Background:The emerging role of pharmacists in chronic kidney disease (CKD) care prompted the pharmacy-led screening and quality use of medicines in CKD trial (QUM-CKD), a pharmacy-led screening initiative to detect previously undiagnosed CKD and improve medication safety.Objective: To explore pharmacists' experiences and perspectives on the implementation of the QUM-CKD trial in Australian community pharmacies. Methods:A descriptive phenomenological qualitative approach was employed, involving in-depth, semi-structured telephone interviews with thirteen metropolitan and rural community pharmacists in the trial. Pharmacists were selected via purposive maximum variation sampling and were recruited mid-trial. Interviews were audio- recorded, transcribed verbatim, and thematically analysed using both deductive and inductive approaches in NVivo 14. Results:Most participating pharmacists reported having positive experiences with the trial's implementation. Facilitators of implementation included pharmacists' knowledge and beliefs, the availability of resources, support and training. The alignment with roles, values, and systems, along with perceived benefits of the service, the point-of-care testing service, a whole-team approach, and patient acceptance coupled with positive feedback, also facilitated implementation. Barriers included insufficient pharmacist staffing, time constraints, heavy workload, trial software and documentation issues, patients' lack of time, interest or unfavourable perceptions of the service, and interprofessional communication challenges between pharmacists and general practitioners (GPs). Pharmacists also suggested several potential improvements and expressed concerns about the sustainability of the service. Conclusions:Australian community pharmacists generally reported positive experiences in implementing the QUM-CKD trial. To ensure the service's success and sustainability, we recommend adequate pharmacy staffing, appropriate pharmacist remuneration, active stakeholder promotion and strong interprofessional collaboration. Pharmacists' suggestions for service improvement should also be considered.

Kidney transplantation offers superior survival to dialysis, but donor organ shortage limits access. Utilizing kidneys from donation after circulatory death (DCD) donors with acute kidney injury (AKI) could expand the donor pool, but concerns about outcomes persist. This systematic review aimed to evaluate the outcomes of kidney transplantation from DCD donors with AKI. A systematic literature search was conducted in PubMed, Embase, and Cochrane Library up to September 25, 2024. Studies reporting kidney transplantation outcomes in recipients of DCD donors with AKI were included. Meta-analysis was planned but limited by the number and weighting of included studies. Delayed graft function (DGF), primary nonfunction (PNF), estimated glomerular filtration rate (eGFR), and graft survival were assessed. Seven studies (5731 patients) were included. Meta-analysis showed a significantly higher risk of DGF in DCD kidney transplants with donor AKI. PNF rates were similar. One-year eGFR and graft survival were comparable between recipients of kidneys from DCD donors with and without AKI. While DCD kidney transplants with donor AKI are associated with an increased risk of DGF, long-term graft survival appears comparable to those without AKI. These findings suggest that utilizing such kidneys can be a viable strategy to expand the donor pool, although careful consideration of DGF risk is necessary. Further research with more robust data is warranted. This meta-analysis of kidney transplants from donors after circulatory death (DCD) indicates comparable long-term outcomes with and without donor acute kidney injury (AKI). While delayed graft function is more frequent in AKI grafts, careful donor selection can expand the donor pool without compromising survival.

Chronic kidney disease (CKD) is a growing global health problem and affects approximately 10–15% of the world’s population. The interactions between kidney disease and endocrine systems are complex, and endocrine abnormalities are common in patients with CKD. In particular, abnormalities in the renin–angiotensin–aldosterone system, parathyroid function, and erythropoietin production and responsiveness are common. In addition, thyroid disease, sexual dysfunction and abnormalities in prolactin, growth hormone, and insulin-like growth factor-1 are often seen. Here in this chapter, we outline common endocrine abnormalities seen in patients with CKD and their pathophysiology, and discuss important aspects of management of these conditions including screening and treatment.

Abstract Background: Patients on chronic dialysis are at increased risk of postoperative mortality following elective surgery compared to patients with normal kidney function, but morbidity outcomes are less often reported. This study ascertains the excess odds of postoperative cardiovascular and infection related morbidity outcomes for patients on chronic dialysis. Methods: Systematic searches were performed using MEDLINE, Embase and the Cochrane Library to identify relevant studies published from inception to January 2020. Eligible studies reported postoperative morbidity outcomes in chronic dialysis and non-dialysis patients undergoing major non-transplant surgery. Risk of bias was assessed using the Newcastle-Ottawa Scale and the certainty of evidence was summarised using GRADE. Random effects meta-analyses were performed to derive summary odds estimates. Meta-regression and sensitivity analyses were performed to explore heterogeneity. Results: Forty-nine studies involving 10 513 934 patients with normal kidney function and 43 092 patients receiving chronic dialysis were included. Patients on chronic dialysis had increased unadjusted odds of postoperative cardiovascular and infectious complications within each surgical discipline. However, the excess odds of cardiovascular complications was attenuated when odds ratios were adjusted for age and comorbidities; myocardial infarction (general surgery, OR 1.83 95% 1.29 – 2.36) and stroke (general surgery, OR 0.95, 95%CI 0.84-1.06). The excess odds of infectious complications remained substantially higher for patients on chronic dialysis, particularly sepsis (general surgery, OR 2.42, 95%CI 2.12-2.72). Conclusion: Patients on chronic dialysis are at increased odds of both cardiovascular and infectious complications following elective surgery, with the excess odds of cardiovascular complications attributable to being on dialysis being highest among younger patients without comorbidities. However, further research is needed to better inform perioperative risk assessment.