IntroductionAcross Latin America (LA), accessibility and affordability of kidney replacement therapy varies, but the prevalence of treated kidney failure generally lags behind higher income regions. Hemodialysis (HD) is more common than peritoneal dialysis (PD) in most LA countries. Expanding PD may help increase dialysis access in acute and chronic kidney disease. This study explored trends in existing kidney replacement therapy programs in LA and the opportunities and challenges for improving PD services from the perspective of physicians.MethodsQualitative data were collected using open-ended, semistructured interviews. Physician participants were recruited from trainees attending a Saving Young Lives workshop on acute kidney injury and acute PD. Thematic analysis was used to identify emergent themes.ResultsThere were 15 study participants. We identified and explored two main themes: (1) Physicians face many barriers to adequately caring for all dialysis patients, including high costs, geography, equipment and supply limitations, and lack of specialists; and (2) Increasing dialysis access through PD presents opportunities and challenges.ConclusionsWhile there are some dialysis programs in LA in which all patients have access to adequate care and dialysis is fully funded, there are many programs with inadequate capacity and funding. PD presents an opportunity to improve dialysis access in LA, particularly for currently underserved patient populations, but challenges related to staff training, supply access, and patient factors must be addressed for PD programs to be sustainable.

BackgroundPeritoneal dialysis (PD) is a prominent treatment option for children with kidney failure. However, cardiovascular disease remains the leading cause of both morbidity and early mortality in this pediatric population, with 50-70% of patients experiencing hypertension. This scoping review aims to assess pediatric hypertension management among those receiving PD, along with exploring new potential techniques to optimize care.MethodsPubMed and Web of Science were used to conduct a literature search using PRISMA-ScR guidelines. The topic was hypertension management in PD in the pediatric population. Studies within the last 10 years that were written in English were included to capture the latest advancements in the literature. Six articles were included in the review.ResultsThe included articles illustrated 3 main management strategies, which were diet, fluid volume, and antihypertensive drugs. More specifically, an inverse relationship between vitamin D and cholesterol levels and a lack of correlation between simple salt balance and hypertension have been described. Bioimpedance spectroscopy and B-type natriuretic peptide were found to be useful in the estimation of fluid volume. Additionally, the persistence of hypertension was found despite the use of antihypertensive drugs.ConclusionsThe presenting studies reflect the uncertainty of the current evidence available on hypertensive treatments in this population. Thus, our findings may help guide further research until the evidence is sufficient for clinical recommendations.

Juvenile dermatomyositis (JDM) is a rare pediatric autoimmune disease. A distinct clinical phenotype is associated with anti-melanoma differentiation-associated gene 5 (anti-MDA5) autoantibodies, which are linked to features such as arthritis, ulcerative skin lesions, and a heightened risk of interstitial lung disease (ILD), including its rapidly progressive form (RP-ILD). Despite increased recognition of this phenotype in East Asian, European, and North American populations, significant gaps remain in understanding its pathogenesis, and no consensus has been reached regarding optimal treatment strategies. Moreover, data on anti-MDA5-associated JDM in African populations are nonexistent. We report the first three documented cases of anti-MDA5-positive JDM with ILD in African children. All patients exhibited characteristic extramuscular manifestations, and all had pulmonary involvement, which was rapidly progressive in two children, one of whom died. The clinical course, diagnostic findings, and treatment strategies are discussed in the context of existing literature. A review of the literature was performed to evaluate the prevalence, clinical presentation, and treatment approaches for RP-ILD in anti-MDA5-associated JDM across different populations. These cases highlight the wide heterogeneity of clinical phenotypes associated with anti-MDA5 autoantibodies in JDM. Given this variability, individualized monitoring and management strategies are essential to optimize outcomes.

Peritoneal dialysis (PD) is being promoted worldwide, but nearly half of all patients who start PD will no longer be on therapy at two years, representing an important barrier to maximizing the safe and effective use of the therapy. Loss most commonly occurs due to HD transfer, death, or the receipt of a kidney transplant, but can also occur because patients recover kidney function, transfer to another dialysis program, or are lost to follow-up. Historically, the term "technique failure" has been used to describe loss from PD, but there has been no consistent definition, and as a consequence, it has been unclear whether the observed variability in the reported risk is related to differences in patient characteristics, practice patterns, or simply differences in the way it was defined, measured, analyzed, or reported. The International Society for Peritoneal Dialysis (ISPD) convened a working group to provide recommendations around key issues related to measuring time on PD therapy. These included standardizing definitions for causes of loss, as well as their measurement, analysis, and reporting. Key performance indicators were proposed for the purpose of benchmarking and to facilitate quality improvement and research. The target audience of this document includes physicians and other healthcare providers, dialysis programs, researchers, and national registries.

BackgroundCritically ill children on peritoneal dialysis (PD) are at an increased risk of raised intra-abdominal pressure (IAP). The aim of this study was to describe IAP and complications with a standard PD fill volume, using conventional PD and continuous flow PD (CFPD) in critically ill children with acute kidney injury. A secondary objective was to compare two IAP measurement techniques, which were direct measurement from the PD catheter via a manometer and indirect measurement via the bladder catheter to a transducer.MethodThis study was a secondary analysis of a previously published randomized controlled crossover trial. Within- and between-group changes in IAP, blood pressure and ventilation parameters were analysed using paired t-tests. Bland-Altman and intraclass correlation tests were used to assess agreement between direct and intravesicular measurement of IAP.ResultsFifteen participants (median (range) age and weight 6.0 (0.2-14) months and 5.8 (2.3-14.0) kg) were included, of which 9 (60%) had raised IAP (>10 mmHg) after filling. No children developed compartment syndrome or other complications. Mean ± standard deviation IAP on conventional versus CFPD was 9.35 ± 2.97 and 11.5 ± 2.96 versus 9.3 ± 3.35 and 11.2 ± 3.62 when measured directly and indirectly, respectively (p > 0.5). Intravesicular measurement of IAP was constantly significantly higher compared to the direct method (p = 0.002); however, there was good correlation (Pearson correlation coefficient 0.7; p < 0.001) and moderate reliability (ICC = 0.6) between the methods.ConclusionIncreased IAP (>10 mmHg) was common, although not associated with serious adverse events, and warrants monitoring in these patients. The pressures measured are different with the two techniques used, although they do correlate well. More studies are needed to define increased IAP depending on the measuring technique and inform IAP measurement practice in children with acute PD.

The EuroQol Infant and Toddlers Populations (EQ-TIPS) instrument may support both 3-level and 5-level versions, mirroring the structure of the EuroQol Adult and Youth descriptive systems. This study compared the performance of the experimental version 2.0 EQ-TIPS-3L (3 L) with EQ-TIPS-5L (5L) in children 0–4 years living with a health condition. Caregivers of children were recruited from specialist outpatient clinics in South Africa. The feasibility of EQ-TIPS-5L and EQ-TIPS-3L was compared using the absolute reduction in the ceiling effect (111111). Discriminatory power was evaluated with Shannon’s H’ and J’ index for absolute and relative informativity. The redistribution of dimension responses between the 5 L and 3L versions was evaluated for inconsistency, defined as a 5 L response that was two or more levels removed from a 3 L response. Convergent validity of EQ-TIPS dimensions was calculated with Kendall Tau B and Gamma correlations. Known-group severity was calculated for the EQ-TIPS-5 L and EQ-TIPS-3 L LSS scores using severity groupings based on PedsQL total score (≤ 74.2) and EQ VAS (≤ 80). Data from 176 children with a median age of 29 months, and more males (54

Acute kidney injury (AKI) is a common condition globally associated with substantial morbidity, mortality and costs to health-care systems. The epidemiology and outcomes of AKI differ within and between countries, and depend on multiple factors. Social determinants of health (SDoHs) are the circumstances in which people are born, grow, work, live and age, including the broader set of forces and systems that influence the conditions of everyday life. Despite advances in medical care, many inequities, including those associated with socioeconomic status, race, ethnicity, gender and environment, persist and are increasingly recognized to influence health outcomes. Superimposed on these inequities are differences in access to health care and health resources, including public health prevention, access to screening, early diagnosis and treatment (including kidney replacement therapy), and quality of care, which vary within and between high- and low-resource settings. Over the past few years, these disparities have intensified as societies have emerged from a global pandemic and are challenged with accelerating climate change and escalating levels of global conflict. However, the role of SDoHs remains poorly defined for people with or at risk of AKI. Targeted policies addressing SDoHs are essential to reduce AKI burden globally. Here, we examine the effects of SDoHs on the incidence, recognition, management, follow-up and outcomes of adult and paediatric populations at risk of or with AKI.

BACKGROUND:Children and young people with chronic kidney disease (CKD) experience impaired life participation, which has been identified as a critically important outcome for them. However, little remains known about strategies to improve life participation in children with CKD. The aim of this report was to identify strategies to improve life participation in children with CKD. METHODS:Four workshops (one in-person [English language], three online [two English and one Spanish language]) were held with 79 patients and caregivers, and 92 health professionals from 16 countries to discuss strategies and interventions to improve life participation in children with CKD. Transcripts were thematically analyzed. RESULTS:Four themes were identified. Emphasizing life priorities involved identifying and addressing patient values, focusing on freedom not restrictions, routinely assessing and monitoring life participation, and establishing and achieving goals. Minimizing treatment burden included allowing flexibility in scheduling appointments, enabling better management of medications, and controlling debilitating side-effects. Facilitating opportunities in community settings encompassed providing ways to engage in education, encouraging engagement in social activities, promoting physical activity and supporting work and career aspirations. Fortifying mental health, self-esteem and motivation included building confidence and addressing depression and anxiety. CONCLUSION:Patients with CKD, caregivers and health professionals identified a need for strategies for life participation to address the domains of personalized life priorities, minimizing treatment burden, facilitating access to opportunities and strengthening wellbeing. Further development and evaluation of interventions that address these are needed to improve life participation in children with CKD.

Background The caregiver burden among parents of children with CKD is high and can impair their life participation, which may in turn have negative consequences on their children’s care and outcomes. We aim to describe effects on the life participation in parents of children with CKD, from the perspectives of their children, health professionals, and their own. Methods We thematically analyzed data from the Standardised Outcomes in Nephrology – Children and Adolescents Initiative (SONG-Kids) life participation workshops involving children with childhood CKD, parents/caregivers, and health professionals, for content related to perspectives on life participation among parents of children with CKD. Results Four international consensus workshops were conducted (one in-person in English language and three online - two in English and one in Spanish) with 171 participants including 79 patients and parents/caregivers and 92 health professionals from 16 countries. Four themes were identified: health priorities undermining ability to participate in activities and socialise; medical responsibilities conflicting with the nurturing parental role; impeding ability to work; and measuring and addressing life participation in parents of children with CKD. Conclusion Managing parental and disease-related responsibilities can impair life participation in parents of children with CKD, particularly in the areas of work and social activities. Strategies to identify and address parental life participation appear to be needed, which may include interventions to alleviate caregiver burden and distress.

BACKGROUND:Blood group incompatibility previously represented an obstacle to living related donor (LRD) options; desensitization modalities have expanded LRD options. ABO-incompatible kidney transplants have been successful in adults and pediatric liver transplants, but to date not yet in pediatric kidney transplants in South Africa. CASE REPORT:Patient X is a 5 year old male with end-stage kidney failure due to Posterior Urethral Valves, requiring peritoneal dialysis pre-transplant. His sister was the only suitable LRD. The recipient was blood group A+; donor was blood group B+; HLA match was 5/10, nil HLA donor specific antibodies and negative CDC and Flow crossmatches. The recipients' anti-B titer pre-transplant was a maximum of 1:8. A pre-emptive desensitization dose of Rituximab (375 mg/m2) was administered 4 weeks before transplant. The anti-B titer decreased to 1:2 following the Rituximab (CD19% of 0%). Post-transplant, the Anti-B titers were monitored for the first 10 days, with a maximum titer of 1:8 (immunoadsorbtion therapy available if > 1:16, or if associated graft dysfunction). Immunosuppressant protocol consisted of Basiliximab, Tacrolimus, Azathioprine, and Prednisone. Post-transplant, the creatinine improved to 60-70 μmol/L at Week 1. 7 weeks post-transplant, serum creatinine increased > 10% with an antibody titer of 1:2. Kidney biopsy showed CNI-related toxicity; renal function improved with reduction in Tacrolimus doses. Kidney function remains stable 1-year post-transplant with nil episodes of rejection. CONCLUSION:This is the first ABO-incompatible kidney transplant in a pediatric patient in South Africa and represents an important step in expanding the pool of potential living related donors.

Introduction: The lack of peritoneal dialysis (PD) catheters designed explicitly for neonates creates significant challenges in the provision of neonatal PD. High resource settings can circumvent this limitation by resorting to alternative extracorporeal dialysis methods. However, in low-resource settings, PD remains the preferred dialysis modality, and the use of off-label catheters for PD results in complications such as omental wrapping and occlusion. This study introduces a novel catheter design featuring a multi-diameter side port configuration and a helical geometry. Methods: We employed numerical simulations to identify an optimal multi-diameter side port configuration, to address fluid dynamic issues that lead to catheter occlusion and omental wrapping. Following the simulations, we experimentally evaluated the catheter's performance in a series of benchtop tests designed to simulate physiological conditions encountered in neonatal PD. Results: Our experimental evaluations demonstrated that the helical catheter outperforms commonly utilized pigtail catheters with same-sized diameter side ports by consistently achieving superior drainage efficiency during fibrin clot occlusion and omental wrapping tests. Conclusion: The catheter is intended to be placed at the bedside to perform renal replacement therapy for neonates in low-resourced settings. (c) 2025 The Author(s). Published by S. Karger AG, Basel

Sex differences exist in acute kidney injury (AKI), and the role that sex and gender play along the AKI care continuum remains unclear. The 33rd Acute Disease Quality Initiative meeting evaluated available data on the role of sex and gender in AKI and identified knowledge gaps. Data from experimental models, pathophysiology, epidemiology, clinical care, gender, social determinants of health, education, and advocacy were reviewed. Recommendations include incorporating sex and gender into research along the bench-to-bedside spectrum, analyzing sex-stratified results, evaluating the effects of sex chromosomes, hormones, and gender on outcomes, considering fluctuations of hormone levels, studying the impact gender may have on access to care, and developing educational tools to inform patients, providers, and stakeholders. This meeting report summarizes what is known about sex and gender along the AKI care continuum and proposes an agenda for translational discovery to elucidate the role of sex and gender in AKI across the lifespan.

Acute kidney injury (AKI) is a common event associated with a high mortality rate in the absence of adequate treatment. In lower-income countries, peritoneal dialysis (PD) plays an essential role in the treatment of AKI, especially in the paediatric population. In 2013, the International Society of Nephrology (ISN) launched the '0 by 25' project, which aims to eliminate preventable deaths from AKI worldwide by 2025. The Saving Young Lives (SYL) program is a key component of this initiative, with the objective that by 2025 there will be no deaths resulting from AKI. Despite SYL's efforts, access to the program and seminars, which were previously held in English, had been limited to English-speaking countries. As a result, French-speaking African countries were underrepresented among participants due to the language barrier. Since 2023, to promote PD training in French-speaking African regions, the Soci & eacute;t & eacute; francophone de n & eacute;phrologie, dialyse et transplantation (SFNDT) has sought to form a partnership with the SYL program. The objective of this partnership is to train healthcare providers from French-speaking African countries in the use of PD and PD catheter placement for the management of AKI. This partnership aims to establish seminars in French with both theoretical and practical workshops. Here, we describe the local context, challenges, and perspectives of this partnership.

Multicystic dysplastic kidney disease (MCDK) is a congenital kidney anomaly frequently misdiagnosed as hydronephrosis on antenatal ultrasound. Confirmatory nuclear imaging is seldom available in resource-limited settings. The study aimed to assess the diagnostic accuracy of kidney ultrasound (KUB scan) for detecting paediatric MCDK, using Mercaptoacetyltriglycine-3 scan ([99mTc]Tc-MAG3) differential renal function as the reference standard. A retrospective diagnostic accuracy analysis of consecutive children under 13 years with suspected unilateral MCDK, who underwent both KUB and [99mTc]Tc-MAG3 scans within 6–8 weeks of presentation at Red Cross War Memorial Children’s Hospital between January 2014 and December 2023 was done. Diagnosis required characteristic MCDK features on KUB and absent function on [99mTc]Tc-MAG3 scans. Reporting adhered to the STARD guidelines. Of 793 eligible children, the [99mTc]Tc-MAG3 classified 101/101 (100.0