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Blockchains enable secure data storage, the verification of data origin and accurate registration of changes in information over time. The widespread adoption of blockchain in nephrology could affect clinical practice and research by enhancing the quality of electronic health records and datasets.
Optimal referral of patients who are at risk of kidney failure to nephrologists could improve their long-term outcomes. Various strategies, including the inclusion of kidney failure risk equations in electronic medical records and the active dissemination of clinical practice guidelines, could help to reduce the gap between optimal referral and what currently happens in clinical practice.
Access to essential medical care can be compromised by social disruptions (such as riots and labour strikes), armed conflict and natural disasters, including extreme weather events. A successful response to such events requires forward planning, preparation and rehearsal with involvement of health-care systems, professionals, patients and their support networks. Following execution of the response, after-action evaluation is required to improve future responses.
People with kidney disease are particularly vulnerable to the impacts of natural disasters and extreme weather events. As climate change is increasing the frequency and severity of these events, a robust response is needed to improve disaster preparedness and increase the resilience of these patients.
Thousands of environmental chemicals are used globally. However, despite clear evidence of their adverse effects on the kidney, substantial knowledge gaps remain. Further studies are needed to better understand the effects of chemical mixtures, windows of physiological susceptibility, vulnerable populations, and the intersection of chemical exposure with health risks associated with climate change and heat stress.
Climate change is increasing global temperatures and causing more frequent and severe extreme heat events. The resulting additional disease burden is inequitably distributed. Strategies that reduce inequities in heat exposure and vulnerability to heat-related illness, as well as health protections at multiple levels (from individual to regional), are urgently needed to contain the looming crisis.
Adequate nutrition is essential for kidney health; however, attempts to improve nutrition and food security have been hindered in recent years by man-made and natural disasters. Approaches to eradicate famine, improve nutritional status and reduce food insecurity are needed to reduce inequities and maintain kidney health in the face of adverse circumstances.
The COVID-19 pandemic exposed flaws in the ability of the nephrology community to efficiently inform clinical decision making. To improve preparedness for the next pandemic, the nephrology community must work more closely together to ensure that research efforts are aligned and put in place a strategy for the effective dissemination of high-quality evidence in real-time.