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Ameliorating the inequitable burden of kidney disease that is experienced by Aboriginal and Torres Strait Islander peoples is an achievable goal. Genuine and committed partnerships between the Australian government, health-care providers and Aboriginal and Torres Strait Islander peoples are imperative to maximize the success of health equity initiatives.
Rationing of scarce health-care resources is distressing. Clinicians therefore require clear guidance, which should be developed systematically and transparently through multi-stakeholder engagement. Rationing is seldom required in high-income settings but is often necessary in low-income settings. Global solidarity and health system strengthening are required to reduce the need for rationing.
Living donor kidney transplantation benefits the recipient. However, kidney failure can occur in a small fraction of donors — the risk is not uniform but varies according to donor characteristics. Studies to date have failed to match on important factors, such as era, environment or family history. Long-term studies with well-matched healthy controls are therefore needed.
Patients with kidney diseases should be prioritized for COVID-19 vaccination and the available data suggest that replication-defective viral-vectored vaccines and mRNA vaccines are safe to use. As vaccine responses are likely to be lower in patients with kidney diseases than in the general population, highly potent vaccines should be preferred.
Venezuela is going through a humanitarian crisis that has severely impacted all programmes of kidney replacement therapy — dialysis coverage has decreased markedly, particularly in small towns and rural areas, and almost all peritoneal dialysis and deceased donor organ procurement for kidney transplantation have been discontinued.
Insomnia is common among patients on maintenance haemodialysis and may be exacerbated by the challenges of the COVID pandemic. However, data on the efficacy of insomnia interventions in this population are limited. Efforts are needed to address this important problem and increase access to insomnia interventions for patients on haemodialysis.
Regular physical activity can help people to live well with kidney disease, yet the promotion, funding, level of interest, and general support of physical activity remains poor. Novel high-quality approaches to increase physical activity must be considered, and practical means of scaling up effective interventions at the population level are required.
Older adults receiving dialysis commonly experience poor quality of life. A cyclical process of quality of life assessment, needs assessment and individualized care plans should be implemented to integrate quality of life into care planning. Improvements in health-care delivery and interpersonal communication are needed to prioritize quality of life.
