News & Comment

Individuals who are members of multiple marginalized populations experience multiple axes of oppression and discrimination. Such intersectional discrimination can have interactive, negative effects on all aspects of life, including health. To achieve health equity, intersectional-discrimination-induced kidney harms must be examined, measured and mitigated.

Chronic kidney disease (CKD) is highly prevalent in women in perimenopause and menopause. Both CKD and menopause affect several important pathologies, such as cardiovascular disease (CVD) and bone mineral disease. More research is needed to better understand the relationships between menopause, CKD, CVD and bone disease.

Mentoring is an essential component of scientific leadership and can have a profound impact on the development and life course of the mentee. Isi Ero-Tolliver, Dean of the School of Science at Hampton University, describes the life-changing and long-lasting effects of mentorship and why it is important to invest time and effort in mentoring.

The importance of incorporating factors related to sex and gender in all aspects of research is increasingly recognized. Kidney disease pathophysiology, presentation, response to therapy and outcomes differ by sex and gender, but these factors are often not considered in basic and clinical studies. It is time for nephrology to catch up.

Specific policies embedded in organ and tissue donation and transplantation systems discriminate against sexual orientation- and gender identity-diverse populations, restricting or excluding the use of donated organs and tissues. Revision of these policies is needed to promote equity and increase the supply of high-quality organs and tissues for those who need them.

The advancement of women to leadership positions in nephrology lags behind that of men by several metrics. Proactive, intentional approaches, including mentorship and sponsorship, family-friendly policies, career development in hard and soft skills, combatting bias and use of transparent institutional metrics of women’s advancement, are required to address this disparity.

Understanding of the barriers to adequate health care experienced by sexual and gender minority (SGM) people cannot be achieved in the absence of robust and appropriate data. The inclusion of SGM populations in health research and the collection of sexual orientation and gender identity data in research and routine clinical practice is therefore essential to understanding the unique needs of these populations and addressing inequities in health outcomes.

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.