The 2023 Spanish Registry of Dialysis and Transplantation (REDYT) real data exceeded previous estimates and forecasts for the prevalence of kidney replacement therapy (KRT). This trend will continue as the baby boom generation reaches the age of peak incidence of chronic kidney disease (CKD) and KRT. REDYT disclosed heterogeneity in clinical practice regarding initiation of KRT in the very elderly across Autonomous Communities, which should lead to benchmarking studies that dissect the drivers and outcomes. REDYT also disclosed an inverse correlation between KRT incidence/prevalence and life expectancy. That is, a lower need for KRT may be considered a key performance indicator of better overall societal health. This is not unexpected, as the main consequence of CKD is accelerated biological aging and kidney health is a key component of cardiovascular-kidney-metabolic (CKM) health. Spanish health authorities should follow the lead of international organizations, such as the 2025 World Health Organization (WHO) kidney health resolution, the associated United Nations political statement, the KDIGO guidance on the prevention of CKD and maintenance of kidney health, and the European Renal Association holistic ABCDE approach to cardiovascular-kidney-metabolic health. These organizations emphasize prevention and early treatment, identifying albuminuria as an actionable diagnostic criterion for CKD. Albuminuria drives interventions that improve cardiovascular-metabolic outcomes and may delay KRT by almost three decades. As deaths from CKD will soon overcome those from colorectal cancer, integrating albuminuria-based CKD screening into colorectal cancer screening programs for baby boomers has the potential to stem the tide of KRT and improve societal health.
INTRODUCTION:Assisted home hemodialysis (assisted HHD) has emerged as a strategy to expand access to home-based dialysis therapies in patients with chronic kidney disease who have functional limitations or difficulties performing the technique independently. However, data on its real-world implementation in Spain and on the profile of caregivers involved remain limited. METHODS:A national, structured, and anonymous survey was conducted under the auspices of the Home Hemodialysis Working Group of the Spanish Society of Nephrology. The survey was addressed to all home hemodialysis units in Spain. The questionnaire comprised 30 items distributed across six thematic sections and was completed by a single healthcare professional per center. It collected information on organizational aspects, characteristics of patients receiving assisted HHD, caregiver profile and burden, available resources, perceived benefits, and barriers to the implementation of structured assisted HHD programs. RESULTS:A total of 39 centers from 14 autonomous communities participated, most of them public hospitals. Overall, 311 prevalent patients on home hemodialysis were reported, of whom 26% were receiving assisted HHD. More than 30% of these patients were older than 70 years, and central venous catheters were the predominant vascular access. The main indications for assisted HHD were reduced mobility, fear of performing the technique independently, and cognitive impairment. Caregivers were predominantly family members and mostly female, with limited involvement of paid caregivers and scarce systematic assessment of caregiver burden. CONCLUSIONS:Assisted HHD enables access to home hemodialysis in an older, frail population with functional limitations. However, its development in Spain remains heterogeneous and largely dependent on informal caregiving. Advancing toward structured assisted HHD models that incorporate appropriate funding, dedicated human resources, and formal caregiver support is essential to ensure equitable, safe, and sustainable implementation.
The synthesis of testosterone and its modifications have allowed its use in treating medical conditions of hormonal deficiency. Currently, the most common use of anabolic-androgenic steroids (AAS)-synthetic testosterone derivatives-is for purposes other than medical treatment. Various complications have been reported among AAS users, with cardiovascular and hepatic complications being the best documented; direct renal toxicity is less well understood. AAS-associated acute kidney injury (AKI-AAS) is an emerging entity, resulting from the increased number of reported cases and greater use of these agents, although its true prevalence is unknown. Analysis of clinical cases suggests that the main mechanisms involved in AKI-AAS are indirect. This review examines the main mechanisms of kidney injury in users of these agents.
