A single geriatrician visit did not help frail older people with CKD reach their goals; a Brazilian position statement backs high-volume haemodiafiltration

The edition in brief

A Kidney International commentary summarises the GOAL trial, in which comprehensive geriatric assessment delivered through a single outpatient geriatrician appointment did not improve goal attainment for older people with chronic kidney disease and frailty; the author argues for evaluating other models of care and for person-centred care as a goal for all nephrology services. The Brazilian Society of Nephrology issued an educational position statement on haemodiafiltration (HDF) in maintenance dialysis, citing meta-analyses and the CONVINCE trial as suggesting better outcomes with high-volume HDF when adequate convective volumes are reached, and covering selection, prescription, safety and economic aspects. A single-centre trial of 100 evaluable ICU patients with sepsis found dapagliflozin 10 mg for 5 days did not change SOFA scores but was associated with higher left ventricular ejection fraction (60% vs 55%) and non-significantly lower 28-day mortality (26% vs 36%; P = 0.387); urine ketones were higher without ketoacidosis. A randomised trial of 181 patients undergoing percutaneous nephrolithotomy found lung ultrasound-guided fluid management reduced postoperative extravascular lung water increases and hypoxaemia compared with central venous pressure-based management. The pearl covers the limits of creatinine-based eGFR.