Kidney Health Australia

BK polyomavirus (BKPyV) is a common opportunistic infection in kidney transplant recipients, typically reactivating in the context of immunosuppression. Although asymptomatic in immunocompetent individuals, reactivation in transplant recipients can cause BKPyV-associated nephropathy (BKPyVAN), a leading cause of graft dysfunction and loss. BKPyV viremia affects approximately 10%-15% of transplant recipients, and once BKPyVAN is established, the risk of graft failure can exceed 50%. The current standard of care involves immunosuppression reduction to restore virus-specific immunity, but this approach increases the risk of acute and chronic rejection. Intravenous immunoglobulin (IVIg), which contains antiviral and immunomodulatory antibodies, has been proposed as an adjunctive therapy, although evidence supporting its efficacy remains limited to small observational studies. The BEAT-BK trial is a multicenter, adaptive, randomized controlled trial comparing standard immunosuppression reduction with or without IVIg in kidney and simultaneous pancreas-kidney transplant recipients with BKPyV viremia or biopsy-confirmed BKPyVAN. The trial will enroll participants aged 2 y and older, randomizing them 1:1 to receive standard care alone or in combination with a total IVIg dose of 2 g/kg for 8 wk. An adaptive Bayesian design will permit interim analyses with the potential for early trial success or futility. The primary endpoint is a composite ordinal outcome at 12 wk, incorporating death, graft loss, estimated glomerular filtration rate decline, acute rejection, viral load, and degree of immunosuppression reduction. Secondary outcomes include viral clearance, development of BKPyVAN and donor-specific antibodies, infections, malignancy, quality of life, and cost-effectiveness. This trial will provide the first high-quality evidence on the role of IVIg in BKPyV management and inform clinical decision-making in posttransplant care.

IntroductionTherapy alerts during automated peritoneal dialysis (APD) can cause significant disruptions to patients' sleep and quality of life and may portend poorer outcomes. Understanding the relationship between alert frequency during this early period and longer-term PD outcomes is important.MethodsFollowing the probabilistic linkage of Vantive's Sharesource database to the Australian and New Zealand Dialysis and Transplant (ANZDATA) Registry, we examined the relationship between alert frequency in the first 30 days of APD and PD discontinuation. We included adult patients in Australia and New Zealand who commenced APD with the Vantive Homechoice Claria cycler over 2019-2023 and continued for at least 30 days. The average alerts per treatment in the first 30 days were divided into quartiles and time to PD discontinuation (inclusive of HD transfer and death), HD transfer only, and infective and non-infective HD transfer were modelled as outcomes.ResultsThe cohort was 1880 patients, 65% male, and median age at PD commencement of 58 years. Overall PD continuation at 1,2, and 3 years was 78%, 56% and 41%, with HD transfer rates at 14%, 23% and 27%. Higher rates of HD transfer in the first 12 months were seen in the groups with a higher average alert number. Within 12 months, there was a progressive risk of non-infective HD transfer with increasing 30-day alert quartile.ConclusionAlert burden in the first 30 days is a risk factor for HD transfer in the first 12 months, and resolving underlying issues early may help to improve PD continuation.

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.

IntroductionGastrointestinal (GI) symptoms are common and can be debilitating for patients receiving peritoneal dialysis (PD). However, they are rarely reported and there is no widely accepted or validated tool for measuring GI health in these patients to facilitate shared decision making.MethodsAn online consensus workshop was conducted to describe the experiences and perspectives about the impacts of GI symptoms in patients receiving PD and their caregivers and suggestions for measuring GI symptoms in clinical practice and research. A diverse range of patients currently receiving PD or who received PD within the past 5 years and their caregivers from different regions were recruited. After the initial presentation, small-group facilitated discussions were conducted similarly to focus groups, followed by a large-group summarisation of the workshop findings. Transcripts were thematically analysed using an inductive approach informed by grounded theory.Summary of the workshopThirty-five participants attended the online workshop, including 32 patients and 3 caregivers from 7 countries. Four themes were identified: restricting the ability to live freely (inability to predict and prepare, suffering from severe and disruptive symptoms), persistent anguish and struggle (living in fear, isolated by burden), uncertainty about healthcare management (inadequate education and information, lack of individualised care, experimenting to find solutions), measuring GI health in a relevant and robust manner (enabling comprehensive symptom monitoring, individualising frequency of symptom recording, recommending user-friendly and innovative tools).ConclusionThis study demonstrated a high burden of GI symptoms in patients receiving PD. These symptoms were unpredictable in their onset, threatening patients' wellbeing and quality of life. A feasible measure of GI symptoms needs to be developed and implemented to inform treatment decisions and aid in consistent reporting in PD trials.

With eating disorder prevalence increasing in Australia and around the world, it is critical that clinicians are trained in eating disorder treatment and that people with eating disorders, their families and supports can identify suitably trained clinicians. With funding from the Australian Government, the Australia & New Zealand Academy for Eating Disorders (ANZAED) and National Eating Disorders Collaboration partnered to develop and implement a novel credentialing system to recognise dietitians and mental health professionals with a minimum level of knowledge, experience, and training in eating disorder care. This paper aims to describe the development and implementation of this credentialing system, exploring its initial uptake by clinicians. In developing the Credential, initial scoping work included extensive consultation with clinicians, peak professional bodies, and those with lived experience of an eating disorder and their families. Once the criteria for the ANZAED Eating Disorder Credential were established and a custom website built, the Credential opened for applications from clinicians on 24 November 2021. To engage with clinicians, incentive schemes were used, including a limited evidence sunset period encouraging the existing workforce to apply, and professional development programs targeting the upskilling of clinicians new to eating disorder treatment. In the first 19 months of the Credential, 1410 clinicians (including 511 dietitians and 899 mental health professionals) were awarded the Credential. Although there was a small amount of anticipated attrition during the first renewal period, 1275 clinicians remained currently credentialed at 30 June 2023. Overall, most credentialed clinicians were private practitioners, likely motivated by the need for professional recognition. To support program improvements and long-term sustainability, future research will explore the benefits, impacts, and challenges of the credentialing system as perceived by clinicians and people with an eating disorder and their families.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40337-025-01310-1.

IntroductionChronic kidney disease (CKD) causes significant morbidity and mortality. Medical therapies can reduce the progression of disease by up to 50%. CKD is undiagnosed in the majority of people who have it, resulting in undertreatment. CKD Stewardship (CKD-S) aims to identify hospital inpatients with undiagnosed mid-stage to late-stage CKD with the goal of facilitating diagnosis and initiating guideline-based therapies.Methods and analysisThis prospective, multicentre, cohort study compares two models of care, CKD-S and standard care, for identification and management of CKD, across six public hospitals in metropolitan Sydney, Australia. CKD-S entails active case finding using the electronic medical record, with nephrologist outreach to admitting teams and kidney nurse provided patient education. Adult inpatients with an admission estimated glomerular filtration rate (eGFR)<45 mL/min/1.73 m2 and not known to a nephrologist will be eligible, excluding those with short life expectancy or advanced age (>80 years). Participants will be enrolled between 1 March 2024 and 1 March 2025. Baseline and demographic data will be collected after discharge from the hospital. Participants will be followed up 12 months after discharge using Pharmaceutical Benefits Schedule and Medical Benefits Schedule data, linked via the Australian Institute of Health and Welfare Hub. We will report the proportion of all adults admitted to the hospital who are not already known to a nephrologist, in which a diagnosis of stage 3b–5 CKD is recognised by the CKD-S intervention team, compared with standard care. We will then compare the proportion in each cohort who have an eGFR or urine albumin:creatinine ratio measured, are referred to a nephrologist, and are prescribed guideline-directed therapies over the 12 months following discharge from the hospital.Ethics and disseminationThe study has ethics approval from the Sydney Local Health District’s Ethics Committee (Concord Hospital Zone). The results of the CKD-S study will be published in peer-reviewed journals and presented at academic conferences.Trial registration numberACTRN12624000452594.

There has been a significant shift in dietary guidance in the past 5 years for people with chronic kidney disease. Multiple best practice guidelines in nephrology now include nutritional guidance that recommends the adoption of healthy dietary patterns with an emphasis on whole foods and diets with adequate fruit, vegetables, legumes, nuts, wholegrain bread and cereals, with minimal amounts of processed foods high in salt, sugar, and fat. While there is shortage of enthusiasm, from health professionals to adopt this new approach, there is a clear knowledge gap on how to get people to adopt plant-based diets. This is particularly apparent in settings where renal dietetic services are lacking. This manuscript, cowritten with consumers with lived experience of chronic kidney disease, outlines seven strategies to facilitate the adoption of plant-based diets and draws on evidence from the fields of marketing, implementation science, and behavior change. These strategies include paying attention to language, starting gradually and increasing variety, then transitioning to increasing vegetable portion size, focusing on adequacy, giving explicit guidance on how to reduce meat, remembering neophobia, and emphasizing the importance of individualized advice. Additional strategies from consumers include the need to address consumer fears about the adequacy of nutrient intake, focus on foods to enjoy not nutrients to restrict; provide advice on how to sensibly include favorite foods and make meals flavorsome and finally consider the adoption of plant-based diets as a spectrum to strive towards—with animal foods included at varying levels depending on food preferences, budget, cultural preferences.