Purpose: This study compared key health indicators of poor, older urban adults attending a free clinic with those of the general older population, using data from the 2023 Korea National Health and Nutrition Examination Survey (KNHANES). Methods: This cross-sectional comparative study included 60 adults aged ≥60 years who attended the Raphael Nanum Homeless Clinic in Seoul. Participants completed a questionnaire, underwent anthropometric assessment, and provided fasting blood samples for measurement of total cholesterol, low density lipoprotein (LDL)-cholesterol, and triglycerides (TG). Obesity, current smoking, monthly alcohol use, poor self-rated health, and strength exercise (≥ 2 days/week) were defined according to 2023 KNHANES criteria and compared with age-matched 2023 KNHANES estimates for adults aged ≥ 60 years using independent t-tests and two-proportion z-tests. Results: Participants were predominantly men (80.0%) with a mean age of 79.9 years; 70.0% reported no regular income, and 46.7% rated their health as poor. Compared with their 2023 KNHANES counterparts, the clinic group had a higher prevalence of obesity (50.0% vs. 35.0%), particularly among men, and a more atherogenic lipid profile characterized by higher LDL-cholesterol despite similar total cholesterol levels and lower TG. The prevalence of current smoking (3.3% vs. 10.6%) and monthly alcohol use (31.7% vs. 53.0%) was significantly lower, whereas participation in strength exercise was low in both groups, with no significant differences observed. Conclusion: Poor, older urban adults exhibited multidimensional health disparities, including obesity, adverse lipid profiles, and markedly poorer self-rated health, despite lower levels of smoking and alcohol consumption. Community-based interventions targeting nutrition, physical activity, and chronic disease management are needed to reduce health inequalities in this vulnerable population.

Cancer is a critically important outcome for kidney transplant recipients that inconsistently and infrequently reported in trials. We convened a consensus workshop to establish a core outcome measure for cancer for trials in kidney transplant recipients. Workshop attendees included 21 transplant recipients, 2 caregivers and 46 health professionals from 12 countries. Transcripts were analyzed thematically. Three themes were identified. “Fear of cancer occurrence due to immunosuppression” reflected the psychological burden and uncertainties when balancing suppression with long-term cancer risk. “Capturing the details of type, stage and recurrence”, encompassed recognizing the differential consequences of cancer types, delineating the stage of cancer to convey severity, and distinguishing recurrent from de novo cancer. “Recognizing the challenges of capturing cancer events” included under-reporting and incomplete documentation of longer-term outcomes, variability in cancer screening practices, and absence of coordinated trial networks to support harmonization and aggregation of cancer outcomes across studies. Participants agreed that occurrence, with stratification by cancer type, stage, and recurrence, where possible, would be a practical and meaningful core outcome measure for cancer. Consistent reporting of cancer using a standardized core outcome measure may help to improve the consistency and relevance of trial findings and assist in shared decision-making in kidney transplantation.

South Korea faces a critical organ shortage, with only 31.2% of families consenting to deceased organ donation following brain death. Traditional public awareness campaigns targeting adults have achieved limited success, suggesting that deeply rooted cultural concerns require more fundamental intervention through youth education. We developed and implemented a values-based education program that integrated deceased organ donation awareness within broader life-respect education. Between November 2023 and July 2024, the program reached 2333 middle and high school students across 8 schools in Seoul, Gyeonggi, and Busan regions. In the post-class evaluation, 1543 students (66% response rate) completed surveys, with 1174 providing open-ended responses (76%). Qualitative analysis employed dual large language models (ChatGPT and Google Gemini) for thematic analysis and contextual sentiment classification. The curriculum achieved high engagement, with 72.1% of students rating it highly helpful and 89.2% reporting increased appreciation for life's value. Thematic analysis identified seven major themes including rediscovery of life's intrinsic value, enhanced self-worth and empathy, suicide prevention awareness, and positive attitudes toward deceased organ donation. Sentiment analysis showed predominantly positive reception, with 86% (ChatGPT) and 87% (Gemini) of responses classified as positive (97.53% inter-model agreement). This implementation study suggests that values-based education cultivating adolescents' appreciation for life's interconnection may provide a promising foundation for deceased organ donation awareness.

Background:Nephrolithiasis is a common complication in autosomal dominant polycystic kidney disease (ADPKD), yet its impact on long-term kidney outcomes remains uncertain. Although experimental and retrospective studies suggest a potential role of kidney stones in accelerating disease progression, prospective evidence based on imaging-confirmed nephrolithiasis is limited. Methods:This prospective cohort study included 410 patients with ADPKD from the HOPE-PKD cohort who underwent baseline abdominal computed tomography (CT) within 1 year of enrollment. Nephrolithiasis was defined as radiopaque lesions located within the collecting system, whereas cyst wall calcifications were excluded based on established CT criteria. The primary outcome was initiation of renal replacement therapy (RRT) due to kidney failure. The secondary outcome was a composite of ≥50% decline in estimated glomerular filtration rate, doubling of serum creatinine, or initiation of RRT. Multivariable Cox proportional hazards models were constructed with adjustment for demographic, metabolic, genetic, and imaging-based risk factors, including imaging-based risk stratification. Results:During a median follow-up of 5.18 years, 51 (12.4%) and 96 (23.4%) participants reached the primary and secondary endpoints, respectively. After adjustment for demographic, metabolic, and disease severity factors, the stone group showed a significantly higher risk of both the primary [Hazard ratio (HR) 2.84; 95% Confidence interval (CI) 1.26-6.38; P = .012] and secondary (HR 1.83; 95% CI 1.03-3.27; P = .041) endpoints compared with the no-stone group. Associations appear to be more pronounced in males, individuals with higher body mass index, worse baseline kidney function, larger kidney volume, and PKD1 genotype. Conclusions:Imaging-confirmed nephrolithiasis is independently associated with adverse kidney outcomes in patients with ADPKD. Early detection and targeted management of kidney stones may improve risk stratification and kidney prognosis in this population.

BACKGROUND:Medical assistance in dying (MAiD) is legally permitted in a growing number of jurisdictions, and in 6, it can currently be followed by organ donation. Organ donation following MAiD offers patients an opportunity to address transplant needs as a final act of altruism, but it also raises complex ethical questions that require strong safeguards to protect patients, professionals, and public trust. METHODS:We identified key ethical issues and safeguards by analyzing guidelines and protocols from the 6 countries where organ donation following MAiD is performed: Australia, Belgium, Canada, the Netherlands, New Zealand, and Spain. This article was developed under the auspices of the Ethics Committee of The Transplantation Society with medical, ethical, and legal experts from these countries. RESULTS:Three domains of ethical concern emerged: (1) safeguarding the integrity of patients' decision-making (voluntariness, informed consent, and how and when information is presented); (2) ethical governance of donation following MAiD (adherence to the Dead Donor Rule, death determination, and consent for premortem interventions); and (3) implications for care relationships and professional practice (end-of-life impacts, recipient information and donor anonymity, and professional support, including conscientious objection). Key recommendations include clear and consistent policies; a patient-centered, nondirective approach; rigorous eligibility and voluntariness assessments; and strict separation between MAiD and donation/transplantation teams. CONCLUSIONS:These recommendations provide practical guidance for implementing organ donation following MAiD in jurisdictions where it is practiced or being considered. They support patients' end-of-life wishes while safeguarding ethical and legal standards and maintaining trust in both MAiD and organ transplantation.

Background: The usefulness of the living kidney donor profile index (LKDPI) has not been widely demonstrated; therefore, it requires verification before clinical application. We analyzed the LKDPI using data from the Korean Organ Transplantation Registry (KOTRY) to confirm whether the LKDPI can be used to predict the survival of allografts in living donor kidney transplantation Methods: The study population was obtained from the KOTRY database. A total of 2,598 kidney recipients registered in the KOTRY database were enrolled between May 2014 and December 2020. Donor and recipient information was observed, and Results: Median LKDPI score was 15.5 with a follow-up duration of 33.7 +/- 16.1 months. According to LKDPI scores (group 1, <0; group 2, 0-20; group 3, 20-40; and group 4, >40), LKDPI group 4 had significantly higher death-censored graft loss than LKDPI group 1 (hazard ratio [HR], 1.89; 95% confidence interval [CI], 1.06- 3.40; p = 0.03). When divided based on the cutoff value (LKDPI, 36.6), the high LKDPI group had higher graft loss than the low LKDPI group (HR, 2.14; 95% CI, 1.37-3.34; p < 0.001). When follow-up was repeated after transplantation, it was confirmed that the higher the LKDPI value was, the lower the average Conclusion: This study confirmed that LKDPI can serve as an independent predictor for assessing the risk of allograft failure and transplant outcomes in Korean LDKT patients.

RATIONALE & OBJECTIVE:Low muscle mass is a risk factor for chronic kidney disease. In this study, we examined the relationship between muscle mass and mortality, as well as end-stage kidney disease (ESKD), in patients with autosomal-dominant polycystic kidney disease (ADPKD). STUDY DESIGN:Retrospective cohort study. SETTING & PARTICIPANTS:1,443 patients with ADPKD from eight tertiary-care hospitals in South Korea between 2006 and 2020. EXPOSURES:Computed tomography images were obtained at the third lumbar vertebra to measure the skeletal muscle area (SMA) using an artificial intelligence system. SMA indexed for the square of height (height2) was classified as low-attenuation muscle area (LAMA) or normal-attenuation muscle area (NAMA) based on muscle quality. OUTCOMES:All-cause mortality and ESKD. ANALYTICAL APPROACH:Cox proportional hazards regression, adjusted for sex, age, creatinine, glucose, and height-adjusted total kidney volume, was used to investigate the associations of muscle indices with all-cause mortality and ESKD. Subgroup analyses were conducted based on body mass index categories: low or normal (<25 kg/m2) and overweight or obese (≥25 kg/m2). RESULTS:The study population included more than half female patients, and the mean estimated glomerular filtration rate was 68.4 mL/min/1.73 m2. Mean follow-up was 5.14 years. Greater SMA/height2 and NAMA/height2 ratios were associated with a lower risk of mortality (HRs, 0.58 [95% CI, 0.39-0.88] and 0.55 [0.39-0.79], respectively). Greater NAMA/height2 ratio was associated with a 26% lower ESKD incidence (HR, 0.74; 95% CI, 0.59-0.92), but a greater LAMA/height2 ratio was associated with a higher ESKD incidence (HR 1.18, 95% CI 1.01-1.37). A higher NAMA/LAMA ratio was associated with a lower ESKD incidence (HR, 0.74; 95% CI, 0.60-0.92). Greater muscle mass was associated with a lower risk of mortality among overweight individuals and a lower risk of ESKD in underweight individuals. LIMITATIONS:Lack of details about muscle strength and performance. CONCLUSIONS:Among individuals with ADPKD, greater and higher-quality muscle mass were associated with lower risks of mortality and progression of chronic kidney disease to ESKD. PLAIN-LANGUAGE SUMMARY:Low muscle mass is a known health concern, and we aimed to study its impact specifically in patients with autosomal-dominant polycystic kidney disease (ADPKD). We investigated how muscle mass relates to patient survival and progression to end-stage kidney disease. Using computed tomography scans performed on more than 1,400 patients with ADPKD, we measured the amount and quality of their muscle. We discovered that patients with more muscle, especially higher-quality muscle, had a significantly lower risk of death and were less likely to develop end-stage kidney disease. Conversely, lower-quality muscle was associated with an increased risk of death. These findings suggest that maintaining good muscle mass may improve outcomes for patients with ADPKD. These data can inform future strategies for improving outcomes in people with ADPKD.

Background. In November 2023, in the context of the Spanish Presidency of the Council of the European Union, the Organization National de Transplante organized a global summit discussing global action in transplantation for the next decade. This article reports the recommendations supporting the need to prioritize transplantation in healthcare systems. Methods. The working group investigated how transplantation addresses noncommunicable disease mortality, particularly related to kidney and liver disease. They also investigated how transplantation can contribute to the achievement of several of the United Nations Sustainable Development Goals, especially Goal 3 (good health and well-being), Goal 8 (sustained, inclusive, and sustainable economic growth and employment for all), and Goal 13 (combat climate change and its impact). Results. By prioritizing transplantation, the increased availability and accessibility of life-saving organs and tissues to the public will not only lead to saving more lives and improving health outcomes for individual patients but also contribute to the development of a resilient health system in general in that country as a consequence of developing the infrastructure required for transplantation. Conclusions. The ethical principles associated with transplantation promote the principles of solidarity in society by fostering the donation process and equity in access to therapy. This article aims to advocate for the widespread availability of solid organ, tissue, and cell transplantation for all patients.

The Kidney Disease: Improving Global Outcomes (KDIGO) 2025 Clinical Practice Guideline for the Evaluation, Management, and Treatment of Autosomal Dominant Polycystic Kidney Disease (ADPKD) represents the first KDIGO guideline on this subject. Its scope includes nomenclature, diagnosis, prognosis, and prevalence; kidney manifestations; chronic kidney disease (CKD) management and progression, kidney failure, and kidney replacement therapy; therapies to delay progression of kidney disease; polycystic liver disease; intracranial aneurysms and other extrarenal manifestations; lifestyle and psychosocial aspects; pregnancy and reproductive issues; pediatric issues; and approaches to the management of people with ADPKD. The guideline has been developed with patient partners, clinicians, and researchers around the world, with the goal to generate a useful resource for healthcare providers and patients by providing actionable recommendations. The development of this guideline followed an explicit process of evidence review and appraisal, based on a rigorous, formal systematic literature review. The strength of recommendations follows the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The guideline also provides practice points serving to direct clinical care or activities relating to areas for which a systematic review was not conducted. Limitations of the evidence are discussed. Research recommendations to address gaps in knowledge, and implications for policy and payment, are provided. The guideline targets a broad audience of healthcare providers, people living with ADPKD, and stakeholders involved in the various aspects of ADPKD care.

Inherited cystic kidney disease is a constellation of heterogenous genetic diseases that commonly share renal cystic phenotype. We have analyzed renal outcome (annual change of estimated glomerular filtration rate (eGFR) and total kidney volume (TKV)) among Korean genetic cohort of inherited cystic kidney disease. Primary genetic analysis was conducted using a targeted gene panel including 89 ciliopathy-associated genes. A total of 1319 patients were included in the cross-sectional analysis. A total of 502 patients with longitudinal data without history of Tolvaptan treatment were included in the renal outcome analysis. Genotypes were classified into PKD1, PKD2, or minor genotypes. PKD1 group showed younger age at diagnosis of cystic kidney disease and hypertension, and higher proportion of rapid progressor. Interestingly, the patients with minor genotypes showed a significantly higher rate of diabetes (11.6%) and proteinuria (3.6 ± 25.4 g/g) compared to other genotypes. In addition, the minor genotype group showed smaller kidneys (858 ± 913 mL) with atypical cystic phenotype (Mayo class 2). In longitudinal analysis, PKD1 genotype showed faster eGFR decline (−2.44 ± 6.1 mL/min/1.73 m2/yr) compared to PKD2 (−1.09 ± 8.5 mL/min/1.73 m2/yr) and minor genotypes (−0.5 ± 5.4 mL/min/1.73 m2/yr, P = 0.037). PKD1 group showed faster growth of kidneys (40.2 ± 188.2 mL per year) while PKD2 (9.6 ± 315.2 mL per year) and minor genotype group (13.4 ± 55.7 mL per year) demonstrated minimal TKV growth during study period (P = 0.635). PKD1 genotype demonstrated poorer renal outcome compared to other genotypes. Minor genotypes showed favorable renal outcome with minimal growth of TKV.

Background. The current landscape of organ donation and transplantation (ODT) registries is not well established. This narrative review sought to identify and characterize the coverage, structure, and data capture of ODT registries globally. Methods. We conducted a literature search using Ovid Medline and web searches to identify ODT registries from 2000 to 2023. A list of ODT registries was compiled based on publications of registry design, studies, and reports. Extracted data elements included operational features of registries and the types of donor and recipient data captured. Results. We identified 129 registries encompassing patients from all continents except Antarctica. Most registries were active, received funding from government or professional societies, were national in scope, included both adult and pediatric patients, and reported patient-level data. Registries included kidney (n = 99), pancreas (n = 32), liver (n = 44), heart (n = 35), lung (n = 30), intestine (n = 15), and islet cell (n = 5) transplants. Most registries captured donor data (including living versus deceased) and recipient features (including demographics, cause of organ failure, and posttransplant outcomes) but there was underreporting of other domains (eg, donor comorbidities, deceased donor referral rates, waitlist statistics). Conclusions. This review highlights existing ODT registries globally and serves as a call for increased visibility and transparency in data management and reporting practices. We propose that standards for ODT registries, a common data model, and technical platforms for collaboration, will enable a high-functioning global ODT system responsive to the needs of transplant candidates, recipients, and donors.

Background. As the imbalance in organ demand and supply is getting worse, <1000 patients waiting for organ transplants die each year in South Korea. To enhance positive attitudes to deceased organ–tissue donation through systematic education, we developed an educational program with delivery pathways for premedical and medical students. Methods. Online and offline self-learning educational materials on deceased organ–tissue donation were generated and posted on the Vitallink Academy YouTube site. Thirty-two pre- and 15 posteducation questionnaires were developed using a web-based survey platform, and conducted before and immediately after the education process. The education proceeded in 3 steps: (1) group study sessions on selected topics, (2) poster submissions by each group and the selection of excellent poster by the organizing committee, and (3) excellent poster presentation and questions and answers. Results. A total of 141 students in the first year of premedical classes at the Seoul National University College of Medicine participated in this program. Only 24.2% of responders agreed that anyone who was diagnosed with brain death should donate. The proportion of students with positive attitudes toward organ–tissue donation increased from 74.7% to 97.7% (P < 0.001) with our education. Likewise, interest in deceased organ–tissue donation-related issues increased from 33.3% to 84.9% (P < 0.001). The expressed willingness for organ–tissue donation also increased from 76.8% to 96.5% (P < 0.001). The proportion of accepting brain death as the determination of death increased from 61.6% to 89.5% (P < 0.001). Moreover, 81.4% changed their approach and planned to register with an organ donor card. Conclusions. In this study, significant improvements were observed in knowledge, awareness, and attitude toward organ–tissue donation with our newly developed co-participatory education program for premedical students. Hence, target-specific education can be regarded as a valuable approach to enhancing public awareness of deceased organ–tissue donation.

Introduction: Life participation has been established as a critically important core for trials in kidney transplantation. We aimed to validate a patient-reported outcome measure for life participation in kidney transplant recipients. Methods: A psychometric evaluation of the Standardized Outcomes in Nephrology life participation (SONG-LP) measure was conducted in adult kidney transplant recipients. The measure includes 4 items of life participation (leisure, family, work, and social) each with a 5-point Likert scale. Each item is scored from 0 (never) to 4 (always) and the summary measure score the average of each item. Results: A total of 249 adult kidney transplant recipients from 20 countries participated. The SONG-LP instrument demonstrated internal consistency (Cronbach's a 1/4 0.87; 95% confidence intervals [CI]: 0.83- 0.90, baseline) and test-retest reliability over 1 week (intraclass correlation coefficient of 0.62; 95% CI: 0.54- 0.70). There was moderate to high correlation (0.65; 95% CI: 0.57-0.72) with the PROMIS Ability to Participate in Social Roles and Activities Short Form 8a that assessed a similar construct, and moderate correlation with measures that assessed related concepts (i.e., EQ5D 0.57; 95% CI: 0.49-0.65), PROMIS Cognitive Functional Abilities Subset Short Form 4a (0.40; 95% CI: 0.29-0.50). Conclusion: The SONG-LP instrument is a simple, internally consistent, reliable measure for kidney trans-plant recipients and correlates with similar measures. Routine incorporation in clinical trials will ensure consistent and appropriate assessment of life participation for informed patient-centered decision-making.

Autosomal dominant polycystic kidney disease (ADPKD) is a genetic kidney disorder with multiple cyst formation that progresses to chronic kidney disease (CKD) and end-stage kidney disease. Plant-based diets have attracted considerable attention because they may prevent CKD development. This study investigated whether adherence to a plant-based diet is associated with kidney function in patients with ADPKD. The overall plant-based diet index (PDI), healthful PDI (hPDI), and unhealthful PDI (uPDI) were calculated using dietary intake data. Among 106 ADPKD patients, 37 (34.91%) were classified as having advanced CKD (eGFR < 60 mL/min/1.73 m2). The overall PDI and hPDI were lower, but the uPDI was higher in patients with advanced CKD than in those with early CKD. The hPDI was negatively correlated with the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio. Moreover, the hPDI was inversely associated with advanced CKD [odds ratio (OR): 0.117 (95% confidence interval (CI): 0.039–0.351), p < 0.001], and the uPDI was positively associated with advanced CKD [OR: 8.450 (95% CI: 2.810–25.409), p < 0.001]. The findings of the current study demonstrate that greater adherence to a healthful plant-based diet is associated with improved kidney function in ADPKD patients.

Asia has the lowest rate of organ transplantation, especially deceased donations despite having the highest growth rate of chronic kidney disease (CKD) and end stage kidney disease (ESKD). This survey was done to evaluate the knowledge, awareness and attitude regarding deceased donation among the family members of CKD patients in Bangladesh.