Valerie Ann Luyckx

In 2025, The World Health Organization adopted a historic resolution that recognises kidney disease as a global health priority and calls on Member States to include kidney care services in universal health coverage packages. However, access to kidney care, particularly kidney replacement therapy, remains highly inequitable worldwide. These disparities are particularly pronounced in resource-limited settings, where kidney disease often goes undiagnosed and untreated, leaving millions without access to life-saving care. Kidney disease is the leading cause of catastrophic health expenditure worldwide and contributes disproportionately to national healthcare costs. In January 2026, Nature Medicine published a Commission on dialysis policy in low- and middle-income countries, which aimed to resolve the ongoing dialysis policy challenges in Thailand and offer lessons for other countries working to expand access to dialysis within universal health coverage frameworks. Nature Medicine and Nature Reviews Nephrology welcomes you to this webinar, in which our speakers — Valerie Luyckx, Ole Norheim, Laura Sola and Yot Teerawattananon — will discuss the key challenges and potential approaches to improve financing for kidney replacement therapy.

Severe pregnancy-associated acute kidney injury (PrAKI) is an uncommon but life-threatening complication of pregnancy. Contemporary population-level data on severe PrAKI in high-income countries, and the impact of the COVID-19 pandemic, remain limited. We examined temporal changes in the clinical context and outcomes of severe PrAKI in the United States from 2012 to 2022, with particular attention to the relationship between illness severity, dialysis utilization, and maternal mortality. A retrospective cohort study was conducted using electronic health care records (EHR), including 4,094,111 pregnancies. Severe PrAKI was identified using a stringent kidney function-based definition (dialysis initiation or a first recorded eGFR < 15 mL/min/1.73 m²). Temporal trends in the incidence of severe PrAKI, maternal all-cause mortality, and pregnancy-associated dialysis were evaluated, and logistic regression was used to identify factors independently associated with severe PrAKI, including the impact of the COVID-19 period. The incidence of severe PrAKI increased nearly three-fold from 9.0 per 10,000 pregnancies in 2012-2013 to 27.6 per 10,000 pregnancies in the COVID-19 era (2020-2022). During the COVID-19 period, maternal all-cause mortality among pregnancies complicated by severe PrAKI increased, whereas the proportion requiring pregnancy-associated dialysis remained stable over time. Pregnancies complicated by severe PrAKI occurred more in individuals who were older and had a higher burden of cardiometabolic comorbidities. Chronic hypertension (aOR: 1.64), obesity (aOR: 1.60), diabetes mellitus (aOR: 1.37), hyperlipidemia (aOR: 1.27), chronic kidney disease (aOR: 1.21), maternal age (aOR: 1.02), and COVID-19 (aOR: 1.12) were independently associated with PrAKI. In this US cohort, severe PrAKI appears to be associated with acute systemic illness occurring in the setting of underlying chronic cardiometabolic vulnerability. The dissociation between rising mortality and stable dialysis utilization underscores the need for earlier risk stratification and multidisciplinary care to reduce maternal mortality.

Background: Kidney replacement therapies (KRT) such as dialysis have a significant environmental impact, yet clinician engagement with sustainable kidney care remains limited. Our objective was to develop a mobile phone application to raise awareness of clinicians about Green Nephrology. Methods: We developed and piloted a web-based mobile application designed to raise awareness of “Green Nephrology” through short, interactive information modules. The app was introduced at the World Congress of Nephrology 2025. It presented users with real-world dilemmas and evidence-based facts about the environmental impact of kidney care choices. We discuss the possibilities of using such interactive modules for sensitizing doctors, nurses and technicians. Results: Thirty-eight delegates used the app and reported it as intuitive, enjoyable, and thought-provoking. Conclusion: This feasibility pilot suggests that lightweight, gamified digital tools can effectively promote reflection and discussion on environmentally sustainable nephrology practices.

Chronic kidney disease (CKD) is a common non-communicable disease in children, and kidney dysfunction is the leading metabolic risk factor for death. Despite this, awareness of the CKD burden remains limited, and significant inequities exist in access to diagnosis and care worldwide. Kidney disease risk in children begins in utero and is dependent on the mother’s health and wellbeing. This is further impacted each day by poverty, nutrition, education, infection, and safety. Greater community awareness is needed, especially in lower resource settings, where children present late and may have no access to care. Early diagnosis, possibly supported by screening at schools, can have important public and individual health consequences. Catastrophic health expenditure is common if families attempt to pay out of pocket for kidney replacement therapy. Health systems require strengthening from the antenatal clinic through tertiary care to ensure children with kidney disease are identified and treated early, appropriately, affordably, and well. Local non-governmental organizations have had some success in mitigating inequities. Governments must step up, measure, and acknowledge the burden of kidney disease in children, ensure appropriate public health measures to reduce risk, strengthen primary care to improve the quality of diagnosis and care, and progressively scale up equitable access to all forms of kidney care. Kidney disease risk is strongly linked with social and structural determinants of health. A holistic approach to supporting child wellbeing—outlined by the Sustainable Development Goals and a One Health Approach—will positively impact child kidney health and promote equity among all children. Graphical abstract

Introduction: Acute kidney injury (AKI) is a major health concern, disproportionately affecting children in low- and lower-middle-income countries (LLMICs). Diarrhoeal diseases, a leading cause of paediatric morbidity and mortality, are significant contributors to AKI. Methods: This study systematically reviewed literature published post-2000 on three groups of children: those hospitalised with diarrhoea who developed AKI (Diarrhoea/AKI), those hospitalised with AKI attributable to diarrhoea (AKI/Diarrhoea), and those with diarrhoea-associated haemolytic uraemic syndrome (D ⁺ -HUS). Results: After screening 1895 titles and abstracts, 92 studies were included. Most focused on D ⁺ -HUS (76%), with fewer addressing AKI/Diarrhoea (15%) and Diarrhoea/AKI (9%). Studies were predominantly retrospective and high-income country (HIC)-based. In children hospitalised with diarrhoea, mean AKI prevalence was higher in LLMICs than in HICs (43.2±30.5% vs 10.1±12.7%). Similarly in children hospitalized with AKI, diarrhoea was more frequent in LLMICs compared with HICs (23.8±12.3% vs . 16.1±5.9%). Among children with D ⁺ -HUS, 60% required dialysis, and mortality was substantially higher in LLMICs compared with HICs (28.5±17.43% vs . 3.7±3.6%). Conclusion: Diarrhoea is a common yet underreported associated clinical finding among children with AKI, particularly in resource-limited settings. Enhanced monitoring of kidney outcomes in children with diarrhoea is essential to address the overlapping burden of these conditions and improve outcomes globally.

Conflicts severely disrupt care for patients with kidney failure, often limiting access to dialysis. In these challenging settings, conservative kidney management (CKM) emerges as a compassionate alternative focused on quality of life and symptom relief. This study explores how conflict conditions shape nephrologists' perceptions and implementation of CKM across the Middle East and North Africa (MENA) region. A web-based survey was distributed across 17 Arabic-speaking MENA countries over 3 months in 2022. Responses were divided into two groups according to the country's conflict status. Of the 334 nephrologist respondents, 66 were practicing in conflict zones and 268 in nonconflict zones. Conflict zone respondents were more likely to work part-time and less likely to be female. Dialysis in conflict zones was more likely funded by charitable sources (odds ratio [OR], 4.22; 95% confidence interval [CI], 1.36 to 13.07). Compared with nonconflict zones, nephrologists in conflict areas reported significantly less access to palliative care (OR, 3.36; 95% CI, 1.3 to 8.68) and cited lack of CKM training and limited access to CKM programs as barriers to its implementation (OR, 2.59; 95% CI, 1.24 to 5.38 and OR, 3.42; 95% CI, 1.59 to 7.35; respectively). While overall awareness of CKM was similar, those in conflict zones expressed greater moral and religious discomfort with withholding dialysis. These findings underscore important ethical, operational, and access-related disparities in CKM delivery in conflict zones in the MENA region. Addressing these gaps through supportive ethical policies focusing on procedural and distributive justice, increased nephrologists' awareness and training, and enhanced efforts to strengthen palliative care services are essential tools for establishing CKM as a viable and ethical approach for patients in conflict-affected regions.