Yael Einbinder

Israel and the United States are both high-income nations committed to providing universal access to KRT for patients with ESKD. Despite this shared principle, the clinical and economic burden of ESKD is substantial, and each country has developed distinct strategies to deliver and finance care. This manuscript presents a comparative analysis of epidemiology, treatment modalities, and health system approaches to ESKD management in Israel and the United States, reviewing trends in dialysis prevalence, modality utilization, and kidney transplantation between 2012 and 2022, alongside differences in health policy, reimbursement structures, and cost-containment strategies. The United States, which maintains the largest ESKD population worldwide, is characterized by high dialysis prevalence and extensive federal funding through Medicare. Israel, while smaller in scale, demonstrates unique patterns of care shaped by universal health coverage and cost-regulation mechanisms. Marked differences are evident in dialysis prevalence, transplantation rates, and per-patient expenditures. Comparative evaluation of these two health systems illustrates how countries with similar commitments to universal access have developed divergent models for financing and delivering KRT, offering important insights into the impact of health system design on patient care, cost management, cultural differences, and the opportunity to learn from each other.

CKD is a prevalent condition that contributes significantly to morbidity and mortality. The prevalence and progression of CKD vary across different ethnic groups. This study aimed to evaluate the prevalence and progression of CKD among various ethnic populations in the state of Israel including native Israelis and immigrant communities. This retrospective longitudinal cohort study included immigrants from Ethiopia and the former Soviet Union as well as native-born Arab and Jewish populations in Israel. Data were obtained from the electronic medical records of Clalit Health Services, the largest health care organization in Israel, serving over 4.7 million members. CKD progression was assessed based on eGFR derived from serum creatinine measurements, identifying cases with a ≥50% decline in eGFR, initiation of renal replacement therapy, or death during the study period. The cohort included 1,612,415 Clalit Health Services members, including 40,599 Ethiopian immigrants (mean age 45.6±15.9 years), 273,330 former Soviet Union immigrants (mean age 55.9±17.4 years), 399,965 Israeli-born Arab individuals (mean age 43.7±13.8 years), and 898,521 Israeli-born Jewish individuals (mean age 43.1±14.3 years). Ethiopian immigrants had a higher baseline eGFR, lower traditional risk factors, and lowest prevalence of CKD stages 3 and 4. However, CKD progression was faster among the younger subset of this group, <50 years, with hazard ratio of 1.47 (95% confidence interval, 1.30 to 1.66) for ≥50% decline in eGFR. The native Arab population had the highest body mass index and higher prevalence of diabetes and demonstrated the highest risk of ≥50% decline in eGFR (hazard ratio,1.75; 95% confidence interval, 1.72 to 1.78), consistent across all age groups. Young Ethiopian individuals demonstrated higher risk and faster decline in eGFR independent of traditional risk factors. The native Arab population had highest risk for CKD progression across all ages. Further studies focusing on both of these ethnic populations are urgently needed.

Background and objectives: Vascular calcification is an integral part of atherosclerosis and has been reported to be an independent risk factor for cardiovascular diSsease. Intra Cranial Arterial Calcifications (ICAC) in maintenance hemodialysis (MHD) is highly prevalent. Materials and Methods: The aim of this retrospective study was to assess the predictors and outcomes of ICAC in MHD patients compared to a control group without kidney disease. A blinded neuroradiologist graded ICAC in brain imaging (computerized tomography) of MHD patients. Age- and sex-matched patients with normal kidney function served as the control group. Results: A total of 280 patients were included in the cohort; 140 of them were MHD patients with a mean ICAC score of 2.3 ± 0.2 versus a mean ICAC score of 1.4 ± 0.2 in the control group (p < 0.01). More than 90% of hemodialysis patients in our study had some degree of ICAC. Lower albumin and higher phosphorus and CRP levels were associated with increased ICACs. The multivariate analysis model for predictors of 1-year mortality demonstrated an increased odds ratio for mortality as the ICAC score increased. Conclusions: ICAC is very prevalent among MHD patients and results not simply from passive deposition of calcium and phosphate but rather from complex and active processes involving inflammation and structural changes in blood vessels. ICAC independently predicted all-cause mortality and may help with risk stratification of this high-risk population.

Introduction: The hemodialysis population is aging, worldwide. In Israel, more than half of the dialysis population is older than 68 years. The policy for vascular access among this population is still a matter of debate, with several studies demonstrating conflicting results. This study compared vascular access outcomes across age groups (75 years) in a single hemodialysis center in Israel. Methods: This was a retrospective, single center analysis of all vascular accesses created in adult hemodialysis patients in our institution, from January 1, 2006, through December 31, 2012. Patient characteristics, primary and secondary access failure, and complications were collected from electronic medical records. Follow-up was until death or up to 5 years. Results: A total of 612 vascular accesses created among maintenance hemodialysis patients were included, of which 196 were in patients >75 years, 184 in patients 65–75 years, and 232 in patients 75 years group was 80.5 ± 4.3 years and 60.7% were men. Vascular access site was the most important predicator for primary access failure (odds ratio for primary failure of radiocephalic arteriovenous fistula was 3.5 (95% CI 2.1–6), whereas age did not affect the primary failure rate (odds ratio 1.5, p = 0.648). Radiocephalic fistulas were more prone to secondary failure than other vascular access sites were. Complications were slightly more common in the oldest group. Eight percent of the patients >75 years died before access was used. Conclusions: In our cohort, age did not affect vascular outcomes, whereas VA site seemed to be the most important parameter in primary and secondary VA failures. Our results support considering VA on an individual basis and supply valuable information regarding complication and failure rates of VA among patients >75 years.

In the originally published version of this manuscript, the order of authors was incorrect.

Coronavirus disease 2019 (COVID-19) is associated with higher morbidity and mortality in patients on maintenance hemodialysis (HD) [ 1]. Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the main priority to prevent COVID-19. The early humoral response among HD patients was lower compared with the general population [ 2–4]. Humoral response among peritoneal dialysis (PD) patients has been evaluated in small groups only. Evaluation of late antibody levels had not been reported for this population.

Peritoneal dialysis (PD) causes structural and functional changes in the peritoneal membrane, which are attributed to local inflammatory process. This study assessed the presence of galectin‐3 (Gal‐3), a known inflammatory modulator, in dialysate effluent and correlated its levels with markers of inflammatory process. Gal‐3 levels in serum and dialysate effluent were measured in prevalent PD patients on morning visits (n = 27) or during peritoneal equilibration tests (PET, n = 16), it association with clinical and laboratory parameters, including dialysate/plasma creatinine (D/P creatinine) and interleukin‐6 (IL‐6) levels was analysed. Gal‐3 levels in dialysate effluent correlated with D/P creatinine (0.663, p = 0.005) and dialysate effluent IL‐6 levels (0.674, p = 0.002), but not with serum Gal‐3 levels or dialysis vintage. Patients who were high transporters had higher Gal‐3 levels in dialysate effluent, as compared to lower transporters. In multivariate regression analysis, dialysate IL‐6 level was the strongest predictor of dialysate Gal‐3 levels. This study found Gal‐3 in dialysate effluent correlated with D/P creatinine and dialysate IL‐6 levels. These findings may imply that Gal‐3 has a role in the intraperitoneal inflammatory process. However, this needs to be investigated further.

Aims: Class A2 gestational diabetes mellitus (GDMA2) has short- and long-term effects on the mother and child. These may include abnormalities of placentation, damage to endothelial cells and cardiovascular disease. This research investigated the function and composition of high-density lipoproteins (HDL) among women with GDMA2 and their fetuses. Methods: Thirty pregnant women were recruited during admission for delivery. The function and expression of HDL, paraoxonase1 (PON1) and apolipoprotein A1 (APOA1) in the blood samples and the placental tissue were evaluated. The effect of HDL on migration of endothelial cells was measured in vitro. Results: Compared to normal pregnancy (NP), APOA1 in the maternal plasma of women with GDMA2 was decreased. More APOA1 and PON1 were released from HDL of women with GDMA2, compared to NP. Placental APOA1 and PON1 were decreased in GDMA2. For endothelial cells stimulated with TNFα, HDL cell migration was decreased when cells were evaluated with NP-HDL, as compared to GDMA2-HDL. Conclusions: GDMA2 affects the composition and function of HDL in plasma. Changes in HDL commonly seen in GDMA2 were observed in maternal and placental samples, but not in cord samples. These results might indicate a placental role in protecting the fetus by preserving the components and functions of HDL and require further investigation.

The incidence of stroke in patients undergoing hemodialysis (HD) is eight-to-ten times greater than that of the general population. However, data on the outcome of stroke in these patients are limited.

Evaluate the efficacy of retraining and catheter exit site care in reducing peritonitis rates.