Effective treatment of kidney failure depends on reliable vascular access; however, options for chronic vascular access for haemodialysis have remained unchanged for decades. This Review evaluates the key existing challenges in establishing and maintaining vascular access and describes novel and innovative technologies under development that address these issues.

Clinical trials have demonstrated that glucagon-like peptide 1 receptor (GLP1R) agonists have therapeutic benefits beyond glycaemic control. Here, the authors examine the protective effects of incretin-based therapies in patients with diabetic kidney disease and how the immunomodulatory and anti-inflammatory effects of GLP1 might underlie this protection.

Here, the authors describe the mechanisms of ultrafiltration during kidney replacement therapy, the effects of ultrafiltration on cardiovascular physiology and the principles of volume management in critically ill patients. They also discuss potential mechanisms that could underlie the association between ultrafiltration rate and organ dysfunction.

Planar cell polarity (PCP) refers to the coordinated orientation of cells in the tissue plane and is important for several key morphogenetic and homeostatic processes. This Review describes the origins of PCP signalling, its activity and cellular targets, with an emphasis on the PCP pathway in kidney development, function and disease.

An increasing body of evidence suggests that genomic disorders and monogenic aetiologies contribute meaningfully to seemingly complex forms of chronic kidney disease (CKD). This Review describes rare genetic causes of CKD and the genetic and phenotypic complexity of this group of disorders, and discusses novel approaches to help to address the challenges posed by the complexity of CKD.