Kidney Care UK

Chronic kidney disease (CKD) is a leading cause of global morbidity and mortality, affecting one in ten Swiss adults. Patient numbers are expected to increase due to demographic shift and increasing comorbidity rates, necessitating strategic healthcare planning. Holistic burden remains unknown and detailed projections-including expectations of prospective economic and environmental impact-are lacking. To inform Switzerland's public health strategies and support its 2050 net-zero healthcare goal, this study aims to forecast the multidimensional burdens of CKD. The IMPACT-CKD microsimulation model was utilised to project CKD-progression and clinical, healthcare resource utilisation, economic, societal, and environmental outcomes in Switzerland over 10years (2023-2032). Modelled individuals were assigned CKD-relevant characteristics-including kidney function, comorbidities and clinical events-based on real-world data. Individuals were categorised into non-CKD or one of six CKD stages and progressed through the disease, diagnosed or undiagnosed. Model inputs and outcomes were validated and calibrated against literature, real-world evidence, and expert consultation. By 2032, IMPACT-CKD projects Switzerland's cases of CKD to rise by 6.7% (0.96m to 1.03m) with late-stage CKD and kidney replacement therapy (KRT) surging by 18.1% (437k to 516k) and 57.2% (8.4k to 13.2k). CKD-related healthcare costs are projected to increase by 27.6% (Swiss francs [CHF] 3.3b to CHF4.2b), driven by a 77.3% rise KRT-related costs. CKD would account for 4.6% of the Swiss healthcare budget, incur CHF12.9b in lost productivity, 43.2m missed workdays and CHF606m in lost tax revenue. Greenhouse gas emissions are projected to increase by 12.9%, driven by rising dialysis demand. IMPACT-CKD projects substantial increases in the multidimensional burdens of CKD in Switzerland. Impact could be mitigated via earlier detection and broader uptake of guideline-directed medical therapy. Comprehensive health policies and strategic public health planning are necessary to reduce burden and sustain Switzerland's 2050 net-zero healthcare ambition.

Abstract The East Nile Delta, offshore Egypt, is a challenging area for seismic imaging due to the presence of substantial velocity heterogeneity created by the complex Messinian unconformity and overlaying fault structures. Existing towed streamer (TS) seismic data has been pushed to its technical limit but remains insufficient for adequate representation of the subsurface. Previous studies show that advanced acquisition, processing, and velocity model building can deliver a step change in imaging. The Atoll field is a candidate to benefit from such improvements in seismic data. Results show that an Ocean Bottom Node (OBN) acquisition provides improved spatial sampling and higher resolution. Acquiring seismic with offsets of more than 30km facilitated the generation of a robust high frequency velocity model that better captures subsurface complexity. The subsurface model generated through this work is effectively used for imaging with conventional migration algorithms and through Full Waveform Inversion Derived Reflectivity (FDR). Results show a significant step change from previous towed streamer images at the Oligocene target with channel features clearly imaged giving an improved understanding of the depositional systems and reduced depth uncertainty. Despite the clear value of OBN surveys, they remain expensive and implementing this type of acquisition over a large area will be difficult, however this type of resolution can unlock exploration opportunities that would otherwise be missed with conventional towed streamer. This paper explores the parameters used in the OBN acquisition to understand what modifications can be made to reduce cost without significantly compromising on image quality. With this understanding we also explore how existing towed streamer data can be used with the OBN data to further reduce cost and shorten the turnaround time to use these products to accelerate resource progression.

To examine the disruption of kidney care services in Sudan following the 2023 conflict, highlighting the compounded risks faced by dialysis and transplant patients during crises, and offering evidence-based strategies for future emergency preparedness. The conflict in Sudan exposed deep systemic weaknesses in an already under-resourced nephrology infrastructure. Hemodialysis centers were damaged or shut down, supply chains collapsed, and patient displacement became widespread. Over 70% of patients experienced treatment interruption and many died due to missed dialysis sessions or transplant rejection. Emergency responses were delayed and uncoordinated. In contrast, experience from Ukraine and Gaza disasters illustrate how registry-based evacuation and cross-border planning can save lives. Egypt's subsequent collaboration with WHO and KSrelief (King Salman Humanitarian Aid and Relief Center) offered a late but instructive model for regional support. Sudan's crisis demonstrates how kidney patients suffer disproportionately from adverse effects of disasters when health systems collapse. Displacement may become a survival tactic in the absence of formal evacuation or support plans. Embedding kidney care into disaster response-through registries, mental health support, cross-border agreements, and sustainable NCD programming-is urgently needed. Global momentum, such as WHA78's kidney resolution, must now translate into national preparedness for fragile settings.

Life participation has been identified as a critically important core outcome to be reported in all trials in people receiving peritoneal dialysis (PD). Life participation is defined as the ability to participate in meaningful activities such as work (e.g. employment, housework, study), family, social (e.g. time with friends) and leisure (travel, hobbies, exercise) activities. However, life participation is rarely and inconsistently reported in trials in PD. The standardised outcomes in nephrology-life participation (SONG-LP) instrument was validated in adult kidney transplant recipients and demonstrated internal consistency and test-retest reliability. In this article, we outline the rationale and process for validating the SONG-LP instrument in people receiving PD.

Dai et al. begin their letter1 on our JASN article “Long-Term Outcomes in Nephrotic Syndrome by Kidney Biopsy Diagnosis and Proteinuria”2 with the statement, “First, the analysis attributes outcomes primarily to proteinuria levels.” Our study did not seek to establish a causal role for proteinuria in idiopathic nephrotic syndrome nor to ascertain the effect of confounders that are clearly part of this real-world analysis. In fact, quite the opposite, we intended to quantify the statistical relationship between early proteinuria levels, as ascertainable by clinicians early in the disease, and long-term outcomes, with clinical variability acknowledged as an intrinsic feature. We welcome this opportunity for clarification in case other readers also make the misinterpretation that the study intent was to attribute protein levels as a direct cause of the outcomes. The point about dynamic variability within disease is well known in this condition and specifically discussed. For example: “Another potential limitation is that the change in proteinuria may reflect differences in underlying pathology, which could be partly responsible for differences in eGFR loss rather than proteinuria itself.”2 Since this observational study was not designed to address underlying mechanisms or causation, a more logical approach would be to design future studies to address this question which, in the light of the associations we present, is clearly of importance. Regarding the time points chosen for analyses, since the aim was to inform clinical practice and interpretation of clinical trials, we elected primarily to present proteinuria metrics that were easily accessible by routinely collected data (lowest urinary protein:creatinine ratio and time-average urinary protein:creatinine ratio over two specific windows of follow-up from disease onset (incident patient population) and from patients with overt proteinuria at least 6 months from disease onset (prevalent population). It is true that some patients with very early decline to kidney failure (<6 months) will not be included in the outcome measures, but a clear reason we choose the 6-month cutoff is to exclude the effect of this small proportion of aggressive disease patients and to smooth out early variability due to acute disease management. The suggested experiment aiming to determine whether differences in composition of proteinuria effect outcomes is not currently feasible because it would require the proposed data to have been collected historically. There are innumerable other parameters that could be proposed (such as specific urinary or plasma biomarkers) and we would welcome future studies that might demonstrate empirically that they add value to clinical care or research studies.