Publisher: Sage Publications   (Total: 1166 journals)

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Showing 1 - 200 of 1166 Journals sorted alphabetically
AADE in Practice     Hybrid Journal   (Followers: 6)
Abstracts in Anthropology     Full-text available via subscription   (Followers: 29)
Academic Pathology     Open Access   (Followers: 6)
Accounting History     Hybrid Journal   (Followers: 18, SJR: 0.527, CiteScore: 1)
Acta Radiologica     Hybrid Journal   (Followers: 1, SJR: 0.754, CiteScore: 2)
Acta Radiologica Open     Open Access   (Followers: 2)
Acta Sociologica     Hybrid Journal   (Followers: 39, SJR: 0.939, CiteScore: 2)
Action Research     Hybrid Journal   (Followers: 53, SJR: 0.308, CiteScore: 1)
Active Learning in Higher Education     Hybrid Journal   (Followers: 398, SJR: 1.397, CiteScore: 2)
Adaptive Behavior     Hybrid Journal   (Followers: 9, SJR: 0.288, CiteScore: 1)
Administration & Society     Hybrid Journal   (Followers: 18, SJR: 0.675, CiteScore: 1)
Adoption & Fostering     Hybrid Journal   (Followers: 25, SJR: 0.313, CiteScore: 0)
Adsorption Science & Technology     Open Access   (Followers: 9, SJR: 0.258, CiteScore: 1)
Adult Education Quarterly     Hybrid Journal   (Followers: 262, SJR: 0.566, CiteScore: 2)
Adult Learning     Hybrid Journal   (Followers: 51)
Advances in Dental Research     Hybrid Journal   (Followers: 11, SJR: 1.791, CiteScore: 4)
Advances in Developing Human Resources     Hybrid Journal   (Followers: 35, SJR: 0.614, CiteScore: 2)
Advances in Mechanical Engineering     Open Access   (Followers: 156, SJR: 0.272, CiteScore: 1)
Advances in Methods and Practices in Psychological Science     Full-text available via subscription   (Followers: 20)
Advances in Structural Engineering     Full-text available via subscription   (Followers: 51, SJR: 0.599, CiteScore: 1)
AERA Open     Open Access   (Followers: 14)
Affilia     Hybrid Journal   (Followers: 6, SJR: 0.496, CiteScore: 1)
Africa Spectrum     Open Access   (Followers: 17)
Agrarian South : J. of Political Economy     Hybrid Journal   (Followers: 3)
Air, Soil & Water Research     Open Access   (Followers: 13, SJR: 0.214, CiteScore: 1)
Alexandria : The J. of National and Intl. Library and Information Issues     Full-text available via subscription   (Followers: 68)
Allergy & Rhinology     Open Access   (Followers: 5)
AlterNative : An Intl. J. of Indigenous Peoples     Full-text available via subscription   (Followers: 39, SJR: 0.194, CiteScore: 0)
Alternative Law J.     Hybrid Journal   (Followers: 12, SJR: 0.176, CiteScore: 0)
Alternatives : Global, Local, Political     Hybrid Journal   (Followers: 13, SJR: 0.351, CiteScore: 1)
Alternatives to Laboratory Animals     Full-text available via subscription   (Followers: 11, SJR: 0.297, CiteScore: 1)
American Behavioral Scientist     Hybrid Journal   (Followers: 26, SJR: 0.982, CiteScore: 2)
American Economist     Hybrid Journal   (Followers: 7)
American Educational Research J.     Hybrid Journal   (Followers: 260, SJR: 2.913, CiteScore: 3)
American J. of Alzheimer's Disease and Other Dementias     Hybrid Journal   (Followers: 23, SJR: 0.67, CiteScore: 2)
American J. of Cosmetic Surgery     Hybrid Journal   (Followers: 9)
American J. of Evaluation     Hybrid Journal   (Followers: 18, SJR: 0.646, CiteScore: 2)
American J. of Health Promotion     Hybrid Journal   (Followers: 35, SJR: 0.807, CiteScore: 1)
American J. of Hospice and Palliative Medicine     Hybrid Journal   (Followers: 47, SJR: 0.65, CiteScore: 1)
American J. of Law & Medicine     Full-text available via subscription   (Followers: 12, SJR: 0.204, CiteScore: 1)
American J. of Lifestyle Medicine     Hybrid Journal   (Followers: 7, SJR: 0.431, CiteScore: 1)
American J. of Medical Quality     Hybrid Journal   (Followers: 13, SJR: 0.777, CiteScore: 1)
American J. of Men's Health     Open Access   (Followers: 9, SJR: 0.595, CiteScore: 2)
American J. of Rhinology and Allergy     Hybrid Journal   (Followers: 11, SJR: 0.972, CiteScore: 2)
American J. of Sports Medicine     Hybrid Journal   (Followers: 249, SJR: 3.949, CiteScore: 6)
American Politics Research     Hybrid Journal   (Followers: 36, SJR: 1.313, CiteScore: 1)
American Review of Public Administration     Hybrid Journal   (Followers: 28, SJR: 2.062, CiteScore: 2)
American Sociological Review     Hybrid Journal   (Followers: 358, SJR: 6.333, CiteScore: 6)
American String Teacher     Full-text available via subscription   (Followers: 3)
Analytical Chemistry Insights     Open Access   (Followers: 26, SJR: 0.224, CiteScore: 1)
Angiology     Hybrid Journal   (Followers: 5, SJR: 0.849, CiteScore: 2)
Animation     Hybrid Journal   (Followers: 15, SJR: 0.197, CiteScore: 0)
Annals of Clinical Biochemistry     Hybrid Journal   (Followers: 10, SJR: 0.634, CiteScore: 1)
Annals of Otology, Rhinology & Laryngology     Hybrid Journal   (Followers: 20, SJR: 0.807, CiteScore: 1)
Annals of Pharmacotherapy     Hybrid Journal   (Followers: 59, SJR: 1.096, CiteScore: 2)
Annals of the American Academy of Political and Social Science     Hybrid Journal   (Followers: 52, SJR: 1.225, CiteScore: 3)
Annals of the ICRP     Hybrid Journal   (Followers: 4, SJR: 0.548, CiteScore: 1)
Anthropocene Review     Hybrid Journal   (Followers: 8, SJR: 3.341, CiteScore: 7)
Anthropological Theory     Hybrid Journal   (Followers: 48, SJR: 0.739, CiteScore: 1)
Antitrust Bulletin     Hybrid Journal   (Followers: 14)
Antiviral Chemistry and Chemotherapy     Open Access   (Followers: 2, SJR: 0.635, CiteScore: 2)
Antyajaa : Indian J. of Women and Social Change     Hybrid Journal   (Followers: 1)
Applied Biosafety     Hybrid Journal   (Followers: 1, SJR: 0.131, CiteScore: 0)
Applied Psychological Measurement     Hybrid Journal   (Followers: 21, SJR: 1.17, CiteScore: 1)
Applied Spectroscopy     Full-text available via subscription   (Followers: 27, SJR: 0.489, CiteScore: 2)
Armed Forces & Society     Hybrid Journal   (Followers: 25, SJR: 0.29, CiteScore: 1)
Arthaniti : J. of Economic Theory and Practice     Full-text available via subscription  
Arts and Humanities in Higher Education     Hybrid Journal   (Followers: 49, SJR: 0.305, CiteScore: 1)
Asia Pacific Media Educator     Hybrid Journal   (Followers: 1, SJR: 0.23, CiteScore: 0)
Asia-Pacific J. of Management Research and Innovation     Full-text available via subscription   (Followers: 3)
Asia-Pacific J. of Public Health     Hybrid Journal   (Followers: 15, SJR: 0.558, CiteScore: 1)
Asia-Pacific J. of Rural Development     Hybrid Journal   (Followers: 2)
Asian and Pacific Migration J.     Full-text available via subscription   (Followers: 8, SJR: 0.324, CiteScore: 1)
Asian Cardiovascular and Thoracic Annals     Hybrid Journal   (Followers: 2, SJR: 0.305, CiteScore: 0)
Asian J. of Comparative Politics     Hybrid Journal   (Followers: 5)
Asian J. of Legal Education     Full-text available via subscription   (Followers: 4)
Asian J. of Management Cases     Hybrid Journal   (Followers: 6, SJR: 0.101, CiteScore: 0)
ASN Neuro     Open Access   (Followers: 2, SJR: 1.534, CiteScore: 3)
Assessment     Hybrid Journal   (Followers: 19, SJR: 1.519, CiteScore: 3)
Assessment for Effective Intervention     Hybrid Journal   (Followers: 15, SJR: 0.578, CiteScore: 1)
Australasian J. of Early Childhood     Hybrid Journal   (Followers: 7, SJR: 0.535, CiteScore: 1)
Australasian Psychiatry     Hybrid Journal   (Followers: 18, SJR: 0.433, CiteScore: 1)
Australian & New Zealand J. of Psychiatry     Hybrid Journal   (Followers: 30, SJR: 1.801, CiteScore: 2)
Australian and New Zealand J. of Criminology     Hybrid Journal   (Followers: 547, SJR: 0.612, CiteScore: 1)
Australian J. of Career Development     Hybrid Journal   (Followers: 5)
Australian J. of Education     Hybrid Journal   (Followers: 51, SJR: 0.403, CiteScore: 1)
Australian J. of Management     Hybrid Journal   (Followers: 13, SJR: 0.497, CiteScore: 1)
Autism     Hybrid Journal   (Followers: 358, SJR: 1.739, CiteScore: 4)
Autism & Developmental Language Impairments     Open Access   (Followers: 17)
Avian Biology Research     Hybrid Journal   (Followers: 6, SJR: 0.401, CiteScore: 1)
Behavior Modification     Hybrid Journal   (Followers: 14, SJR: 0.877, CiteScore: 2)
Behavioral and Cognitive Neuroscience Reviews     Hybrid Journal   (Followers: 27)
Behavioral Disorders     Hybrid Journal   (Followers: 2)
Beyond Behavior     Hybrid Journal   (Followers: 2)
Bible Translator     Hybrid Journal   (Followers: 13)
Biblical Theology Bulletin     Hybrid Journal   (Followers: 24, SJR: 0.184, CiteScore: 0)
Big Data & Society     Open Access   (Followers: 56)
Biochemistry Insights     Open Access   (Followers: 7)
Bioinformatics and Biology Insights     Open Access   (Followers: 12, SJR: 1.141, CiteScore: 2)
Biological Research for Nursing     Hybrid Journal   (Followers: 7, SJR: 0.685, CiteScore: 2)
Biomarker Insights     Open Access   (Followers: 1, SJR: 0.81, CiteScore: 2)
Biomarkers in Cancer     Open Access   (Followers: 11)
Biomedical Engineering and Computational Biology     Open Access   (Followers: 14)
Biomedical Informatics Insights     Open Access   (Followers: 8)
Bioscope: South Asian Screen Studies     Hybrid Journal   (Followers: 4, SJR: 0.235, CiteScore: 0)
BMS: Bulletin of Sociological Methodology/Bulletin de Méthodologie Sociologique     Hybrid Journal   (Followers: 4, SJR: 0.226, CiteScore: 0)
Body & Society     Hybrid Journal   (Followers: 29, SJR: 1.531, CiteScore: 3)
Bone and Tissue Regeneration Insights     Open Access   (Followers: 2)
Brain and Neuroscience Advances     Open Access  
Brain Science Advances     Open Access  
Breast Cancer : Basic and Clinical Research     Open Access   (Followers: 12, SJR: 0.823, CiteScore: 2)
British J. of Music Therapy     Hybrid Journal   (Followers: 9)
British J. of Occupational Therapy     Hybrid Journal   (Followers: 254, SJR: 0.323, CiteScore: 1)
British J. of Pain     Hybrid Journal   (Followers: 31, SJR: 0.579, CiteScore: 2)
British J. of Politics and Intl. Relations     Hybrid Journal   (Followers: 39, SJR: 0.91, CiteScore: 2)
British J. of Visual Impairment     Hybrid Journal   (Followers: 14, SJR: 0.337, CiteScore: 1)
British J.ism Review     Hybrid Journal   (Followers: 18)
BRQ Business Review Quarterly     Open Access   (Followers: 1)
Building Acoustics     Hybrid Journal   (Followers: 4, SJR: 0.215, CiteScore: 1)
Building Services Engineering Research & Technology     Hybrid Journal   (Followers: 3, SJR: 0.583, CiteScore: 1)
Bulletin of Science, Technology & Society     Hybrid Journal   (Followers: 9)
Business & Society     Hybrid Journal   (Followers: 15)
Business and Professional Communication Quarterly     Hybrid Journal   (Followers: 9, SJR: 0.348, CiteScore: 1)
Business Information Review     Hybrid Journal   (Followers: 17, SJR: 0.279, CiteScore: 0)
Business Perspectives and Research     Hybrid Journal   (Followers: 3)
Cahiers Élisabéthains     Hybrid Journal   (Followers: 1, SJR: 0.111, CiteScore: 0)
Calcutta Statistical Association Bulletin     Hybrid Journal   (Followers: 1)
California Management Review     Hybrid Journal   (Followers: 37, SJR: 2.209, CiteScore: 4)
Canadian Association of Radiologists J.     Full-text available via subscription   (Followers: 2, SJR: 0.463, CiteScore: 1)
Canadian J. of Kidney Health and Disease     Open Access   (Followers: 8, SJR: 1.007, CiteScore: 2)
Canadian J. of Nursing Research (CJNR)     Hybrid Journal   (Followers: 15)
Canadian J. of Occupational Therapy     Hybrid Journal   (Followers: 168, SJR: 0.626, CiteScore: 1)
Canadian J. of Psychiatry     Hybrid Journal   (Followers: 28, SJR: 1.769, CiteScore: 3)
Canadian J. of School Psychology     Hybrid Journal   (Followers: 12, SJR: 0.266, CiteScore: 1)
Canadian Pharmacists J. / Revue des Pharmaciens du Canada     Hybrid Journal   (Followers: 3, SJR: 0.536, CiteScore: 1)
Cancer Control     Open Access   (Followers: 2)
Cancer Growth and Metastasis     Open Access   (Followers: 1)
Cancer Informatics     Open Access   (Followers: 4, SJR: 0.64, CiteScore: 1)
Capital and Class     Hybrid Journal   (Followers: 10, SJR: 0.282, CiteScore: 1)
Cardiac Cath Lab Director     Full-text available via subscription   (Followers: 1)
Cardiovascular and Thoracic Open     Open Access   (Followers: 1)
Career Development and Transition for Exceptional Individuals     Hybrid Journal   (Followers: 10, SJR: 0.44, CiteScore: 1)
Cartilage     Hybrid Journal   (Followers: 6, SJR: 0.889, CiteScore: 3)
Cell Transplantation     Open Access   (Followers: 5, SJR: 1.023, CiteScore: 3)
Cephalalgia     Hybrid Journal   (Followers: 8, SJR: 1.581, CiteScore: 3)
Cephalalgia Reports     Open Access   (Followers: 4)
Child Language Teaching and Therapy     Hybrid Journal   (Followers: 34, SJR: 0.501, CiteScore: 1)
Child Maltreatment     Hybrid Journal   (Followers: 11, SJR: 1.22, CiteScore: 3)
Child Neurology Open     Open Access   (Followers: 6)
Childhood     Hybrid Journal   (Followers: 19, SJR: 0.894, CiteScore: 2)
Childhood Obesity and Nutrition     Open Access   (Followers: 12)
China Information     Hybrid Journal   (Followers: 9, SJR: 0.767, CiteScore: 2)
China Report     Hybrid Journal   (Followers: 11, SJR: 0.221, CiteScore: 0)
Chinese J. of Sociology     Full-text available via subscription   (Followers: 5)
Christian Education J. : Research on Educational Ministry     Hybrid Journal   (Followers: 1)
Chronic Illness     Hybrid Journal   (Followers: 6, SJR: 0.672, CiteScore: 2)
Chronic Respiratory Disease     Hybrid Journal   (Followers: 12, SJR: 0.808, CiteScore: 2)
Chronic Stress     Open Access  
Citizenship, Social and Economics Education     Full-text available via subscription   (Followers: 6, SJR: 0.145, CiteScore: 0)
Cleft Palate-Craniofacial J.     Hybrid Journal   (Followers: 8, SJR: 0.757, CiteScore: 1)
Clin-Alert     Hybrid Journal   (Followers: 1)
Clinical and Applied Thrombosis/Hemostasis     Open Access   (Followers: 32, SJR: 0.49, CiteScore: 1)
Clinical and Translational Neuroscience     Open Access   (Followers: 1)
Clinical Case Studies     Hybrid Journal   (Followers: 3, SJR: 0.364, CiteScore: 1)
Clinical Child Psychology and Psychiatry     Hybrid Journal   (Followers: 45, SJR: 0.73, CiteScore: 2)
Clinical EEG and Neuroscience     Hybrid Journal   (Followers: 8, SJR: 0.552, CiteScore: 2)
Clinical Ethics     Hybrid Journal   (Followers: 13, SJR: 0.296, CiteScore: 1)
Clinical Medicine Insights : Arthritis and Musculoskeletal Disorders     Open Access   (Followers: 3, SJR: 0.537, CiteScore: 2)
Clinical Medicine Insights : Blood Disorders     Open Access   (Followers: 1, SJR: 0.314, CiteScore: 2)
Clinical Medicine Insights : Cardiology     Open Access   (Followers: 8, SJR: 0.686, CiteScore: 2)
Clinical Medicine Insights : Case Reports     Open Access   (Followers: 1, SJR: 0.283, CiteScore: 1)
Clinical Medicine Insights : Circulatory, Respiratory and Pulmonary Medicine     Open Access   (Followers: 4, SJR: 0.425, CiteScore: 2)
Clinical Medicine Insights : Ear, Nose and Throat     Open Access   (Followers: 2)
Clinical Medicine Insights : Endocrinology and Diabetes     Open Access   (Followers: 34, SJR: 0.63, CiteScore: 2)
Clinical Medicine Insights : Oncology     Open Access   (Followers: 3, SJR: 1.129, CiteScore: 3)
Clinical Medicine Insights : Pediatrics     Open Access   (Followers: 3)
Clinical Medicine Insights : Psychiatry     Open Access   (Followers: 10)
Clinical Medicine Insights : Reproductive Health     Open Access   (Followers: 1, SJR: 0.776, CiteScore: 0)
Clinical Medicine Insights : Therapeutics     Open Access   (Followers: 1, SJR: 0.172, CiteScore: 0)
Clinical Medicine Insights : Trauma and Intensive Medicine     Open Access   (Followers: 4)
Clinical Medicine Insights : Urology     Open Access   (Followers: 3)
Clinical Medicine Insights : Women's Health     Open Access   (Followers: 4)
Clinical Nursing Research     Hybrid Journal   (Followers: 34, SJR: 0.471, CiteScore: 1)
Clinical Pathology     Open Access   (Followers: 5)
Clinical Pediatrics     Hybrid Journal   (Followers: 25, SJR: 0.487, CiteScore: 1)
Clinical Psychological Science     Hybrid Journal   (Followers: 16, SJR: 3.281, CiteScore: 5)
Clinical Rehabilitation     Hybrid Journal   (Followers: 78, SJR: 1.322, CiteScore: 3)
Clinical Risk     Hybrid Journal   (Followers: 5, SJR: 0.133, CiteScore: 0)
Clinical Trials     Hybrid Journal   (Followers: 22, SJR: 2.399, CiteScore: 2)
Clothing and Textiles Research J.     Hybrid Journal   (Followers: 28, SJR: 0.36, CiteScore: 1)
Collections : A J. for Museum and Archives Professionals     Full-text available via subscription   (Followers: 3)
Common Law World Review     Full-text available via subscription   (Followers: 17)
Communication & Sport     Hybrid Journal   (Followers: 8, SJR: 0.385, CiteScore: 1)
Communication and the Public     Hybrid Journal   (Followers: 2)
Communication Disorders Quarterly     Hybrid Journal   (Followers: 15, SJR: 0.458, CiteScore: 1)
Communication Research     Hybrid Journal   (Followers: 24, SJR: 2.171, CiteScore: 3)
Community College Review     Hybrid Journal   (Followers: 8, SJR: 1.451, CiteScore: 1)
Comparative Political Studies     Hybrid Journal   (Followers: 293, SJR: 3.772, CiteScore: 3)
Compensation & Benefits Review     Hybrid Journal   (Followers: 8)
Competition & Change     Hybrid Journal   (Followers: 12, SJR: 0.843, CiteScore: 2)

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Similar Journals
Journal Cover
Canadian Journal of Kidney Health and Disease
Journal Prestige (SJR): 1.007
Citation Impact (citeScore): 2
Number of Followers: 8  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2054-3581 - ISSN (Online) 2054-3581
Published by Sage Publications Homepage  [1166 journals]
  • Podocyte Infolding Glomerulopathy, First Case Report From North America

    • Authors: Julie Anne Ting, Wayne Hung, Susanna A. McRae, Sean J. Barbour, Michael Copland, Maziar Riazy
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Rationale:Podocyte infolding glomerulopathy (PIG) is a newly described condition with only 37 cases reported worldwide. Due to its rarity, the pathogenesis and evolution of this disease is unclear. This case report contributes to our collective knowledge about the clinical and histological progression of this disease.Presenting concerns of the patient:Over the course of a year, a 52-year-old Malaysian woman with no known prior medical history developed progressively worsening edema and other findings consistent with nephrotic syndrome.Diagnosis:Unlike most patients with PIG, this patient did not have any autoimmune disease. She was Hepatitis B core antibody positive with a Hepatitis B surface antibody >1000, suggesting prior Hepatitis B infection with immunity. A renal biopsy was performed which was consistent with PIG. A second renal biopsy was done 2 years later which again showed characteristic findings of PIG with worsened podocyte effacement but no interval change in chronicity.Interventions:The patient was treated with blood pressure control and renin-angiotensin-aldosterone system (RAAS) blockade with irbesartan and spironolactone. She was also treated with prednisone at 1 mg/kg for 2 months followed by a taper for a total of 7 months of prednisone treatment.Outcomes:The patient had a partial response to a course of prednisone. However, since stopping steroids, her proteinuria and renal function has been gradually worsening.Teaching points:PIG is mostly found in patients of East Asian descent. It presents as proteinuria and is often associated with autoimmune disease but can be idiopathic. It is characterized on renal biopsy by infolding or protrusion of podocyte cytoplasm into glomerular basement membrane, as well as intramembranous cytoplasmic microspherules or microtubules. Atypical membranous nephropathy should be ruled out prior to diagnosis. Unlike membranous nephropathy, PIG usually responds at least partially to steroid monotherapy. To our knowledge, this is the first reported case of PIG from North America. Furthermore, it is the first case of PIG with repeat biopsy showing interval worsening of PIG rather than either resolution of PIG or transformation of PIG to a different diagnosis.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-10-12T12:44:33Z
      DOI: 10.1177/20543581211048357
      Issue No: Vol. 8 (2021)
       
  • A Randomized Controlled Trial of Comparative Efficacy between Sodium
           Bicarbonate and Heparin as A Locking Solution for Tunneled Central Venous
           Catheters Among Patients Requiring Maintenance Hemodialysis

    • Authors: Wannasit Wathanavasin, Jeerath Phannajit, Manorom Poosoonthornsri, Songkiat Lewsuwan, Patchara Tanateerapong, Kamonrat Chongthanakorn, Kullaya Takkavatakarn, Pisut Katavetin, Khajohn Tiranathanagul, Somchai Eiam-ong, Paweena Susantitaphong
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Sodium bicarbonate (NaHCO3) is one of the promising solutions that has good safety profile and theoretical advantages regarding antimicrobial and antithrombotic properties but there are still limited reports.Objective:To compare the efficacy in lowering rate of catheter loss due to catheter-related thrombosis (CRT) or catheter-related blood stream infection (CRBSI) between sodium bicarbonate and heparin lock in prevalent chronic hemodialysis (HD) patients.Design:A multicenter, randomized, open-label studySetting:In a developing country, ThailandPatients:Chronic HD patients with tunneled central venous catheterMeasurements:Catheter loss rate, rate of catheter-related blood stream infection, catheter-related thrombosis, and exit site or tunnel infectionMethods:The prospective multicenter randomized controlled trial was conducted, we randomly assigned 118 patients undergoing HD with tunneled central venous catheter to receive a catheter locking solution of sodium bicarbonate or heparin. The primary outcome was a catheter loss rate due to CRT or CRBSI, while the secondary outcome was a composite outcome of CRT, CRBSI, or exit site/tunnel infection (ESI/TI).Results:The present study was stopped early due to an excess of catheter-related thrombosis in the sodium bicarbonate group. From the first 6 weeks of follow-up, there were no catheter losses due to CRT or CRBSI in both groups. The sodium bicarbonate group had a significantly higher rate of the secondary composite outcomes and this was entirely caused by CRT with the median time to thrombosis of 23.6 days. Every CRT event could be successfully rescued by using a single dose of recombinant tissue plasminogen activator (rt-PA).Limitations:Short follow-up period.Conclusions:In prevalent HD patients with tunneled CVCs, use of a sodium bicarbonate locking solution for prevention of CRT is inferior to heparin and is associated with a high rate of catheter-related thrombosis.Trial registration:The study was registered with the Thai Clinical Trials Registry TCTR 20200610003
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-09-30T12:37:29Z
      DOI: 10.1177/20543581211046077
      Issue No: Vol. 8 (2021)
       
  • Retraction of “Rhabdomyolysis and Acute Kidney Injury Associated With
           Terbinafine Use: A Case Report”

    • Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.

      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-09-24T09:42:29Z
      DOI: 10.1177/20543581211049874
      Issue No: Vol. 8 (2021)
       
  • Time in Therapeutic Range Using a Nomogram for Dose Adjustment of Warfarin
           in Patients on Hemodialysis With Atrial Fibrillation

    • Authors: Kimberly Defoe, Jenny Wichart, Kelvin Leung
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Patients treated with hemodialysis and prescribed warfarin typically have lower time in therapeutic range (TTR) compared to the general population. This may result in less benefit or increased risk of over anticoagulation in these patients.Objective:To assess effectiveness of use of an electronic nomogram for the management of warfarin therapy in patients treated with hemodialysis.Design:Retrospective chart review.Setting:Adult patients treated with hemodialysis.Patients:Patients on hemodialysis receiving warfarin for the management of atrial fibrillation (AF) with therapy managed by nursing led electronic nomogram.Measurements:Time in therapeutic range (as fraction and Rosendaal).Methods:Retrospective chart review over 1 year of international normalized ratio (INR) results was completed, and TTR was calculated. Comparison of patients with TTR greater than 60% to those less than 60% was completed using chi-square analysis.Results:Of 43 patients with warfarin therapy managed by the nomogram, the mean TTR was 55.2% (calculated by fraction method) or 61.2% (calculated by Rosendaal method). More than half of the patients (63.5%) had moderate to good control, defined as TTR greater than 60%. Female sex, liver disease, or history of substance use and more medication holds were associated with lower TTR.Limitations:Small sample size and retrospective nature of review.Conclusions:The results of this review supports the use of an electronic, nursing-led nomogram for the maintenance management of warfarin therapy in stable patients treated with hemodialysis, as use results in TTR greater than 60% for more than half of patients.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-09-16T11:49:01Z
      DOI: 10.1177/20543581211046079
      Issue No: Vol. 8 (2021)
       
  • Kidney Transplantation in Times of Covid-19: Decision Analysis in the
           Canadian Context

    • Authors: Ivan Yanev, Michael Gagnon, Matthew P. Cheng, Steven Paraskevas, Deepali Kumar, Alice Dragomir, Ruth Sapir-Pichhadze
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:The coronavirus disease 2019 (COVID-19) pandemic impacted transplant programs across Canada.Objective:We evaluated the implications of delays in transplantation among Canadian end-stage kidney disease (ESKD) patients to allow pretransplant vaccination.Design:We used a Markov microsimulation model and ESKD patient perspective to study the effectiveness (quality-adjusted life years [QALY]) of living (LD) or deceased donor (DD) kidney transplantation followed by 2-dose SARS-CoV-2 vaccine versus delay in LD (“Delay LD”) or refusal of DD offer (“Delay DD”) to receive 2-dose SARS-CoV-2 vaccine pretransplant.Setting:Canadian dialysis and transplant centers.Patients:We simulated a 10 000-waitlisted ESKD patient cohort, which was predictively modeled for a lifetime horizon in monthly cycles.Measurements:Inputs on patient and graft survival estimates by patient, LD or DD characteristics, were extracted from the Treatment of End-Stage Organ Failure in Canada, Canadian Organ Replacement Register, 2009 to 2018. In addition, a literature review provided inputs on quality of life, SARS-CoV-2 transmissibility, new variants of concern, mortality risk, and antibody responses to 2-dose SARS-CoV-2 mRNA vaccines.Methods:We conducted base case, scenario, and sensitivity analyses to illustrate the impact of patient, donor, vaccine, and pandemic characteristics on the preferred strategy.Results:In the average waitlisted Canadian patient, receiving 2-dose SARS-CoV-2 vaccine post-transplant provided an effectiveness of 22.32 (95% confidence interval: 22.00-22.7) for LD and 19.34 (19.02-19.67) QALYs for DD. Delaying transplants for 6 months to allow 2-dose SARS-CoV-2 vaccine before LD and DD transplant yielded effectiveness of 22.83 (21.51-23.14) and 20.65 (20.33-20.96) QALYs, respectively. Scenario analysis suggested a benefit to short delays in DD transplants to receive 2-dose SARS-CoV-2 vaccine in waitlisted patients ≥55 years. Two-way sensitivity analysis suggested decreased effectiveness of the strategy prioritizing 2-dose SARS-CoV-2 vaccine prior to DD transplant the longer the delay and the higher the Kidney Donor Risk Index of the eventual DD transplant. When assessing the impact of SARS-CoV-2 variants of concern (infection rates ≥10-fold and associated mortality ≥3-fold vs base case), we found short delays to allow 2-dose SARS-CoV-2 vaccine administration pretransplant to be preferable.Limitations:Risks associated with nosocomial exposure of LDs were not considered. There was uncertainty regarding input parameters related to SARS-CoV-2 infection, new variants, and COVID-19 severity in ESKD patients. Given rollout of population-level SARS-CoV-2 vaccination, we assumed a linear decrease in infection rates over 1 year. Proportions of patients mounting an antibody response to 2-dose SARS-CoV-2 mRNA vaccines were considered in lieu of data on vaccine efficacy in dialysis and following transplantation. Non-age-stratified annual mortality rates were used for waitlisted candidates.Conclusions:Our analyses suggest that short delays allowing pretransplant vaccination offered comparable to greater effectiveness than pursuing transplantation without delay, proposing transplant candidates should be prioritized to receive at least 2 doses of SARS-CoV-2 vaccine. Our scenario and sensitivity analyses suggest that caution must be exercised when declining DD offers in patients offered low risk DD and who are likely to incur significant delays in access to transplantation. While population-level herd immunity may decrease infection risk in transplant patients, more data are required on vaccine efficacy against SARS-CoV-2 and variants of concern in ESKD, and how efficacy may be modified by a third vaccine dose, maintenance immunosuppression and timing of induction and rejection therapies.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-09-15T06:38:15Z
      DOI: 10.1177/20543581211040332
      Issue No: Vol. 8 (2021)
       
  • Training Programs for Fundamental and Clinician-Scientists: Balanced
           Outcomes for Graduates by Gender

    • Authors: Christie Rampersad, Todd Alexander, Elisabeth Fowler, Sunny Hartwig, Adeera Levin, Norman D. Rosenblum, Susan Samuel, Chris Wiebe, Julie Ho
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Women scientists are less likely to obtain Assistant Professorship and achieve promotion, and obtain less grant funding than men. Scientist/clinician-scientist training programs which provide salary awards as well as training and mentorship are a potential intervention to improve outcomes among women scientists. We hypothesized whether a programmatic approach to scientist/clinician-scientist training is associated with improved outcomes for women scientists in Canada when compared with salary awards alone. Trainees within the Kidney Research Scientist Core Education and National Training Program (KRESCENT), Canadian Child Health Clinician Scientist Program (CCHCSP), and the Canadian Institutes of Health Research (CIHR) salary award programs were evaluated.Objective:To examine whether the structured KRESCENT training program with salary support improves academic success for women scientists relative to salary awards alone.Design:Retrospective cohort study.Setting:Canadian national research scientist and clinician-scientist training programs and salary awards.Participants:KRESCENT cohort (n = 59, 2005-2017), CCHCSP cohort (n = 58, 2002-2015), and CIHR (n = 571, 2005-2015) Salary Awardees for postdoctoral fellows (PDF) and new investigators (NI).Measurements:National operating grant funding success, achieving an academic position as an Assistant Professor for PDF, or achieving promotion to Associate Professor for NI.Methods:The gender distribution of each cohort was determined using first name and NamepediA and was examined for PDF and NI, followed by a description of trainee outcomes by gender and training level.Results:KRESCENT and CIHR PDF were balanced (12/27, 44% men and 55/116, 47% women) while CCHCSP had a higher proportion of women (13/20, 65%). KRESCENT and CCHCSP NI retained women scientists (19/32, 59% and 22/38, 58% women), whereas CIHR NI had fewer women (165/455, 36% women vs 290/455, 64% men, P = 0.01). There was a high rate of NI operating grant success (91%-95%) with no gender differences in each cohort. There was a high proportion of CCHCSP PDF who achieved an Assistant Professorship (18/20, 90%) that may be due in part to a longer follow-up period (9.3 ± 3 years) compared with KRESCENT PDF (7/27, 26%, 0.88 ± 4.5 years), and these data were not available for CIHR PDF. Women KRESCENT NI showed increased promotion to Associate Professor (P = 0.02, 0.25 ± 3.2 years follow-up) and CCHCSP NI had high promotion rates (37/38, 97%, 6.9 ± 3.6 years follow-up) irrespective of gender. There was an overall trend toward more men pursuing biomedical research.Limitations:KRESCENT and CCHCSP training program cohort size and heterogeneity; assigning gender by first name may result in misclassification; lack of data on the respective applicant pools; and inability to examine intersectionality with gender, ethnicity, and sexual orientation.Conclusion:Overall trainee performance across programs is remarkable by community standards regardless of gender. KRESCENT and CCHCSP training programs demonstrated balanced success in their PDF and NI, whereas the CIHR awardees had reduced representation of women scientists from PDF to NI. This exploratory study highlights the utility of programmatic training approaches like the KRESCENT program as potential tools to support and retain women scientists in the academic pipeline during the challenging PDF to NI transition period.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-09-03T06:52:03Z
      DOI: 10.1177/20543581211033405
      Issue No: Vol. 8 (2021)
       
  • MyTEMP: Statistical Analysis Plan of a Registry-Based, Cluster-Randomized
           Clinical Trial

    • Authors: Stephanie N. Dixon, Jessica M. Sontrop, Ahmed Al-Jaishi, Lauren Killin, Christopher W. McIntyre, Sierra Anderson, Amit Bagga, Derek Benjamin, Peter Blake, P. J. Devereaux, Eduard Iliescu, Arsh Jain, Charmaine E. Lok, Gihad Nesrallah, Matthew J. Oliver, Sanjay Pandeya, Manish M. Sood, Paul Tam, Ron Wald, Michael Walsh, Merrick Zwarenstein, Amit X. Garg
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Major Outcomes with Personalized Dialysate TEMPerature (MyTEMP) is a 4-year cluster-randomized clinical trial comparing the effect of using a personalized, temperature-reduced dialysate protocol versus a dialysate temperature of 36.5°C on cardiovascular-related death and hospitalization. Randomization was performed at the level of the dialysis center (“the cluster”).Objective:The objective is to outline the statistical analysis plan for the MyTEMP trial.Design:MyTEMP is a pragmatic, 2-arm, parallel-group, registry-based, open-label, cluster-randomized trial.Setting:A total of 84 dialysis centers in Ontario, Canada.Patients:Approximately 13 500 patients will have received in-center hemodialysis at the 84 participating dialysis centers during the trial period (April 3, 2017, to March 1, 2021, with a maximum follow-up to March 31, 2021).Methods:Patient identification, baseline characteristics, and study outcomes will be obtained primarily through Ontario administrative health care databases held at ICES. Covariate-constrained randomization was used to allocate the 84 dialysis centers (1:1) to the intervention group or the control group. Centers in the intervention group used a personalized, temperature-reduced dialysate protocol, and centers in the control group used a fixed dialysate temperature of 36.5°C.Outcomes:The primary outcome is a composite of cardiovascular-related death or major cardiovascular-related hospitalization (defined as a hospital admission with myocardial infarction, congestive heart failure, or ischemic stroke) recorded in administrative health care databases. The key secondary outcome is the mean drop in intradialytic systolic blood pressure, defined as the patients’ predialysis systolic blood pressure minus their nadir systolic blood pressure during the dialysis treatment. Anonymized data on patients’ predialysis and intradialytic systolic blood pressure were collected at monthly intervals from each dialysis center.Analysis plan:The primary analysis will follow an intent-to-treat approach. The primary outcome will be analyzed at the patient level as the hazard ratio of time-to-first event, estimated from a subdistribution hazards model. Within-center correlation will be accounted for using a robust sandwich estimator. In the primary analysis, patients’ observation time will end if they experience the primary outcome, emigrate from Ontario, or die of a noncardiovascular cause (which will be treated as a competing risk event). The between-group difference in the mean drop in intradialytic systolic blood pressure obtained during the dialysis sessions throughout the trial period will be analyzed at the center level using an unadjusted random-effects linear mixed model.Trial status:The MyTEMP trial period is April 3, 2017, to March 31, 2021. We expect to analyze and report results by 2023 once the updated data are available at ICES.Trial registration:MyTEMP is registered with the US National Institutes of Health at clincaltrials.gov (NCT02628366).Statistical analytic plan:Version 1.1 June 15, 2021.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-08-27T10:20:20Z
      DOI: 10.1177/20543581211041182
      Issue No: Vol. 8 (2021)
       
  • T Scores, FRAX, Frailty Phenotype, Falls, and Its Relationship to
           Fractures in Patients on Maintenance Hemodialysis

    • Authors: Maryam Jafari, Salman Anwar, Kaval Kour, Shubrandu Sanjoy, Kunal Goyal, Bhanu Prasad
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Despite the magnitude of fracture and the consequences in patients receiving hemodialysis, optimal risk assessment tools in this population are not well explored. Frailty and falls—known risk factors for fracture in chronic kidney disease (CKD) and non-CKD populations—are common in patients receiving hemodialysis (HD) therapy. While the relationship between T scores in relation to fractures in patients receiving HD is recognized, there is a paucity of data to the additional contributions of fracture assessment tool (FRAX), frailty status, and falls in its relationship with fracture.Objectives:To evaluate the clinical utility of adding FRAX, frailty status, and falls to T scores at the femoral neck to determine whether it enhances fracture discrimination in patients on maintenance HD.Design:A cross-sectional observational study.Setting:Two main dialysis units in Regina, Saskatchewan, Canada.Patients:A total of 109 patients on maintenance HD at two dialysis units from January 1, 2017, to December 31, 2018, were included in the study.Measurements:Fracture (the main outcome) was documented based on the review of medical charts, self-recall, and additionally vertebral fractures were identified by an x-ray. Areal bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry (DXA). FRAX score was calculated using an online algorithm based on 11 clinical risk factors. We calculated the FRAX score for hip fracture and major osteoprotoic fracture with and without the inclusion of BMD. Frailty was assessed using the Fried criteria, which included assessments of unintentional weight loss, weakness (handgrip strength), slowness (walking speed), and questionnaires for physical activity and self-perceived exhaustion. Patients were enquired about the history and frequency of falls.Methods:A total of 131 patients underwent frailty assessments at the two dialysis units during the dialysis treatment. Following frailty assessments, they were referred for DXA scans and upon receipt of the results undertook FRAX questionnaires. They were additionally sent for lumbar x-rays and contacted for a history of falls. Association between the BMD-T score, FRAX, frailty status, falls, with fracture were examined with sequential multivariable logistic regression models. Differences were considered statistically significant at P values
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-08-25T06:58:49Z
      DOI: 10.1177/20543581211041184
      Issue No: Vol. 8 (2021)
       
  • Impact of Perioperative Complications on Living Kidney Donor
           Health-Related Quality of Life and Mental Health: Results From a
           Prospective Cohort Study

    • Authors: Carlos Garcia-Ochoa, Liane S. Feldman, Chris Nguan, Mauricio Monroy-Caudros, Jennifer B. Arnold, Lianne Barnieh, Neil Boudville, Meaghan S. Cuerden, Christine Dipchand, John S. Gill, Martin Karpinski, Scott Klarenbach, Greg Knoll, Charmaine E. Lok, Matthew Miller, G. V. Ramesh Prasad, Jessica M. Sontrop, Leroy Storsley, Amit X. Garg
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Although living kidney donation is safe, some donors experience perioperative complications.Objective:This study explored how perioperative complications affected donor-reported health-related quality of life, depression, and anxiety.Design:This research was a conducted as a prospective cohort study.Setting:Twelve transplant centers across Canada.Patients:A total of 912 living kidney donors were included in this study.Measurements:Short Form 36 health survey, Beck Depression Inventory and Beck Anxiety Inventory.Methods:Living kidney donors were prospectively enrolled predonation between 2009 to 2014. Donor perioperative complications were graded using the Clavien-Dindo classification system. Mental and physical health-related quality of life was assessed with the 3 measurements; measurements were taken predonation and at 3- and 12-months postdonation.Results:Seventy-four donors (8%) experienced a perioperative complication; most were minor (n = 67 [91%]), and all minor complications resolved before hospital discharge. The presence (versus absence) of a perioperative complication was associated with lower mental health-related quality of life and higher depression symptoms 3-month postdonation; neither of these differences persisted at 12-month. Perioperative complications were not associated with any changes in physical health-related quality of life or anxiety 3-month postdonation.Limitations:Minor complications may have been missed and information on complications postdischarge were not collected. No minimal clinically significant change has been defined for kidney donors across the 3 measurements.Conclusions:These findings highlight a potential opportunity to better support the psychosocial needs of donors who experience perioperative complications in the months following donation.Trial registration:NCT00319579 and NCT00936078.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-08-11T10:16:40Z
      DOI: 10.1177/20543581211037429
      Issue No: Vol. 8 (2021)
       
  • Nephrologists’ Attitudes Regarding Psychosocial Care in Hemodialysis
           Units

    • Authors: Aidan Lehecka, David Mendelssohn, Gavril Hercz
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:There is a high prevalence of psychosocial issues affecting patients with kidney failure.Objective:We sought to examine Canadian nephrologists’ attitudes and opinions regarding the importance of renal patient psychosocial care, nephrologists’ roles, and experience with psychosocial care in addition to what barriers, if any, prevent these physicians from providing psychosocial care to their patients.Design:A self-administered, survey questionnaire.Setting:Online.Sample:Canadian Society of Nephrology members who predominantly work in clinical care with adult, in-center hemodialysis patients.Measurements:Measurements of the survey include demographics, training, and nephrologists’ opinions regarding their role in administering psychosocial care, potential administrative and patient time constraints, accessibility of other health care workers for this activity, and factors that influence or impede physicians’ ability to address their patients’ psychosocial needs.Methods:A self-administered survey was sent to almost 500 members of the Canadian Society of Nephrology between November 2018 and December 2018. The survey questionnaire was designed to gather opinions and attitudes on psychosocial care delivery as well as potential influencing factors on nephrologists’ ability to provide this care. A univariate statistical analysis was used to analyze survey responses.Results:A total of 30 nephrologists responded to the survey, generating a 6% response rate. Respondents varied across provinces, with the majority being staff nephrologists (80%). While over 94% of respondents either agreed or strongly agreed that focus on psychosocial care improves patient outcomes, only 43% felt that staff nephrologists were suited to provide this care to patients; 97% of respondents believed social workers to be the most suited to provide this. Lack of additional supporting health care members, the need for additional training, too many administrative duties, and empathy fatigue were some of the predominant barriers respondents felt prevented them from addressing the psychosocial care of their patients.Limitations:A low response rate for the survey was obtained, roughly 6%, limiting our ability to draw definitive conclusions. Survey answers by respondents may be different from those by nonrespondents. Answers may be subject to social desirability and/or selection bias.Conclusion:Nephrologists believe that the current psychosocial care of patients in hemodialysis units is inadequate. However, further research is necessary to elucidate the barriers nephrologists face in providing psychosocial care and the changes required to most effectively implement optimal psychosocial care for patients with kidney failure in hemodialysis units.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-08-11T10:00:23Z
      DOI: 10.1177/20543581211037426
      Issue No: Vol. 8 (2021)
       
  • Province-Wide Prevalence Testing for SARS-CoV-2 of In-Center Hemodialysis
           Patients and Staff in Ontario, Canada: A Cross-Sectional Study

    • Authors: Daphne C. Sniekers, James K. H. Jung, Peter G. Blake, Rebecca Cooper, Jerome A. Leis, Matthew P. Muller, Vlad Padure, Philip Holm, Angie Yeung, Leena Taji, Phil McFarlane, Matthew J. Oliver
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:People receiving in-center hemodialysis face a high risk for contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and experience poor outcomes. During the first wave of the coronavirus disease 2019 (COVID-19) pandemic in Ontario (between March and June 2020), it was unclear whether asymptomatic or presymptomatic cases were common and whether widespread testing of all dialysis patients and staff would identify cases earlier and prevent transmission. Ontario has a population of about 14.5 million. Approximately 8900 people receive dialysis across 102 in-center dialysis units.Objective:The objective of this study was to determine participation rates for patients and staff in point prevalence testing in dialysis units across the province and to determine the prevalence of asymptomatic or presymptomatic infection.Design:Cross-sectional study design.Setting:In-center hemodialysis units at 27 renal programs across Ontario.Participants:Patients and staff in in-center dialysis units in Ontario.Measurements:Participation rates, demographic data, SARS-CoV-2 positivity rates, and COVID-19-related symptom data.Methods:From June 8 to 30, 2020, all in-center dialysis patients and staff in the Province of Ontario were requested to undergo a symptom screening assessment and nasopharyngeal swab. Testing was done using polymerase chain reaction to detect SARS-CoV-2. A standardized questionnaire of atypical and typical COVID-19-related symptoms was administered to patients, to assess for new or worsening COVID-19-related symptoms.Results:Patient participation was 83% (7155 of 8612) of which 15 tests were positive: less than 5 (
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-08-05T10:13:23Z
      DOI: 10.1177/20543581211036213
      Issue No: Vol. 8 (2021)
       
  • Association Between Attempted Arteriovenous Fistula Creation and Mortality
           in People Starting Hemodialysis via a Catheter: A Multicenter,
           Retrospective Cohort Study

    • Authors: Derek J. Roberts, Alix Clarke, Meghan Elliott, Kathryn King-Shier, Swapnil Hiremath, Matthew Oliver, Robert R. Quinn, Pietro Ravani
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:In North America, most people start hemodialysis via a central venous catheter (“catheter”). These patients are counseled to undergo arteriovenous fistula (“fistula”) creation within weeks of starting hemodialysis because fistulas are associated with improved survival.Objectives:To determine whether attempting to create a fistula in patients who start hemodialysis via a catheter is associated with improved mortality. We also sought to determine whether differences in baseline patient characteristics, vascular procedures for access-related complications, or days in hospital may confound or mediate the relationship between attempted fistula creation and mortality.Design:Multicenter, retrospective cohort study.Setting:Six dialysis programs located in Ontario, Alberta, and Manitoba.Patients:Patients aged ≥18 years who initiated hemodialysis via a catheter between January 1, 2004, and May 31, 2012, who had not had a previous attempt at fistula creation. We excluded those who had a life expectancy less than 1 year, who transitioned to peritoneal dialysis within 6 months of starting dialysis, and people who started hemodialysis via a graft.Measurements:Attempted fistula creation, all-cause mortality, patient characteristics and comorbidities, vascular procedures for access-related complications, and days spent in hospital.Methods:We used survival methods, including marginal structural models, to account for immortal time bias and time-varying confounding.Results:In total, 1832 patients initiated hemodialysis via a catheter during the study period and met inclusion criteria. Of these patients, 565 (31%) underwent an attempt at fistula creation following hemodialysis start. As compared to those who did not receive a fistula attempt, these people were younger, had fewer comorbidities, and were more likely to have started dialysis as an outpatient and to have received pre-dialysis care. In a marginal structural model controlling for baseline characteristics and comorbidities, attempted fistula creation was associated with a significantly lower mortality (hazard ratio [HR] = 0.53; 95% confidence interval [CI] = 0.43-0.66). This effect did not appear to be confounded or mediated by differences in the number of days spent in hospital or vascular procedures for access-related complications. It also remained similar in analyses restricted to patients who survived at least 6 months (HR = 0.60; 95% CI = 0.47-0.77) and to patients who started hemodialysis as an outpatient (HR = 0.48; 95% CI = 0.33-0.68).Limitations:There is likely residual confounding and treatment selection bias.Conclusions:In this multicenter cohort study, attempting fistula creation in people who started hemodialysis via a catheter was associated with significantly reduced mortality. This reduction in mortality could not be explained by differences in patient characteristics or comorbidities, days spent in hospital, or vascular procedures for access-related complications. Residual confounding or selection bias may explain the observed benefits of fistulas for hemodialysis access.Trial Registration:Not applicable (cohort study).
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-07-31T05:15:40Z
      DOI: 10.1177/20543581211032846
      Issue No: Vol. 8 (2021)
       
  • The BC ADPKD Network: A Comprehensive Provincial Approach to Support
           Specialized and Locally Delivered Multidisciplinary ADPKD Care

    • Authors: M. Bevilacqua, S. Gradin, J. Williams, A. Romann, C. Lo, O. Djurdjev, A. Levin
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Purpose:With evolving evidence around the progression, assessment, and management of autosomal dominant polycystic kidney disease (ADPKD), care of the disease has become increasingly complex. Needs assessments in British Columbia (BC) described variability in knowledge and comfort with incorporating these new aspects of ADPKD care into clinical practice. Undercapture of early-stage ADPKD patients in existing renal databases was also identified as an unmet need.Sources of Information:A multidisciplinary group of clinicians and patient partners with interest and expertise in ADPKD and/or multidisciplinary kidney care informed the project work. An existing provincial renal database was used to support the provincial ADPKD registry.Methods:A formalized, comprehensive provincial ADPKD Network was created within the existing infrastructure of multidisciplinary kidney clinics (MDCs) in BC. The Network is coordinated provincially and implemented locally. It incorporates robust data collection, education, creation, and dissemination of dedicated clinical tools; collaboration between clinics and clinicians across the province; and ongoing evaluation and continuous quality improvement.Key Findings:Over the 5 years since its inception, the BC ADPKD Network has enabled increased and earlier identification of British Columbians living with ADPKD and a shift in practice toward increased and earlier enrollment of ADPKD patients into MDCs. A host of tailored ADPKD clinical tools have been created and implemented in all MDCs across the province to support existing MDC staff in the delivery of more standardized and specialized ADPKD care. A collaborative provincial clinician network founded on Local Clinical Champions has been established to support ongoing experience sharing between clinics. An evaluation framework has been established to evaluate outcomes and enable ongoing refinement of the Network.Limitations:The provincial ADPKD registry is undergoing enhancements to enable more comprehensive capture of APDKD-specific information such as total kidney volume and genetic results, but at present, this remains a limitation. It remains to be seen whether the activities of the ADPKD Network will improve long-term clinical outcomes and care experiences of patients living with ADPKD, and a long-term sustainability assessment of this model of care will be required.Implications:The structure, tools, and coordinated and collaborative clinician network established through this comprehensive provincial ADPKD Network may be valuable in addressing the variability and gaps in existing ADPKD care while allowing patients and families across BC to receive enhanced care locally, in their usual kidney care environments.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-07-29T10:15:08Z
      DOI: 10.1177/20543581211035218
      Issue No: Vol. 8 (2021)
       
  • Voicing Individual Concerns for Engagement in Hemodialysis (VOICE-HD): A
           Mixed Method, Randomized Pilot Trial of Digital Health in Dialysis Care
           Delivery

    • Authors: Stephanie Thompson, Kara Schick-Makaroff, Aminu Bello, Marcello Tonelli, Natasha Wiebe, Robert Buzinski, Mark Courtney, Susan Szigety, Nikhil Shah, Clara Bohm
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:People receiving in-center hemodialysis (HD) have prioritized the need for more individualized health information and better communication with nephrologists. The most common setting for patient-nephrologist interactions is during the HD treatment, which is a time pressured setting that lacks privacy.Objective:To facilitate effective communication in the hemodialysis (HD) unit, we evaluated the usability of a web application (web app) from both the patient and physician perspective. The main aim of the web app was to support patients in prioritizing their dialysis concerns outside of the clinical HD encounter.Design:Mixed method, parallel arm, multi-site, pilot randomized controlled trial.Setting:Two outpatient Canadian HD centers.Participants:Adult patients receiving in-center HD and their attending nephrologists.Methods:Patients were randomized to either a web application or an active control (paper form) for logging concerns to be addressed at weekly encounters with the nephrologist over 8 weeks. Topics included: HD treatment, symptoms, modality, and medications. The primary outcome was usability, defined as effectiveness (engagement with the tool, frequency of submitted concerns, whether the concern was satisfactorily addressed) and satisfaction with the tool using a priori thresholds and explored in interviews with patients and nephrologists.Results:77 patients (30 women, median age 61, interquartile range [53,67], median 2 years [1,4] on dialysis) and 19 nephrologists (4 women, median age 46 [36,65]) were enrolled. Patient use of a digital device at baseline was low (20%). Engagement with the tool was 70% (web app) and 100% (paper) with a lower proportion of patients in the web app group submitting at least one concern over 8 weeks compared to the paper form group: 56.7% vs 87.9%. Weekly concerns were satisfactorily addressed in both groups and ≥70% of patients would continue to use the tools. For patients, both tools promoted preparation and participation in the encounter; however, only the web app facilitated greater privacy in relaying concerns. For most nephrologists, the tools were disruptive to their workflow and were perceived as unnecessary given existing processes and familiarity with patients. For future versions of the app, patients suggested more features to facilitate self-management and nephrologists suggested integration with health databases and multidisciplinary teams.Limitations:Tertiary setting may limit generalizability.Conclusions:Both tools promoted fundamental components of self-management; however, patients in the paper form group submitted concerns more often and this tool was easier to remember to use. Although modifications would likely enhance web app usability, successful future adoption is limited by physician acceptance.Trial registration ClinicalTrials.gov NCT03605875
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-07-28T05:37:31Z
      DOI: 10.1177/20543581211032857
      Issue No: Vol. 8 (2021)
       
  • Isolated Penile Calciphylaxis Diagnosed by Ultrasound Imaging in a New
           Dialysis Patient: A Case Report

    • Authors: Wryan Helmeczi, Tyler Pitre, Emma Hudson, Suhas Mondhe, Kevin Burns
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Rationale:The recognition of calciphylaxis often eludes practitioners because of its multiple ambiguous presentations. It classically targets areas of the body dense with adipose tissue. A heightened suspicion for the disorder is therefore required in the case of penile calciphylaxis, given its unconventional location. The diagnosis of calciphylaxis is also challenging as the gold standard for diagnosis is biopsy which can often yield equivocal results. Unfortunately, in penile calciphylaxis, the utility of biopsies is further debated due to their potential to precipitate new lesions and their decreased sensitivity due to the limited depth of tissue that can be sampled. For these reasons, it is important that practitioners recognize other accessible and accurate investigative tools which can aid in their diagnosis.Presenting concerns of the patient:We present the case of a 49-year-old man who presented to the emergency room with penile pain in the context of known chronic kidney disease secondary to diabetic nephropathy. The pain had been present for about a week, was exquisitely tender, and was initially associated with a faint violaceous lesion. This gentleman had just recently initiated peritoneal dialysis and had no other lesions on his body.Diagnosis:His pain was determined by ultrasound and plain radiograph to be secondary to calciphylaxis after two biopsies were nondiagnostic.Interventions:The patient had already made changes to his diet to reduce phosphate and calcium intake, and had been on phosphate-lowering therapy with both calcium and phosphate being within their respective target range. Following his diagnosis, this patient was promptly converted from peritoneal dialysis to hemodialysis with sodium thiosulphate and initiated hyperbaric oxygen therapy. This patient continues to be followed by nephrology and urology specialists.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-07-26T12:41:05Z
      DOI: 10.1177/20543581211025846
      Issue No: Vol. 8 (2021)
       
  • Patient Partner Perspectives Regarding Ethically and Clinically Important
           Aspects of Trial Design in Pragmatic Cluster Randomized Trials for
           Hemodialysis

    • Authors: Stuart G. Nicholls, Kelly Carroll, Cory E. Goldstein, Jamie C. Brehaut, Charles Weijer, Merrick Zwarenstein, Stephanie Dixon, Jeremy M. Grimshaw, Amit X. Garg, Monica Taljaard
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Cluster randomized trials (CRTs) are trials in which intact groups such as hemodialysis centers or shifts are randomized to treatment or control arms. Pragmatic CRTs have been promoted as a promising trial design for nephrology research yet may also pose ethical challenges. While randomization occurs at the cluster level, the intervention and data collection may vary in a CRT, challenging the identification of research participants. Moreover, when a waiver of patient consent is granted by a research ethics committee, there is an open question as to whether and to what degree patients should be notified about ongoing research or be provided with a debrief regarding the nature and results of the trial upon completion. While empirical and conceptual research exploring ethical issues in pragmatic CRTs has begun to emerge, there has been limited discussion with patients, families, or caregivers of patients undergoing hemodialysis.Objective:To explore with patients and families with experience of hemodialysis research the challenges raised by different approaches to designing pragmatic CRTs in hemodialysis. Specifically, their perceptions of (1) the use of a waiver of consent, (2) notification processes and information provided to participants, and (3) any other concerns about cluster randomized designs in hemodialysis.Design:Focus group and interview discussions of hypothetical clinical trial designs.Setting:Focus groups and interviews were conducted in-person or via videoconference or telephone.Participants:Patient partners in hemodialysis research, defined as patients with personal experience of dialysis or a family member who had experience supporting a patient receiving hemodialysis, who have been actively involved in discussions to advise a research team on the design, conduct, or implementation of a hemodialysis trial.Methods:Participants were invited to participate in focus groups or individual discussions that were audio recorded with consent. Recorded interviews were transcribed verbatim prior to analysis. Transcripts were analyzed using a thematic analysis approach.Results:Two focus groups, three individual interviews, and one interview involving a patient and family member were conducted with 17 individuals between February 2019 and May 2020. Participants expressed support for approaches that emphasized patient choice. Disclosure of patient-relevant risks and information were key themes. Both consent and notification processes served to generate trust, but bypassing patient choice was perceived as undermining this trust. Participants did not dismiss the option of a waiver of consent. They were, however, more restrictive in their views about when a waiver of consent may be acceptable. Patient partners were skeptical of claims to impracticability based on costs or the time commitments for staff.Limitations:All participants were from Canada and had been involved in the design or conduct of a trial, limiting the degree to which results may be extrapolated.Conclusions:Given the preferences of participants to be afforded the opportunity to decide about trial participation, we argue that investigators should thoroughly investigate approaches that allow participants to make an informed choice regarding trial participation. In keeping with the preference for autonomous choice, there remains a need to further explore how consent approaches can be designed to facilitate clinical trial conduct while meeting their ethical requirements. Finally, further work is needed to define the limited circumstances in which waivers of consent are appropriate.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-07-26T11:12:54Z
      DOI: 10.1177/20543581211032818
      Issue No: Vol. 8 (2021)
       
  • Expanding the Deceased Donor Pool in Manitoba Using Hepatitis C-Viremic
           Donors: Program Report

    • Authors: Susan Cuvelier, Paul Van Caeseele, Matthew Kadatz, Kathryn Peterson, Siyao Sun, Nancy Dodd, Kim Werestiuk, Joshua Koulack, Peter Nickerson, Julie Ho
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Purpose of program:The ongoing shortage of organs for transplant combined with Manitoba having the highest prevalence of end-stage renal disease (ESRD) in Canada has resulted in long wait times on the deceased donor waitlist. Therefore, the Transplant Manitoba Adult Kidney Program has ongoing quality improvement initiatives to expand the deceased donor pool. This clinical transplant protocol describes the use of prophylactic pan-genotypic direct-acting anti-viral agents (DAA) for transplanting hepatitis C (HCV)-viremic kidneys (HCV antibody positive/nucleic acid [nucleic acid amplification testing, NAT] positive) to HCV-naïve recipients as routine standard of care. We will evaluate the provincial implementation of this protocol as a prospective observational cohort study.Sources of information:Scoping literature review and key stakeholder engagement with interdisciplinary health care providers and health system leaders/decision markers.Methods:Patients will be screened pre-transplant for eligibility and undergo a multilevel education and consent process to participate in this expanded donor program. Incident adult HCV-naïve recipients of an HCV-viremic kidney transplant will be treated prophylactically with glecaprevir-pibrentasvir with the first dose administered on call to the operation. Glecaprevir-pibrentasvir will be used for 8 weeks with viral monitoring and hepatology follow-up. Primary outcomes are sustained virologic response (SVR) at 12 weeks and the tolerability of DAA therapy. Secondary outcomes within the first year post-transplant are patient and graft survival, graft function, biopsy-proven rejection, HCV transmission to recipient (HCV NAT positive), and HCV nonstructural protein 5A (NS5A) resistance. Safety outcomes within the first year post-transplant include fibrosing cholestatic hepatitis, acute liver failure, primary and secondary DAA treatment failure, HCV transmission to a recipient’s partner, elevated liver enzymes ≥2-fold, abnormal international normalized ratio (INR), angioedema, anaphylaxis, cirrhosis, and hepatocellular carcinoma.Key findings:This program successfully advocated for and obtained hospital formulary, provincial Exceptional Drug Status (EDS), and Non-Insured Health Benefits (NIHB) to provide prophylactic DAA therapy for this indication, and this information may be useful to other provincial transplant organizations seeking to establish an HCV-viremic kidney transplant program with prophylactic DAA drug coverage.Limitations:(1) Patient engagement was not undertaken during the program design phase, but patient-reported experience measures will be obtained for continuous quality improvement. (2) Only standard criteria donors (optimal kidney donor profile index [KDPI] ≤60) will be used. If this approach is safe and feasible, then higher KDPI donors may be included.Implications:The goal of this quality improvement project is to improve access to kidney transplantation for Manitobans. This program will provide prophylactic DAA therapy for HCV-viremic kidney transplant to HCV-naïve recipients as routine standard of care outside a clinical trial protocol. We anticipate this program will be a safe and effective way to expand kidney transplantation from a previously unutilized donor pool.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-07-26T11:11:05Z
      DOI: 10.1177/20543581211033496
      Issue No: Vol. 8 (2021)
       
  • Peritoneal Dialysis After Liver Transplantation: A Systematic Review

    • Authors: Jean Maxime Côté, Isabelle Ethier, Héloïse Cardinal, Marie-Noëlle Pépin
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Chronic kidney disease following liver transplantation is a major long-term complication. Most liver transplant recipients with kidney failure will be treated with dialysis instead of kidney transplantation due to noneligibility and shortage in organ availability. In this population, the role of peritoneal dialysis (PD) as a modality of kidney replacement therapy (KRT) remains unclear.Objective:To determine the feasibility regarding safety, technique survival, and dialysis efficiency of PD in liver transplant recipients requiring KRT for maintenance dialysis.Design:Systematic review.Setting:Interventional and observational studies reporting the use of PD after liver transplantation.Patients:Adult liver transplant recipients with kidney failure treated with maintenance KRT.Measurements:Extracted data included eligibility criteria, study design, demographics, and PD modality. The following outcomes of interest were extracted: rate of peritonitis and microorganisms involved, noninfectious peritoneal complications, technique survival, and kidney transplantation-censored technique survival. Non-PD complications included overall survival, liver graft dysfunction, and hospitalization rate.Methods:The following databases were searched until July 2020: MedLine/PubMed, EMBASE, CINAHL, and Cochrane Library. Two reviewers independently screening all titles and abstracts of all identified articles. Due to the limited sample size, observational designs and study heterogeneity expected, no meta-analysis was pre-planned. Descriptive statistics were used to report all results.Results:From the 5263 identified studies, 4 were included in the analysis as they reported at least 1 outcome of interest on a total of 21 liver transplant recipients, with an overall follow-up duration on PD of 19.0 (Interquartile range [IQR]: 9.5-29.5) months. Fifteen episodes of peritonitis occurred in a total cumulative PD follow-up of 514 patient-months, representing an incidence rate of 0.35 per year. These episodes did not result in PD technique failure, mortality, or impairment of liver graft function.Limitations:Limitations include the paucity of studies in the field and the small number of patients included in each report, a risk of publication bias and the impossibility to directly compare hemodialysis to PD in this population. These results, therefore, must be interpreted with caution.Conclusions:Based on limited data reporting the feasibility of PD in liver transplant recipients with kidney failure, no signal was associated with an increased risk of infectious complications. Long-term studies evaluating this modality need to be performed.Registration (PROSPERO):CRD42020218374.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-07-19T04:31:23Z
      DOI: 10.1177/20543581211029722
      Issue No: Vol. 8 (2021)
       
  • The Association of Matrix Metalloproteinases With Acute Kidney Injury
           Following CPB-Supported Cardiac Surgery

    • Authors: Erick D. McNair, Jennifer Bezaire, Michael Moser, Prosanta Mondal, Josie Conacher, Aleksandra Franczak, Greg Sawicki, David Reid, Abass Khani-Hanjani
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Cardiac surgery–associated acute kidney injury (AKI) is an adverse outcome that increases morbidity and mortality in patients undergoing cardiac surgical procedures. To date, the use of serum creatinine levels as an early indicator of AKI has limitations because of its slow rise and poor predictive accuracy for renal injury. This delay in diagnosis may lead to prolonged initiation in treatment and increased risk for adverse outcomes.Objective:This pilot study explores serum and urine matrix metalloproteinases (MMPs)-2 and MMP-9 and their association, and potentially earlier detection of AKI in patients following cardiopulmonary bypass (CPB)–supported cardiac surgery. We hypothesize that increased activity of serum and urine levels MMP-2 and/ or MMP-9 are associated with AKI. Furthermore, MMP-2 and/ or MMP-9 may provide earlier identification of AKI as compared with serum levels of creatinine.Methods:During the study period, there were 150 CPB-supported surgeries, 21 of which developed AKI according to the Kidney Disease Improving Global Outcomes criteria. We then selected a sample of 21 matched cases from those patients who went through the surgery without developing AKI. Primary outcomes were the measurement via gel zymography of the serum and urine activity of MMP-2 and MMP-9 drawn at the following intervals: pre-CPB; 10-minute post-CPB; and 4-hour post-CPB time points. Secondary variables were the measurement of serum creatinine, intensive care unit (ICU) fluid balance, and length of ICU stay.Results:At the 10-minute and 4-hour post-CPB time points, the serum MMP-2 activity of AKI patients were significantly higher as compared with non-AKI patients (P < .001 and P = .004), respectively. Similarly, at the 10-minute and 4-hour post-CPB time points, the serum MMP-9 activity of AKI patients was significantly higher as compared with non-AKI patients (P = .001 and P = .014), respectively. The activity of urine MMP-2 and MMP-9 of AKI patients was significantly higher as compared with non-AKI patients at all 3 time points (P = .004, P < .001, P < .001), respectively.Conclusion:Although the pilot study may have limitations, it has demonstrated that the serum and urine levels of activity of MMP-2 and MMP-9 are associated with the clinical endpoint of AKI and appear to have earlier rising levels as compared with those of serum creatinine. Furthermore, in depth, exploration is underway with a larger sample size to attempt validation of the analytical performance and reproducibility of the assay for MMP-2 and MMP-9 to aid in earlier diagnosis of AKI following CPB-supported cardiac surgery.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-07-16T09:58:57Z
      DOI: 10.1177/20543581211019640
      Issue No: Vol. 8 (2021)
       
  • Re-Envisioning the Canadian Nephrology Trials Network: A Can-SOLVE-CKD
           Stakeholder Meeting of Patient Partners and Researchers

    • Authors: Alicia Murdoch, Karthik K. Tennankore, Clara Bohm, Catherine M. Clase, Adeera Levin, Hans Vorster, Rita S. Suri
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Purpose:The Canadian Nephrology Trials Network (CNTN) was formed in 2014 to support Canadian researchers in developing, designing, and conducting prospective studies in nephrology. In response to the changing landscape and needs within the Canadian nephrology research community, an interest in further growth and development of the network was identified. In the following report, we describe the process undertaken to re-envision the network through the creation of 3 new committees and how the committees are facilitating change and growth within the CNTN for future sustainability.Sources of information:To understand areas for improvement and capacity building, the organization charged with overseeing the CNTN, Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD), began by conducting an environmental scan. As well, 2 informal surveys were sent to nephrology professionals (who were members of the CNTN and the Canadian Society of Nephrology) and patient partners (from Can-SOLVE CKD).Methods:In September 2018, 44 CNTN members and other stakeholders from across Canada (including patient partners and representatives from research funding agencies) convened for a 2-day visioning workshop in Mississauga, Ontario. The agenda for this workshop was largely based on the results from the informal surveys. CNTN leadership participated and chose other workshop participants through informal stakeholder mapping and purposeful recruitment. Patient partners were recruited to participate in the workshop through advertisement within the Can-SOLVE-CKD patient council. The survey results and discussion questions were presented to participants at the workshop who, in turn, discussed in large- and small-group session ways in which the CNTN might be expanded.Results:Surveys of patient partners indicated that they would like to see greater involvement of patients in the research process. Surveys of researchers indicated that they wanted more support and resources for coordinating prospective trials. The themes which emerged from the workshop discussions were peer review, engagement, and training. These themes were broadened and formally re-named to Scientific Operations, Communications and Engagement, and Capacity Building. A working committee, each co-led by a nephrologist with research experience and a patient partner, was created to advance each of these identified themes. An executive committee was created to provide overall strategic leadership and governance to the network. The Scientific Operations Committee conducts peer reviews; provides letters of endorsement after peer review; and holds semi-annual in-person meetings where researchers can present their proposals and obtain feedback from multiple stakeholders, including patients. The Communications and Engagement Committee publishes a quarterly newsletter, engages the community on Twitter, and reaches out to community sites and new nephrologists to engage them in research. The Capacity Building Committee conducts webinars to encourage patient partners to develop their own research questions and is developing a hub-and-spoke model to improve research collaboration.Limitations:We did not conduct formal stakeholder mapping. Only attendees of the visioning workshop provided input, and not everyone’s comment or opinion was included in the workshop report. Perspectives were limited to the sample of people who attended the workshop or were surveyed and may not reflect perspectives of all stakeholders in nephrology research in Canada. We did not use formal qualitative methodology to summarize the workshops.Implications:Renewed areas of focus and related committees within the CNTN could lead to an increased capacity for nephrology research, increased engagement and collaboration with researchers, a higher likelihood of funding with rigorous peer review, and more clinical trials and multicenter collaborative prospective research being conducted in Canada.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-07-14T10:20:00Z
      DOI: 10.1177/20543581211030396
      Issue No: Vol. 8 (2021)
       
  • Incidence and Outcomes of Acute Kidney Injury in Patients Admitted to
           Hospital With COVID-19: A Retrospective Cohort Study

    • Authors: Tyler Pitre, Angela (Hong Tian) Dong, Aaron Jones, Jessica Kapralik, Sonya Cui, Jasmine Mah, Wryan Helmeczi, Johnny Su, Vivek Patel, Zaka Zia, Michael Mallender, Xinxin Tang, Cooper Webb, Nivedh Patro, Mats Junek, MyLinh Duong, Terence Ho, Marla K. Beauchamp, Andrew P. Costa, Rebecca Kruisselbrink, Jennifer L.Y. Tsang, Michael Walsh
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:The incidence of acute kidney injury (AKI) in patients with COVID-19 and its association with mortality and disease severity is understudied in the Canadian population.Objective:To determine the incidence of AKI in a cohort of patients with COVID-19 admitted to medicine and intensive care unit (ICU) wards, its association with in-hospital mortality, and disease severity. Our aim was to stratify these outcomes by out-of-hospital AKI and in-hospital AKI.Design:Retrospective cohort study from a registry of patients with COVID-19.Setting:Three community and 3 academic hospitals.Patients:A total of 815 patients admitted to hospital with COVID-19 between March 4, 2020, and April 23, 2021.Measurements:Stage of AKI, ICU admission, mechanical ventilation, and in-hospital mortality.Methods:We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the outcomes of ICU admission, mechanical ventilation, and in-hospital mortality.Results:Of the 815 patients registered, 439 (53.9%) developed AKI, 253 (57.6%) presented with AKI, and 186 (42.4%) developed AKI in-hospital. The odds of ICU admission, mechanical ventilation, and death increased as the AKI stage worsened. Stage 3 AKI that occurred during hospitalization increased the odds of death (odds ratio [OR] = 7.87 [4.35, 14.23]). Stage 3 AKI that occurred prior to hospitalization carried an increased odds of death (OR = 5.28 [2.60, 10.73]).Limitations:Observational study with small sample size limits precision of estimates. Lack of nonhospitalized patients with COVID-19 and hospitalized patients without COVID-19 as controls limits causal inferences.Conclusions:Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk stratification.Trial registration:The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-07-12T04:37:31Z
      DOI: 10.1177/20543581211027759
      Issue No: Vol. 8 (2021)
       
  • Perioperative Outcomes Following Kidney-Pancreas Transplantation in
           Alberta, Canada: Research Letter

    • Authors: Danielle E. Fox, Robert R. Quinn, Paul E. Ronksley, Tyrone G. Harrison, Hude Quan, David Bigam, A. M. James Shapiro, Rachel Jeong, Ngan N. Lam
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Simultaneous kidney-pancreas transplantation (SPK) has benefits for patients with kidney failure and type I diabetes mellitus, but is associated with greater perioperative risk compared with kidney-alone transplantation. Postoperative care settings for SPK recipients vary across Canada and may have implications for patient outcomes and hospital resource use.Objective:To compare outcomes following SPK transplantation between patients receiving postoperative care in the intensive care unit (ICU) compared with the ward.Design:Retrospective cohort study using administrative health data.Setting:In Alberta, the 2 transplant centers (Calgary and Edmonton) have different protocols for routine postoperative care of SPK recipients. In Edmonton, SPK recipients are routinely transferred to the ICU, whereas in Calgary, SPK recipients are transferred to the ward.Patients:129 adult SPK recipients (2002-2019).Measurements:Data from the Canadian Institute for Health Information Discharge Abstract Database (CIHI-DAD) were used to identify SPK recipients (procedure codes) and the outcomes of inpatient mortality, length of initial hospital stay (LOS), and the occurrence of 16 different patient safety indicators (PSIs).Methods:We followed SPK recipients from the admission date of their transplant hospitalization until the first of hospital discharge or death. Unadjusted quantile regression was used to determine differences in LOS, and age- and sex-adjusted marginal probabilities were used to determine differences in PSIs between centers.Results:There were no perioperative deaths and no major differences in the demographic characteristics between the centers. The majority of the SPK transplants were performed in Edmonton (n = 82, 64%). All SPK recipients in Edmonton were admitted to the ICU postoperatively, compared with only 11% in Calgary. There was no statistically significant difference in the LOS or probability of a PSI between the 2 centers (LOS for Edmonton vs Calgary:16 vs 13 days, P = .12; PSIs for Edmonton vs Calgary: 60%, 95% confidence interval [CI] = 0.50-0.71 vs 44%, 95% CI = 0.29-0.59, P = .08).Limitations:This study was conducted using administrative data and is limited by variable availability. The small sample size limited precision of estimated differences between type of postoperative care.Conclusions:Following SPK transplantation, we found no difference in inpatient outcomes for recipients who received routine postoperative ICU care compared with ward care. Further research using larger data sets and interventional study designs is needed to better understand the implications of postoperative care settings on patient outcomes and health care resource utilization.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-07-10T06:43:22Z
      DOI: 10.1177/20543581211029389
      Issue No: Vol. 8 (2021)
       
  • Acute Kidney Injury and Associated Factors in Intensive Care Units at a
           Tertiary Hospital in Northern Tanzania

    • Authors: Neema W. Minja, Huda Akrabi, Karen Yeates, Kajiru Gad Kilonzo
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Acute kidney injury (AKI) is a recognized complication in critically ill patients. The epidemiology of AKI varies worldwide, depending on the diagnostic criteria used and the setting. The International Society of Nephrology has called for a reduction in preventable deaths from AKI to zero by the year 2025. It is suspected that the majority of AKI cases are in limited-resource countries, but the true burden of AKI in these settings remains unknown.Objective:We aimed to determine, using standardized KDIGO (Kidney Disease Improving Global Outcomes) criteria, the prevalence of AKI, associated factors, and clinical characteristics of adult (≥18 years) patients admitted to intensive care units (ICUs) at a tertiary hospital in Tanzania.Design:Prospective observational study from November 2017 to May 2018.Methods:In all, 320 patients admitted to medical and surgical ICUs were consecutively enrolled. Baseline, clinical, and laboratory data were collected on admission and during their ICU stay. Serum creatinine and urine output were measured, and KDIGO criteria were used to determine AKI status.Results:More than half (55.3%) of ICU patients were diagnosed with AKI. Of these, 80% were diagnosed within 24 hours of admission. Acute kidney injury stage 3 accounted for 35% of patients with AKI. Patients with AKI were older, more likely to have cardiovascular comorbidities, and with higher baseline serum levels of creatinine, potassium, universal vital assessment admission scores, and total white cell count ≥12. Sepsis (odds ratio [OR] = 3.81; confidence interval [CI] = 1.21-11.99), diabetes (OR = 2.54; CI = 1.24-5.17), and use of vasopressors (OR = 3.78; CI = 1.36-10.54) were independently associated with AKI in multivariable logistic regression. Less than one-third of those who needed dialysis received it. There was 100% mortality in those who needed dialysis but did not receive (n = 19).Limitations:Being based at a referral center, the findings do not represent the true burden of AKI in the community.Conclusion:The prevalence of AKI was very high in ICUs in Northern Tanzania. The majority of patients presented with AKI and were severely ill, suggesting late presentation, underscoring the importance of prioritizing prevention and early intervention. Further studies should explore locally suitable AKI risk scores that could be used to identify high-risk patients in the community health centers from where patients are referred.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-07-08T09:09:39Z
      DOI: 10.1177/20543581211027971
      Issue No: Vol. 8 (2021)
       
  • An Environmental Scan and Evaluation of Quality Indicators Across Canadian
           Kidney Transplant Centers

    • Authors: Tamara Glavinovic, Amanda J. Vinson, Samuel A. Silver, Seychelle Yohanna
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Kidney transplantation is the optimal treatment for an individual requiring kidney replacement therapy, resulting in improved survival and quality of life while costing the health care system less than maintenance dialysis. Achieving and maintaining a kidney transplant requires extensive coordination of several different health care services. To improve the quality of kidney transplant care, quality metrics or indicators that encompass all aspects of the individual’s journey to transplant should be measured in a standardized fashion.Objective:To identify, categorize, and evaluate strengths and weaknesses of kidney transplant quality indicators currently being used across Canada.Design:An environmental scan of quality indicators being used by kidney organizations and programs.Setting:A 16-member volunteer pan-Canadian panel with expertise in nephrology, transplant, and quality improvement.Sample:Transplant programs, as well as provincial transplant and kidney agencies across Canada.Methods:Indicators were first categorized based on the period of transplant care and then using the Institute of Medicine and Donabedian frameworks. A 4-member subcommittee rated each indicator using a modified version of the Delphi consensus technique based on the American College of Physician/Agency for Healthcare Research and Quality criteria. Consensus ratings were subsequently shared with the entire 16-member panel for additional comments.Results:We identified 46 measures related to transplant care across 7 Canadian provinces (9 referral and evaluation, 9 waitlist activity and outcomes, 6 hospitalization for transplant surgery, 12 posttransplant care, 6 organ utilization, 4 living donor). We rated 24 indicators (52%) as necessary to distinguish high-quality from low-quality care, most of which measured effective (n = 10) or efficient (n = 6) care. Only 7 (15%) of 46 indicators evaluated person-centered or equitable care. Fourteen common indicators were measured by 5 of 7 provinces, 10 of which were deemed “necessary,” measuring safe (n = 2), effective (n = 5), efficient (n = 2), and equitable (n = 1) care.Limitations:The panel lacked patient and allied health representation.Conclusions:There are a large number of kidney transplant quality indicators currently being used in Canada, some of which are common across provinces and focus primarily on measuring effective care. Person-centered and equitable care indicators were lacking, and only half of these indicators were deemed “necessary” for quality improvement. Our results should complement ongoing work to achieve national consensus on the standardization of quality indicators in kidney transplantation.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-06-28T11:46:00Z
      DOI: 10.1177/20543581211027969
      Issue No: Vol. 8 (2021)
       
  • Perspectives on Opt-Out Versus Opt-In Legislation for Deceased Organ
           Donation: An Opinion Piece

    • Authors: Karthik K. Tennankore, Scott Klarenbach, Aviva Goldberg
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.

      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-06-16T07:34:35Z
      DOI: 10.1177/20543581211022151
      Issue No: Vol. 8 (2021)
       
  • Retrospective Analysis of Tacrolimus Intrapatient Variability as a Measure
           of Medication Adherence

    • Authors: Jordana Herblum, Niki Dacouris, Michael Huang, Jeffrey Zaltzman, G. V. Ramesh Prasad, Michelle Nash, Lucy Chen
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Increased intrapatient variability (IPV) in tacrolimus levels is associated with graft rejection, de novo donor-specific antibodies, and graft loss. Medication nonadherence may be a significant contributor to high IPV.Objective:The objective of this study is to determine the utility of tacrolimus IPV in detecting nonadherence by examining the relationship between self-reported adherence and tacrolimus coefficient of variability (COV), a measure of IPV.Design:Retrospective cohort study.Setting:St. Michael’s Hospital, Toronto, Ontario.Patients:All patients who were at least 1-year post-kidney transplant as of March 31, 2019, prescribed tacrolimus as an immunosuppressant and had a self-reported adherence status. Patients were excluded from the primary analysis of examining the correlation between COV and self-reported adherence if they lacked a calculatable COV.Measurements:Self-reported adherence, COV, demographic data, transplant, and medication history.Methods:A modified Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS) administered by healthcare professionals to assess self-reported adherence was used. The COV of tacrolimus trough levels was calculated and its correlation to BAASIS response was noted. The median COV was used as a cutoff to examine the characteristics of patients deemed “high COV” and “low COV.”Results:A total of 591 patients fit the initial criteria; however, only 525 had a recent calculatable COV. Overall, 92.38% of the population were adherent by self-report. Primary analysis identified a COV of 25.2% and 29.6% in self-reported adherent and nonadherent patients, respectively, though the result was not significant (P = .2). Secondary analyses showed a significant correlation between younger age at transplant and at the time of adherence self-reporting with nonadherence (P = .01). In addition, there was a strong correlation between those nonadherent with routine post-transplant blood work and younger age (P < .01).Limitations:The limitations included modified nonvalidated BAASIS questionnaire, social desirability bias, BAASIS only administered in English, and patients with graft failure not active in clinic not being captured.Conclusions:The COV should not be used as the sole method for determining medication adherence. However, COV may have some utility in capturing individuals who are not adherent to their blood work or patients who are having a poor response to tacrolimus and should be switched to another medication.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-06-15T09:49:52Z
      DOI: 10.1177/20543581211021742
      Issue No: Vol. 8 (2021)
       
  • Predictors of Health Deterioration Among Older New Zealanders Undergoing
           Dialysis: A Three-Year Accelerated Longitudinal Cohort Study

    • Authors: Reshma Shettigar, Ari Samaranayaka, John B. W. Schollum, Emma H. Wyeth, Sarah Derrett, Robert J. Walker
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Patient involvement in dialysis decision-making is crucial, yet little is known about patient-reported outcomes over time on dialysis.Objective:To examine health-related outcomes over 24 and 36 months in an older cohort of dialysis patients.Design:The “Dialysis outcomes in those aged ≥65 years study” is a prospective longitudinal cohort study of New Zealanders with kidney failure.Setting:Three New Zealand nephrology units.Patients:Kidney failure (dialysis and predialysis) patients aged 65 or above. We have previously described outcomes after 12 months of dialysis therapy relative to baseline.Measurements:Patient-reported social and health factors using the SF-36, EQ-5D, and Kidney Symptom Score questionnaires.Methods:This article describes and compares characteristics of 120 older kidney failure patients according to whether they report “Same/better” or “Worse” health 24 and 36 months later, and identifies predictors of “worse health.” Modified Poisson regression modeling estimated relative risks (RR) of worse health.Results:Of 120 patients at 12 months, 47.5% had worse health or had died by 24 months. Of those surviving at 24 months (n = 80), 40% had “Worse health” or had died at 36 months. Variables independently associated with reduced risk of “Worse health” (24 months) were as follows: Māori ethnicity (RR = 0.44; 95% CI = 0.26-0.75), Pacific ethnicity (RR = 0.39; 95% CI = 0.33-0.46); greater social satisfaction (RR = 0.57; 95% CI = 0.46-0.7). Variables associated with an increased risk of “Worse health” were as follows: problems with usual activities (RR = 1.32; 95% CI = 1.04-1.37); pain or discomfort (RR = 1.48; 95% CI = 1.34, 1.63). At 36 months, lack of sense of community (RR = 1.41; 95% CI = 1.18-1.69), 2 or more comorbidities (RR = 1.21; 95% CI = 1.13-1.29), and problems with poor health (RR = 1.47; 95% CI = 1.41-1.54) were associated with “Worse health.”Limitations:Participant numbers restricted the number of variables able to be included in the multivariable model, and hence there may have been insufficient power to detect certain associations.Conclusions:In this study, the majority of older dialyzing patients report “Same/better health” at 24 and 36 months. Māori and Pacific people report better outcomes on dialysis. Social and/or clinical interventions aimed at improving social satisfaction, sense of community, and help with usual activities may impact favorably on the experiences for older dialysis patients.Trial registration:Australian and New Zealand clinical trials registry: ACTRN12611000024943.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-06-14T06:18:03Z
      DOI: 10.1177/20543581211022207
      Issue No: Vol. 8 (2021)
       
  • Understanding Home Hemodialysis Patient Attrition: A Cohort Study

    • Authors: Bailey Paterson, Danielle E. Fox, Chel Hee Lee, Victoria Riehl-Tonn, Elena Qirzaji, Rob Quinn, David Ward, Jennifer M. MacRae
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Home hemodialysis (HHD) offers a flexible, patient-centered modality for patients with kidney failure. Growth in HHD is achieved by increasing the number of patients starting HHD and reducing attrition with strategies to prevent the modifiable reasons for loss.Objective:Our primary objective was to describe a Canadian HHD population in terms of technique failure and time to exit from HHD in order to understand reasons for exit. Our secondary objectives include the following: (1) determining reasons for training failure, (2) reasons for early exit from HHD, and (3) timing of program exit.Design:A retrospective cohort study of incident adult HHD patients between January 1, 2013—June 30, 2020.Setting:Alberta Kidney Care South, AKC-S HHD program.Participants:Patients who started training for HHD in AKC-S.Methods:A retrospective, cohort study of incident adult HHD patients with primary outcome time on home hemodialysis, secondary outcomes include reason for train failure, time to and reasons for technique failure. Cox-proportional hazard model to determine associations between patient characteristics and technique failure. The cumulative probability of technique failure over time was reported using a competing risks model.Results:A total of 167 patients entered HHD. Training failure occurred in 20 (12%), at 3.1 [2.0, 5.5] weeks; these patients were older (P < .001) and had 2 or more comorbidities (P < .001). Reasons for HHD exit after training included transplant (35; 21%), death (8; 4.8%), and technique failure (24; 14.4%). Overall, the median time to HHD exit, was 23 months [11, 41] and the median time of technique failure was 17 months [8.9, 36]. Reasons for technique failure included: psychosocial reasons (37%) at a median time 8.9 months [7.7, 13], safety (12.5%) at 19 months [19, 36], and medical (37.5%) at 26 months [11, 50].Limitations:Small patient population with quality of data limited by the electronic-based medical record and non-standardized definitions of reasons for exit.Conclusions:Training failure is a particularly important source of patient loss. Reasons for exit differ according to duration on HHD. Early interventions aimed at reducing train failure and increasing psychosocial supports may help program growth.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-06-14T06:17:49Z
      DOI: 10.1177/20543581211022195
      Issue No: Vol. 8 (2021)
       
  • Frailty Severity and Hospitalization After Dialysis Initiation

    • Authors: David Clark, Kara Matheson, Benjamin West, Amanda Vinson, Kenneth West, Arsh Jain, Kenneth Rockwood, Karthik Tennankore
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Frailty is associated with hospitalization and mortality among dialysis patients. To now, few studies have considered the degree of frailty as a predictor of hospitalization.Objective:We evaluated whether frailty severity was associated with hospitalization after dialysis initiation.Design:Retrolective cohort study.Setting:Nova Scotia, Canada.Patients:Consecutive adult, chronic dialysis patients who initiated dialysis from January 1, 2009 to June 30, 2014, (last follow-up June, 2015).Methods:Frailty Severity, as determined by the 7-point Clinical Frailty Scale (CFS, ranging from 1 = very fit to 7 = severely frail), was measured at dialysis initiation and treated as continuous and in categories (CFS scores of 1-3, 4/5, and 6/7). Hospitalization was characterized by cumulative time admitted to hospital (proportion of days admitted/time at risk) and by the joint risk of hospitalization and death. Time at risk included time in hospital after dialysis initiation and patients were followed until transplantation or death.Results:Of 647 patients (mean age: 62 ± 15), 564 (87%) had CFS scores. The mean CFS score was 4 (“corresponding to “vulnerable”) ± 2 (“well” to “moderately frail”). In an adjusted negative binomial regression model, moderate-severely frail patients (CFS 6/7) had a >2-fold increased risk of cumulative time admitted to hospital compared to the lowest CFS category (IRR = 2.18, 95% confidence interval [CI] = 1.31-3.63). In the joint model, moderate-severely frail patients had a 61% increase in the relative hazard for hospitalization (hazard ratio [HR] = 1.61, 95% CI = 1.29-2.02) and a 93% increase in the relative hazard for death compared to the lowest CFS category (HR = 1.93, 95% CI = 1.16-3.22).Limitations:Potential unknown confounders may have affected the association between frailty severity and hospitalization given observational study design. The CFS is subjective and different clinicians may grade frailty severity differently or misclassify patients on the basis of limited availability.Conclusions:Among incident dialysis patients, a higher frailty severity as defined by the CFS is associated with both an increased risk of cumulative time admitted to hospital and joint risk of hospitalization and death.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-06-10T09:32:19Z
      DOI: 10.1177/20543581211023330
      Issue No: Vol. 8 (2021)
       
  • Cost of Potentially Preventable Hospitalizations Among Adults With Chronic
           Kidney Disease: A Population-Based Cohort Study

    • Authors: Christy Chong, James Wick, Scott Klarenbach, Braden Manns, Brenda Hemmelgarn, Paul Ronksley
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Prior studies report high hospitalization rates among patients with chronic kidney disease (CKD) and approximately 10% to 20.9% of hospitalizations are potentially preventable.Objective:To determine the rate, proportion, and cost of potentially preventable hospitalizations and whether this varied by CKD category.Design:Retrospective cohort study using population-based data.Setting:Alberta, Canada.Patients:All adults with an outpatient serum creatinine measurement between January 1 and December 31, 2017 in the Alberta Kidney Disease Network data repository.Measurements:CKD risk categories were based on measures of proteinuria (where available), eGFR, and use of dialysis. Patients were linked to administrative data to capture frequency and cost of hospital encounters and followed until death or end of study (December 31, 2018). The outcomes of interest were the rate and cost of potentially preventable hospitalizations, as identified using the Canadian Institute for Health Information (CIHI)-defined ambulatory care sensitive condition (ACSC) algorithm and a CKD-related ACSC algorithm.Methods:Unadjusted and adjusted rates per 1000-patient years, proportions, and cost attributable to preventable hospitalizations were identified for the cohort as a whole and for patients within each CKD risk category.Results:Of the 1,110,895 adults with eGFR and proteinuria measurements, 181,422 had CKD. During a median follow-up of 1 year, there were 62,023 hospitalizations among patients with CKD resulting in a total cost of $946 million CAD; 6907 (11.1%) of these hospitalizations were for CIHI-defined ACSCs while 4323 (7.0%) were for CKD-related ACSCs. Adjusted rates of hospitalization for ACSCs increased with CKD risk category and were highest among patients treated with dialysis. Among CKD patients, the total cost of potentially preventable hospitalizations was $79 million and $58 million CAD for CIHI-defined and CKD-related ACSCs (8.4% and 6.2% of total hospitalization cost, respectively).Limitations:Based on the ACSC construct, we were unable to determine if these hospitalizations were truly preventable.Conclusions:Potentially preventable hospitalizations have a substantial cost and burden on the health care system among people with CKD. Effective strategies that reduce preventable admissions among CKD patients may lead to significant cost savings.Trial registration:Not applicable—observational study design
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-06-04T10:51:28Z
      DOI: 10.1177/20543581211018528
      Issue No: Vol. 8 (2021)
       
  • The WISHED Randomized Controlled Trial: Impact of an Interactive Health
           Communication Application on Home Dialysis Use in People With Chronic
           Kidney Disease

    • Authors: Amber O. Molnar, Andrea Harvey, Michael Walsh, Arsh K. Jain, Eric Bosch, K. Scott Brimble
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:While home dialysis therapies are more cost effective and may offer improved health-related quality of life, uptake compared to in-center hemodialysis remains low.Objective:To test whether a web-based interactive health communication application (IHCA) compared to usual care would increase home dialysis use.Design:Randomized control trialSetting:Patients were recruited from 3 multidisciplinary kidney clinics across Ontario, Canada (Hamilton, Kingston, London).Patients:We included adults with advanced chronic kidney disease (CKD) followed in multidisciplinary kidney clinics. Patients who had not completed dialysis modality education, who did not have access to a home computer or the internet, who had significant hearing or vision impairment, who could not read/write/speak English, who had a medical contraindication for home dialysis, or who had selected conservative kidney care were excluded.Measurements:The primary outcome was any use of home dialysis (peritoneal dialysis or home hemodialysis) within 90 days of dialysis initiation. Secondary outcomes were social support, decision conflict and dialysis knowledge measured at baseline, 6 months and 1 year.Methods:Eligible patients were randomized to either usual care or the IHCA in addition to usual care in a 1:1 ratio. As part of usual care, all patients received education about dialysis modalities and kidney transplantation delivered by clinic nurses according to local practices. Randomization was performed using a computer-generated sequence in randomly permuted block sizes, stratified by site, and allocation occurred using sequentially numbered sealed, opaque envelopes. Participants, care providers, and outcome assessors were not blinded to the intervention. All analyses were performed blinded using an intention to treat approach. We estimated the effect of the ICHA on the odds of the primary outcome using unadjusted logistic regression models. Linear mixed models for repeated measures over time were used to analyze the impact of the IHCA on the secondary outcomes of interest.Results:We randomized 140 (usual care, n = 71; IHCA, n = 69) out of a planned 264 patients (mean [SD] age 61 [14.5] years, 65% men). Among patients randomized to the IHCA group that completed 6-month and 1-year follow-up visits, 56.8% and 71.4%, respectively, had not accessed the IHCA website within the past month. There were 23 (32.4%) and 26 (37.7%) patients in the usual care and IHCA groups who received a home dialysis therapy within 90 days of dialysis initiation (odds ratio, OR = 1.3, 95% CI = [0.6-2.5], P = .5). Among the 78 patients who initiated dialysis (n = 38 usual care, n = 40 IHCA), 60.5% and 65% in the usual care and IHCA groups received a home therapy within 90 days of dialysis initiation (OR = 1.2, 95% CI = [0.5-3.0], P = .7). Secondary outcomes did not differ by intervention group over time.Limitations:The trial was underpowered due to poor recruitment and use of the IHCA was low.Conclusions:We did not find evidence of a difference in home dialysis uptake with IHCA use, but our analyses were notably underpowered. The incorporation of greater patient engagement, qualitative research and design research, and pilot implementation may help future evaluations of strategies to improve home dialysis uptake.Trial Registration:ClinicalTrials.gov #NCT01403454, registration date: Jul 21, 2011
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-06-04T10:48:47Z
      DOI: 10.1177/20543581211019631
      Issue No: Vol. 8 (2021)
       
  • Response to “Assessment of Renal Function in Transgender Patients
           With Kidney Disease”

    • Authors: David Collister, Nathalie Saad, Emily Christie, Sofia Ahmed
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.

      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-06-04T10:46:27Z
      DOI: 10.1177/20543581211020178
      Issue No: Vol. 8 (2021)
       
  • Assessment of Renal Function in Transgender Patients With Kidney Disease

    • Authors: Joshua S. Jue, David Mikhail, Javier González, Mahmoud Alameddine
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.

      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-06-04T10:41:26Z
      DOI: 10.1177/20543581211020168
      Issue No: Vol. 8 (2021)
       
  • Assessment of Kidney Function After Transcatheter Aortic Valve Replacement

    • Authors: Orit Kliuk-Ben Bassat, Sapir Sadon, Svetlana Sirota, Arie Steinvil, Maayan Konigstein, Amir Halkin, Samuel Bazan, Ayelet Grupper, Shmuel Banai, Ariel Finkelstein, Yaron Arbel
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Transcatheter aortic valve replacement (TAVR), although associated with an increased risk for acute kidney injury (AKI), may also result in improvement in renal function.Objective:The aim of this study is to evaluate the magnitude of kidney function improvement (KFI) after TAVR and to assess its significance on long-term mortality.Design:This is a prospective single center study.Setting:The study was conducted in cardiology department, interventional unit, in a tertiary hospital.Patients:The cohort included 1321 patients who underwent TAVR.Measurements:Serum creatinine level was measured at baseline, before the procedure, and over the next 7 days or until discharge.Methods:Kidney function improvement was defined as the mirror image of AKI, a reduction in pre-procedural to post-procedural minimal creatinine of more than 0.3 mg/dL, or a ratio of post-procedural minimal creatinine to pre-procedural creatinine of less than 0.66, up to 7 days after the procedure. Patients were categorized and compared for clinical endpoints according to post-procedural renal function change into 3 groups: KFI, AKI, or preserved kidney function (PKF). The primary endpoint was long-term all-cause mortality.Results:The incidence of KFI was 5%. In 55 out of 66 patients patients, the improvement in kidney function was minor and of unclear clinical significance. Acute kidney injury occurred in 19.1%. Estimated glomerular filtration rate (eGFR)
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-06-04T10:39:36Z
      DOI: 10.1177/20543581211018029
      Issue No: Vol. 8 (2021)
       
  • A Case Report of Recurrent Hypokalemia During Pregnancies Associated With
           Nonaldosterone-Mediated Renal Potassium Loss

    • Authors: Pairach Pintavorn, Stephanie Munie
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Rationale:Geller et al reported a rare mutation in the mineralocorticoid receptor (MR) resulting in constitutive MR activity. Progesterone, normally an MR antagonist, acts as a potent agonist with this mutation. Progesterone levels can increase 100-fold during pregnancy and thus lead to increased MR activity in this setting, resulting in hypertension (HTN) and hypokalemia during pregnancy and resolution of hypokalemia after delivery.Presenting concerns:Our patient was a 33-year-old African American female with a history of pregnancy-induced HTN associated with hypokalemia during her last pregnancy. She presented with muscle weakness from profound hypokalemia complicated by nephrogenic diabetes insipidus (DI) and rhabdomyolysis.Diagnosis:Her admission potassium was 1.9 mmol/L (3.5-5.1 mmol/L) with a 24-hour urine potassium of 35 mmol per day and an unmeasurable serum aldosterone level. Her potassium normalized 1 day after delivery off potassium supplementation and amiloride, which were last given 1 day prior to her delivery. Recurrent hypokalemia from nonaldosterone-mediated renal potassium wasting during pregnancy (with normal potassium in a nongestational state) is consistent with the cases of gain-of-function mutation in MR that Geller et al report. A definite diagnosis requires genetic analysis.Interventions:Her hypokalemia was refractory to potassium replacement but quickly responded to an inhibitor of the epithelial sodium channel (ENaC), amiloride.Outcomes:Her potassium normalized on amiloride 10 mg per day and KCL 40 mEq daily during the remainder of her pregnancy, and her nephrogenic DI resolved after this correction of hypokalemia. After her delivery, her potassium remained normal off the potassium supplements and amiloride.Novel findings:Pregnancy-induced hypokalemia from an activating MR mutation has rarely been reported. Pregnancy-induced HTN is often the first differential diagnosis in a patient who develops worsening in her HTN during pregnancy. We should also consider the possibility of a gain-of-function mutation in MR in these patients who also have associated hypokalemia.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-05-29T06:47:16Z
      DOI: 10.1177/20543581211017424
      Issue No: Vol. 8 (2021)
       
  • Initial and Recurrent Hyperkalemia Events in Patients With CKD in Older
           Adults: A Population-Based Cohort Study

    • Authors: Sriram Sriperumbuduri, Eric McArthur, Gregory L. Hundemer, Mark Canney, Navdeep Tangri, Silvia J. Leon, Sara Bota, Ann Bugeja, Ayub Akbari, Greg Knoll, Manish M. Sood
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:The risk of hyperkalemia is elevated in chronic kidney disease (CKD); however, the initial and recurrent risk among older individuals is less clear.Objectives:We set out to examine the initial and 1-year recurrent risk of hyperkalemia by level of kidney function (estimated glomerular filtration rate, eGFR) in older adults (≥66 years old).Design:Population-based, retrospective cohort studySettings:Ontario, CanadaParticipants:905 167 individuals (≥66 years old) from 2008 to 2015.Measurements:Serum potassium valuesMethods:Individuals were stratified by eGFR (≥90, 60-89, 30-59, 15-29 mL/min/1.73 m2) and examined for the risk of incident hyperkalemia (K ≥ 5.5 mEq/L) using adjusted Cox proportional hazards models. The 1-year risk of recurrent hyperkalemia was examined using multivariable Andersen-Gill models.Results:Among a population of 905 167 individuals (15% eGFR ≥ 90, 58% eGFR 60-89, 25% eGFR 30-59, 3% eGFR 15-29) with a potassium measurement, there were a total of 18 979 (2.1%) individuals with hyperkalemia identified. The event rate (per 1000 person-years) and adjusted hazard ratio (HR) of hyperkalemia was inversely associated with eGFR (mL/min; eGFR >90 mL/min: 8.8, referent, 60-89 mL/min: 11.8 HR 1.41; eGFR 30-59: 39.8, HR 4.37; eGFR 15-29: 133.6, 13.65) and with an increasing urine albumin-to-creatinine ratio (ACR, mg/mmol; ACR< 3: 14, referent, ACR 3-30: 35.1, HR 1.98; ACR >30: 93.7, 4.71). The 1-year event rate and adjusted risk of recurrent hyperkalemia was similarly inversely associated with eGFR (eGFR ≥ 90: 10.1, referent, eGFR 60-89: 14.4, HR 1.47; eGFR 30-59: 54.8, HR 4.90; eGFR 15-29: 208.0, HR 12.98). Among individuals with a baseline eGFR of 30 to 59 and 15 to 29, 0.9 and 3.8% had greater than 2 hyperkalemia events. The relative risk of initial and recurrent hyperkalemia was marginally higher with RAAS blockade. Roughly 1 in 4 individuals with hyperkalemia required hospitalization the day of or within 30 days after their hyperkalemia event.Limitations:Limited to individuals aged 66 years and above.Conclusions:Patients with low eGFR are at a high risk of initial and recurrent hyperkalemia.Trial registration:N/A
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-05-27T10:21:29Z
      DOI: 10.1177/20543581211017408
      Issue No: Vol. 8 (2021)
       
  • In Search of a Better Outcome: Opting Into the Live Donor Paired Kidney
           Exchange Program

    • Authors: Amanda J. Vinson, Bryce A. Kiberd, Karthik K. Tennankore
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Live donor (LD) kidney transplantation is the best option for patients with end-stage kidney disease (ESKD). However, this may not be the best option if a patient’s donor is older and considerably smaller in weight. Patient (A) with a less than ideal donor (Donor A) might enter into a live donor paired exchange (LDPE) program with the hopes of swapping for a better-quality organ. A second patient (B) who is in the LDPE may or may not benefit from this exchange with Donor A.Methods:This medical decision analysis examines the conditions that favor Patient A entering into the LDPE compared to directly accepting a kidney from their intended donor, as well as the circumstances where Patient B also benefits by accepting a lower-quality organ.Results:Under select circumstances, a paired exchange could benefit both Patients A and B. For example, a 30-year-old Patient A with a lower-quality donor might gain 1.201.521.84 quality adjusted life years (QALYs) by entering into a LDPE for a better-quality kidney, whereas a 60-year-old Patient B might gain 0.931.031.13 QALYs by accepting Donor A’s kidney rather than waiting longer in the LDPE. The net benefit (or loss) of entering the LDPE differs by recipient age, donor organ quality, likelihood of Patient B being transplanted in LDPE, and likelihood of Patient A finding an ideal donor in the LDPE.Conclusion:This study shows there are ways to increase live donor utilization and effectiveness that require further research and potentially changes to the LDPE process.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-05-26T09:19:58Z
      DOI: 10.1177/20543581211017412
      Issue No: Vol. 8 (2021)
       
  • Acute Tubulointerstitial Nephritis in a Patient on Anti-Programmed
           Death-Ligand 1 Triggered by COVID-19: A Case Report

    • Authors: Dimitry Buyansky, Catherine Fallaha, François Gougeon, Marie-Noëlle Pépin, Jean-François Cailhier, William Beaubien-Souligny
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Rationale:Immune checkpoint inhibitors are monoclonal antibodies used in the treatment of various types of cancers. The downside of using such molecules is the potential risk of developing immune-related adverse events. Factors that trigger these autoimmune side effects are yet to be elucidated. Although any organ can potentially be affected, kidney involvement is usually rare. In this case report, we describe the first known instance of a patient being treated with an inhibitor of programmed death-ligand 1 (anti-PD-L1, a checkpoint inhibitor) who develops acute tubulointerstitial nephritis after contracting the severe acute respiratory syndrome coronavirus 2.Presenting concerns of the patient:A 62-year-old patient, on immunotherapy treatment for stage 4 squamous cell carcinoma, presents to the emergency department with symptoms of lower respiratory tract infection. Severe acute kidney injury is discovered with electrolyte imbalances requiring urgent dialysis initiation. Further testing reveals that the patient has contracted the severe acute respiratory syndrome coronavirus 2.Diagnosis:A kidney biopsy was performed and was compatible with acute tubulointerstitial nephritis.Interventions:The patient was treated with high dose corticosteroid therapy followed by progressive tapering.Outcomes:Rapid and sustained normalization of kidney function was achieved after completion of the steroid course.Novel findings:We hypothesize that the viral infection along with checkpoint inhibitor use has created a proinflammatory environment which led to a loss of self-tolerance to renal parenchyma. Viruses may play a more important role in the pathogenesis of autoimmunity in this patient population than was previously thought.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-05-19T11:12:15Z
      DOI: 10.1177/20543581211014745
      Issue No: Vol. 8 (2021)
       
  • Cerebral Perfusion in Hemodialysis Patients: A Feasibility Study

    • Authors: Jessica Anne Vanderlinden, Rachel Mary Holden, Stephen Harold Scott, John Gordon Boyd
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Patients on hemodialysis (HD) are known to exhibit low values of regional cerebral oxygenation (rSO2) and impaired cognitive functioning. The etiology of both is currently unknown.Objective:To determine the feasibility of serially monitoring rSO2 in patients initiating HD. In addition, we sought to investigate how rSO2 is related to hemodynamic and dialysis parameters.Design:Prospective observational study.Setting:Single-center tertiary academic teaching hospital in Ontario, Canada.Participants:Six patients initiating HD were enrolled in the study.Methods:Feasibility was defined as successful study enrollment (>1 patient/month), successful consent rate (>70%), high data capture rates (>90%), and assessment tolerability. Regional cerebral oxygenation monitoring was performed 1 time/wk for the first year of dialysis. A neuropsychological battery was performed 3 times during the study: before dialysis initiation, 3 months, and 1 year after dialysis initiation. The neuropsychological battery included a traditional screening tool: the Repeatable Battery for the Assessment of Neuropsychological Status, and a robot-based assessment: Kinarm.Results:Our overall consent rate was 33%, and our enrollment rate was 0.4 patients/mo. In total 243 rSO2 sessions were recorded, with a data capture rate of 91.4% (222/243) across the 6 patients. Throughout the study, no adverse interactions were reported. Correlations between rSO2 with hemodynamic and dialysis parameters showed individual patient variability. However, at the individual level, all patients demonstrated positive correlations between mean arterial pressure and rSO2. Patients who had more than 3 liters of fluid showed significant negative correlations with rSO2. Less cognitive impairment was detected after initiating dialysis.Limitation:This small cohort limits conclusions that can be made between rSO2 and hemodynamic and dialysis parameters.Conclusions:Prospectively monitoring rSO2 in patients was unfeasible in a single dialysis unit, due to low consent and enrollment rates. However, rSO2 monitoring may provide unique insights into the effects of HD on cerebral oxygenation that should be further investigated.Trial Registration:Due to the feasibility nature of this study, no trial registration was performed.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-05-07T04:57:23Z
      DOI: 10.1177/20543581211010654
      Issue No: Vol. 8 (2021)
       
  • The Impact of Clinical Presentation on Survival in Patients Requiring
           Hemodialysis Catheters for Acute and Unplanned Dialysis: A Prospective
           Observational Study

    • Authors: Benjamin Talbot, Ray Lin, Qiang Li, Min Jun, Sradha Kotwal, Shaundeep Sen, Martin Gallagher
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Most studies addressing hemodialysis initiation with a dialysis catheter focus on patients entering maintenance dialysis programs and exclude other patients, such as those with acute kidney injury (AKI), making interpretation and application of the results difficult for clinicians managing patients at the time of dialysis commencement.Objective:To compare the survival of all patients requiring a catheter for hemodialysis access according to the nature of clinical presentation.Design:Prospective observational.Setting:An Australian tertiary renal unit.Patients:All patients requiring a central venous catheter (CVC) for hemodialysis access between 2005 and 2015.Measurements:Baseline comorbidities, demographics, and nature of clinical presentation. Data regarding each episode of dialysis access insufficiency and each CVC were collected. The primary outcome was all-cause mortality.Methods:Patients were classified into 1 of 3 groups based on physician assessment at the time of presentation: patients believed to have AKI with expected renal recovery (AKI), patients considered to be entering the maintenance dialysis program without a functioning dialysis access (Maintenance Dialysis), patients unable to perform peritoneal dialysis, or use their existing hemodialysis access (Access Failure). Time-split multivariable Cox regression analyses were used to compare survival between groups.Results:A total of 557 eligible patients had complete prospective data regarding CVC use and were included in the analyses. The majority of patients were in the AKI (246/557, 44%) and Maintenance Dialysis groups (182/557, 33%) compared with the Access Failure group (129/557, 23%). During a median follow-up of 3 years, 302 (54%) of the 557 patients died. Following adjustment, risk of all-cause mortality was higher in the AKI group (hazard ratio [HR]: 2.01, 95% confidence interval [CI]: 1.31-3.60, P = .001) during the first 2 years after catheter insertion and lower in years 2 to 4 (HR: 0.42, 95% CI: 0.20-0.88, P = .02) than in the reference Maintenance Dialysis group. No difference in mortality risk between the Access Failure and reference group was found.Limitations:Single-center study. Possible residual confounding owing to the observational study design.Conclusions:Patients requiring acute or unplanned hemodialysis experience high mortality, and the nature of clinical presentation does influence outcomes. Most notable is the greater early mortality experienced by patients with AKI compared to other patient groups. Prospective definition of the nature of unplanned dialysis initiation is important to accurately measure and improve outcomes in this high-risk patient population.Human Research Ethics Committee Approval NumberCH62/6/2017-042.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-04-26T09:28:44Z
      DOI: 10.1177/20543581211009986
      Issue No: Vol. 8 (2021)
       
  • Video Visits Using the Zoom for Healthcare Platform for People Receiving
           Maintenance Hemodialysis and Nephrologists: A Feasibility Study in
           Alberta, Canada

    • Authors: Meaghan Lunney, Chandra Thomas, Doreen Rabi, Aminu K. Bello, Marcello Tonelli
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Demand for virtual visits (an online synchronous medical appointment between a health care provider and patient) is increasing due to the COVID-19 pandemic. There may be additional benefits of virtual visits as they appear to be convenient and potentially cost-saving to patients. People receiving maintenance hemodialysis require ongoing care from their nephrologist and may benefit from virtual visits; however, the optimal model for a virtual kidney clinic is unknown.Objective:To codesign and assess the feasibility of a virtual (video) kidney clinic model with clinic staff, nephrologists, and patients receiving maintenance hemodialysis, to be used for routine follow-up visits.Design:Mixed-methods study.Setting:Two main kidney clinics in central Calgary, Alberta.Participants:Adults with kidney failure receiving maintenance hemodialysis, nephrologists, and clinic staff.Methods:First, we individually interviewed clinic staff and nephrologists to assess the needs of the clinic to deliver virtual visits. Then, we used participant observation with patients and nephrologists to codesign the virtual visit model. Finally, we used structured surveys to evaluate the patients’ and nephrologists’ experiences when using the virtual model.Results:Eight video visits (8 patients; 6 nephrologists) were scheduled between October 2019 and February 2020 and 7 were successfully completed. Among completed visits, all participants reported high satisfaction with the service, were willing to use it again, and would recommend it to others. Three main themes were identified with respect to factors influencing visit success: IT infrastructure, administration, and process.Limitations:Patients received training on how to use the videoconference platform by the PhD student, whom also set up the technical components of the visit for the nephrologist. This may have overestimated the feasibility of virtual visits if this level of support is not available in future. Second, interviews were not audio-recorded and thematic analysis relied on field notes.Conclusions:Video visits for routine follow-up care between people receiving hemodialysis and nephrologists were acceptable to patients and nephrologists. Video visits appear to be feasible if clinics are equipped with appropriate equipment and IT infrastructure, physicians are remunerated appropriately, and patients receive training on how to use software as needed.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-04-26T09:25:36Z
      DOI: 10.1177/20543581211008698
      Issue No: Vol. 8 (2021)
       
  • MicroRNA in Human Acute Kidney Injury: A Systematic Review Protocol

    • Authors: Adrianna Douvris, Dylan Burger, Rosendo A. Rodriguez, Edward G. Clark, Jose Viñas, Manoj M. Lalu, Risa Shorr, Kevin D. Burns
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Acute kidney injury (AKI) is a common complication of hospitalization with high morbidity and mortality for which no effective treatments exist and for which current diagnostic tools have limitations for earlier identification. MicroRNAs (miRNAs) are small non-coding RNAs that have been implicated in the pathogenesis of AKI, and some miRNAs have shown promise as therapeutic tools in animal models of AKI. However, less is known about the role of miRNAs in human AKI.Objective:To evaluate the role of miRNAs in human subjects with AKI.Design:Systematic review and meta-analysisMeasurements:Quantification of miRNA levels from human blood, urine, or kidney biopsy samples, and measures of renal function as defined in the study protocol.Methods:A comprehensive search strategy for Ovid MEDLINE All, Embase, Web of Science, and CENTRAL will be developed to identify investigational studies that evaluated the relationship between miRNA levels and human AKI. Primary outcomes will include measurements of kidney function and miRNA levels. Study screening, review and data extraction will be performed independently by 2 reviewers. Study quality and certainty of evidence will be assessed with validated tools. A narrative synthesis will be included and the possibility for meta-analysis will be assessed according to characteristics of clinical and statistical heterogeneity between studies.Limitations:These include (1) lack of randomized trials of miRNAs for the prevention or treatment of human AKI, (2) quality of included studies, and (3) sources of clinical and statistical heterogeneity that may affect strength and reproducibility of results.Conclusion:Previous studies of miRNAs in different animal models of AKI have generated strong interest on their use for the prevention and treatment of human AKI. This systematic review will characterize the most promising miRNAs for human research and will identify methodological constraints from miRNA research in human AKI to help inform the design of future studies.Systematic review registration:PROSPERO CRD42020201253
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-04-24T11:23:19Z
      DOI: 10.1177/20543581211009999
      Issue No: Vol. 8 (2021)
       
  • Making the Correct Diagnosis in Thrombotic Microangiopathy: A Narrative
           Review

    • Authors: Philip A. McFarlane, Martin Bitzan, Catherine Broome, Dana Baran, Jocelyn Garland, Louis-Philippe Girard, Kuljit Grewal, Anne-Laure Lapeyraque, Christopher Jordan Patriquin, Katerina Pavenski, Christoph Licht
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Purpose of review:Thrombotic microangiopathy (TMA) is suspected in patients presenting with thrombocytopenia and evidence of a microangiopathic hemolytic anemia. Patients with TMA can be critically ill, so rapid and accurate identification of the underlying etiology is essential. Due to better insights into pathophysiology and causes of TMA, we can now categorize TMAs as thrombotic thrombocytopenic purpura, postinfectious (mainly Shiga toxin-producing Escherichia coli–induced) hemolytic uremic syndrome (HUS), TMA associated with a coexisting condition, or atypical HUS (aHUS). We recognized an unmet need in the medical community to guide the timely and accurate identification of TMA, the selection of tests to clarify its etiology, and the sequence of steps to initiate treatment.Sources of information:Key published studies relevant to the identification, classification, and treatment of TMAs in children or adults. These studies were obtained through literature searches conducted with PubMed or based on the prior knowledge of the authors.Methods:This review is the result of a consultation process that reflects the consensus of experts from Canada, the United States, and the United Arab Emirates. The members represent individuals who are clinicians, researchers, and teachers in pediatric and adult medicine from the fields of hematology, nephrology, and laboratory medicine.
      Authors , through an iterative review process identified and synthesized information from relevant published studies.Key findings:Thrombotic thrombocytopenic purpura occurs in the setting of insufficient activity of the von Willebrand factor protease known as ADAMTS13. Shiga toxin-producing Escherichia coli–induced hemolytic uremic syndrome, also known as “typical” HUS, is caused by gastrointestinal infections with bacteria that produce Shiga toxin (initially called verocytotoxin). A variety of clinical conditions or drug exposures can trigger TMA. Finally, aHUS occurs in the setting of inherited or acquired abnormalities in the alternative complement pathway leading to dysregulated complement activation, often following a triggering event such as an infection. It is possible to break the process of etiological diagnosis of TMA into 2 distinct steps. The first covers the initial presentation and diagnostic workup, including the processes of identifying the presence of TMA, appropriate initial tests and referrals, and empiric treatments when appropriate. The second step involves confirming the etiological diagnosis and moving to definitive treatment. For many forms of TMA, the ultimate response to therapies and the outcome of the patient depends on the rapid and accurate identification of the presence of TMA and then a standardized approach to seeking the etiological diagnosis. We present a structured approach to identifying the presence of TMA and steps to identifying the etiology including standardized lab panels. We emphasize the importance of early consultation with appropriate specialists in hematology and nephrology, as well as identification of whether the patient requires plasma exchange. Clinicians should consider appropriate empiric therapies while following the steps we have recommended toward definitive etiologic diagnosis and management of the TMA.Limitations:The evidence base for our recommendations consists of small clinical studies, case reports, and case series. They are generally not controlled or randomized and do not lend themselves to a stricter guideline-based methodology or a Grading of Recommendations Assessment, Development and Evaluation (GRADE)-based approach.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-04-22T09:34:51Z
      DOI: 10.1177/20543581211008707
      Issue No: Vol. 8 (2021)
       
  • A Quality Improvement Intervention to Enhance Access to Kidney
           Transplantation and Living Kidney Donation (EnAKT LKD) in Patients With
           Chronic Kidney Disease: Clinical Research Protocol of a Cluster-Randomized
           Clinical Trial

    • Authors: Seychelle Yohanna, Kyla L. Naylor, Istvan Mucsi, Susan McKenzie, Dmitri Belenko, Peter G. Blake, Candice Coghlan, Stephanie N. Dixon, Lori Elliott, Leah Getchell, Vincent Ki, Gihad Nesrallah, Rachel E. Patzer, Justin Presseau, Marian Reich, Jessica M. Sontrop, Darin Treleaven, Amy D. Waterman, Jeffrey Zaltzman, Amit X. Garg
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Many patients with kidney failure will live longer and healthier lives if they receive a kidney transplant rather than dialysis. However, multiple barriers prevent patients from accessing this treatment option.Objective:To determine if a quality improvement intervention provided in chronic kidney disease (CKD) programs (vs. usual care) enables more patients with no recorded contraindications to kidney transplant to complete more steps toward receiving a kidney transplant.Design:This protocol describes a pragmatic 2-arm, parallel-group, open-label, registry-based, cluster-randomized clinical trial—the Enhance Access to Kidney Transplantation and Living Kidney Donation (EnAKT LKD) trial.Setting:All 26 CKD programs in Ontario, Canada, with a trial start date of November 1, 2017. The original end date of March 31, 2021 (3.4 years) has been extended to December 31, 2021 (4.1 years) due to the COVID-19 pandemic.Participants:During the trial, the 26 CKD programs are expected to care for more than 10 000 adult patients with CKD (including patients approaching the need for dialysis and patients receiving dialysis) with no recorded contraindications to a kidney transplant.Intervention:Programs were randomly allocated to provide a quality improvement intervention or usual care. The intervention has 4 main components: (1) local quality improvement teams and administrative support; (2) tailored education and resources for staff, patients, and living kidney donor candidates; (3) support from kidney transplant recipients and living kidney donors; and (4) program-level performance reports and oversight by program leaders.Primary Outcome:The primary outcome is the number of key steps completed toward receiving a kidney transplant analyzed at the cluster level (CKD program). The following 4 unique steps per patient will be counted: (1) patient referred to a transplant center for evaluation, (2) at least one living kidney donor candidate contacts a transplant center for an intended recipient and completes a health history questionnaire to begin their evaluation, (3) patient added to the deceased donor transplant wait list, and (4) patient receives a kidney transplant from a living or deceased donor.Planned Primary Analysis:Study data will be obtained from Ontario’s linked administrative healthcare databases. An intent-to-treat analysis will be conducted comparing the primary outcome between randomized groups using a 2-stage approach. First stage: residuals are obtained from fitting a regression model to individual-level variables ignoring intervention and clustering effects. Second stage: residuals from the first stage are aggregated at the cluster level as the outcome.Limitations:It may not be possible to isolate independent effects of each intervention component, the usual care group could adopt intervention components leading to contamination bias, and the relatively small number of clusters could mean the 2 arms are not balanced on all baseline prognostic factors.Conclusions:The EnAKT LKD trial will provide high-quality evidence on whether a multi-component quality improvement intervention helps patients complete more steps toward receiving a kidney transplant.Trial registration:Clinicaltrials.gov; identifier: NCT03329521.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-04-15T12:22:15Z
      DOI: 10.1177/2054358121997266
      Issue No: Vol. 8 (2021)
       
  • Defining the Scope of Knowledge Translation Within a National,
           Patient-Oriented Kidney Research Network

    • Authors: Meghan J. Elliott, Selina Allu, Mary Beaucage, Susan McKenzie, Joanne Kappel, Rebecca Harvey, Louise Morrin, Steven Soroka, Janet Graham, Cheryl Harding, Maury Pinsk, Heather Harris, Mila Tang, Braden Manns
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Purpose of program:Integrated knowledge translation (IKT) is a collaborative approach whereby knowledge created through health research is utilized in ways that are relevant to the needs of all stakeholders. However, research teams have limited capacity and know-how for achieving IKT, resulting in a disconnect between the generation and application of knowledge. The goal of this report is to describe how IKT research was achieved across a large-scale, patient-oriented research network, Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD).Sources of information:Resources to facilitate knowledge translation (KT) planning across the network were developed by the Can-SOLVE CKD Knowledge User/Knowledge Translation Committee with reference to established Canadian KT and patient engagement tools and frameworks, review of the published and gray literature, and expertise of committee members.Methods:The Can-SOLVE CKD Knowledge User/Knowledge Translation Committee consisting of patient partners, health care providers, policymakers, and researchers provided oversight of the development and implementation of the network’s IKT initiatives. Guided by its strategic framework, the committee developed KT planning templates and review checklists to assist network projects with preparing for dissemination, implementation, and scale and spread of their interventions. The committee has acted in a consultative capacity to facilitate IKT across network initiatives and has supported capacity building through KT activities aimed at network membership and knowledge users more broadly.Key findings:The Can-SOLVE CKD Knowledge User/Knowledge Translation Committee established a nation-wide strategy for KT infrastructure and capacity building. Acting as a knowledge intermediary, the committee has connected research teams with knowledge users across Canada to support practices and policies informed by evidence generated by the network. The committee has developed KT initiatives, including a Community of Practice, whereby participants across different regions and disciplines convene regularly to share health research knowledge and communications strategies relevant to the network. Critically, patients are engaged and contribute throughout the research process. Examples of IKT activities from select projects are provided, as well as ways for sustaining the network’s KT platform.Limitations:The KT resources developed by the committee were adapted from other established resources to meet the needs of the network and have not undergone formal evaluation in this context. Given the broad scope of the network, resources to facilitate implementation and knowledge user engagement may not meet the needs of all initiatives and must be tailored accordingly. Knowledge barriers, including a lack of information and skills related to conceptual and practical aspects of KT, among network members provided a rationale for various KT capacity–building initiatives.Implications:The approach described here offers a practical method for achieving IKT, including how to plan, implement, and sustain initiatives across large-scale health research networks. Within the context of Can-SOLVE CKD, these efforts will shorten knowledge-practice gaps through producing and applying relevant research to improve the lives of people living with kidney disease.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-04-08T01:23:13Z
      DOI: 10.1177/20543581211004803
      Issue No: Vol. 8 (2021)
       
  • Starting Dialysis on Time, At Home on the Right Therapy (START):
           Description of an Intervention to Increase the Safe and Effective Use of
           Peritoneal Dialysis

    • Authors: Robert R. Quinn, Farah Mohamed, Robert Pauly, Tracy Schwartz, Nairne Scott-Douglas, Louise Morrin, Anita Kozinski, Braden J. Manns, Scott Klarenbach, Alix Clarke, Danielle E. Fox, Matthew J. Oliver
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Most of the patients with end-stage kidney failure are treated with dialysis. Jurisdictions around the world are actively promoting peritoneal dialysis (PD) because it is equivalent to hemodialysis in terms of clinical outcomes, but is less costly. Unfortunately, PD penetration remains low.Objectives:The Starting dialysis on Time, At Home, on the Right Therapy (START) Project had 2 overarching goals: (1) to provide information that would help programs increase the safe and effective use of PD, and (2) to reduce inappropriate, early initiation of dialysis in patients with kidney failure. In this article, we focus on the first objective and describe the rationale for START and the methods employed.Design:The START Project was a comprehensive, province-wide quality improvement intervention.Setting:The START project was implemented in both Alberta Kidney Care (AKC)-South and AKC-North, including all 7 renal programs in the province.Patients:The project included all patients who commenced maintenance dialysis between October 1, 2015, and March 31, 2018, in Alberta, Canada who met our inclusion criteria.Measurements:We reported baseline characteristics of incident dialysis patients overall, and by site. Our key performance indicator was the proportion of patients who received PD for any period of time within 180 days of the first dialysis treatment. Reports also included detailed metrics pertaining to the 6 steps in the process of modality selection and we had the capacity to provide more granular data on an as-needed basis. To understand loss of PD patients, we reported the numbers of incident patients who recovered kidney function, experienced technique failure, received a transplant, were lost to follow-up, transferred to another program, or died.Methods:START provided dialysis programs with a conceptual framework for understanding the drivers of PD utilization. High-quality, detailed data were collected using a tool that was custom-built for this purpose, and were mapped to steps in the process of care that drove the outcomes of interest. This allowed sites to identify gaps in care, develop action plans, and implement local interventions to address them. The process was supported by an Innovation Learning Collaborative consisting of 3 learning sessions that brought frontline staff together from across the province to share strategies and learnings. Ongoing data collection allowed teams to determine whether their interventions were effective at each subsequent learning session, and to revisit their interventions if required (the “Plan-Do-Study-Act Cycle”).Results:Future work will report on the impact of the START project on incident PD utilization at a provincial and regional level.Limitations:The time required to design and implement interventions in practice, as well as the need for multiple PDSA (Plan-Do-Study-Act) cycles to see results, meant that the true potential may not be realized during a relatively short intervention period. Change required buy-in and support from local and provincial leadership and frontline staff. In the absence of accountability for local performance, we relied on the goodwill of participating programs to use the information and resources provided to effect change. Finally, the burden of documentation and data collection for frontline staff was high at baseline. We anticipated that adding supplemental data collection would be difficult.Conclusions:The START project was a comprehensive, province-wide initiative to maximize the safe and effective use of PD in Alberta, Canada. It standardized the management of incident dialysis patients, leveraged high-quality data to facilitate the reporting of metrics mapped to steps in the process of care that drove incident PD utilization, and helped programs to identify gaps in care and target them for improvement. Future work will report on the impact of the program on incident utilization at the provincial and regional level.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-03-31T11:14:52Z
      DOI: 10.1177/20543581211003764
      Issue No: Vol. 8 (2021)
       
  • Prophylactic or Early Use of Eculizumab and Graft Survival in Kidney
           Transplant Recipients With Atypical Hemolytic Uremic Syndrome in the
           United States: Research Letter

    • Authors: Richard A. Plasse, Stephen W. Olson, Christina M. Yuan, Lawrence Y. Agodoa, Kevin C. Abbott, Robert Nee
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Introduction:Among kidney transplant recipients (KTRs) with end-stage kidney disease (ESKD) due to atypical hemolytic uremic syndrome (aHUS), recurrence is associated with poor allograft outcomes. We compared graft and patient survival of aHUS KTRs with and without prophylactic/early use of eculizumab, a monoclonal antibody that binds complement protein C5, at the time of transplantation.Methods:We conducted a retrospective cohort study using the United States Renal Data System. Out of 123 624 ESKD patients transplanted between January 1, 2008, and June 1, 2016, we identified 348 (0.28%) patients who had “hemolytic uremic syndrome” as the primary cause of ESKD. We then linked these patients to datasets containing the Healthcare Common Procedure Coding System (HCPCS) code for eculizumab infusion. Patients who received eculizumab prior to or within 30 days of transplant represented the exposure group. We calculated crude incidence rates and conducted exact logistic regression, adjusted for recipient age and sex, for the study outcomes of graft loss, death-censored graft loss, and mortality. We also estimated the average treatment effect (ATE) by propensity-score matching, to reduce the bias in the estimated treatment effect on graft loss.Results:Our final study cohort included 335 aHUS KTRs (23 received eculizumab, 312 did not), with a mean duration of follow-up of 5.8 ± 2.7 years. There were no significant differences in baseline demographic and clinical characteristics between the eculizumab versus non-eculizumab group. Patients who received prophylactic/early eculizumab were less likely to experience graft loss compared with those who did not receive eculizumab (0% vs 20%, P = .02), with an adjusted odds ratio of 0.13 (P = .02). In the propensity-score-matched sample, the ATE (eculizumab vs non-eculizumab) was −0.20 (95% confidence interval [CI] = −0.25 to −0.15, P < .001); thus, treatment was associated with an average of 20% reduction in graft loss. There was no significant difference in the risk of death between the 2 groups.Conclusions:Although there was no significant difference in the risk of death, prophylactic/early use of eculizumab was significantly associated with improved graft survival among aHUS KTRs. Given the high cost of eculizumab, randomized controlled trials are much needed to guide prophylactic strategies to prevent graft loss.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-03-31T11:10:04Z
      DOI: 10.1177/20543581211003763
      Issue No: Vol. 8 (2021)
       
  • Kidney Check Point-of-Care Testing—Furthering Patient Engagement and
           Patient-Centered Care in Canada’s Rural and Remote Indigenous
           Communities: Program Report

    • Authors: Sarah Curtis, Heather Martin, Michelle DiNella, Barry Lavallee, Caroline Chartrand, Lorraine McLeod, Cathy Woods, Allison Dart, Navdeep Tangri, Claudio Rigatto, Paul Komenda
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Purpose of program:Access to health care services remains a significant barrier for many Indigenous people’s living in rural and remote regions of Canada. Driven by geographical isolation and compounded by socioeconomic and environmental disparities, individuals living under these circumstances face disproportionately poor health outcomes. Kidney Check is a comprehensive screening, triage, and treatment initiative working to bring culturally safe preventive care to rural and remote Indigenous communities across Manitoba, Ontario, BC, Alberta, and Saskatchewan. The project’s patient-oriented approach addresses concerns raised by kidney patients and their caregivers using culturally safe practices. Using the various expertise of their multidisciplinary team, Kidney Check seeks to further collaborative efforts to improve access to preventive health care for these groups. Meaningful engagement with patients, communities, and local health care stakeholders ensures Indigenous voices are heard and incorporated into the project in a way that promotes shared decision-making and sustainability.Sources of information:As an affiliate program of the Can-SOLVE CKD Network, Kidney Check’s guiding priorities were developed over 3 years of patient consultation and finalized during 2 workshops held with more than 30 patients, caregivers, Indigenous peoples, researchers, and policy makers using a modified Delphi process. Today, patients continue to participate in project development via 2 governing bodies: The Patient Governance Circle and the Indigenous Peoples Engagement and Research Council (IPERC).Methods:Modeled after the Indigenous-led 2015 FINISHED project in Manitoba, Kidney Check employs point-of-care testing to identify diabetes, hypertension, and chronic kidney disease (CKD) in individuals, ages 10 and above, regardless of pre-existing risk factors. The Kidney Check team consists of 4 working groups: project leadership, provincial management, local community partners, and patient partners. By using and building on existing relationships between local and provincial health care stakeholders and various Indigenous communities, the program furthers collaborative efforts to bridge gaps in health equity.Key findings:The Kidney Check program has established an infrastructure that integrates patient engagement at all stages of the program from priority setting to deployment and dissemination strategies.Limitations:While we encourage and offer screening services to all, many still choose not to attend for a variety of reasons which may introduce selection bias. Kidney Check uses patient engagement as a foundational component of the program; however, there is currently a limited amount of research documenting the benefits of patient engagement in health care settings. More formal qualitative evaluations of these activities are needed. In addition, as the COVID-19 pandemic has halted screening procedures in most communities, we currently do not have quantitative data to support the efficacy of the Kidney Check program.Implications:For many Indigenous people, lack of accessibility to health care services is compounded by sociopolitical barriers that disrupt relationships between patients and providers. Meaningful engagement presents one opportunity to ensure the voices and perspectives of Indigenous patients and communities are incorporated into health services. In addition, this screening paradigm has shown to be cost effective as shown by analyses done on the FINISHED screening program.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-03-31T11:07:43Z
      DOI: 10.1177/20543581211003744
      Issue No: Vol. 8 (2021)
       
  • Risk of Hospital Encounters With Kidney Stones in Autosomal Dominant
           Polycystic Kidney Disease: A Cohort Study

    • Authors: Vinusha Kalatharan, Blayne Welk, Danielle M. Nash, Stephanie N. Dixon, Justin Slater, York Pei, Sisira Sarma, Amit X. Garg
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:There is a perception that patients with autosomal dominant polycystic kidney disease (ADPKD) are more likely to develop kidney stones than the general population.Objective:To compare the rate of hospital encounter with kidney stones and the rate of stone interventions between patients with and without ADPKD.Design:Retrospective cohort study.Setting:Ontario, Canada.Patients:Patients with and without ADPKD who had a prior hospital encounter between 2002 and 2016.Measurements:Rate of hospital encounter with kidney stones and rate of stone intervention.Methods:We used inverse probability exposure weighting based on propensity scores to balance baseline indicators of health between patients with and without ADPKD. We followed each patient until death, emigration, outcomes, or March 31, 2017. We used a Cox proportional hazards model to compare event rates between the two groups.Results:Patients with ADPKD were at higher risk of hospital encounter with stones compared with patients without ADPKD (81 patients of 2094 with ADPKD [3.8%] vs 60 patients of 1902 without ADPKD [3.2%]; 8.9 vs 5.1 events per 1000 person-years; hazard ratio 1.6 [95% CI, 1.3-2.1]). ADPKD was not associated with a higher risk of stone intervention (49 of 2094 [2.3%] vs 47 of 1902 [2.4%]; 5.3 vs 3.9 events per 1000 person-years; hazard ratio 1.2 [95% CI = 0.9-1.3]).Limitations:We did not have information on kidney stone events outside of the hospital. There is a possibility of residual confounding.Conclusion:ADPKD was a significant risk factor for hospital encounters with kidney stones.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-03-16T10:13:33Z
      DOI: 10.1177/20543581211000227
      Issue No: Vol. 8 (2021)
       
  • The Association Between Estimated Glomerular Filtration Rate and
           Hospitalization for Fatigue: A Population-Based Cohort Study

    • Authors: Janine F. Farragher, Jianguo Zhang, Tyrone G. Harrison, Pietro Ravani, Meghan J. Elliott, Brenda Hemmelgarn
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Fatigue is a pervasive symptom among patients with chronic kidney disease (CKD) that is associated with several adverse outcomes, but the incidence of hospitalization for fatigue is unknown.Objective:To explore the association between estimated glomerular filtration rate (eGFR) and incidence of hospitalization for fatigue.Design:Population-based retrospective cohort study using a provincial administrative dataset.Setting:Alberta, Canada.Patients:People above age 18 who had at least 1 outpatient serum creatinine measurement taken in Alberta between January 1, 2009, and December 31, 2016.Measurements:The first outpatient serum creatinine was used to estimate GFR. Hospitalization for fatigue was identified using International Classification of Diseases, Tenth Revision (ICD-10) code R53.x.Methods:Patients were stratified by CKD category based on their index eGFR. We used negative binomial regression to determine if there was an increased incidence of hospitalization for fatigue by declining kidney function (reference eGFR ≥ 60 mL/min/1.73m2). Estimates were stratified by age, and adjusted for age, sex, socioeconomic status, and comorbidity.Results:The study cohort consisted of 2 823 270 adults, with a mean age of 46.1 years and median follow-up duration of 6.0 years; 5 422 hospitalizations for fatigue occurred over 14 703 914 person-years of follow-up. Adjusted rates of hospitalization for fatigue increased with decreasing kidney function, across all age strata. The highest rates were seen in adults on dialysis (adjusted incident rate ratios 24.47, 6.66, and 3.13 for those aged 18 to 64, 65 to 74, and 75+, respectively, compared with eGFR ≥ 60 mL/min/1.73m2).Limitations:Fatigue hospitalization codes have not been validated; reference group limited to adults with at least 1 outpatient serum creatinine measurement; remaining potential for residual confounding.Conclusions:Declining kidney function was associated with increased incidence of hospitalization for fatigue. Further research into ways to address fatigue in the CKD population is warranted.Trial Registration:Not applicable (not a clinical trial).
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-03-16T10:11:34Z
      DOI: 10.1177/20543581211001224
      Issue No: Vol. 8 (2021)
       
  • Living Well With Kidney Disease by Patient and Care-Partner Empowerment:
           Kidney Health for Everyone Everywhere

    • Authors: Kamyar Kalantar-Zadeh, Philip Kam-Tao Li, Ekamol Tantisattamo, Latha Kumaraswami, Vassilios Liakopoulos, Siu-Fai Lui, Ifeoma Ulasi, Sharon Andreoli, Alessandro Balducci, Sophie Dupuis, Tess Harris, Anne Hradsky, Richard Knight, Sajay Kumar, Maggie Ng, Alice Poidevin, Gamal Saadi, Allison Tong
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Living with chronic kidney disease (CKD) is associated with hardships for patients and their care-partners. Empowering patients and their care-partners, including family members or friends involved in their care, may help minimize burden and consequences of CKD-related symptoms to enable life participation. There is a need to broaden the focus on living well with kidney disease and re-engagement in life, including emphasis on patients being in control. The World Kidney Day (WKD) Joint Steering Committee has declared 2021 the year of “Living Well with Kidney Disease” in an effort to increase education and awareness on the important goal of patient empowerment and life participation. This calls for the development and implementation of validated patient-reported outcome measures to assess and address areas of life participation in routine care. It could be supported by regulatory agencies as a metric for quality care or to support labeling claims for medicines and devices. Funding agencies could establish targeted calls for research that address the priorities of patients. Patients with kidney disease and their care-partners should feel supported to live well through concerted efforts by kidney care communities including during pandemics. In the overall wellness program for kidney disease patients, the need for prevention should be reiterated. Early detection with prolonged course of wellness despite kidney disease, after effective secondary and tertiary prevention programs, should be promoted. WKD 2021 continues to call for increased awareness of the importance of preventive measures throughout populations, professionals, and policy makers, applicable to both developed and developing countries.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-03-10T05:19:09Z
      DOI: 10.1177/2054358121995276
      Issue No: Vol. 8 (2021)
       
  • Barriers to Accessing Kidney Transplantation Among Populations
           Marginalized by Race and Ethnicity in Canada: A Scoping Review Part
           1—Indigenous Communities in Canada

    • Authors: Noor El-Dassouki, Dorothy Wong, Deanna M. Toews, Jagbir Gill, Beth Edwards, Ani Orchanian-Cheff, Mary Smith, Paula Neves, Lydia-Joi Marshall, Istvan Mucsi
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Kidney transplantation (KT), a treatment option for end-stage kidney disease (ESKD), is associated with longer survival and improved quality of life compared with dialysis. Inequities in access to KT, and specifically, living donor kidney transplantation (LDKT), have been documented in Canada along various demographic dimensions. In this article, we review existing evidence about inequitable access and barriers to KT and LDKT for patients from Indigenous communities in Canada.Objective:To characterize the current state of literature on access to KT and LDKT among Indigenous communities in Canada and to answer the research question, “what factors may influence inequitable access to KT among Indigenous communities in Canada.”Eligibility criteria:Databases and gray literature were searched in June and November 2020 for full-text original research articles or gray literature resources addressing KT access or barriers in Indigenous communities in Canada. A total of 26 articles were analyzed thematically.Sources of evidence:Gray literature and CINAHL, OVID Medline, OVID Embase, and Cochrane databases.Charting methods:Literature characteristics were recorded and findings which described rates of and factors that influence access to KT were summarized in a narrative account. Key themes were subsequently identified and synthesized thematically in the review.Results:Indigenous communities in Canada experience various barriers in accessing culturally safe medical information and care, resulting in inequitable access to KT. Barriers include insufficient incorporation of Indigenous ways of knowing and being in information dissemination and care for ESKD and KT, spiritual concerns, health beliefs, logistical hurdles to accessing care, and systemic mistrust resulting from colonialism and systemic racism.Limitations:This review included studies that used various methodologies and did not assess study quality. Data on Indigenous status were not reported or defined in a standardized manner. Indigenous communities are not homogeneous and views on organ donation and KT vary by individual.Conclusions:Our scoping review has identified potential barriers that Indigenous communities may face in accessing KT and LDKT. Further research is urgently needed to better understand barriers and support needs and to develop strategies to improve equitable access to KT and LDKT for Indigenous populations in Canada.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-03-03T11:31:37Z
      DOI: 10.1177/2054358121996835
      Issue No: Vol. 8 (2021)
       
  • Barriers to Accessing Kidney Transplantation Among Populations
           Marginalized by Race and Ethnicity in Canada: A Scoping Review Part
           2—East Asian, South Asian, and African, Caribbean, and Black Canadians

    • Authors: Noor El-Dassouki, Dorothy Wong, Deanna M. Toews, Jagbir Gill, Beth Edwards, Ani Orchanian-Cheff, Paula Neves, Lydia-Joi Marshall, Istvan Mucsi
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Kidney transplantation (KT), a treatment option for end-stage kidney disease (ESKD), is associated with longer survival and improved quality of life compared with dialysis. Inequities in access to KT, and specifically, living donor kidney transplantation (LDKT), have been documented in Canada, along various demographic dimensions. In this article, we review existing evidence about inequitable access to KT and LDKT for patients from communities marginalized by race and ethnicity in Canada.Objective:To characterize the currently published data on rates of KT and LDKT among East Asian, South Asian, and African, Caribbean, and Black (ACB) Canadian communities and to answer the research question, “what factors may influence inequitable access to KT among East Asian, South Asian, and ACB Canadian communities'.”Eligibility criteria:Databases and gray literature were searched in June and November 2020 for full-text original research articles or gray literature resources addressing KT access or barriers in East Asian, South Asian, and ACB Canadian communities. A total of 25 articles were analyzed thematically.Sources of evidence:Gray literature and CINAHL, OVID Medline, OVID Embase, and Cochrane databases.Charting methods:Literature characteristics were recorded and findings which described rates of and factors that influence access to KT were summarized in a narrative account. Key themes were subsequently identified and synthesized thematically in the review.Results:East Asian, South Asian, and ACB communities in Canada face barriers in accessing culturally appropriate medical knowledge and care and experience inequitable access to KT. Potential barriers include gaps in knowledge about ESKD and KT, religious and spiritual concerns, stigma of ESKD and KT, health beliefs, social determinants of health, and experiences of systemic racism in health care.Limitations:This review included literature that used various methodologies and did not assess study quality. Data on ethnicity and race were not reported or defined in a standardized manner. The communities examined in this review are not homogeneous and views on organ donation and KT vary by individual.Conclusions:Our review has identified potential barriers for communities marginalized by race and ethnicity in accessing KT and LDKT. Further research is urgently needed to better understand the barriers and support needs of these communities, and to develop strategies to improve equitable access to LDKT for the growingly diverse population in Canada.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-03-03T11:28:38Z
      DOI: 10.1177/2054358121996834
      Issue No: Vol. 8 (2021)
       
  • Hemodialysis vs Peritoneal Dialysis: Comparison of Net Survival in
           Incident Patients on Chronic Dialysis in Colombia

    • Authors: Lina Herrera, Fabián Gil, Mauricio Sanabria
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:In the area of nephrology, the practical application of relative survival methodologies can provide information regarding the impact of outcomes for patients with kidney failure on dialysis compared with what would be expected in the absence of this condition.Objective:Compare the net survival of hemodialysis (HD) and peritoneal dialysis (PD) patients in a cohort of incident patients on chronic dialysis in Colombia, according to the dialysis therapy modality.Design:Observational, analytic, historical cohort.Setting:Renal Therapy Services (RTS) clinic network across Colombia.Patients:Patients over 18 years old with chronic kidney disease, incidents in dialytic therapy, which reached day 90 of therapy. Recruitment took place from January 1, 2008, to December 31, 2013, with a follow-up until December 31, 2018. The final cohort for analysis corresponds to a total of 12 508 patients, of which 5330 patients (42.6%) began HD and 7178 patients (57.4%) began PD.Measurements:Demographic, socioeconomic, and clinical variables were measured.Methods:Analyses were conducted according to the treatment assigned (PD or HD) at the time of the inception of the cohort and another approach of analysis was done with a subsample of those patients who never changed the initial modality. To calculate expected survival, life tables were constructed for Colombia for the years 2006 to 2018. Net survival estimates were made using the Pohar Perme estimator. The comparison of the net survival curves was done using the method developed by Pavlič and Perme, the log-rank type.Results:Net survival at 5 years compared with the general population was estimated at 0.53 (95% confidence interval 0.52-0.54) in the dialysis cohort. In intention-to-treat analyses of 7178 patients on PD and 5330 patients on HD, by global and Pohar-Perme methods, survival (expressed as a ratio of survival in patients on dialysis to survival in an age-, sex- and geographic-matched general Colombian population) was higher in patients on HD than in those on PD. In year 1, net survival by Pavlov-Perme on PD was 0.79 (95% confidence intervals [CI] 0.78 - 0.80) and on HD 0.85 (95% CI 0.84 - 0.86); in year 5, 0.36 (95% CI 0.34 – 0.38) and 0.57 (95% CI 0.55 – 0.59) for PD and HD respectively.Limitation:There may be imbalances among the populations analyzed (HD vs PD), in which one or more variables other than the type of therapy may influence the survival of the patients. In Colombia there are marginal levels of underreporting of demographic data in some subpopulations that may affect life-tables construction.Conclusion:An important difference was observed in terms of survival between the dialysis population and the population of reference without dialysis. Statistically significant differences were found in net survival between HD and PD, net survival was higher in patients on HD than in those on PD.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-03-02T06:40:57Z
      DOI: 10.1177/2054358120987055
      Issue No: Vol. 8 (2021)
       
  • Cannabis and Cigarette Use Before and After Living Kidney Donation

    • Authors: Ann Bugeja, Ieta Shams, Sophie Harris, Edward G. Clark, Kevin D. Burns, Manish M. Sood, Ayub Akbari
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:It is unclear whether kidney donation leads to lifestyle changes in terms of cannabis and cigarette use.Objective:To describe cigarette and cannabis use before and after kidney donation and to determine their associations with lifestyle and clinical factors.Design:Retrospective cohort study.Setting:The Living Kidney Donor program in the Champlain Local Health Integration Network at The Ottawa Hospital in Ottawa, Canada.Patients:The study included 178 living kidney donors who donated between January 2009 and December 2018.Measurements:Donors were screened for cannabis and cigarette use by telephone interview. Their clinical characteristics and changes in kidney function before and after donation were recorded.Methods:Cannabis and cigarette use before and after kidney donation were compared using chi-square test. Risk factors associated with their use was examined by univariate and multivariate logistic regression. Wilcoxon rank sum test was used to examine the association of cannabis and Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) estimated glomerular filtration rate (eGFR) at donation and at last follow-up. T-test was used to examine the association of cigarette smoking and CKD-EPI eGFR at donation and at last follow-up.Results:Among 305 donors, 262 met inclusion criteria and 178 participated (mean of 4.7 ± 2.9 years from kidney donation). Cannabis and cigarette use were reported by 5% (9 of 178) and 13% (23 of 178) at donation. After donation, 8% (14 of 178) and 5% (9 of 178) started cannabis and cigarettes, respectively; 74% (17 of 23) of smokers remained smokers after donation and 88% (53 of 60) who quit smoking before donation did not restart after donation. In multivariate analysis, non-married/common-in-law status was associated with cannabis use (odds ratio, 2.73; 95% confidence interval, 1.05-7.11; P = .04). There was no difference in eGFR pre- or post-donation among cannabis or cigarette users.Limitations:The single-center study design limits generalizability. Social desirability bias may have affected survey responses and cigarette smoking was not quantified.Conclusions:Cannabis and cigarette use was uncommon in the studied population and was not associated with remaining kidney function. Cannabis use increased post-donation. Most smokers remained smokers after donation and most donors who quit smoking before donation did not restart after donation. This warrants education and support for potential donors who smoke, to quit smoking prior to donation to reduce risks of cardiovascular and end-stage kidney disease.Trial Registration:Not applicable as this is not a clinical trial.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-02-27T11:06:16Z
      DOI: 10.1177/2054358121997243
      Issue No: Vol. 8 (2021)
       
  • Defining Quality Criteria for Success in Organ Donation Programs: A
           Scoping Review

    • Authors: Vanessa Silva e Silva, Janine Schirmer, Bartira D’Aguiar Roza, Priscilla Caroliny de Oliveira, Sonny Dhanani, Joan Almost, Markus Schafer, Joan Tranmer
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Well-established performance measures for organ donation programs do not fully address the complexity and multifactorial nature of organ donation programs such as the influence of relationships and organizational attributes.Objective:To synthesize the current evidence on key organizational attributes and processes of international organ donation programs associated with successful outcomes and to generate a framework to categorize those attributes.Design:Scoping Review using a mixed methods approach for data extraction.Setting:Databases included PubMed, CINAHL, Embase, LILACS, ABI Business ProQuest, Business Source Premier, and gray literature (organ donation association websites, Google Scholar—first 8 pages), and searches for gray literature were performed, and relevant websites were perused.Sample:Organ donation programs or processes.Methods:We systematically searched the literature to identify any research design, including text and opinion papers and unpublished material (research data, reports, institutional protocols, government documents, etc). Searches were completed on January 2018, updated it in May 2019, and lastly in March 2020. Title, abstracts, and full texts were screened independently by 2 reviewers with disagreements resolved by a third. Data extraction followed a mixed method approach in which we extracted specific details about study characteristics such as type of research, year of publication, origin/country of study, type of journal published, and key findings. Studies included considered definitions and descriptions of success in organ donation programs in any country by considering studies that described (1) attributes associated with success or effectiveness, (2) organ donation processes, (3) quality improvement initiatives, (4) definitions of organ donation program effectiveness, (5) evidence-based practices in organ donation, and (6) improvements or success in such programs. We tabulated the type and frequency of the presence or absence of reported improvement quality indicators and used a qualitative thematic analysis approach to synthesize results.Results:A total of 84 articles were included. Quantitative analysis identified that most of the included articles originated from the United States (n = 32, 38%), used quantitative approaches (n = 46, 55%), and were published in transplant journals (n = 34, 40.5%). Qualitative analysis revealed 16 categories that were described as positively influencing success/effectiveness of organ donation programs. Our thematic analysis identified 16 attributes across the 84 articles, which were grouped into 3 categories influencing organ donation programs’ success: context (n = 39, 46%), process (n = 48, 57%), and structural (n = 59, 70%).Limitations:Consistent with scoping review methodology, the methodological quality of included studies was not assessed.Conclusions:This scoping review identified a number of factors that led to successful outcomes. However, those factors were rarely studied in combination representing a gap in the literature. Therefore, we suggest the development and reporting of primary research investigating and measuring those attributes associated with the performance of organ donation programs holistically.Trial Registration:Not applicable.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-02-20T10:28:42Z
      DOI: 10.1177/2054358121992921
      Issue No: Vol. 8 (2021)
       
  • The Prevalence and Severity of Chronic Pain in Patients With Chronic
           Kidney Disease: A Systematic Review and Meta-Analysis

    • Authors: Sara N. Davison, Sarah Rathwell, Sunita Ghosh, Chelsy George, Ted Pfister, Liz Dennett
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Chronic pain is a common and distressing symptom reported by patients with chronic kidney disease (CKD). Clinical practice and research in this area do not appear to be advancing sufficiently to address the issue of chronic pain management in patients with CKD.Objectives:To determine the prevalence and severity of chronic pain in patients with CKD.Design:Systematic review and meta-analysis.Setting:Interventional and observational studies presenting data from 2000 or later. Exclusion criteria included acute kidney injury or studies that limited the study population to a specific cause, symptom, and/or comorbidity.Patients:Adults with glomerular filtration rate (GFR) category 3 to 5 CKD including dialysis patients and those managed conservatively without dialysis.Measurements:Data extracted included title, first author, design, country, year of data collection, publication year, mean age, stage of CKD, prevalence of pain, and severity of pain.Methods:Databases searched included MEDLINE, CINAHL, EMBASE, and Cochrane Library, last searched on February 3, 2020. Two reviewers independently screened all titles and abstracts, assessed potentially relevant articles, and extracted data. We estimated pooled prevalence of overall chronic pain, musculoskeletal pain, bone/joint pain, muscle pain/soreness, and neuropathic pain and the I2 statistic was computed to measure heterogeneity. Random effects models were used to account for variations in study design and sample populations and a double arcsine transformation was used in the model calculations to account for potential overweighting of studies reporting either very high or very low prevalence measurements. Pain severity scores were calibrated to a score out of 10, to compare across studies. Weighted mean severity scores and 95% confidence intervals were reported.Results:Sixty-eight studies representing 16 558 patients from 26 countries were included. The mean prevalence of chronic pain in hemodialysis patients was 60.5%, and the mean prevalence of moderate or severe pain was 43.6%. Although limited, pain prevalence data for peritoneal dialysis patients (35.9%), those managed conservatively without dialysis (59.8%), those following withdrawal of dialysis (39.2%), and patients with earlier GFR category of CKD (61.2%) suggest similarly high prevalence rates.Limitations:Studies lacked a consistent approach to defining the chronicity and nature of pain. There was also variability in the measures used to determine pain severity, limiting the ability to compare findings across populations. Furthermore, most studies reported mean severity scores for the entire cohort, rather than reporting the prevalence (numerator and denominator) for each of the pain severity categories (mild, moderate, and severe). Mean severity scores for a population do not allow for “responder analyses” nor allow for an understanding of clinically relevant pain.Conclusions:Chronic pain is common and often severe across diverse CKD populations providing a strong imperative to establish chronic pain management as a clinical and research priority. Future research needs to move toward a better understanding of the determinants of chronic pain and to evaluating the effectiveness of pain management strategies with particular attention to the patient outcomes such as overall symptom burden, physical function, and quality of life. The current variability in the outcome measures used to assess pain limits the ability to pool data or make comparisons among studies, which will hinder future evaluations of the efficacy and effectiveness of treatments. Recommendations for measuring and reporting pain in future CKD studies are provided.Trial registration:PROSPERO Registration number CRD42020166965
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-02-19T09:59:00Z
      DOI: 10.1177/2054358121993995
      Issue No: Vol. 8 (2021)
       
  • Pharmacokinetics of Tobramycin Administered at the Beginning of
           Intermittent Hemodialysis Session (ESRD Study)

    • Authors: Marjolaine Giroux, Nicolas Bouchard, Anik Henderson, Lesly Lam, Van Anh Sylvie Tran, Denis Projean, Jean-François Tessier, Laurence Lepage, Paul Gavra, Georges Ouellet, Michel Vallée, Jean-Philippe Lafrance
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background and Objectives:There is a renewed interest in the successful use of aminoglycosides due to increasing resistance in gram-negative infections. Few studies to date have examined the pharmacokinetics (PK) of intradialytic infusions of tobramycin. This study sought to characterize the pharmacokinetic profile of intradialytically administered tobramycin in infected patients receiving chronic intermittent hemodialysis and to determine whether it is possible to achieve favorable PK targets.Design, Setting, Participants, and Measurements:In this prospective pharmacokinetic study, a single dose (5 mg/kg) of tobramycin was administered intradialytically to 11 noncritically ill patients undergoing chronic intermittent hemodialysis. Blood samples were collected at selected time to determine tobramycin serum concentrations. The PK analysis was performed using Phoenix™ NLME. The efficacy exposure outcome for nonsevere gram-negative infections sensitive to tobramycin with a minimum inhibitory concentration ≤1 were maximum concentration (Cmax ≥ 10 mg/L) and area under the curve (AUC24 h > 30 mg⋅h/L). For toxicity, the goal was to identify plasma trough concentrations
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-02-19T09:58:47Z
      DOI: 10.1177/2054358120987061
      Issue No: Vol. 8 (2021)
       
  • Maintaining the Uptake of Peritoneal Dialysis During the COVID-19
           Pandemic: A Research Letter

    • Authors: Mark Canney, Lee Er, John Antonsen, Michael Copland, Rajinder Suneet Singh, Adeera Levin
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Due to inherent challenges in maintaining physical distancing in hemodialysis units, the Canadian Society of Nephrology has recommended peritoneal dialysis as the preferred modality for patients requiring maintenance dialysis during the coronavirus disease 19 (COVID-19) pandemic. However, pursuing peritoneal dialysis is not without risk due to the requirement for in-person contact during catheter insertion and training, and there is a paucity of data regarding the experience of peritoneal dialysis during the early phases of the pandemic.Objective:To examine the incidence and outcomes of peritoneal dialysis between March 17 and June 01, 2020 compared to the same time period in preceding years.Design:Retrospective observational study.Setting:British Columbia, Canada. After the pandemic was declared on March 17, 2020, patients continued to be trained in peritoneal dialysis. In an effort to limit time spent in hospital, patients were preferentially trained in continuous ambulatory peritoneal dialysis, training times were truncated for some patients, and peritoneal dialysis catheters were inserted by a physician at the bedside whenever feasible.Patients:All patients aged >18 years who started chronic maintenance dialysis during the period March 17 to June 01 in the years 2018 to 2020 inclusive. The time period was extended to include the years 2010 to 2020 inclusive to evaluate longer term trends in dialysis incidence.Measurements:A provincial clinical information system was used to capture the date of commencing dialysis, dialysis modality, and complications including peritonitis. Overall uptake of peritoneal dialysis included new starts and transitions to peritoneal dialysis from in-center hemodialysis during the observation period.Methods:The incidence of dialysis during the specified time period, overall and by modality, was calculated per million population using census figures for the population at risk. Patients were followed for a minimum of 30 days from the start of peritoneal dialysis to capture episodes of peritonitis and COVID-19.Results:A total of 211 patients started maintenance dialysis between March 17 and June 01, 2020. The incidence dialysis rate (41.3 per million population) was lower than that expected based on the 10-year trend from 2010 to 2019 inclusive (expected rate 45.7 per million population, 95% confidence interval 41.7 to 50.1). A total of 93 patients started peritoneal dialysis, including 32 patients who transitioned from in-center hemodialysis, contributing to a higher overall uptake of peritoneal dialysis compared to preceding years. The incidence rate for peritoneal dialysis of 18.2 per million population was higher than that expected (16.3 per million population, 95% confidence interval 14.0 to 19.0). Half of patients (48%) underwent a bedside peritoneal dialysis catheter insertion by a physician. During 30 days of follow-up, 2 (2.2%) patients experienced peritonitis and no patients were diagnosed with COVID-19.Limitations:Results are short term and generalizable only to regions with similarly low community rates of transmission of severe acute respiratory syndrome coronavirus 2.Conclusions:These preliminary findings indicate that peritoneal dialysis can be safely started and perhaps expanded as a means of mitigating the anticipated surge in in-center hemodialysis during the COVID-19 pandemic. Important contributors to the uptake of peritoneal dialysis in British Columbia were bedside catheter insertions and expediting transitions from in-center hemodialysis to peritoneal dialysis.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-02-16T05:55:56Z
      DOI: 10.1177/2054358120986265
      Issue No: Vol. 8 (2021)
       
  • Quantifying Missed Opportunities for Recruitment to Home Dialysis
           Therapies

    • Authors: Krishna Poinen, Lee Er, Michael A. Copland, Rajinder S. Singh, Mark Canney
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Despite the recognized benefits of home therapies for patients and the health care system, most individuals with kidney failure in Canada continue to be initiated on in-center hemodialysis. To optimize recruitment to home therapies, there is a need for programs to better understand the extent to which potential candidates are not successfully initiated on these therapies.Objective:We aimed to quantify missed opportunities to recruit patients to home therapies and explore where in the modality selection process this occurs.Design:Retrospective observational study.Setting:British Columbia, Canada.Patients:All patients aged >18 years who started chronic dialysis in British Columbia between January 01, 2015, and December 31, 2017. The sample was further restricted to include patients who received at least 3 months of predialysis care. All patients were followed for a minimum of 12 months from the start of dialysis to capture any transition to home therapies.Methods:Cases were defined as a “missed opportunity” if a patient had chosen a home therapy, or remained undecided about their preferred modality, and ultimately received in-center hemodialysis as their destination therapy. These cases were assessed for: (1) documentation of a contraindication to home therapies; and (2) the type of dialysis education received. Differences in characteristics among patients classified as an appropriate outcome or a missed opportunity were examined using Wilcoxon rank-sum test or χ2 test, as appropriate.Results:Of the 1845 patients who started chronic dialysis during the study period, 635 (34%) were initiated on a home therapy. A total of 320 (17.3%) missed opportunities were identified, with 165 (8.9%) having initially chosen a home therapy and 155 (8.4%) being undecided about their preferred modality. Compared with patients who chose and initiated or transitioned to a home therapy, those identified as a missed opportunity tended to be older with a higher prevalence of cardiovascular disease. A contraindication to both peritoneal dialysis and home hemodialysis was documented in 8 “missed opportunity” patients. General modality orientation was provided to most (71%) patients who had initially chosen a home therapy but who ultimately received in-center hemodialysis. These patients received less home therapy–specific education compared with patients who chose and subsequently started a home therapy (20% vs 35%, P < .001).Limitations:Contraindications to home therapies were potentially under-ascertained, and the nature of contraindications was not systematically captured.Conclusions:Even within a mature home therapy program, we discovered a substantial number of missed opportunities to recruit patients to home therapies. Better characterization of modality contraindications and enhanced education that is specific to home therapies may be of benefit. Mapping the recruitment pathway in this way can define the magnitude of missed opportunities and identify areas that could be optimized. This is to be encouraged, as even small incremental improvements in the uptake of home therapies could lead to better patient outcomes and contribute to significant cost savings for the health care system.Trial Registration:Not applicable as this was a qualitative study.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-02-12T12:51:55Z
      DOI: 10.1177/2054358121993250
      Issue No: Vol. 8 (2021)
       
  • Thanks to Reviewers

    • Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.

      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-02-12T12:44:51Z
      DOI: 10.1177/2054358121994008
      Issue No: Vol. 8 (2021)
       
  • Adapting Nephrology Training Curriculum in the Era of COVID-19

    • Authors: Amanda Cunningham, Wayne Hung, Adeera Levin, Abeed Jamal
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Purpose of review:The COVID-19 pandemic has widespread implications not only for clinical practice but also for academic medicine and postgraduate training. The need to promote physical distancing and flexibility within our department has generated important revisions to the core curriculum for the Adult Nephrology Training Program in Vancouver, Canada.Sources of information:We reviewed available educational resources and objectives to develop curricular adaptations informed by staff and trainee feedback.Methods:Many facets of the program including clinical rotations, scholarly activities, evaluation, and wellness have been impacted, and thus revised for online delivery where possible. Trainees have personalized a learning plan based on individual goals and supplemented by a list of internet-based resources for independent review. Changes in learning objectives and methods for specific rotations have occurred and are described. Ongoing evaluation will be undertaken.Key findings:Curriculum adaptation in the era of COVID-19 is necessary to ensure ongoing high-quality education for future nephrologists. We describe existing changes to formal training in British Columbia (BC), which will be tailored as the pandemic evolves, and anticipate them to have lasting impact on the way we structure training programs in the future. Standardization and harmonization of modified curriculum may be possible across Canada with sharing of these learnings.Limitations:Formal evaluation of these changes in terms of knowledge acquisition and examination performance has not yet been undertaken. Next steps will include assessing and documenting the impact of this curricular transformation to further optimize scheduling, educational yield, and trainee wellness.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-02-05T12:06:36Z
      DOI: 10.1177/2054358120988446
      Issue No: Vol. 8 (2021)
       
  • Immunoglobulin-A Vasculitis With Renal Involvement in a Patient With
           COVID-19: A Case Report and Review of Acute Kidney Injury Related to
           SARS-CoV-2

    • Authors: Nicholas L. Li, Adam B. Papini, Tiffany Shao, Louis Girard
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Rationale:Acute kidney injury is a common complication of COVID-19 and is associated with significantly increased mortality. The most frequent renal biopsy finding with SARS-CoV-2 infection is acute tubular injury; however, new onset glomerular diseases have been reported. The development of persistent urinary abnormalities in patients with COVID-19 should prompt consideration for renal biopsy to rule out glomerulonephritis.Presenting Concerns:A 30-year-old man with no prior medical history presented to the emergency department with symptoms of COVID-19 and new onset painful purpuric rash, arthralgia, and abdominal pain. SARS-CoV-2 infection was confirmed with nucleic acid testing and laboratory investigations revealed preserved renal function with dysmorphic hematuria and nephrotic range proteinuria.Diagnosis:A skin biopsy of the purpuric rash was performed, which demonstrated leukocytoclastic vasculitis. Renal biopsy revealed focally crescentic and segmentally necrotizing IgA nephropathy. Overall, given the clinical syndrome of glomerulonephritis with purpuric rash, arthralgia, and abdominal pain, the presentation is most in keeping with a diagnosis of IgA vasculitis in the setting of COVID-19.Interventions:The patient was treated conservatively for COVID-19 in the community. A 7-day course of prednisone was started for the vasculitic rash. IgA nephropathy was managed conservatively with blood pressure control and RAAS blockade with losartan.Outcomes:With conservative management, the patient’s COVID-19 symptoms resolved completely and he did not require hospital admission. Following prednisone therapy, the patient’s rash, arthralgia, and abdominal pain improved. However, despite resolution of COVID-19, hematuria and proteinuria persisted. With the initiation of RAAS blockade, renal function remained stable and proteinuria improved dramatically at 6 weeks.Novel Findings:De novo glomerulonephritis is a renal manifestation of SARS-CoV-2 infection beyond acute tubular injury. IgA vasculitis appears to be a rare complication of COVID-19.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-02-05T10:06:49Z
      DOI: 10.1177/2054358121991684
      Issue No: Vol. 8 (2021)
       
  • An Environmental Scan of Ambulatory Care Quality Indicators for Patients
           With Advanced Kidney Disease Currently Used in Canada

    • Authors: Jay Hingwala, Amber O. Molnar, Priyanka Mysore, Samuel A. Silver
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Quality indicators can be used to identify gaps in care and drive frontline improvement activities. These efforts are important to prevent adverse events in the increasing number of ambulatory patients with advanced kidney disease in Canada, but it is unclear what indicators exist and the components of health care quality they measure.Objective:We sought to identify, categorize, and evaluate quality indicators currently in use across Canada for ambulatory patients with advanced kidney disease.Design:Environmental scan of quality indicators currently being collected by various organizations.Setting:We assembled a 16-member group from across Canada with expertise in nephrology and quality improvement.Patients:Our scan included indicators relevant to patients with chronic kidney disease in ambulatory care clinics.Measurements:We categorized the identified quality indicators using the Institute of Medicine and Donabedian frameworks.Methods:A 4-member panel used a modified Delphi process to evaluate the indicators found during the environmental scan using the American College of Physicians/Agency for Healthcare Research and Quality criteria. The ratings were then shared with the full panel for further comments and approval.Results:The environmental scan found 28 quality indicators across 7 provinces, with 8 (29%) rated as “necessary” to distinguish high-quality from poor-quality care. Of these 8 indicators, 3 were measured by more than 1 province (% of patients on a statin, number of patients receiving a preemptive transplant, and estimated glomerular filtration rate at dialysis start); no indicator was used by more than 2 provinces. None of the indicators rated as necessary measured timely or equitable care, nor did we identify any measures that assessed the setting in which care occurs (ie, structure measures).Limitations:Our list cannot be considered as an exhaustive list of available quality indicators at hand in Canada. Our work focused on quality indicators for nephrology providers and programs, and not indicators that can be applied across primary and specialty providers. We also focused on indicator constructs and not the detailed definitions or their application. Last, our panel does not represent the views of other important stakeholders.Conclusions:Our environmental scan provides a snapshot of the scope of quality indicators for ambulatory patients with advanced kidney disease in Canada. This catalog should inform indicator selection and the development of new indicators based on the identified gaps, as well as motivate increased pan-Canadian collaboration on quality measurement and improvement.Trial registration:Not applicable as this article is not a systematic review, nor does it report results of a health intervention on human participants.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-02-05T10:01:09Z
      DOI: 10.1177/2054358121991096
      Issue No: Vol. 8 (2021)
       
  • Canadian Association of Paediatric Nephrologists COVID-19 Rapid Response:
           Guidelines for Management of Acute Kidney Injury in Children

    • Authors: Abdullah Alabbas, Amrit Kirpalani, Catherine Morgan, Cherry Mammen, Christoph Licht, Veronique Phan, Andrew Wade, Elizabeth Harvey, Michael Zappitelli, Edward G. Clark, Swapnil Hiremath, Steven D. Soroka, Ron Wald, Matthew A. Weir, Rahul Chanchlani, Mathieu Lemaire
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Purpose:This article provides guidance on managing acute kidney injury (AKI) and kidney replacement therapy (KRT) in pediatrics during the COVID-19 pandemic in the Canadian context. It is adapted from recently published rapid guidelines on the management of AKI and KRT in adults, from the Canadian Society of Nephrology (CSN). The goal is to provide the best possible care for pediatric patients with kidney disease during the pandemic and ensure the health care team’s safety.Information sources:The Canadian Association of Paediatric Nephrologists (CAPN) COVID-19 Rapid Response team derived these rapid guidelines from the CSN consensus recommendations for adult patients with AKI. We have also consulted specific documents from other national and international agencies focused on pediatric kidney health. We identified additional information by reviewing the published academic literature relevant to pediatric AKI and KRT, including recent journal articles and preprints related to COVID-19 in children. Finally, our group also sought expert opinions from pediatric nephrologists across Canada.Methods:The leadership of the CAPN, which is affiliated with the CSN, solicited a team of clinicians and researchers with expertise in pediatric AKI and acute KRT. The goal was to adapt the guidelines recently adopted for Canadian adult patients for pediatric-specific settings. These included specific COVID-19-related themes relevant to AKI and KRT in a Canadian setting, as determined by a group of kidney disease experts and leaders. An expert group of clinicians in pediatric AKI and acute KRT reviewed the revised pediatric guidelines.Key findings:(1) Current Canadian data do not suggest an imminent threat of an increase in acute KRT needs in children because of COVID-19; however, close coordination between nephrology programs and critical care programs is crucial as the pandemic continues to evolve. (2) Pediatric centers should prepare to reallocate resources to adult centers as needed based on broader health care needs during the COVID-19 pandemic. (3) Specific suggestions pertinent to the optimal management of AKI and KRT in COVID-19 patients are provided. These suggestions include but are not limited to aspects of fluid management, KRT vascular access, and KRT modality choice. (4) Considerations to ensure adequate provision of KRT if resources become scarce during the COVID-19 pandemic.Limitations:We did not conduct a formal systematic review or meta-analysis. We did not evaluate our specific suggestions in the clinical environment. The local context, including how the provision of care for AKI and acute KRT is organized, may impede the implementation of many suggestions. As knowledge is advancing rapidly in the area of COVID-19, suggestions may become outdated quickly. Finally, most of the literature for AKI and KRT in COVID-19 comes from adult data, and there are few pediatric-specific studies.Implications:Given that most acute KRT related to COVID-19 is likely to be required in the pediatric intensive care unit initial setting, close collaboration and planning between critical care and pediatric nephrology programs are needed. Our group will update these suggestions with a supplement if necessary as newer evidence becomes available that may change or add to the recommendations provided.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-02-05T09:02:57Z
      DOI: 10.1177/2054358121990135
      Issue No: Vol. 8 (2021)
       
  • Evaluation of Transplant Candidates With a History of Nonadherence: An
           Opinion Piece

    • Authors: Shaifali Sandal, Tianyan Chen, Marcelo Cantarovich
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.

      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-01-28T06:05:26Z
      DOI: 10.1177/2054358121990137
      Issue No: Vol. 8 (2021)
       
  • Treatment Preferences for Cardiac Procedures of Patients With Chronic
           Kidney Disease in Acute Coronary Syndrome: Design and Pilot Testing of a
           Discrete Choice Experiment

    • Authors: T. Wilson, P. Javaheri, J. Finlay, G. Hazlewood, S. B. Wilton, T. Sajobi, A. Levin, W. Pearson, C. Connolly, M. T. James
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Chronic kidney disease is associated with a high incidence of acute coronary syndrome and related morbidity and mortality. Treatment choices for patients with chronic kidney disease involve trade-offs in the potential benefits and harms of invasive management options.Objective:The objective was to quantify preferences of patients with chronic kidney disease toward invasive heart procedures.Design:Design and pilot a discrete choice experiment.Setting:We piloted the discrete choice experiment in 2 multidisciplinary chronic kidney disease clinics in Calgary, Alberta, using an 8-question survey.Patients:Eligible patients included those aged 18 years and older, an estimated glomerular filtration rate < 45 mL/min/1.73 m2, not currently receiving dialysis, and able to communicate in English.Measurements:Quantification of the average importances of key attributes of invasive heart procedures.Methods:We identified attributes most important to patients and physicians concerning invasive versus conservative management for acute coronary syndrome, using semi-structured qualitative interviews. Levels for each attribute were derived from analysis of early invasive versus conservative acute coronary syndrome management clinical trials and cohort studies, where subgroups of patients with chronic kidney disease were reported. We designed the pilot study with patient partners with relevant lived experience and considered statistical efficiency to estimate main effects and interactions, as well as response efficiency. Hierarchical Bayesian estimation was used to quantify average importances of attributes.Results:We recruited 43 patients with chronic kidney disease, mean (SD) age 67 (14) years, 67% male, and 35% with a history of cardiovascular disease, of whom 39 completed the survey within 2 weeks of enrollment. The results of the pilot revealed acute kidney injury requiring dialysis and permanent kidney replacement therapy, as well as death within 1 year were the most important attributes. Measures of internal validity for the pilot discrete choice experiment were comparable to those for other published discrete choice experiments.Limitations:Discrete choice experiments are complex instruments and often cognitively demanding for patients. This survey included multiple risk attributes which may have been challenging for some patients to understand.Conclusions:This pilot study demonstrates the feasibility of a discrete choice experiment to quantify preferences of patients with chronic kidney disease toward the benefits and trade-offs related to invasive versus conservative management for acute coronary syndrome. These preliminary findings suggest that patients with chronic kidney disease may be on average similarly risk averse toward kidney replacement therapy and death. This pilot information will be used to inform a larger discrete choice experiment that will refine these estimates of patient preferences and characterize subgroups with distinct treatment preferences, which should provide new knowledge that can facilitate shared decision-making between patients with chronic kidney disease and their care providers in the setting of acute coronary syndrome.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-01-27T11:42:33Z
      DOI: 10.1177/2054358120985375
      Issue No: Vol. 8 (2021)
       
  • A Physical Activity Intervention Feasibility Study for Kidney Inpatients:
           A Basic Research Protocol

    • Authors: Kathryn Wytsma-Fisher, Stefan Mustata, Theresa Cowan, Manuel Ester, S. Nicole Culos-Reed
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:Low physical activity levels and poor physical functioning are strongly associated with poor clinical outcomes and mortality in adult kidney failure patients, regardless of treatment modality. Compared with the general population, individuals with chronic kidney disease are physically inactive, have reduced physical abilities and difficulties performing routine daily tasks, lower health-related quality of life, and higher cardiovascular morbidity and mortality. In addition, frail kidney failure patients have higher hospitalization and mortality rates as compared with other kidney failure patients. Evidence suggests that assessment and recommendations for physical activity should be part of standard care for kidney failure patients. Structured exercise can improve physical function and quality of life in frail older adults and may be used specifically for management of frailty in kidney failure. However, research is needed to determine best practices for implementation of physical function measurements and physical activity promotion in standard kidney failure care.Objective:The proposed Move More study will assess the feasibility of a physical activity intervention offered to the kidney failure inpatients in Calgary, Alberta. Specifically, this study is designed to examine the effects of an early physical activity/mobility intervention led by a kinesiologist, and supported by the clinical care team including physiotherapists (PT) and nurse clinicians.Methods:The Move More study is a single-arm pilot intervention examining feasibility and optimal improvement in real-world conditions. Kidney failure inpatients at the Foothills Medical Centre will be recruited to participate. Patients will receive an individualized in-hospital physical activity/mobility intervention. Frailty and physical function will be assessed at baseline and postintervention prior to hospital discharge. The goal is to recruit 24 to 36 patients.Conclusions:Evidence needed to support the inclusion of mobility and physical activity as part of standard care will be gathered, with knowledge gained used to help direct future physical activity programming for kidney failure inpatients.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-01-22T05:34:44Z
      DOI: 10.1177/2054358120987052
      Issue No: Vol. 8 (2021)
       
  • Outcomes of an Inpatient Dialysis Start in Patients With Kidney Graft
           Failure: A Population-Based Multicentre Cohort Study

    • Authors: Kyla L. Naylor, Gregory A. Knoll, Eric McArthur, Amit X. Garg, Ngan N. Lam, Bonnie Field, Leah E. Getchell, Emma Hahn, S. Joseph Kim
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Background:The frequency and outcomes of starting maintenance dialysis in the hospital as an inpatient in kidney transplant recipients with graft failure are poorly understood.Objective:To determine the frequency of inpatient dialysis starts in patients with kidney graft failure and examine whether dialysis start status (hospital inpatient vs outpatient setting) is associated with all-cause mortality and kidney re-transplantation.Design:Population-based cohort study.Setting:We used linked administrative healthcare databases from Ontario, Canada.Patients:We included 1164 patients with kidney graft failure from 1994 to 2016.Measurements:All-cause mortality and kidney re-transplantation.Methods:The cumulative incidence function was used to calculate the cumulative incidence of all-cause mortality and kidney re-transplantation, accounting for competing risks. Subdistribution hazard ratios from the Fine and Gray model were used to examine the relationship between inpatient dialysis starts (vs outpatient dialysis start [reference]) and the dependent variables (ie, mortality or re-transplant).Results:We included 1164 patients with kidney graft failure. More than half (55.8%) of patients with kidney graft failure, initiated dialysis as an inpatient. Compared with outpatient dialysis starters, inpatient dialysis starters had a significantly higher cumulative incidence of mortality and a significantly lower incidence of kidney re-transplantation (P < .001). The 10-year cumulative incidence of mortality was 51.9% (95% confidence interval [CI]: 47.4, 56.9%) (inpatient) and 35.3% (95% CI: 31.1, 40.1%) (outpatient). After adjusting for clinical characteristics, we found inpatient dialysis starters had a significantly increased hazard of mortality in the first year after graft failure (hazard ratio: 2.18 [95% CI: 1.43, 3.33]) but at 1+ years there was no significant difference between groups.Limitations:Possibility of residual confounding and unable to determine inpatient dialysis starts that were unavoidable.Conclusions:In this study we identified that most patients with kidney graft failure had inpatient dialysis starts, which was associated with an increased risk of mortality. Further research is needed to better understand the reasons for an inpatient dialysis start in this patient population.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-01-22T05:30:42Z
      DOI: 10.1177/2054358120985376
      Issue No: Vol. 8 (2021)
       
  • Providing Care for Transgender Persons With Kidney Disease: A Narrative
           Review

    • Authors: David Collister, Nathalie Saad, Emily Christie, Sofia Ahmed
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Purpose of review:Nephrologists are increasingly providing care to transgender individuals with chronic kidney disease (CKD). However, they may lack familiarity with this patient population that faces unique challenges. The purpose of this review is to discuss the care of transgender persons and what nephrologists should be aware of when providing care to their transgender patients.Sources of information:Original research articles were identified from MEDLINE and Google Scholar using the search terms “transgender,” “gender,” “sex,” “chronic kidney disease,” “end stage kidney disease,” “dialysis,” “transplant,” and “nephrology.”Methods:A focused review and critical appraisal of existing literature regarding the provision of care to transgender men and women with CKD including dialysis and transplant to identify specific issues related to gender-affirming therapy and chronic disease management in transgender persons.Key findings:Transgender persons are at an increased risk of adverse outcomes compared with the cisgender population including mental health, cardiovascular disease, malignancy, sexually transmitted infections, and mortality. Individuals with CKD have a degree of hypogonadotropic hypogonadism and decreased levels of endogenous sex hormones; therefore, transgender persons with CKD may require reduced exogenous sex hormone dosing. Exogenous estradiol therapy increases the risk of venous thromboembolism and cardiovascular disease which may be further increased in CKD. Exogenous testosterone therapy increases the risk of polycythemia which should be closely monitored. The impact of gender-affirming hormone therapy on glomerular filtration rate (GFR) trajectory in CKD is unclear. Gender-affirming hormone therapy with testosterone, estradiol, and anti-androgen therapies changes body composition and lean body mass which influences creatinine generation and the performance for estimated glomerular filtration rate (eGFR) equations in transgender persons. Confirmation of eGFR with measured GFR is reasonable if an accurate knowledge of GFR is needed for clinical decision-making.Limitations:There are limited studies regarding the intersection of transgender persons and kidney disease and those that exist are mostly case reports. Randomized controlled trials and observational studies in nephrology do not routinely differentiate between cisgender and transgender participants.Implications:This review highlights important considerations for providing care to transgender persons with kidney disease. Additional research is needed to evaluate the performance of eGFR equations in transgender persons, the effects of gender-affirming hormone therapy, and the impact of being transgender on outcomes in persons with kidney disease.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-01-21T05:57:59Z
      DOI: 10.1177/2054358120985379
      Issue No: Vol. 8 (2021)
       
  • Renal Manifestations of Fabry Disease: A Narrative Review

    • Authors: Cassiano Augusto Braga Silva, José A. Moura-Neto, Marlene Antônia dos Reis, Osvaldo Merege Vieira Neto, Fellype Carvalho Barreto
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 8, Issue , January-December 2021.
      Purpose of review:In this narrative review, we describe general aspects, histological alterations, treatment, and implications of Fabry disease (FD) nephropathy. This information should be used to guide physicians and patients in a shared decision-making process.Source of information:Original peer-reviewed articles, review articles, and opinion pieces were identified from PubMed and Google Scholar databases. Only sources in English were accessed.Methods:We performed a focused narrative review assessing the main aspects of FD nephropathy. The literature was critically analyzed from a theoretical and contextual perspective, and thematic analysis was performed.Key findings:FD nephropathy is related to the progressive accumulation of GL3, which occurs in all types of renal cells. It is more prominent in podocytes, which seem to play an important role in the pathogenesis of this nephropathy. A precise detection of renal disorders is of fundamental importance because the specific treatment of FD is usually delayed, making reversibility unlikely and leading to a worse prognosis.Limitations:As no formal tool was applied to assess the quality of the included studies, selection bias may have occurred. Nonetheless, we have attempted to provide a comprehensive review on the topic using current studies from experts in FD and extensive review of the literature.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2021-01-20T06:58:09Z
      DOI: 10.1177/2054358120985627
      Issue No: Vol. 8 (2021)
       
 
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