurrent major arterial disease and dialysis access complications. However, further studies and clinical observations are needed to establish a standardized treatment algorithm and facilitate its widespread implementation in clinical practice.