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UROLOGY, NEPHROLOGY AND ANDROLOGY (151 journals)                     

Showing 1 - 144 of 144 Journals sorted alphabetically
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Advances in Chronic Kidney Disease     Hybrid Journal   (Followers: 15)
Advances in Urology     Open Access   (Followers: 13)
African Journal of Nephrology     Open Access   (Followers: 1)
African Journal of Urology     Open Access   (Followers: 7)
AJP Renal Physiology     Hybrid Journal   (Followers: 8)
Aktuelle Urologie     Hybrid Journal   (Followers: 4)
American Journal of Kidney Diseases     Hybrid Journal   (Followers: 53)
American Journal of Men's Health     Open Access   (Followers: 9)
American Journal of Nephrology     Full-text available via subscription   (Followers: 31)
Andrologia     Hybrid Journal   (Followers: 3)
Andrology     Hybrid Journal   (Followers: 5)
Andrology & Gynecology : Current Research     Hybrid Journal   (Followers: 4)
Andrology and Genital Surgery     Open Access   (Followers: 8)
Arab Journal of Nephrology and Transplantation     Open Access   (Followers: 2)
Arab Journal of Urology     Open Access   (Followers: 7)
Archives of Clinical Nephrology     Open Access   (Followers: 2)
Archivio Italiano di Urologia e Andrologia     Open Access   (Followers: 1)
Archivos Españoles de Urología     Open Access   (Followers: 1)
Asian Journal of Andrology     Open Access   (Followers: 1)
Asian Journal of Urology     Open Access   (Followers: 3)
Asian Pediatric Nephrology Association     Open Access   (Followers: 3)
Bangladesh Journal of Urology     Open Access   (Followers: 5)
Basic and Clinical Andrology     Open Access  
BJU International     Hybrid Journal   (Followers: 19)
BJUI Compass     Open Access   (Followers: 1)
BMC Nephrology     Open Access   (Followers: 9)
BMC Urology     Open Access   (Followers: 13)
Canadian Journal of Kidney Health and Disease     Open Access   (Followers: 7)
Canadian Urological Association Journal     Open Access   (Followers: 1)
Cancer Urology     Open Access   (Followers: 1)
Cardiorenal Medicine     Full-text available via subscription   (Followers: 1)
Case Reports in Nephrology     Open Access   (Followers: 6)
Case Reports in Nephrology and Dialysis     Open Access   (Followers: 8)
Case Reports in Urology     Open Access   (Followers: 11)
Clinical and Experimental Nephrology     Hybrid Journal   (Followers: 5)
Clinical Journal of the American Society of Nephrology     Full-text available via subscription   (Followers: 24)
Clinical Kidney Journal     Open Access   (Followers: 5)
Clinical Medicine Insights : Urology     Open Access   (Followers: 3)
Clinical Nephrology     Full-text available via subscription   (Followers: 8)
Cuadernos de Cirugía     Open Access  
Current Opinion in Nephrology & Hypertension     Hybrid Journal   (Followers: 12)
Current Opinion in Urology     Hybrid Journal   (Followers: 11)
Current Urology     Open Access   (Followers: 10)
Current Urology Reports     Hybrid Journal   (Followers: 5)
Der Nephrologe     Hybrid Journal  
Der Urologe     Hybrid Journal   (Followers: 1)
Diabetic Nephropathy     Open Access  
EMC - Urología     Full-text available via subscription  
Enfermería Nefrológica     Open Access   (Followers: 1)
European Urology     Hybrid Journal   (Followers: 23)
European Urology Focus     Hybrid Journal   (Followers: 4)
European Urology Oncology     Hybrid Journal  
European Urology Open Science     Open Access   (Followers: 8)
Forum Nefrologiczne     Full-text available via subscription  
Geriatric Nephrology and Urology     Hybrid Journal   (Followers: 7)
Giornale di Clinica Nefrologica e Dialisi     Open Access  
Hellenic Urology     Open Access   (Followers: 4)
IJU Case Reports     Open Access  
Indian Journal of Nephrology     Open Access   (Followers: 2)
Indian Journal of Urology     Open Access   (Followers: 5)
International Brazilian Journal of Urology     Open Access   (Followers: 5)
International Journal of Nephrology     Open Access   (Followers: 2)
International Journal of Nephrology and Renovascular Disease     Open Access   (Followers: 2)
International Journal of Urology     Hybrid Journal   (Followers: 10)
International Urology and Nephrology     Hybrid Journal   (Followers: 6)
Journal für Urologie und Urogynäkologie/Österreich     Hybrid Journal  
Journal of Clinical Nephrology     Open Access   (Followers: 1)
Journal of Clinical Urology     Hybrid Journal   (Followers: 12)
Journal of Endoluminal Endourology     Open Access  
Journal of Endourology     Hybrid Journal   (Followers: 2)
Journal of Endourology Case Reports     Hybrid Journal  
Journal of Genital System & Disorders     Hybrid Journal   (Followers: 1)
Journal of Integrative Nephrology and Andrology     Open Access   (Followers: 2)
Journal of Kidney Cancer and VHL     Open Access  
Journal of Lower Genital Tract Disease     Hybrid Journal  
Journal of Nephrology     Hybrid Journal   (Followers: 5)
Journal of Nephrology Research     Open Access   (Followers: 2)
Journal of Pediatric Nephrology     Open Access   (Followers: 3)
Journal of Renal Care     Hybrid Journal   (Followers: 8)
Journal of Renal Nursing     Full-text available via subscription   (Followers: 8)
Journal of Renal Nutrition     Hybrid Journal   (Followers: 28)
Journal of Renal Nutrition and Metabolism     Open Access   (Followers: 2)
Journal of the American Society of Nephrology     Full-text available via subscription   (Followers: 38)
Journal of The Egyptian Society of Nephrology and Transplantation     Open Access  
Journal of Urology & Nephrology     Open Access  
Kidney Diseases     Open Access   (Followers: 3)
Kidney International     Hybrid Journal   (Followers: 52)
Kidney International Reports     Open Access   (Followers: 6)
Kidney Medicine     Open Access   (Followers: 1)
Kidney Research Journal     Open Access   (Followers: 6)
Kidneys (Počki)     Open Access  
Nature Reviews Nephrology     Full-text available via subscription   (Followers: 29)
Nature Reviews Urology     Full-text available via subscription   (Followers: 9)
Nefrología     Open Access  
Nefrología (English Edition)     Open Access  
Nephro-Urology Monthly     Open Access   (Followers: 1)
Nephrology     Hybrid Journal   (Followers: 13)
Nephrology Dialysis Transplantation     Hybrid Journal   (Followers: 26)
Nephron     Hybrid Journal   (Followers: 3)
Nephron Clinical Practice     Full-text available via subscription   (Followers: 3)
Nephron Experimental Nephrology     Full-text available via subscription   (Followers: 4)
Nephron Extra     Open Access   (Followers: 1)
Nephron Physiology     Full-text available via subscription   (Followers: 4)
Neurourology and Urodynamics     Hybrid Journal   (Followers: 1)
OA Nephrology     Open Access   (Followers: 2)
Open Access Journal of Urology     Open Access   (Followers: 6)
Open Journal of Nephrology     Open Access   (Followers: 4)
Open Journal of Urology     Open Access   (Followers: 6)
Open Urology & Nephrology Journal     Open Access  
Paediatric Nephrology Journal of Bangladesh     Open Access   (Followers: 4)
Portuguese Journal of Nephrology & Hypertension     Open Access   (Followers: 1)
Progrès en Urologie     Full-text available via subscription  
Progrès en Urologie - FMC     Full-text available via subscription  
Prostate Cancer and Prostatic Diseases     Hybrid Journal   (Followers: 4)
Renal Failure     Open Access   (Followers: 11)
Renal Replacement Therapy     Open Access   (Followers: 3)
Research and Reports in Urology     Open Access   (Followers: 4)
Revista de Nefrología, Diálisis y Trasplante     Open Access   (Followers: 1)
Revista Mexicana de Urología     Open Access  
Revista Urologia Colombiana     Open Access  
Scandinavian Journal of Urology     Hybrid Journal   (Followers: 6)
Seminars in Nephrology     Hybrid Journal   (Followers: 11)
The Prostate     Hybrid Journal   (Followers: 6)
Therapeutic Advances in Urology     Open Access   (Followers: 3)
Translational Research in Urology     Open Access   (Followers: 1)
Trends in Urology & Men's Health     Partially Free   (Followers: 1)
Urine     Open Access  
Uro-News     Hybrid Journal  
Urolithiasis     Hybrid Journal   (Followers: 1)
Urologia Internationalis     Full-text available via subscription   (Followers: 1)
Urologia Journal     Hybrid Journal  
Urologic Clinics of North America     Full-text available via subscription   (Followers: 3)
Urologic Nursing     Full-text available via subscription   (Followers: 3)
Urological Science     Open Access  
Urologicheskie Vedomosti     Open Access  
Urologie in der Praxis     Hybrid Journal  
Urology     Hybrid Journal   (Followers: 26)
Urology Case Reports     Open Access   (Followers: 3)
Urology Times     Free   (Followers: 3)
Urology Video Journal     Open Access  
World Journal of Nephrology and Urology     Open Access   (Followers: 5)
World Journal of Urology     Hybrid Journal   (Followers: 10)


Similar Journals
Journal Cover
Canadian Journal of Kidney Health and Disease
Journal Prestige (SJR): 1.007
Citation Impact (citeScore): 2
Number of Followers: 7  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2054-3581 - ISSN (Online) 2054-3581
Published by Sage Publications Homepage  [1174 journals]
  • Dialysis Patients’ Preferences on Resuscitation: A Cross-Sectional
           Study Design

    • Authors: Husam Alzayer, Annette M. Geraghty, Kuruvilla K. Sebastian, Hardarsh Panesar, Donal N. Reddan
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:End-stage kidney disease is associated with a 10- to 100-fold increase in cardiovascular mortality compared with age-, sex-, and race-matched population. Cardiopulmonary resuscitation (CPR) in this cohort has poor outcomes and leads to increased functional morbidity.Objective:The aim of this study is to assess patients’ preferences toward CPR and advance care planning (ACP).Design:cross-sectional study design.Setting:Two outpatient dialysis units.Patients:Adults undergoing dialysis for more than 3 months were included. Exclusion criteria were severe cognitive impairment or non-English-speaking patients.Measurements:A structured interview with the use of Willingness to Accept Life-Sustaining Treatment (WALT) tool.Methods:Demographic data were collected, and baseline Montreal Cognitive Assessment, Patient Health Questionnaire–9, Duke Activity Status Index, Charlson comorbidity index, and WALT instruments were used. Descriptive analysis, chi-square, and t test were performed along with probability plot for testing hypotheses.Results:Seventy participants were included in this analysis representing a 62.5% response rate. There was a clear association between treatment burden, anticipated clinical outcome, and the likelihood of that outcome with patient preferences. Low-burden treatment with expected return to baseline was associated with 98.5% willingness to accept treatment, whereas high-burden treatment with expected return to baseline was associated with 94.2% willingness. When the outcome was severe functional or cognitive impairment, then 45.7% and 28.5% would accept low-burden treatment, respectively. The response changed based on the likelihood of the outcome. In terms of resuscitation, more than 75% of the participants would be in favor of receiving CPR and mechanical ventilation at their current health state. Over 94% of patients stated they had never discussed ACP, whereas 59.4% expressed their wish to discuss this with their primary nephrologist.Limitations:Limited generalizability due to lack of diversity. Unclear decision stability due to changes in health status and patients’ priorities.Conclusions:ACP should be incorporated in managing chronic kidney disease (CKD) to improve communication and encourage patient involvement.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-07-27T12:21:36Z
      DOI: 10.1177/20543581221113383
      Issue No: Vol. 9 (2022)
  • The Use of Indomethacin for Nocturnal Enuresis in Children With
           Nephrogenic Diabetes Insipidus: A Case Report and Review of the Literature

    • Authors: Erin Hedin, Abdullah Alabbas
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Rationale:Nocturnal enuresis is a common symptom of nephrogenic diabetes insipidus (NDI) in children. Published reports on the treatment of nocturnal enuresis in this population are scarce. Presenting concern of the patient: 2 brothers, aged 8 and 9 years, presented for outpatient pediatric nephrology follow-up. Despite being medically stable on their current medication regimen, they both experienced significant distress due to primary nocturnal enuresis, including decreased self-esteem and social stress.Diagnoses:The brothers had primary nocturnal enuresis related to their high urine output from NDI. Interventions: we describe a case of 2 brothers with NDI in whom indomethacin was added to their pharmacologic treatment specifically to address enuresis.Outcome:Both brothers experienced a significant decrease in the frequency of nocturnal enuresis and improvement in their perceived quality of life.Teaching points:Nocturnal enuresis is a bothersome symptom of NDI with adverse psychological effects. Indomethacin can improve nocturnal enuresis in some patients. Treatment with nonsteroidal anti-inflammatory drugs carries a risk of gastrointestinal and kidney side effects. We advocate for a patient-centered approach to the treatment of NDI which includes optimizing both the medical and the psychological needs of the patient.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-07-26T10:17:57Z
      DOI: 10.1177/20543581221114693
      Issue No: Vol. 9 (2022)
  • Association of Serum Phosphate Derangement With Mortality in Patients on
           Continuous Renal Replacement Therapy

    • Authors: Charat Thongprayoon, Yeshwanter Radhakrishnan, Wisit Cheungpasitporn, Tananchai Petnak, Fawad Qureshi, Michael A. Mao, Kianoush B. Kashani
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:There is limited evidence on the association of serum phosphate with mortality in patients receiving continuous renal replacement therapy (CRRT).Objective:To assess the association of serum phosphate with mortality in critically ill patients requiring CRRT for acute kidney injury (AKI).Design:A cohort study.Setting:A tertiary referral hospital in the United States.Patients:Acute kidney injury patients receiving CRRT from 2006 through 2015 in intensive care units.Measurements:(1) Serum phosphate before CRRT and (2) mean serum phosphate during CRRT were categorized into 3 groups; ≤2.4 (hypophosphatemia), 2.5 to 4.5 (normal serum phosphate group), and ≥4.6 (hyperphosphatemia) mg/dL.Methods:Multivariable logistic regression was used to assess the association between serum phosphate and 90-day mortality.Results:A total of 1108 patients were included in this study. Of these, 55% died within 90 days after CRRT initiation. Before CRRT, 3%, 30%, and 66% had hypophosphatemia, normophosphatemia, and hyperphosphatemia, respectively. Before CRRT, both hypophosphatemia and hyperphosphatemia were significantly associated with higher 90-day mortality with the adjusted odds ratio (OR) of 2.22 (95% confidence interval [CI]: [1.03, 4.78]) and 1.62 (95% CI: [1.21, 2.18]), respectively. During CRRT, 3%, 85%, and 12% had mean serum phosphate in hypophosphatemia, normophosphatemia, and hyperphosphatemia range. During CRRT, hyperphosphatemia was significantly associated with higher 90-day mortality with adjusted OR of 2.22 (95% CI: [1.45, 3.38]).Limitations:Single center, observational design, lack of information regarding causes of serum phosphate derangement.Conclusion:Most CRRT patients had hyperphosphatemia before CRRT initiation but maintain normal serum phosphate during CRRT. Before CRRT, hypo- and hyperphosphatemia, and during CRRT, hyperphosphatemia predicted higher mortality.Trial registration:Not registered.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-07-26T10:12:41Z
      DOI: 10.1177/20543581221114697
      Issue No: Vol. 9 (2022)
  • Corrigendum: Primary Hyperoxaluria Type 1 (PH1) Presenting with End-Stage
           Kidney Disease and Cutaneous Manifestations in Adulthood: A Case Report

    • Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.

      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-07-26T01:15:09Z
      DOI: 10.1177/20543581221106665
      Issue No: Vol. 9 (2022)
  • Using Administrative Health Care Databases to Identify Patients With
           End-Stage Kidney Disease With No Recorded Contraindication to Receiving a
           Kidney Transplant

    • Authors: Carol Wang, Kyla L. Naylor, Bin Luo, Sarah E. Bota, Stephanie N. Dixon, Seychelle Yohanna, Darin Treleaven, Lori Elliott, Amit X. Garg
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Administrative health care databases can be efficiently analyzed to describe the degree to which patients with end-stage kidney disease (ESKD) have access to kidney transplantation. Measures of access to transplantation are better represented when restricting to only those patients eligible to receive a kidney transplant. The way administrative data can be used to assess kidney transplant eligibility in the absence of clinical data has not been well described.Objective:To demonstrate a method that uses administrative health care databases to identify patients with ESKD who have no recorded contraindication to receiving a kidney transplant.Design and setting:Population-based cohort study using linked administrative health care databases in Ontario, Canada.Patients:Adult patients with ESKD approaching the need for dialysis (predialysis) or receiving maintenance dialysis between January 1, 2013 and March 31, 2015 in Ontario, Canada.Measurements:Recipient of a kidney-only or kidney-pancreas transplant.Methods:We assessed more than 80 baseline characteristics, including demographic information, comorbidities, kidney-specific characteristics, and referral and listing criteria for kidney transplantation. We compared these characteristics between patients who did and did not receive a kidney transplant.Results:We included 23 642 patients with ESKD (11 195 who were predialysis and 12 447 receiving maintenance dialysis). Over a median follow-up of 3.2 years (25th, 75th percentile: 1.3, 5.6), 3215 (13.6%) received a kidney-only or kidney-pancreas transplant. Of the studied characteristics available in administrative databases, >97% of patients with one or more of these characteristics did not receive a kidney transplant during follow-up: ESKD-modified Charlson Comorbidity Index score ≥7 (a higher score represents greater comorbidity), home oxygen use, age above 75 years, dementia, living in a long-term care facility, receiving at least one physician house call in the past year, and a combination of select malignancies (ie, lung, lymphoma, cervical, colorectal, liver, active multiple myeloma, and bladder cancer). Using these combined criteria reduced the total number of patients from 23 642 to 12 539 with no recorded contraindications to transplant (a 47% reduction), while the proportion who received a kidney transplant changed from 13.6% (denominator of 23 642) to 24.9% (denominator of 12 539).Limitations:Administrative databases are unable to capture all the complexities of determining transplant eligibility.Conclusion:We identified several criteria available within administrative health care databases that can be used to identify patients with ESKD who have no recorded contraindications to kidney transplant. These criteria could be applied when reporting measures of access to kidney transplantation that require knowledge of transplant eligibility.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-07-22T05:57:59Z
      DOI: 10.1177/20543581221111712
      Issue No: Vol. 9 (2022)
  • Assisted Peritoneal Dialysis Implementation: A Pilot Program From a Large
           Dialysis Unit in Quebec

    • Authors: Julien Melanson, Jessica Kachmar, Louis-Philippe Laurin, Naoual Elftouh, Annie-Claire Nadeau-Fredette
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Kidney failure prevalence is increasing in older patients for whom dialysis initiation can be challenging. Assisted peritoneal dialysis (PD), where PD is performed with the help of a healthcare worker, can facilitate PD for frailer patients who may not be candidate otherwise.Objectives:This study aimed to assess the feasibility of implementing the first pilot assisted PD program in Quebec (Canada) and to evaluate the characteristics and outcomes of the PD cohort before and after assisted PD availability.Design:Observational retrospective cohort study.Setting and Population:All adult patients initiating PD between 2015 and 2020 in a single-center dialysis unit were included.Measurements:Incidence, characteristics, and outcomes of patients with PD were compared between (1) the “pre” (2015-2017) and the “post” assisted PD era (2018-2020) and (2) patients with assisted PD and independent PD in the more recent period.Methods:The primary outcome was peritonitis rate over the first year. Secondary outcomes included hospitalization, transfers to in-center hemodialysis (HD) and mortality.Results:Overall, 124 patients initiated PD with an annual incidence of 17 ± 3 patients during the “pre” and 24 ± 8 patients during the “post” assisted PD era (P = .18). First-year peritonitis rate was similar over the 2 eras. Years of PD initiation and use of assisted PD were not associated with risk peritonitis (over total follow-up) after adjustment. Adjusted hazard of transfer to HD or death was higher during the “post” era (hazard ratio [HR]: 2.77; 95% confidence interval [CI]: 1.42-5.58). Seventeen patients received assisted PD including 13 (18%) of the 72 patients initiated between 2018 and 2020. Patients with assisted PD were older than those with independent PD (72 [64-84] vs. 59 [47-67], P = .006) and received assistance for 0.8 (0.4-1.5) years. When comparing assisted and independent cohorts, there were no differences in crude rates of peritonitis or hospitalization.Limitations:Single-center study with small sample size.Conclusion:This study shows the feasibility of implementing an assisted PD program, with favorable overall outcomes including similar rates of peritonitis during the first year after PD initiation.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-07-19T05:19:33Z
      DOI: 10.1177/20543581221113387
      Issue No: Vol. 9 (2022)
  • Experience With Pre-Dialysis Administration of Tobramycin in the
           Outpatient Setting

    • Authors: Jean-François Tessier, Georges Ouellet, Michel Vallée, Jean-Philippe Lafrance
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.

      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-07-16T08:18:55Z
      DOI: 10.1177/20543581221112505
      Issue No: Vol. 9 (2022)
  • Determining Factors Influencing RAS Inhibitors Re-Initiation in ICU: A
           Modified Delphi Method

    • Authors: Hadjer Dahel, Jean-Philippe Lafrance, Mathilde Patenaude, Kelley Kilpatrick, William Beaubien-Souligny, Mathieu Moreau, Han Ting Wang
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Renin-angiotensin system inhibitors (RASi) are not re-initiated for almost a quarter of patients who suffered acute kidney injury 6 months after discharge. This discontinuation might be partly explained by the nephrotoxicity of these medications, yet they remain of benefit, especially for patients with heart failure.Objective:To determine the factors deemed by clinicians to influence RASi re-initiation and set threshold values for important safety parameters.Design:Three-round modified online Delphi survey.Setting:The study was conducted in Quebec, Canada.Participants:Twenty clinicians from nephrology, intensive care medicine, and internal medicine.Measurements:The factors’ importance was rated on 4-point Likert-type scale, ranging from “not important” to “very important” by the panelists.Methods:We conducted a brief literature review to uncover possible influencing factors followed by a 3-round modified Delphi survey to establish a consensus on the importance of these factors.Results:We recruited 20 clinicians (7 nephrologists, 3 internists, and 10 intensive care physicians). We created a list of 25 factors, 15 of which met consensus. Eleven of these factors, including serum creatinine, glomerular filtration rate, and acute kidney injury (AKI) stage, were deemed as important while 4, such as responsibility ambiguity and absence of feedback, were deemed as not important. The majority of the 10 factors which did not meet consensus were related to the clinical setting, such as a pharmacist follow-up and the required time to ensure optimal RASi re-initiation.Limitations:Quebec clinicians’ agreement might not reflect the opinion of the rest of Canada. The survey measures clinicians’ belief rather than their actual practice.Conclusion:Renin-angiotensin system inhibitors re-initiation is a rather complex concept which encompasses several factors. Our research uncovered some of these factors which may be used to develop guidelines on optimal RASi re-initiation.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-07-15T12:03:46Z
      DOI: 10.1177/20543581221112266
      Issue No: Vol. 9 (2022)
  • Sustainable Nephrology Action Planning (“SNAP”)—A New Committee of
           the Canadian Society of Nephrology

    • Authors: Caroline Stigant
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.

      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-07-12T10:17:17Z
      DOI: 10.1177/20543581221102042
      Issue No: Vol. 9 (2022)
  • The Effects of Resistant Starch Consumption in Adult Patients With Chronic
           Kidney Disease: A Systematic Review

    • Authors: Kulwant Kingra, Sarah Curtis, Rebecca C. Mollard, Maryam Shamloo, Nicole Askin, Navdeep Tangri, Dylan MacKay
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Resistant starches (RSs) are not digested by human digestive enzymes and pass through the upper digestive tract to become substrates for colonic bacteria. Resistant starch supplementation has shown promising results in altering the microbiota of animal models of chronic kidney disease (CKD). Resistant starch consumption may influence the production of uremic toxins in CKD.Objective:To conduct a systematic review to determine whether the consumption of RS reduces the progression of kidney disease in adult patients with CKD.Design:We included randomized controlled trials comparing RS supplementation to placebo, no treatment, or standard care. Cochrane Central, Embase, MEDLINE, Web of Science, and CINAHL databases were searched. There was no limitation on publication date, but only English manuscripts were included. The search was conducted in July 2020.Patients:Adult outpatient populations with CKD, using any recognized diagnostic criteria.Measurements:The primary outcome was change in glomerular filtration rate (GFR) from baseline through the end of the trial in patients not on dialysis; secondary outcomes included change in uremic toxin concentrations (p-cresol/p-cresyl sulfate [p-CS], indoxyl sulfate [IS]) and inflammatory markers (tumor necrosis factor alpha [TNF-α], C-reactive protein [CRP], interleukin 6 [IL-6]) from baseline through the end of the trial, and changes in self-reported symptom scores.Methods:The Cochrane Collaboration Risk of Bias tool was used to assess risk of bias in included studies. The systematic review results are reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.Results:We identified 4 unique studies, reported in 9 publications that met our inclusion criteria, including a total of 215 enrolled participants. Results were calculated using data from the longest reported follow-up time. The primary outcome of changes in kidney function markers was only studied in 1 trial; this trial reported an increase in creatinine and a decrease in blood urea nitrogen; no changes in GFR were reported. A review of the secondary outcomes showed an overall decline in IS, TNF-α, and IL-6, in RS groups, but with mixed results in p-CS and CRP/high-sensitivity CRP. Safety data showed that RS was well tolerated with no reports of excessive side effects.Limitations:We determined a meta-analysis was not feasible due to clinical heterogeneity between study populations and differences in reported outcomes in the included studies.Conclusion:There is limited and inconsistent evidence on the impact of RS in adult patients with CKD. Further research is needed to determine the safety and efficacy of RS supplementation in this population.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-07-12T10:15:01Z
      DOI: 10.1177/20543581221100023
      Issue No: Vol. 9 (2022)
  • Corrigendum

    • Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.

      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-07-06T12:14:09Z
      DOI: 10.1177/20543581221110098
      Issue No: Vol. 9 (2022)
  • De-Prescribing Proton Pump Inhibitors in Patients With End Stage Kidney
           Disease: A Quality Improvement Project

    • Authors: Daniel Czikk, Yasin Parpia, Katelyn Roberts, Gaurav Jain, Dan-Cung Vu, Deborah Zimmerman
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Proton pump inhibitors (PPIs) are widely prescribed and may be associated with harm; hypomagnesemia and reduced effectiveness of calcium carbonate phosphate binders may be important in end-stage kidney disease (ESKD).Objectives:Our objectives included (1) discontinuing PPIs and H2 blockers and (2) assessing the impact on serum magnesium and markers of mineral metabolism.Design:Prospective cohort.Setting:Satellite hemodialysis unit of a tertiary care hospital.Patients:Incident and prevalent patients with ESKD treated with hemodialysis.Measurements:We assessed the impact of stopping PPI/H2 blockers in patients who did not have an absolute indication as per guidelines in the general population; serum magnesium, calcium, and phosphate were measured before and approximately 8 weeks later. Analysis of variance (ANOVA) test and Kruskal-Wallis was used to describe the population. Wilcoxon signed rank test for the paired change scores (from pre to post)Methods:The electronic medical record (EMR) was extensively searched for absolute indications for a PPI. Results were reviewed with the primary nephrology team before approaching patients about stopping the PPI. Basic demographic information and select medications were also collected.Results:Electronic medical records were reviewed for 179 patients, 74 had a PPI or H2 antagonist or both on their medication list (43%); 23 (31%) were assessed as appropriate. After primary team and patient review, 29 patients agreed to a trial of PPI withdrawal. Fourteen patients restarted their PPI, most for gastroesophageal reflux disease. Three patients had a GI bleed, 1 fatally. Serum calcium (P = .17) and the dose of phosphate binders (P = .075) did not change but serum phosphate increased (1.55 [0.29] to 1.85 [0.34] mmol/L; P = .0005). Serum magnesium also increased (1.01 [0.16] to 1.06 [0.14] mmol/L; P = .01).Limitations:Small patient numbers and observational nature of the study does not establish causation in this population at high risk to experience a gastrointestinal bleed.Conclusions:Our results suggest that PPI deprescribing as recommended in the general population may be associated with harm in patients with ESKD and requires further study.Trial Registration:Not registered.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-06-27T06:54:38Z
      DOI: 10.1177/20543581221106244
      Issue No: Vol. 9 (2022)
  • Perceived Barriers to Peritoneal Dialysis Among Kenyan Nephrologists: A
           Cross-Sectional Descriptive Study

    • Authors: Saleem Abdul Karim Sokwala, John Otieno Odhiambo, Ahmed Parwizali Sokwala
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Peritoneal dialysis (PD) is a well-recognized technique of renal replacement therapy (RRT), with similar efficacy as well as survival outcomes as hemodialysis (HD). Despite its advantages including prolonged preservation of residual renal function, potentially lower cost and advances with automated techniques, and commercialization of more biocompatible solutions, the overall prevalence of patients treated with PD is still very low in developed countries and even more so in Africa and low-middle income countries like Kenya. According to our knowledge, no local studies have been done on prevalence of peritoneal dialysis or on potential barriers to utilization of PD as an RRT modality.Objective:To explore perceptive barriers of nephrologists to PD utilization.Methodology:A computer-base, 22-question questionnaire was formulated using the Delphi technique and sent out to all the nephrologists via emails. There were 30 nephrologists, in clinical practice in Kenya, at the time when the study was conducted. This is according to the registry maintained by the Kenya Renal Association (KRA). Their contacts were obtained from the registry.Design:A cross-sectional descriptive studySetting:A computer based 22-question questionnaire was administered to 23 nephrologists in Kenya.Results:Among the total number of 23 nephrologists, 39% reported to be looking after patients maintained on PD despite 59% of them reporting that they think patients should be maintained on PD. Only 21% of respondents felt limited training in PD limited their use of PD and only 23% felt poor personal experience contributed to limited use. Other barriers that came up with a relative majority of the respondents included lack of nursing expertise, concerns with PD catheter placement, concerns about long-term viability of continuous peritoneal dialysis, concerns about technique failure and peritonitis, lack of facility support for PD, and lack of dialysis education programs.Conclusion:A significant proportion of nephrologists in this survey felt PD, as a modality of RRT, was underutilized and reported systemic and technical factors as being potential barriers.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-06-24T10:16:09Z
      DOI: 10.1177/20543581221107756
      Issue No: Vol. 9 (2022)
  • Impact of Donation Physicians on Deceased Organ Donation: A Systematic

    • Authors: Janet E. Squires, Laura D. Aloisio, Wilmer John Santos, Danielle Cho-Young, Monica Taljaard, Nills Gritters, Sonny Dhanani, Gregory Knoll
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:An emerging strategy to increase deceased organ donation is to use dedicated donation physicians to champion organ donation. We sought to conduct a systematic review of the effectiveness of donation physicians in improving organ donation outcomes.Objective:A systematic review was conducted following Cochrane principles. MEDLINE, Embase, and CINHAL databases were searched from inception to March 26, 2020.Methods:Quantitative studies examining the effects of donation physicians on all deceased organ donation outcomes were considered for inclusion. Review articles, editorials and opinion articles, and case studies were excluded. Study selection was completed independently by 2 team members; all discrepancies were resolved by consensus. Two team members independently extracted data from studies.Results:A total of 1017 studies were screened, and 12 met inclusion criteria. Included studies were published between 1994 and 2019. Half used an interrupted time series design (n = 6; 50%), 3 (25%) were cohort studies, and 3 (25%) used a before-and-after study design. Outcomes (reported in greater than 50% of included articles) included consent/refusal rate (n = 8; 67%), number of potential donors (n = 7; 58%), and number of actual donors (n = 7; 58%). Across studies and design types, there was an increase in potential organ donors ranging from 8% to 143% (Mdn = 33%), an increase in actual organ donors from 15% to 113% (Mdn = 27%), an increase in donor consent rate from −3% to 258% (Mdn = 12%), and an increase in deceased donor transplants from 13% to 24% (Mdn = 19%) following the introduction of donation physicians.Conclusions:Donation physicians have the potential to significantly improve deceased organ donation. Further implementation and evaluation of donation physician programs is warranted. However, implementation should be undertaken with a clear plan for a methodologically rigorous evaluation of outcomes.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-06-21T11:38:47Z
      DOI: 10.1177/20543581221107751
      Issue No: Vol. 9 (2022)
  • Five Things to Know About Intradialytic Hypertension

    • Authors: Bhanu Prasad, Juliya Hemmett, Rita Suri
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.

      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-06-21T11:27:26Z
      DOI: 10.1177/20543581221106657
      Issue No: Vol. 9 (2022)
  • Impact of Home Telemonitoring and Management Support on Blood Pressure
           Control in Nondialysis CKD: A Systematic Review and Meta-Analysis

    • Authors: Shezel Muneer, Ikechi G. Okpechi, Feng Ye, Deenaz Zaidi, Mohammed M. Tinwala, Laura N. Hamonic, Anukul Ghimire, Naima Sultana, Dan Slabu, Maryam Khan, Branko Braam, Kailash Jindal, Scott Klarenbach, Raj Padwal, Jennifer Ringrose, Nairne Scott-Douglas, Soroush Shojai, Stephanie Thompson, Aminu K. Bello
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Hypertension is a major cause of cardiovascular disease, chronic kidney disease (CKD), and death. Several studies have demonstrated the efficacy of home blood pressure telemonitoring (HBPT) for blood pressure (BP) control and outcomes, but the effects of this intervention remain unclear in patients with CKD.Objective:To determine the impact of HBPT on cardiovascular–related and kidney disease–related outcomes in patients with CKD.Design:Systematic review and meta-analysis.Setting:All studies that met our criteria regardless of country of origin.Participants:Patients with chronic kidney disease included in studies using HBPT for BP assessment and control.Measurements:Descriptive and quantitative analysis of our primary and secondary outcomes.Methods:We searched MEDLINE, Embase, CINAHL Plus, PsycINFO, Cochrane CENTRAL, Web of Science, and gray literature from inception for observational and randomized controlled studies in nondialysis (ND) CKD using HBPT for BP control. We selected studies that used HBPT as intervention (with or without a control arm) for BP control in ND-CKD populations. The primary outcome was change in mean systolic BP (SBP) and mean diastolic BP (DBP).Results:We selected 7 studies from 1669 articles that were initially identified. Overall, pooled estimates in the mean difference (MD) for SBP and DBP were −8.8 mm Hg; 95% confidence interval (CI): −16.2 to −1.4; P = .02 and −2.4 mm Hg; 95% CI: −3.8 to −1.0; P < .001, respectively. For studies comparing intervention with usual care (UC), pooled estimate in MD for SBP was −8.0 mm Hg (P = .02) with no significant reduction for DBP (−2.6 mm Hg; P = .18). In studies without a UC arm, both SBP and DBP were not significantly reduced (P> .05). The pooled estimate in MD for estimated glomerular filtration rate showed a significant improvement (5.4 mL/min/1.73 m2; P < .001).Limitations:Heterogeneity and few available studies for inclusion limited our ability to identify a robust link between HBPT use and BP and kidney function improvement.Conclusion:Home blood pressure telemonitoring is associated with mild lowering of BP and moderately improved kidney function in patients with CKD. However, larger studies with improved designs and prolonged interventions are still needed to assess the effects of HBPT on patients’ outcomes.PROSPERO registration IDCRD42020190705
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-06-21T11:26:04Z
      DOI: 10.1177/20543581221106248
      Issue No: Vol. 9 (2022)
  • Targeted Cancer Therapies Causing Elevations in Serum Creatinine Through
           Tubular Secretion Inhibition: A Case Report and Review of the Literature

    • Authors: Tiffany Mach, Amy Qi, Nathaniel Bouganim, Emilie Trinh
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Rationale:Targeted cancer therapies have revolutionized the field of oncology by selecting for specific molecular pathways, thus improving overall clinical prognosis. However, many of these targeted treatments have been reported to have adverse kidney effects, including acute kidney injury, interstitial nephritis, and glomerular disease. Furthermore, some of these targeted therapies have also been found to cause an asymptomatic rise in serum creatinine levels through inhibition of active tubular secretion.Presenting concerns:A 79-year-old woman was being followed for stage 4 A2 chronic kidney disease secondary to type 2 diabetes and longstanding hypertension. She was diagnosed with invasive mammary carcinoma and was initiated on letrozole, an aromatase inhibitor, and palbociclib, a selective cyclin-dependent kinase inhibitor, was subsequently added. Prior to the initiation of her treatments, her baseline estimated glomerular filtration rate (eGFR) fluctuated between 25 and 28 mL/min/1.73 m2 over the previous year. After initiating palbociclib, her serum creatinine progressively increased, despite having well-controlled blood pressure and diabetes. In addition, there was no history of pre-renal events nor any sonographic evidence of obstruction. Within 7 months, her eGFR based on serum creatinine had decreased down to 12 mL/min/1.73 m2.Interventions:Given that there were no clinical or other biochemical changes suggestive of worsening renal function, a serum cystatin C was measured using an immunoturbidimetric assay, which was 1.71 mg/L and correlated with an eGFR of 33 mL/min/1.73 m2 based on the chronic kidney disease epidemiology collaboration (CKD-EPI) cystatin C equation (2012). This value was consistent with her previous baseline. Based on these findings, the significant decrease in eGFR measured by serum creatinine was attributed to the inhibitory effects of palbociclib on tubular creatinine secretion, rather than representing true kidney damage. Thus, a kidney biopsy was not performed in this context.Outcomes:Seven months later, a repeat serum cystatin C was repeated to assess for any worsening of the patient’s kidney function and revealed an eGFR of 35 mL/min/1.73 m2 based on the CKD-EPI cystatin C equation (2012), thus revealing stable kidney function and reinforcing the inhibitory effects of palbociclib on tubular creatinine secretion through its direct effects on kidney transporters.Teaching points:This case report and literature review acknowledges the importance of using alternative methods of assessing kidney function when patients are undergoing targeted cancer therapies known to affect tubular creatinine secretion, which include cyclin-dependent kinase 4/6 inhibitors, poly(adenosine diphosphate-ribose) polymerase inhibitors, tyrosine kinase inhibitors, and mesenchymal-epithelial transition inhibitors. The use of non–creatinine-based markers of glomerular filtration rate (GFR), such as cystatin C and nuclear renal scans, will allow for more accurate estimation of kidney function in the appropriate setting, thus avoiding invasive diagnostic tests and unnecessary adjustments of treatment plans. However, certain targeted cancer therapies have also been proven to cause true kidney injury; therefore, physicians must still maintain a high degree of suspicion and consider invasive investigations and/or cessation or reduction of treatments when alternative measurements of kidney function do not suggest an underestimation of GFR via serum creatinine.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-06-21T11:20:24Z
      DOI: 10.1177/20543581221106246
      Issue No: Vol. 9 (2022)
  • Design and Development of a Digital Counseling Program for Chronic Kidney

    • Authors: Stephanie W. Ong, Julia V. Wong, Bourne L. Auguste, Alexander G. Logan, Robert P. Nolan, Christopher T. Chan
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Self-management has shown to improve the quality of life in patients with chronic kidney disease (CKD). Readily accessible self-management tools are essential in promoting adherence to self-care behaviors. In recognizing that digital health facilitates efficient access to self-management programs, we developed a digital counseling program, ODYSSEE Kidney Health, to promote self-care behaviors while supporting health-related quality of life.Objective:To present the design and development of ODYSSEE Kidney Health for digital counseling for patients with CKD.Design:The study involved an iterative design process based on user-centered design principles to develop the digital counseling program, ODYSSEE Kidney Health.Setting:A sample of 10 to 15 participants were purposively sampled from nephrology clinics at the University Health Network, Toronto, Canada.Methods:Participants underwent 2 phases in the development process. In each phase, participants were presented with a component of the program, asked to perform goal-oriented tasks, and participate in the “think-aloud” process. Semi-structured interviews followed the first phase to identify feedback about the overall program. Thematic analysis of the interviews identified themes from the usability testing. Descriptive statistics were used to summarize patient demographic data.Results:We enrolled 11 participants (n = 7 males, n = 4 females, ages 30-82). The main themes generated anchored on (1) impact on nephrology care, (2) technical features, and (3) CKD content. Overall, participants reported positive satisfaction toward the navigation, layout, and content of the program. They cited the value of the program in their daily CKD care.Limitations:Study limitations included using a single center to recruit participants, most of the participants having prior technology use, and using one module as a representative of the entire digital platform.Conclusion:The acceptability of a digital counseling program for patients with CKD relies on taking the patients’ perspective using a user-centered design process. It is vital in ensuring adoption and adherence to self-management interventions aimed at sustaining behavioral change.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-06-17T11:31:41Z
      DOI: 10.1177/20543581221103683
      Issue No: Vol. 9 (2022)
  • Use of Guideline-Based Therapy for Diabetes, Coronary Artery Disease, and
           Chronic Kidney Disease After Acute Kidney Injury: A Retrospective
           Observational Study

    • Authors: Sunchit Madan, Patrick A. Norman, Ron Wald, Javier A. Neyra, Alejandro Meraz-Muñoz, Ziv Harel, Samuel A. Silver
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Survivors of acute kidney injury (AKI) are at a high risk for cardiovascular complications. An underrecognition of this risk may contribute to the low utilization of relevant guideline-based therapies in this population.Objective:We sought to assess accordance with guideline-based recommendations for survivors of AKI with diabetes, coronary artery disease (CAD), and preexisting chronic kidney disease (CKD) in a post-AKI clinic, and identify factors that may be associated with guideline accordance.Design:Retrospective cohort study.Setting:Post-AKI clinics at 2 tertiary care centers in Ontario, Canada.Patients:We included adult patients seen in both post-AKI clinics between 2013 and 2019 who had at least 2 clinic visits within 24 months of an index AKI hospitalization.Measurements:We assessed accordance to recommendations from the most recent North American and international guidelines available at the time of study completion for diabetes, CAD, and CKD.Methods:We compared guideline accordance between visits using the Cochran Mantel Haenszel test. We used multivariable Poisson regression to identify prespecified factors associated with accordance.Results:Of 213 eligible patients, 192 (90%) had Kidney Disease Improving Global Outcomes Stage 2-3 AKI, 91 (43%) had diabetes, 76 (36%) had CAD, and 88 (41%) had preexisting CKD. From the first clinic visit to the second, there was an increase in angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACE-I/ARB) use across all disease groups—from 33% to 46% (P = .028) in patients with diabetes, from 30% to 57% (P = .002) in patients with CAD, and from 16% to 35% (P < .001) in patients with preexisting CKD. Statin use increased in patients with preexisting CKD from 64% to 71% (P = .034). Every 25 μmol/L rise in the discharge serum creatinine was associated with a 19% (95% confidence interval [CI], 8%-28%) and 12% (95% CI, 2%-21%) lower likelihood of being on an ACE-I/ARB in patients with diabetes and preexisting CKD, respectively.Limitations:The study lacked a comparison group that received usual care. The small sample and multiple comparisons make false positives possible.Conclusion:There is room to improve guideline-based cardiovascular risk factor management in survivors of AKI, particularly ACE-I/ARB use in patients with an elevated discharge serum creatinine.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-06-14T12:34:47Z
      DOI: 10.1177/20543581221103682
      Issue No: Vol. 9 (2022)
  • Visuospatial and Executive Dysfunction in Patients With Acute Kidney
           Injury, Chronic Kidney Disease, and Kidney Failure: A Multilevel Modeling

    • Authors: Natasha A. Jawa, Jessica A. Vanderlinden, Stephen H. Scott, Jill A. Jacobson, Samuel A. Silver, Rachel Holden, J. Gordon Boyd
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Neurocognitive impairment is a common finding across the spectrum of kidney disease and carries important consequences for quality of life. We previously demonstrated that robotic technology can identify neurocognitive impairments not readily detectable by traditional testing in patients with acute kidney injury (AKI) and chronic kidney disease (CKD).Objective:The present study aimed to assess whether these quantifiable deficits in neurocognition differ based on a diagnosis of AKI, CKD, or kidney failure.Design:This was a cross-sectional analysis of participants previously enrolled in an observational study.Setting:Patients were enrolled at a tertiary academic hospital, Kingston Health Sciences Centre, Kingston, ON, Canada.Patients:Adults with AKI, CKD, or kidney failure.Measurements:Each participant underwent robotic neurocognitive assessment using the Kinarm: an interactive robotic device that uses a series of behavioral tasks involving movement of the upper limbs to precisely quantify neurocognitive impairment across a variety of neurocognitive domains.Methods:Multilevel modeling was used to determine the effect of Kinarm task type, kidney diagnostic group (AKI vs CKD vs kidney failure), and the interaction between the two, on neurocognitive performance.Results:A total of 104 participants within 1 year of an AKI event or with CKD category G3-5 were enrolled. We found that across all of the kidney diagnostic groups, participants performed worst on the Kinarm tasks of Reverse Visually Guided Reaching (b = 0.64 [95% confidence interval = 0.42, 0.85]), Visually Guided Reaching (b = 0.28 [0.07, 0.49]), and Trail Making (b = 0.50 [0.28, 0.72]), relative to all other tasks. There were no significant differences in average performance across tasks based on kidney diagnostic group. However, diagnostic group and neurocognitive task type interacted to determine performance, such that patients with AKI performed worse than those with either CKD or kidney failure on the Reverse Visually Guided Reaching task.Limitations:Kinarm assessment was performed at a single time point, and the sample size itself was small, which may lead to the risk of a false-positive association despite the use of multilevel modeling. Our sample size also did not permit inclusion of the underlying etiology of kidney impairment as a covariate in our analyses, which may have also influenced neurocognitive function.Conclusions:In this study that utilized the Kinarm to assess neurocognitive function, patients with AKI demonstrated significantly worse neurocognitive functioning than patients with CKD or kidney failure on a task measuring executive function and visuomotor control.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-06-14T09:10:32Z
      DOI: 10.1177/20543581221103100
      Issue No: Vol. 9 (2022)
  • Protocol for a Multistage Mixed-Methods Evaluation of Multidisciplinary
           Chronic Kidney Disease Care Quality Following Integration of Virtual and
           In-Person Care During the COVID-19 Pandemic

    • Authors: Micheli Bevilacqua, Helen Chiu, Yuriy Melnyk, Janet Williams, Robin Chohan, Julie Wei, Dominik Stoll, Michele Fryer, Marlee McGuire, Anne Logie, Paul Watson, Adeera Levin
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Multidisciplinary care of patients with chronic kidney disease (CKD) as it previously existed was predicated on an evidence and experience base of improved patient outcomes within an established and well-described service delivery model. The onset of the COVID-19 pandemic brought with it a departure from this established care delivery model toward integration of virtual care and in-person care.Objective:To develop an evaluation framework to determine whether this shift in service delivery models has affected quality of multidisciplinary kidney care and/or patient-clinician interactions and relationships.Design:A sequential multiphase, mixed-methods evaluation.Setting:All 15 British Columbia (BC) multidisciplinary kidney care clinics (KCCs).Participants:All patients and all clinicians in all KCCs across BC will be invited to participate in the planned evaluation.Measurements:Qualitative and quantitative feedback from patients and families living with CKD and KCC clinicians.Methods:The planned multiphase evaluation of virtual care integration in KCCs will be conducted across all 15 KCCs in the province of BC, Canada. The following phases are proposed: (1) review of current virtual care integration and practices, (2) assessment of patient and clinician experiences and perspectives via semi-structured interviews, (3) validation of those patient and clinician perspectives via survey of a larger sample, (4) compilation and analysis of all phases to provide informed recommendations for patient and visit format selection in a mixed in-person and virtual multidisciplinary clinic setting.Limitations:This work will not capture any information about the relationship between differences in virtual usage parameters and clinical outcomes or financial implications.Conclusions:There is no existing framework for either evaluation of multidisciplinary CKD care quality in a virtual setting or evaluation of care quality following a substantial change in service delivery models. The proposed evaluation protocol will enable better understanding of the nuances in kidney care delivery in this new format and inform how best to optimize the integration of virtual and pre-existing formats into kidney clinic care delivery beyond the pandemic. Beyond the current evaluation, this protocol may be of use for other jurisdictions to evaluate their own local instances of virtual care implementation and integration. The model may be adapted to evaluate quality of multidisciplinary kidney care delivery following other changes to clinic service delivery models.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-06-02T06:41:07Z
      DOI: 10.1177/20543581221103103
      Issue No: Vol. 9 (2022)
  • The Renal Community Photo Initiative

    • Authors: Ruth Skinner, Cindy House, Andrew A House, Christopher McIntyre, Ann Tillmann, Elaine Hayter, Jared McGregor, Pamela Ireland
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.

      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-05-31T12:58:13Z
      DOI: 10.1177/20543581221079950
      Issue No: Vol. 9 (2022)
  • Canadian Association of Radiologists Guidance on Contrast-Associated Acute
           Kidney Injury

    • Authors: D. Blair Macdonald, Casey D. Hurrell, Andreu F. Costa, Matthew D. F. McInnes, Martin O’Malley, Brendan J. Barrett, Pierre Antoine Brown, Edward G. Clark, Anastasia Hadjivassiliou, Iain Donald Craik Kirkpatrick, Jeremy Rempel, Paul Jeon, Swapnil Hiremath
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Purpose:Iodinated contrast media is one of the most frequently administered pharmaceuticals. In Canada, over 5.4 million computed tomography (CT) examinations were performed in 2019, of which 50% were contrast enhanced. Acute kidney injury (AKI) occurring after iodinated contrast administration was historically considered a common iatrogenic complication which was managed by screening patients, prophylactic strategies, and follow-up evaluation of renal function. The Canadian Association of Radiologists (CAR) initially published guidelines on the prevention of contrast induced nephropathy in 2007, with an update in 2012. However, new developments in the field have led to the availability of safer contrast agents and changes in clinical practice, prompting a complete revision of the earlier recommendations.Information sources:Published literature, including clinical trials, retrospective cohort series, review articles, and case reports, along with expert opinions from radiologists and nephrologists across Canada.Methods:The leadership of the CAR formed a working group of radiologists and nephrologists with expertise in contrast administration and patient management related to contrast-associated AKI. We conducted a comprehensive review of the published literature to evaluate the evidence about contrast as a cause of AKI, and to inform evidence-based recommendations. Based on the available literature, the working group developed consensus recommendations.Key Findings:The working group developed 21 recommendations, on screening, choice of iodinated contrast media, prophylaxis, medication considerations, and post contrast administration management. The key changes from the 2012 guidelines were (1) Simplification of screening to a simple questionnaire, and not delaying emergent examinations due to a need for creatinine measurements (2) Prophylaxis considerations only for patients with estimated glomerular filtration rate (eGFR) less than 30 mL/min/1.73 m2 (3) Not recommending the routine discontinuation of any drugs to decrease risk of AKI, except metformin when eGFR is less than 30 mL/min/1.73 m2 and (4) Not requiring routine follow up serum creatinine measurements post iodinated contrast administration.Limitations:We did not conduct a formal systematic review or meta-analysis. We did not evaluate our specific suggestions in the clinical environment.Implications:Given the importance of iodinated contrast media use in diagnosis and management, and the low risk of AKI after contrast use, these guidelines aim to streamline the processes around iodinated contrast use in most clinical settings. As newer evidence arises that may change or add to the recommendations provided, the working group will revise these guidelines.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-05-24T01:24:34Z
      DOI: 10.1177/20543581221097455
      Issue No: Vol. 9 (2022)
  • The Renal Community Photo Initiative: A Program Report in Ontario, Canada

    • Authors: Ruth Skinner, Cindy House, Andrew A. House, Chris McIntyre, Elaine Hayter, Pamela Ireland, Jared McGregor, Ann Tillmann
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Purpose of Program:We initiated the Renal Community Photo Initiative to better understand why some hemodialysis users express significant capacities for resilience and hope, demonstrating outward-looking perspectives and enjoying a rich quality of life.Sources of Information:“Photovoice” is a participatory research methodology that encourages individuals to develop positive self-perceptions with photography. Photovoice empowers participants as informants within their communities. Visual arts researchers surveyed existing Photovoice studies to identify gaps in knowledge to be addressed in this study, including challenges related to fostering participant agency and social action. Images and logs were collected and reviewed during organized, participant-led substudy groups. These meetings provided researchers with core study values and direction as to how the images and additional information should be used to raise awareness about living with chronic kidney disease.Methods:To address the complexity of the human condition, the Renal Community Photo Initiative offered participants an array of diverse and accessible image-making techniques. No narrative directives for image-making were provided. This qualitative, interdisciplinary, participant-centric study invited adult chronic hemodialysis patients in 4 dialysis units in London and Stratford, Ontario, to participate. The research team designed a selection of different, accessible photo technologies for participant use. Eligible participants were invited to select photographic technologies and given the additional option to write accompanying logs. Researchers organized substudy meetings for participant-led focus groups to discuss core study values and personal encounters with images and image-making. Participants directed how their generated images should be shared with the public and researchers.Key Findings:A total of 40 participants have been recruited to date, producing more than 1600 images and an archive of handwritten logs. Three participant-led focus groups have established priorities for image sharing and a core set of values for subsequent study phases. A series of public presentations of participant images took place. The research team will pursue further public presentation opportunities and the development of a suitable research database.Limitations:Organizing and categorizing images for access in an interdisciplinary research database remains a challenge. Current health and safety protocols related to COVID-19 require the study to pause recruitment and substudy meetings and reassess immediate outputs for visuals.Implications:A qualitative study of this scope offers a new model for participant agency and collaboration. It requires the onboarding of interdisciplinary researchers to effectively engage with its significant image and log archive. Participants should remain involved in directing future steps for disseminating their images. Following substudy directives, researchers are developing visuals for health care and public settings, and determining opportunities for participants to share their experience in both clinic- and public-based settings.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-05-21T11:40:54Z
      DOI: 10.1177/20543581221100292
      Issue No: Vol. 9 (2022)
  • Waitlisted and Transplant Patient Perspectives on Expanding Access to
           Deceased-Donor Kidney Transplant: A Qualitative Study

    • Authors: Canute Rosaasen, Nicola Rosaasen, Rahul Mainra, Aaron Trachtenberg, Julie Ho, Christina Parsons, Sean Delaney, Holly Mansell
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:A concerning number of kidneys (eg, expanded donor criteria, extended criteria, or marginal kidneys) are discarded yearly while patients experience significant morbidity and mortality on the transplant waitlist. Novel solutions are needed to solve the shortage of kidneys available for transplant. Patient perceptions regarding the use of these less than ideal kidneys remain unexplored.Objective:To explore the perspectives of patients who have previously received a less than ideal kidney in the past and patients awaiting transplant who could potentially benefit from one.Design:Qualitative description study.Setting:2 provinces in Canada participated (Saskatchewan and Manitoba).Patients:Patients with end-stage kidney disease who were awaiting kidney transplant and were either (a) aged 65 years and older, or (b) 55 years and older with other medical conditions (eg, diabetes).Methods:Criterion sampling was used to identify participants. Semi-structured, one-on-one interviews were conducted virtually, which explored perceived quality of life, perceptions of less than ideal kidneys, risk tolerance for accepting one, and educational needs to make such a choice. The interviews were transcribed verbatim and thematic analysis was used to analyze the data.Results:15 interviews were conducted with usable data (n = 10 pretransplant; n = 5 posttransplant). Participants were a mean of 65.5 ± 8.8 years old. Four interrelated themes became prominent including (1) patient awareness and understanding of their situation or context, (2) a desire for information, (3) a desire for freedom from dialysis, and (4) trust. Subthemes of transparency, clarity, standardization, and autonomy were deemed important for participant education. The majority of pretransplant participants (n = 8/10) indicated that between 3 and 5 years off of dialysis would make the risk of accepting a less than ideal kidney feel worthwhile.Limitation:The study setting was limited to 2 Canadian provinces, which limits the generalizability. Furthermore, the participants were homogenous in demographics such as ethnicity.Conclusion:These findings indicate that patients are comfortable to accept a less than ideal kidney for transplant in situations where their autonomy is respected, they are provided clear, standardized, and transparent information, and when they trust their physician. These results will be used to inform the development of a new national registry for expanding access to deceased-donor kidney transplant.Trial Registration:Not registered.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-05-21T11:39:18Z
      DOI: 10.1177/20543581221100291
      Issue No: Vol. 9 (2022)
  • Complement-Amplifying Conditions in Atypical Hemolytic Uremic Syndrome: A
           Canadian Case Series

    • Authors: Christopher J. Patriquin, Katerina Pavenski, Jocelyn Garland, Louis-Philippe Girard, Paul Isenring
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Rationale:Thrombotic microangiopathies (TMAs) are systemic disorders that often affect the kidneys and encompass a heterogeneous group of conditions, including atypical hemolytic uremic syndrome (aHUS). The complement pathway is thought to play a crucial role in the pathogenesis of aHUS, and a favorable response can be obtained through complement C5 inhibition. There is emerging evidence to suggest that the same is also true for several other forms of TMA.Objective:The purpose of this series is to report cases of aHUS in which both an innate defect of the alternative complement pathway and a complement-amplifying condition were suspected.Methods:This case series describes 8 patients who were managed in Canadian tertiary centers for aHUS and who presented initially with complement-amplifying conditions.Results:In all cases, aHUS was associated with organ dysfunction and in some, with an innate defect of the alternative complement pathway. The complement-amplifying conditions identified were diverse including immune disorders, pregnancy, and a Shiga toxin infection. Patients improved rapidly when treated with eculizumab or plasma exchange.Conclusions:These observations illustrate the seriousness of secondary aHUS. They also add to existing lines of evidence that the complement pathway is potentially involved in this condition and that it should be considered as a therapeutic target of interest under such circumstances.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-05-19T11:54:23Z
      DOI: 10.1177/20543581221100288
      Issue No: Vol. 9 (2022)
  • Mutations in CLDN2 Are Not a Common Cause of Pediatric Idiopathic
           Hypercalciuria in Canada

    • Authors: Emma H. Ulrich, Elizabeth Harvey, Catherine J. Morgan, Maury Pinsk, Robin Erickson, Lisa A. Robinson, R. Todd Alexander
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Hypercalciuria is the most common risk factor for kidney stone formation, including in pediatric patients. However, the etiology is often unknown and children are frequently diagnosed with idiopathic hypercalciuria. Nearly 50% of children with hypercalciuria have a first-degree relative with kidney stones, suggesting a strong genetic basis for this disease. A failure of calcium reabsorption from the proximal nephron is implicated in the pathogenesis of hypercalciuria. Claudin-2 is a tight junction protein abundantly expressed in the proximal tubule. It confers paracellular permeability to calcium that is essential for transport across the proximal tubule where the majority of filtered calcium is reabsorbed.Objective:Our objective was to examine the frequency of coding variations in CLDN2 in a cohort of children with idiopathic hypercalciuria.Design:Mixed method including retrospective chart review and patient interview, followed by genetic sequencing.Setting:Three tertiary care centers in Canada.Patients:Children (age 1-18 years) with idiopathic hypercalciuria. Patients with other causes of hypercalciuria were excluded.Methods:Data were collected from 40 patients with idiopathic hypercalciuria. Informed consent to collect DNA was obtained from 13 patients, and the final and only coding exon of CLDN2 was sequenced.Results:The majority of patients were male, white, and had a positive family history of kidney stones. Parathyroid hormone levels were significantly lower than the reference range (P < .001). The levels of 1,25-dihydroxyvitamin D were also significantly higher in our patient cohort, relative to the reference range (P < .001). Sequence analysis of CLDN2 did not identify any coding variations.Limitations:Sequencing analysis was limited to the final coding exon and small sample size.Conclusions:CLDN2 coding variations are not a common cause of idiopathic hypercalciuria in Canadian children. Further study is needed to determine the causes of hypercalciuria in pediatric patients and develop targeted therapies.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-05-19T11:52:31Z
      DOI: 10.1177/20543581221098782
      Issue No: Vol. 9 (2022)
  • Deprescribing Opportunities for Hospitalized Patients With End-Stage
           Kidney Disease on Hemodialysis: A Secondary Analysis of the MedSafer
           Cluster Randomized Controlled Trial

    • Authors: Joseph Moryousef, Émilie Bortolussi-Courval, Tiina Podymow, Todd C. Lee, Emilie Trinh, Emily G. McDonald
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:End-stage kidney disease patients on dialysis have a substantial risk of polypharmacy due their propensity for comorbidity and contact with the health care system. MedSafer is an electronic decision support tool that integrates patient comorbidity and medication lists to generate personalized deprescribing reports focused on identifying potentially inappropriate medications (PIMs).Objective:To conduct a secondary analysis of patients on regular hemodialysis included in the MedSafer randomized controlled trial to investigate the patterns of polypharmacy and evaluate the efficacy of the MedSafer deprescribing algorithms.Design:Secondary analysis of a cluster randomized clinical trial.Setting:Medical units in 11 acute care hospitals in Canada.Patients:The MedSafer trial enrolled 5698 participants with an expected prognosis of >3 months, age 65 years and older, and on 5 or more daily home medications; 140 participants were receiving chronic hemodialysis.Measurements:The primary outcome of the trial was 30-day adverse drug events (ADEs) post-hospital discharge, and a key secondary outcome was deprescribing.Methods:Control patients received usual care (medication reconciliation), whereas clinicians caring for intervention patients received a MedSafer report that highlighted individualized opportunities for deprescribing.Results:There were 70 patients in each of the control and intervention arms. The median number of home medications was 14 (compared with a median of 10 medications in the general trial population). The most frequent medications observed that were potentially inappropriate were proton pump inhibitors (potentially inappropriate in 55/76 users; 72.4%), diabetes medications in patients with a HBA1C
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-05-14T05:36:04Z
      DOI: 10.1177/20543581221098778
      Issue No: Vol. 9 (2022)
  • Use of Google Analytics to Explore Dissemination Activities for an Online
           CKD Clinical Pathway: A Retrospective Study

    • Authors: Christy Chong, Michelle Smekal, Brenda Hemmelgarn, Meghan Elliott, Selina Allu, James Wick, Kerry McBrien, Wes Jackson, Aminu Bello, Kailash Jindal, Nairne Scott-Douglas, Braden Manns, Marcello Tonelli, Maoliosa Donald
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Data on dissemination strategies that generate awareness of clinical pathways for kidney care are limited.Objective:This study reports the application of Google Analytics to describe the reach and use of the Chronic Kidney Disease Pathway (CKD-P) using a multi-faceted dissemination strategy.Design:The design of this study is a retrospective descriptive study.Setting:This study was conducted in Alberta, Canada.Patients:Individuals who accessed the CKD-P Web site between November 5, 2014, and May 31, 2019.Measurements:Dissemination activities included print, electronic, in-person meetings, and a laboratory prompt. We used Google Analytics over a 5-year period to evaluate the following CKD-P Web site user metrics: number of sessions, pageviews, visit duration, user path, and bounce rate (when an individual visits a single page of the Web site and leaves the Web site without interacting with additional pages).Methods:We plotted dissemination activities alongside Web site metrics using control charts and described the data using means and percentages. We performed chi-square test for trends to evaluate year-over-year usage.Results:There were 83 294 users, 90 805 sessions, and 231 684 pageviews. The overall bounce rate was 45.7%. Each user had an average of 1.5 sessions and a session duration of 2 minutes and 8 seconds. There was a significant positive trend for total annual users (P = .008), new users (P = .009), number of sessions (P = .006), and pageviews per day (P = .016).Limitations:We were unable to confirm if users were primary care providers and if word-of-mouth dissemination among providers/researchers drove people to use the CKD-P.Conclusions:Google Analytics was a useful and accessible tool for evaluating CKD-P reach and use trends. It was challenging to identify how individual dissemination activities contributed to CKD-P reach; however, repeated dissemination appeared to play a role in increasing CKD-P use.Trial registration:Not applicable—observational study design.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-05-11T11:53:25Z
      DOI: 10.1177/20543581221097456
      Issue No: Vol. 9 (2022)
  • Q-uestioning the Diagnosis: An Educational Case Report

    • Authors: Aran Thanamayooran, Karthik Tennankore, Laurette Geldenhuys, Elana Murphy, Keigan More
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Rationale:Q fever is a zoonotic infection that may lead to acute or long-term renal injury. Given its rare incidence, Q fever is not often considered on the initial differential diagnosis for glomerular disease which can lead to delays in treatment. This case highlights the importance of avoiding early diagnostic closure and revisiting the differential diagnosis in the setting of an atypical clinical presentation or response to treatment.Presenting Concerns:A 52-year-old female was referred for assessment of possible glomerulonephritis. She described a 3-month history of bilateral lower extremity rash, intermittent knee pain with swelling, and a 2-year history of subjective fevers. Urinalysis showed persistent microscopic hematuria, and her creatinine was elevated at 94 umol/L (baseline 59 umol/L). Her initial investigations included an elevated C-reactive protein (CRP) and rheumatoid factor with a weakly positive anti nuclear antibody (ANA).Diagnoses:Kidney biopsy was consistent with an immune complex mesangial proliferative glomerulonephritis. Light microscopy showed diffuse global mesangial hypercellularity. Immunofluorescence was positive for trace mesangial IgG and kappa, 1+ IgM, lambda and C1q, and 2+ C3. Electron microscopy showed mesangial electron dense deposits. These findings were felt to be most in keeping with mesangial proliferative lupus nephritis; however, it was acknowledged that clinical and laboratory findings supporting this diagnosis were lacking.Interventions:Following treatment with oral prednisone her symptoms resolved, and renal function improved. However, she was unable to taper off prednisone completely without her symptoms returning. Additional immunosuppressive therapies were trialed, but she remained steroid dependent with disease flares related to prednisone tapers. Her atypical response to treatment led to consideration of alternative diagnoses, and further investigation revealed positive Q fever serology (phase-I IgG 1:1892, phase II IgG 1:8192, phase-I and -II IgM < 1:16). She was diagnosed with long-term Q fever and was treated with doxycycline and hydroxychloroquine.Outcomes:She remained on treatment for 2 years. During this time, her symptoms resolved, hematuria disappeared, and her creatinine returned to baseline. Following cessation of therapy, her Q fever IgM titres rose, and she was restarted on doxycycline and hydroxychloroquine indefinitely.Teaching Points:(1) Keeping a broad differential diagnosis in the setting of atypical clinical features or unexpected response to therapy is important for ensuring accurate diagnosis and appropriate treatment. (2) Clinical improvement in relation to immunosuppressive therapy does not preclude an infectious cause of glomerular disease.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-05-03T05:34:47Z
      DOI: 10.1177/20543581221097749
      Issue No: Vol. 9 (2022)
  • Can Peer Review Be Kinder' Supportive Peer Review: A Re-Commitment to
           Kindness and a Call to Action

    • Authors: Catherine M. Clase, Elizabeth Dicks, Rachel Holden, Manish M. Sood, Adeera Levin, Kamyar Kalantar-Zadeh, Linda W Moore, Susan J. Bartlett, Aminu K. Bello, Clara Bohm, Darren Bridgewater, Josee Bouchard, Dylan Burger, Juan Jesús Carrero, Maoliosa Donald, Meghan Elliott, Maya J. Goldenberg, Meg Jardine, Ngan N. Lam, W. Joy Maddigan, François Madore, Thomas A. Mavrakanas, Amber O. Molnar, G. V. Ramesh Prasad, Claudio Rigatto, Karthik K. Tennankore, Elena Torban, Laurel Trainor, Christine A. White, Sunny Hartwig
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Peer review aims to select articles for publication and to improve articles before publication. We believe that this process can be infused by kindness without losing rigor. In 2014, the founding editorial team of the Canadian Journal of Kidney Health and Disease (CJKHD) made an explicit commitment to treat authors as we would wish to be treated ourselves. This broader group of authors reaffirms this principle, for which we suggest the terminology “supportive review.”
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-05-01T05:52:58Z
      DOI: 10.1177/20543581221080327
      Issue No: Vol. 9 (2022)
  • Health-Related Quality of Life and Disability Among Older New Zealanders
           With Kidney Failure: A Prospective Study

    • Authors: Elizabeth Butcher, Robert Walker, Emma Wyeth, Ari Samaranayaka, John Schollum, Sarah Derrett
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Disability is prevalent in individuals with kidney failure and can contribute to significantly reduced quality of life and survival. In older individuals with kidney failure, disability can be caused by a combination of factors, including issues directly related to their kidney disease and/or treatment, including weakness, low energy, and low activity. Few studies have investigated health-related quality of life (HRQoL) as a possible predictor of disability among older individuals experiencing kidney failure.Objective:This study aimed to determine if patient-reported HRQoL, and/or other factors at baseline, predicts disability in people with kidney failure, aged ≥65 years, after 12 months of follow-up.Design:The DOS65+ study was an accelerated longitudinal cohort design comprising of both cross-sectional and longitudinal components. Participants were eligible if they were aged ≥65 years, had chronic kidney disease stage 5G (CKD G5) (estimated glomerular filtration rate (eGFR)
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-04-27T06:15:07Z
      DOI: 10.1177/20543581221094712
      Issue No: Vol. 9 (2022)
  • Rituximab for Adults With Multi-Drug Resistant Focal Segmental
           Glomerulosclerosis: A Case Series and Review of the Literature

    • Authors: Ellia Zhong, Siavash Ghadiri, Alexander Pai, Judith G. Marin, Sean J. Barbour
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Adults with primary focal segmental glomerulosclerosis (FSGS) are frequently resistant to multiple immunosuppressive agents, which is associated with ongoing complications of nephrotic syndrome and a high risk of progression to end-stage renal disease (ESRD). Rituximab, a monoclonal antibody against the B cell CD20 antigen, has shown some preliminary evidence in treating nephrotic syndrome.Objectives:Describe the usage and the efficacy of rituximab for adults with FSGS in British Columbia (BC) (Canada) and perform a literature review of multi-immunosuppressive drug resistant FSGS in adult patients treated with rituximab to estimate the overall response rate.Design:Case series report and a literature review.Patients:For the case-series, all BC patients who received rituximab for a diagnosis of primary FSGS were included. The literature review included all cases of immunosuppressive-resistant FSGS patients treated with rituximab. We excluded transplant and pediatric patients in both groups.Methods:We describe all cases of adults with native-kidney FSGS resistant to conventional immunosuppressive medications from our provincial health database who were treated with rituximab from 2014 to 2018. A review of the existing literature was performed via PubMed, MEDLINE, and Embase using the following keywords: rituximab, focal segmental glomerulosclerosis, and FSGS up to August 2019.Results:We characterize four immunosuppressive-resistant FSGS patients who were treated with rituximab as part of our provincial program, all of whom showed a response to rituximab with a sustained remission. We found 29 specific cases in the literature of adults with native-kidney FSGS treated with rituximab after being resistant to other immunosuppressive medications, of whom 15 cases showed a response to rituximab. This has increased the total response rate from 15/29 (52%) to 19/33 (58%).Limitations:Literature on this topic is coming predominantly from case series. Prospective trials are needed to confirm efficacy, tolerability, and duration of remission.Conclusions:Due to the low number of currently reported cases and variable response rates, these four cases provide critical data to generate a more accurate understanding of the role of rituximab in adults with resistant FSGS. Adding these results to the confirmed literature cases of multiple-immunosuppressive-resistant FSGS patients treated with rituximab results in a total remission rate of 19/33 cases.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-04-19T12:30:30Z
      DOI: 10.1177/20543581221090010
      Issue No: Vol. 9 (2022)
  • Experiences of Caregivers of Patients With Conservatively Managed Kidney
           Failure: A Mixed Methods Systematic Review

    • Authors: Anisha Walavalkar, Alison Craswell, Nicholas A. Gray
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Older people with kidney failure often choose conservative kidney care. The experiences and quality of life (QOL) of caregivers who support them are incompletely characterized.Objective:To determine the burden, QOL, and understand experiences of caregivers supporting patients managed conservatively.Design:Systematic review of quantitative and qualitative studies.Sources of information:PubMed, Embase, PsycINFO, CINAHL, and MEDLINE electronic databases were systematically searched for quantitative and qualitative studies published between January 2000 and July 2020.Subjects:Caregivers of adults with kidney failure (estimated glomerular filtration rate < 15 mL/min/1.73 m2) managed conservatively.Methods:Data were extracted by 2 independent reviewers using a prespecified extraction tool. Study quality was assessed using the Critical Appraisal Skills Program (CASP) tool.Measurements:Descriptive reports of demographics, measurement scales, and outcomes. Thematic synthesis of qualitative data.Results:Six studies met inclusion criteria, including 3 quantitative and 3 descriptive qualitative studies. Caregivers of patients receiving conservative kidney management (CKM) experienced significant caregiver burden and similar impacts to their QOL as those caring for patients receiving dialysis. Thematic synthesis revealed 5 themes: Understanding the concept of CKM, Need for involvement in the decision for CKM, Identifying available supports, Uncertainty about the future and negotiating deteriorations and dying, and Burden of care impacting on QOL.Limitations:Low numbers of included studies, data collection and recruitment biases in qualitative studies and small caregiver numbers in quantitative studies, limit transferability of findings. Heterogeneity in study design and outcome measures precluded meta-analysis.Conclusions:Caregivers of patients with conservatively managed kidney failure suffer significant burden and experience QOL comparable with those caring for patients on dialysis. Limited understanding and involvement in conservative management decision making, and a fear of deterioration and dying, result in anxiety in caregivers. Further research into the experiences of caregivers will help support both caregivers and the patients who choose conservative management.Registration:PROSPERO registration number CRD42021209811.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-04-15T12:38:43Z
      DOI: 10.1177/20543581221089080
      Issue No: Vol. 9 (2022)
  • The Canadian Glomerulonephritis Registry (CGNR) and Translational Research
           Initiative: Rationale and Clinical Research Protocol

    • Authors: Ainslie M. Hildebrand, Moumita Barua, Sean J. Barbour, Karthik K. Tennankore, Daniel C. Cattran, Tomoko Takano, Ping Lam, Sacha A. De Serres, Ratna Samanta, Michelle A. Hladunewich, Todd Fairhead, Penelope Poyah, D. Danielle Bush, Brian MacLaren, Dwight Sparkes, Philip Boll, Arenn Jauhal, Rohan John, Carmen Avila-Casado, Heather N. Reich
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Glomerulonephritis (GN) is a leading cause of kidney failure and accounts for 20% of incident cases of end-stage kidney disease (ESKD) in Canada annually. Reversal of kidney injury and prevention of progression to kidney failure is possible; however, limited knowledge of underlying disease mechanisms and lack of noninvasive biomarkers and therapeutic targets are major barriers to successful therapeutic intervention. Multicenter approaches that link longitudinal clinical and outcomes data with serial biologic specimen collection would help bridge this gap.Objective:To establish a national, patient-centered, multidimensional web-based clinical database and federated virtual biobank to conduct human-based molecular and clinical research in GN in Canada.Design:Multicenter, prospective observational registry, starting in 2019.Setting:Nine participating Canadian tertiary care centers.Patients:Adult patients with a histopathologic pattern of injury consistent with IgA nephropathy, focal and segmental glomerulosclerosis, minimal change disease, membranous nephropathy, C3 glomerulopathy, and membranoproliferative GN recruited within 24 months of biopsy.Measurements:Initial visits include detailed clinical, histopathological, and laboratory data collection, blood, urine, and tonsil swab biospecimen collection, and a self-administered quality of life questionnaire. Follow-up clinical and laboratory data collection, biospecimen collection, and questionnaires are obtained every 6 months thereafter.Methods:Patients receive care as defined by their physician, with study visits scheduled every 6 months. Patients are followed until death, dialysis, transplantation, or withdrawal from the study. Key outcomes include a composite of ESKD or a 40% decline in estimated glomerular filtration rate (eGFR) at 2 years, rate of kidney function decline, and remission of proteinuria. Clinical and molecular phenotypical data will be analyzed by GN subtype to identify disease predictors and discover therapeutic targets.Limitations:Given the relative rarity of individual glomerular diseases, one of the major challenges is patient recruitment. Initial registry studies may be underpowered to detect small differences in clinically meaningful outcomes such as ESKD or death due to small sample sizes and short duration of follow-up in the initial 2-year phase of the study.Conclusions:The Canadian Glomerulonephritis Registry (CGNR) supports national collaborative efforts to study glomerular disease patients and their outcomes.Trial registration:NCT03460054.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-04-08T09:27:14Z
      DOI: 10.1177/20543581221089094
      Issue No: Vol. 9 (2022)
  • Ethnic Differences in Health Literacy, Self-Efficacy, and Self-Management
           in Patients Treated With Maintenance Hemodialysis

    • Authors: Uchenna Ibelo, Theresa Green, Bejoy Thomas, Sandra Reilly, Kathryn King-Shier
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:There is a gap in research investigating the potential impact of ethnicity on health literacy, self-efficacy, and self-management in patients treated with maintenance hemodialysis (MHD).Objective:To explore (1) the associations between health literacy, self-efficacy, and self-management among outpatients with kidney failure receiving treatment with MHD, and (2) the differences in health literacy and self-efficacy based on characteristics of ethnicity (ie, physical resemblance and proficiency in the language of the host population), known to be associated with health care access and health outcomes.Design:Cross-sectionalSetting:Outpatients receiving MHD at 7 adult hemodialysis centers in Calgary, Alberta from September 2014 to December 2014.Patients:Participants were grouped into 2 groups based on a proposed 4-quadrant framework of a multicultural society. Quadrant 1 comprised outpatients with physical resemblance and first language of the host population (ie, white and English as a first language), whereas quadrant 4 participants comprised outpatients with physical resemblance and first language not of the host population (ie, non-white and first language other than English). A total of 78 patients (nQ1 = 44, nQ4 = 34) were included.Measurements:Heath literacy, self-efficacy, and self-management were measured using the Health Literacy Questionnaire (HLQ), Strategies Used by People to Promote Health (SUPPH), and Patient Activation Measure-13 (PAM-13), respectively.Methods:Convenience sampling was used to recruit participants at each of the 7 adult hemodialysis centers. All participants completed a study package, which included a demographic questionnaire, HLQ, SUPPH, and PAM-13. Spearman rho was calculated to identify correlations between patient activation level and HLQ and SUPPH scores. Independent t tests were performed to identify differences in HLQ and SUPPH scores between Q1 and Q4 participants. Stepwise regression was performed in other analyses to identify predictor variables of patient activation level.Results:Statistically significant correlations were identified between patient activation level and the health literacy domains of “ability to actively engage with health care providers” (rHLQ6= .535, P < .001), “ability to find good health information” (rHLQ8 = .611, P < .001), and “understanding health information well enough to know what to do” (rHLQ9 = .712, P < .001). There was a statistically significant difference between Q1 and Q4 participants in the health literacy domain of “ability to find good health information” (P = .048). “Understanding health information well enough to know what to do” and “actively managing health” were included in the final stepwise regression model, F(2, 72) = 32.232, P < .001.Limitations:The cross-sectional design limits the generalizability of the results. The small sample size limits the power to identify significant associations and differences. Although English was not the first language of Q4 participants, all were proficient in English, meaning potential differences of a key subgroup of Q4 (ie, those who did not speak any English) were not captured.Conclusion:The HLQ allowed for the creation of a health literacy profile of patients with end-stage kidney disease receiving treatment with MHD. The findings suggest possible associations between specific domains of health literacy and patient activation. Outpatients’ representative of Q4 receiving treatment with MHD appear to struggle more with finding good health information, which may leave them at a disadvantage in the early phases of their self-management efforts. The findings highlight potential opportunities to better tailor patient care to support patients in their self-management, particularly for patients from ethnic minority backgrounds.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-03-26T08:58:47Z
      DOI: 10.1177/20543581221086685
      Issue No: Vol. 9 (2022)
  • The Challenges of Diagnosing Nondilated Obstructive Uropathy: A Case

    • Authors: Muhammad Asim Shahzad, Pravir V. Baxi, Roger A. Rodby
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Rationale:Nondilated obstructive uropathy (NDOU) is a rare cause of acute renal failure reported in less than 5% of cases of obstructive uropathy. It is typically associated with intrapelvic malignancies and diseases causing retroperitoneal lymphadenopathy and retroperitoneal fibrosis. As these conditions may prevent radiographic dilation of the collecting system, the diagnosis of NDOU may be missed by usual diagnostic testing.Presenting concerns of the patient:We present a case of acute anuric renal failure in a middle-aged woman with metastatic breast cancer associated with abdominal and retroperitoneal lymphadenopathy. Acute kidney injury was initially deemed secondary to drug-induced acute tubular necrosis (ATN) from bisphosphonate; however, there remained a high clinical suspicion of NDOU due to the presence of enlarged retroperitoneal lymph nodes on CT abdomen and pelvis with concerns for encasement of bilateral renal pelvic regions and ureters.Diagnoses:The patient underwent a retrograde pyelogram which demonstrated questionable narrowing bilaterally at the level of the renal pelvices. This led to an even stronger clinical suspicion of NDOU and urology service was consulted for evaluation.Intervention:Bilateral ureteral stents were placed by urology which led to robust urine output and rapid reversal of renal failure over the next 24 to 48 hours.Outcomes:Despite 2 weeks of anuria and hemodialysis, this patient’s creatinine came back to her baseline. She was able to discontinue hemodialysis and her creatinine stabilized at 88.4 μmol/L (1 mg/dL).Teaching points:Nondilated obstructive uropathy is rare but important diagnosis that requires a high clinical suspicion in the appropriate clinical scenario. The lack of dilatation is believed to be related to encasement of the collecting system by tumor, fibrosis, or as in our case metastatic retroperitoneal lymphadenopathy. As this diagnosis cannot be overlooked, aggressive direct visualization or even intervention with internal or external stenting may be required to both diagnose and treat this condition.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-03-26T08:56:52Z
      DOI: 10.1177/20543581221086683
      Issue No: Vol. 9 (2022)
  • Mental Health Care for Adults Treated With Dialysis in Canada: A Scoping

    • Authors: Laurence Fernandez, Stephanie Thompson, Charlotte Berendonk, Kara Schick-Makaroff
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Purpose of review:Mental illnesses, especially depression and anxiety, are common conditions frequently underrecognized and untreated among individuals with end-stage kidney disease. Existing tools/interventions, approaches to care, and resources to support mental health for people treated with dialysis in Canada are not well known. The aim of this scoping review was to systematically describe how mental health care is provided to adults treated with dialysis in Canada. The research questions we sought to answer were the following: (1) What mental health assessment tools and interventions for adults treated with dialysis have been investigated and utilized in Canada' (2) what is the structure and process of mental health care delivered by kidney care to adults treated with dialysis in Canada' and (3) what is the availability of mental health care resources developed for adults treated with dialysis in Canada'Sources of information:Electronic databases included Medline, Embase, CINAHL, PsycINFO, Cochrane Library, Scopus, and Web of Science for peer-reviewed literature, and Google search engine for gray literature.Methods:Systematic searches were conducted to identify peer-reviewed and gray literature that focused on mental health care or support offered to adults receiving any form of dialysis in Canadian kidney care settings and/or community organizations. Mental health care and support was defined to include mental health assessment tools, interventions, resources, guidelines, and/or pathways used in dialysis in Canada. Title, abstracts, and full texts were screened independently by 2 reviewers with discrepancies resolved by additional team members. Web sites were screened by individual members. Data from included studies and Web sites were extracted based on the abovementioned research questions.Key findings:We identified 8 peer-reviewed articles from electronic databases, and 28 separate Web site addresses. Of the 8 articles, 4 investigated mental health assessment tools and 4 examined mental health interventions for individuals treated with dialysis in Canada. The mental health assessment tools that have been used are Beck Depression Inventory-II (BDI-II), Edmonton System Assessment Scale (ESAS), Edmonton System Assessment Scale revised (ESAS-r): Renal, Hospital Anxiety and Depression Scale (HADS), and Distress Assessment and Response Tool (DART), and the nonpharmacological interventions that have been investigated are intradialytic exercise, tai chi exercise program, medical music therapy, and brief mindfulness meditation. Of the 28 Web site addresses, 2 contained clinical tools for kidney care providers for the management of depression and anxiety in individuals treated with dialysis. The 26 remaining Web sites contained mental health resources for individuals with kidney disease, which presented different types of resources, including psychoeducation, peer support, and linkage to other services.Conclusion:In conclusion, we found only a limited number of studies investigating mental health assessment tools and interventions in Canada; there was a paucity of randomized controlled trials. Clinical pathways for the assessment and management of mental illness or symptoms in individuals treated with dialysis in Canada are also limited, and no clinical practice guidelines exist. Several mental health resources for people living with dialysis are available, predominantly focused on psychoeducation and peer support. Despite increasing prevalence of mental health concerns by people treated with dialysis, mental health care remains underaddressed.Limitations:It is plausible that additional literature related to mental health assessment tools, interventions, resources, guidelines, and pathways exists that we did not find during our systematic search, especially in gray literature that was limited to one search engine. In addition, health care agencies or organizations may have developed other mental health resources, which may not be available on the Internet.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-03-23T02:34:18Z
      DOI: 10.1177/20543581221086328
      Issue No: Vol. 9 (2022)
  • Patient and Clinician Perspectives on the use of Remote Patient Monitoring
           in Peritoneal Dialysis

    • Authors: Benjamin Talbot, Sara Farnbach, Allison Tong, Steve Chadban, Shaundeep Sen, Vincent Garvey, Martin Gallagher, John Knight
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Numerous factors influence patient recruitment to, and retention on, peritoneal dialysis (PD), but a major challenge is a perceived “inaccessibility” to treating clinicians. It has been suggested that remote patient monitoring (RPM) could be a means of improving such oversight and, thereby, uptake of PD.Objective:To describe patient and clinician perspectives toward RPM and the use of applications (Apps) suitable for mobiles, tablets, or computers to support the provision of PD care.Design:Qualitative design using semi-structured interviews.Setting:All patient participants perform PD treatment at home under the oversight of an urban PD unit in Sydney, Australia. Patient and clinician interviews were conducted within the PD unit.Participants:14 participants (5 clinicians [2 nephrologists, 3 PD nurses] and 9 patients treated with PD).Methods:Semi-structured interviews were conducted using interview guides tailored for clinician and patient participants. Transcripts were coded and analyzed by a single researcher using thematic analysis.Results:Six themes were identified: perceived benefits of RPM implementation (offering convenience and efficiency, patient assurance through increased surveillance, more complete data and monitoring adherence), uncertainty regarding data governance (protection of personal data, data reliability), reduced patient engagement (transfer of responsibility leading to complacency), changing patient-clinician relationships (reduced patient-initiated communication, the need to maintain patient independence), increased patient and clinician burden (inadequate technological literacy, overmanagement leading to frequent treatment changes), and clinician preference influencing patient behavior.Limitations:The interviews were conducted in English only and with participants from a single urban dialysis unit, which may limit generalizability.Conclusions:For patients and clinicians, advantages from the use of RPM in PD may include increased patient confidence and assurance, improved treatment oversight, more complete data capture, and overcoming barriers to data documentation. Careful patient selection and patient and clinician education may help to optimize the benefits of RPM, maintain patient independence, and reduce the risks of patient disengagement. The use of an App may support RPM; however, participants expressed concerns about increasing the burden on some patients through the use of unfamiliar technology.Human Research Ethics Committee Approval Number:CH62/6/2019-028
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-03-21T10:58:12Z
      DOI: 10.1177/20543581221084499
      Issue No: Vol. 9 (2022)
  • Protocol for a Process Evaluation of the Quality Improvement Intervention
           to Enhance Access to Kidney Transplantation and Living Kidney Donation
           (EnAKT LKD) Cluster-Randomized Clinical Trial

    • Authors: Seychelle Yohanna, Mackenzie Wilson, Kyla L. Naylor, Amit X. Garg, Jessica M. Sontrop, Dmitri Belenko, Lori Elliott, Susan McKenzie, Sara Macanovic, Istvan Mucsi, Rachel Patzer, Irina Voronin, Iris Lui, Peter G. Blake, Amy D. Waterman, Darin Treleaven, Justin Presseau
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Many patients who would benefit from a kidney transplant never receive one. The Enhance Access to Kidney Transplantation and Living Kidney Donation (EnAKT LKD) pragmatic, cluster-randomized clinical trial is testing whether a multi-component quality improvement intervention, provided in chronic kidney disease (CKD) programs (vs. usual care), can help patients with CKD with no recorded contraindications to kidney transplant complete more steps toward receiving a transplant (primary outcome of the trial). The EnAKT LKD intervention has 4 components: (1) quality Improvement teams and administrative support, (2) improved transplant education for patients and healthcare providers, (3) access to support and (4) program-level performance monitoring.Objective:To conduct a process evaluation of the EnAKT LKD quality improvement intervention to determine if the components were delivered, received, and enacted as designed (fidelity), and if the intervention addressed intended barriers (mechanisms of change).Design:A mixed-methods process evaluation informed by new practice implementation and theories of behavior change.Setting:Chronic kidney disease programs in Ontario, Canada, began receiving the EnAKT LKD intervention on November 1, 2017 and will continue to receive it until December 31, 2021. The process evaluation (interviews and surveys) will occur alongside the trial, between December 2020 to May 2021.Participants:Healthcare providers (eg, dialysis nurses, nephrologists, members of the multi-care kidney clinic team) at Ontario’s 27 CKD programs.Methods:We will survey and interview healthcare providers at each CKD program, and complete an intervention implementation checklist. Quantitative data from the surveys and the intervention implementation checklist will assess fidelity to the intervention, while quantitative and qualitative data from surveys and interviews will provide insight into the mechanisms of change.Limitations:The long trial period may result in poor participant recall.Conclusion:This process evaluation will enhance interpretation of the trial findings, guide improvements in the intervention components, and inform future implementation.Trial; identifier: NCT03329521.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-03-19T12:03:19Z
      DOI: 10.1177/20543581221084502
      Issue No: Vol. 9 (2022)
  • Urinary Potassium Excretion and Progression From Advanced CKD to Kidney

    • Authors: Gregory L. Hundemer, Manish M. Sood, Tim Ramsay, Ayub Akbari
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Increased dietary potassium intake has well-proven beneficial effects on cardiovascular health and mortality. However, the association between dietary potassium intake and chronic kidney disease (CKD) progression remains unclear with prior studies reporting conflicting results.Objective:To study the association between 24-hour urinary potassium excretion (a surrogate for dietary potassium intake) and progression to kidney failure.Design:Retrospective cohort study.Setting:Ottawa, CanadaPatients:Patients with advanced CKD referred to the Ottawa Hospital Multi-Care Kidney Clinic from 2010 to 2020.Measurements:Twenty-four-hour urinary potassium excretion measured upon referral to the Ottawa Hospital Multi-Care Kidney Clinic as part of routine clinic protocol.Methods:Multivariable Cox and Fine and Gray models provided hazard ratios (HRs) and 95% confidence intervals (CIs) to estimate the association between quartiles of 24-hour urinary potassium excretion and progression to kidney failure. A restricted cubic spline analysis examined the possible nonlinear relationship between 24-hour urinary potassium excretion (as a continuous variable) and progression to kidney failure.Results:Overall, 432/695 (62%) patients progressed to kidney failure. Across all models, there was no significant difference in kidney failure risk by quartile of 24-hour urinary potassium excretion (all P values for trend ≥.05). Hazard ratios (95% CIs) from the multivariable-adjusted Cox model were as follows: quartile 1, referent; quartile 2, 0.95 (0.71-1.27); quartile 3, 1.00 (0.76-1.33); and quartile 4 0.85 (0.63-1.14); P value for trend = .36. Restricted cubic spline analysis showed an overall linear and nonsignificant relationship between 24-hour urinary potassium excretion as a continuous variable and progression to kidney failure.Limitations:Observational design, single center.Conclusions:We found no association between 24-hour urinary potassium excretion and progression to kidney failure in patients with advanced CKD. Therefore, we identified no clear evidence that increasing or decreasing dietary potassium intake significantly associates with CKD progression in this population.Trial Registration:Not registered.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-03-19T12:00:59Z
      DOI: 10.1177/20543581221084501
      Issue No: Vol. 9 (2022)
  • Patient Perspectives on Integrating Risk Prediction Into Kidney Care:
           Opinion Piece

    • Authors: Dwight Sparkes, Loretta Lee, Blair Rutter, Oksana Harasemiw, Bjoerg Thorsteinsdottir, Navdeep Tangri
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Although Chronic Kidney Disease is common, only a relatively small proportion of individuals will reach kidney failure requiring dialysis or transplantation. Validated risk equations using routine laboratory tests have been developed that can easily be used at the bedside to help clinicians accurately predict the risk of kidney failure in their patient population, in turn informing patient-centered conversations, guiding appropriate nephrology referrals, improving the timing of dialysis treatment planning, and identifying individuals who are most likely to benefit from interventions. In this article, individuals living with kidney disease share why access to individualized prediction of kidney failure risk can help patients manage their disease and why it should be considered an essential component of kidney care.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-03-14T09:38:16Z
      DOI: 10.1177/20543581221084522
      Issue No: Vol. 9 (2022)
  • Rituximab Use for the Treatment of Childhood Nephrotic Syndrome by
           Canadian Pediatric Nephrologists: A National Survey

    • Authors: Cory Meeuwisse, Catherine J. Morgan, Susan Samuel, R Todd Alexander, Sara Rodriguez-Lopez
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:There is known practice variation in the treatment of frequently relapsing, steroid-dependent, and steroid-resistant nephrotic syndrome in children. Rituximab is an emerging therapy for difficult-to-treat nephrotic syndrome; however, there are no clear treatment guidelines. We therefore hypothesized that a wide variety of approaches to this therapy exist.Objective:To evaluate when and how rituximab is used for the treatment of childhood nephrotic syndrome in Canada.Design and setting:An online survey was used.Participants:Canadian pediatric nephrologists.Methods:A cross-sectional survey was distributed across Canada through the Canadian Association of Pediatric Nephrologists (CAPN) to evaluate rituximab treatment practices.Results:Of a total of 20 responses, 19 (95%) use rituximab in the treatment of nephrotic syndrome, usually as a third or fourth agent. For the number of rituximab doses, the majority (68%) uses 2 doses each time they use it. Eighteen respondents (90%) measure B cells when using this medication, mostly monthly (50%) or every 3 months (39%). Respondents were administered additional doses of rituximab prophylactically (74%) or at first relapse (47%). Long-term drug safety and drug funding were identified as the main barriers to rituximab use.Limitations:This survey represents the practice styles of physicians in a single country, and there is a nonresponse bias of 63%. Also, associations were not calculated.Conclusions:Among Canadian pediatric nephrologists, rituximab use for nephrotic syndrome appears to be increasing, but significant practice variations remain, including approaches to B-cell monitoring. It is reserved mostly for second-line and third-line use due to cost, funding issues, and residual uncertainty regarding long-term safety. Understanding these critical areas of practice uncertainty is a first step to optimize treatment of nephrotic syndrome in children.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-03-12T06:21:35Z
      DOI: 10.1177/20543581221079959
      Issue No: Vol. 9 (2022)
  • Kidney Health for All: Bridging the Gap in Kidney Health Education and

    • Authors: Robyn G. Langham, Kamyar Kalantar-Zadeh, Ann Bonner, Alessandro Balducci, Li-Li Hsiao, Latha A. Kumaraswami, Paul Laffin, Vassilios Liakopoulos, Gamal Saadi, Ekamol Tantisattamo, Ifeoma Ulasi, Siu-Fai Lui
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      The high burden of kidney disease, global disparities in kidney care, and poor outcomes of kidney failure bring a concomitant growing burden to persons affected, their families, and carers, and the community at large. Health literacy is the degree to which persons and organizations have or equitably enable individuals to have the ability to find, understand, and use information and services to make informed health-related decisions and actions for themselves and others. Rather than viewing health literacy as a patient-deficit, improving health literacy largely rests with health care providers communicating and educating effectively in codesigned partnership with those with kidney disease. For kidney policy makers, health literacy provides the imperative to shift organizations to a culture that places the person at the center of health care. The growing capability of and access to technology provides new opportunities to enhance education and awareness of kidney disease for all stakeholders. Advances in telecommunication, including social media platforms, can be leveraged to enhance persons’ and providers’ education; The World Kidney Day declares 2022 as the year of “Kidney Health for All” to promote global teamwork in advancing strategies in bridging the gap in kidney health education and literacy. Kidney organizations should work toward shifting the patient-deficit health literacy narrative to that of being the responsibility of health care providers and health policy makers. By engaging in and supporting kidney health–centered policy-making, community health planning, and health literacy approaches for all, the kidney communities strive to prevent kidney diseases and enable living well with kidney disease.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-03-09T07:01:08Z
      DOI: 10.1177/20543581221085075
      Issue No: Vol. 9 (2022)
  • Development and Feasibility of a Multidisciplinary Approach to AKI
           Survivorship in Care Transitions: Research Letter

    • Authors: Erin F. Barreto, Heather P. May, Diana J. Schreier, Laurie A. Meade, Brenda K. Anderson, Megan E. Rensing, Kari L. Ruud, Andrea G. Kattah, Andrew D. Rule, Rozalina G. McCoy, Dawn M. Finnie, Joseph R. Herges, Kianoush B. Kashani
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Acute kidney injury (AKI) survivors are at heightened risk for poor short- and long-term health outcomes. Even among those who recover after an AKI episode, the risk for chronic kidney disease is 4- to 6-fold higher than in patients without AKI, underscoring the importance of identifying methods to improve AKI survivorship.Objective:The purpose of this report was to describe the development and feasibility of a novel multidisciplinary approach to caring for AKI survivors at care transitions (ACT).Design:Observational process improvement initiative.Setting:Single academic medical center in the United States.Patients:The studied population was adults with stage 3 AKI not discharging on dialysis who were established with a primary care provider (PCP) at our institution.Methods:An electronic health record tool was developed prior to implementation to identify AKI survivors. The ACT program encompassed engaging patients in the hospital, delivering education by nephrology-trained nurses before discharge, completing recommended laboratory testing after discharge, and conducting structured kidney-focused follow-up with a pharmacist and a PCP within 7 to 14 days after discharge. Patients could be referred for nephrology evaluation at the discretion of the PCP.Results:Preliminary data demonstrated that most AKI survivors of interest could be identified, educated, and followed up with this model. This strategy appeared feasible, scalable, and maximized the unique expertise of each member of the multidisciplinary team.Limitations:Small sample size, future assessment of process, clinical, and patient-reported outcomes needed.Conclusions:The multidisciplinary ACT workflow supported by clinical decision support was feasible and addressed gaps in existing care transition models. Team-based care delivery in primary care appears to be a mechanism to extend the capacity for kidney health monitoring for AKI survivors.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-03-07T05:22:16Z
      DOI: 10.1177/20543581221081258
      Issue No: Vol. 9 (2022)
  • Long-term Effects of a Brief Mindfulness Intervention Versus a Health
           Enhancement Program for Treating Depression and Anxiety in Patients
           Undergoing Hemodialysis: A Randomized Controlled Trial

    • Authors: Christina Rigas, Haley Park, Marouane Nassim, Chien-Lin Su, Kyle Greenway, Mark Lipman, Clare McVeigh, Marta Novak, Emilie Trinh, Ahsan Alam, Rita S. Suri, Istvan Mucsi, Susana G. Torres-Platas, Helen Noble, Harmehr Sekhon, Soham Rej, Michael Lifshitz
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Depression and anxiety affect approximately 50% of patients with kidney failure receiving hemodialysis and are associated with decreased quality of life and increased risk of hospitalization and mortality. A Brief Mindfulness Intervention (BMI) may be promising in treating depressive and anxiety symptoms in this population, but the long-term sustainability of the intervention’s effects is unknown.Objective:We previously conducted a randomized controlled trial (RCT; n = 55) comparing an 8-week BMI with an active control (Health Enhancement Program [HEP]) for patients receiving dialysis, with depression and/or anxiety. Here, we examine the 6-month follow-up data to determine the long-term sustainability of BMI versus HEP in reducing (1) depressive symptoms, (2) anxiety symptoms, and (3) the efficacy of BMI versus HEP in reducing the likelihood of hospitalization.Design:In this study, we analyzed 6-month follow-up data from an 8-week assessor-blinded parallel RCT, which evaluated the efficacy of a BMI against an active control, HEP, in patients receiving hemodialysis with symptoms of depression and/or anxiety.Setting:The study took place at hemodialysis centers in 4 tertiary-care hospitals in Montreal, Canada.Participants:Participants included adults aged ≥18 years who were receiving in-center hemodialysis 3 times per week and had symptoms of depression and/or anxiety as indicated by a score ≥6 on the Patient Health Questionnaire–9 (PHQ-9) and/or the General Anxiety Disorder–7 (GAD-7).Methods:Participants were randomized to the treatment arm (BMI) or the active control arm (HEP) and completed assessments at baseline, 8 weeks, and 6-month follow-up. Depression was assessed using the PHQ-9, and anxiety was assessed by the GAD-7. Hospitalization rates were assessed using medical chart information.Results:We observed significant decrease in depression scores over 6 months in both BMI and HEP groups, with no significant difference between groups. Anxiety scores significantly decreased over 6 months, but only in the BMI group. Brief Mindfulness Intervention and Health Enhancement Program were comparable in terms of hospitalization rates.Limitations:The limitations of our study include the modest sample size and lack of a third arm such as a waitlist control.Conclusions:Our results suggest that the beneficial effects of BMI and HEP for improving mood disorder symptoms in patients receiving dialysis persist at 6-month follow-up. Both interventions showed sustained effects for depressive symptoms, but BMI may be more useful in this population given its efficacy in reducing anxiety symptoms as well.Trial registration:Prior to recruitment, the trial had been registered ( Identifier: NCT03406845).
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-03-05T06:14:22Z
      DOI: 10.1177/20543581221074562
      Issue No: Vol. 9 (2022)
  • Update on Existing Care Models for Chronic Kidney Disease in Low- and
           Middle-Income Countries: A Systematic Review

    • Authors: Victoria Nkunu, Natasha Wiebe, Aminu Bello, Sandra Campbell, Elliot Tannor, Cherian Varghese, John Stanifer, Marcello Tonelli
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Approximately 78% of chronic kidney disease (CKD) cases reside in low- and middle-income countries (LMICs). However, little is known about the care models for CKD in LMICs.Objective:Our objective was to update a prior systematic review on CKD care models in LMICs and summarize information on multidisciplinary care and management of CKD complications.Design:We searched MEDLINE, EMBASE, and Global Health databases in September 2020, for papers published between January 1, 2017, and September 14, 2020. We used a combination of search terms, which were different iterations of CKD, care models, and LMICs. The World Bank definition (2019) was used to identify LMICs.Setting:Our review included studies published in LMICs across 4 continents: Africa, Asia, North America (Mexico), and Europe (Ukraine). The study settings included tertiary hospitals (n = 6), multidisciplinary clinics (n = 1), primary health centers (n = 2), referral centers (n = 2), district hospitals (n = 1), teaching hospitals (n = 1), regional hospital (n = 1), and an urban medical center (n = 1).Patients:Eighteen studies met inclusion criteria, and encompassed 4679 patients, of which 4665 were adults. Only 9 studies reported mean eGFR which ranged from 7 to 45.90 ml/min/1.73 m2.Measurements:We retrieved the following details about CKD care: funding, urban or rural location, types of health care staff, and type of care provided, as defined by Kidney Disease Improving Global Outcomes (KDIGO) guidelines for CKD care.Methods:We included studies which met the following criteria: (1) population was largely adults, defined as age 18 years and older; (2) most of the study population had CKD, and not end-stage kidney disease (ESKD); (3) population resided in an LMIC as defined by the World Bank; (4) manuscript described in some detail a clinical care model for CKD; (5) manuscript was in either English or French. Animal studies, case reports, comments, and editorials were excluded.Results:Eighteen studies (24 care models with 4665 patients) met inclusion criteria. Out of 24 care models, 20 involved interdisciplinary health care teams. Twenty models incorporated international guidelines for CKD management. However, conservative kidney management (management of kidney failure without dialysis or renal transplant) was in a minority of models (11 of 24). Although there were similarities between all the clinical care models, there was variation in services provided and in funding arrangement; the latter ranged from comprehensive government funding (eg, Sri Lanka, Thailand), to out-of-pocket payments (eg, Benin, Togo).Limitations:These include (1) lack of detail on CKD care in many of the studies, (2) small number of included studies, (3) using a different definition of care model from the original Stanifer et al paper, and (4) using the KDIGO Guidelines as the standard for defining a CKD care model.Conclusions:Most of the CKD models of care include the key elements of CKD care. However, access to such care depends on the funding mechanism available. In addition, few models included conservative kidney management, which should be a priority for future investment.Trial registration:Not applicable.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-03-02T12:09:58Z
      DOI: 10.1177/20543581221077505
      Issue No: Vol. 9 (2022)
  • A Unique Multi- and Interdisciplinary Cardiology-Renal-Endocrine Clinic: A
           Description and Assessment of Outcomes

    • Authors: Lisa Dubrofsky, Jason F. Lee, Parisa Hajimirzarahimshirazi, Hongyan Liu, Alanna Weisman, Patrick R. Lawler, Michael E. Farkouh, Jacob A. Udell, David Z. Cherney
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Patients with diabetes and co-existing chronic kidney disease and/or cardiovascular disease have complex medical needs with multiple indications for different guideline-directed medical therapies and require high health care resource utilization. The Cardiac and Renal Endocrine Clinic (C.a.R.E. Clinic) is a multi- and interdisciplinary clinic offering a unique care model to this population to overcome barriers to optimal care.Objective:To describe the patient characteristics and clinical data of consecutive patients seen in the C.a.R.E. Clinic between 2014 and 2020, with a focus on the feasibility, strengths, and challenges of this outpatient care model.Design:Single-center retrospective cohort study.Setting:The C.a.R.E. Clinic is a multi- and interdisciplinary clinic at Toronto General Hospital in Toronto, Canada.Patients:We reviewed the charts of all 118 patients who had been referred to the C.a.R.E. Clinic with type 2 diabetes mellitus, co-existing renal disease, and/or cardiovascular disease.Measurements:Demographic data, medication data, clinic blood pressure measurements, and laboratory data were assessed at the first and last available clinic visit.Methods:Data were extracted via manual chart review of paper and electronic medical records.Results:First and last attended clinic visit data were available for descriptive analysis in 74 patients. There was a significant improvement in low-density lipoprotein (LDL) cholesterol (1.9 mmol/L vs 1.5 mmol/L, P < .01), hemoglobin A1C (7.5% vs 7.1%, P = .02), and the proportion of patients with blood pressure at target (52.7% vs 36.5%, P = .04), but not body mass index (29.7 kg/m² vs 29.6 kg/m², P = .15) between the last and first available clinic visits. There was higher uptake in evidence-based medication use including statins (93.2% vs 81.1%, P = .01), SGLT-2i (35.1% vs 4.1%, P < .01), and GLP-1 receptor agonists (13.5% vs 4.1%, P = .02), while RAAS inhibitor use was already high at baseline (81.8% vs 78.4%, P = .56). There remains a significant opportunity for therapy with sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists.Limitations:This is a retrospective chart review lacking a control group, therefore clinical improvements cannot be causally attributed to the clinic alone. New evidence and changes to guideline-recommended therapies also contributed to practice changes during this time period.Conclusions:A multi- and interdisciplinary clinic is a feasible and potentially effective way to improve evidence-based and patient-centered care for patients with diabetes, kidney, and cardiovascular disease.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-02-28T12:15:06Z
      DOI: 10.1177/20543581221081207
      Issue No: Vol. 9 (2022)
  • Quality Improvement in Canadian Nephrology: Key Considerations in Ensuring
           Thoughtful Ethical Oversight

    • Authors: Tamara Glavinovic, Jay Hingwala, Claire Harris
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Purpose of review:Quality improvement (QI) work is a cornerstone of health care, and a growing area within nephrology. With such growth comes the need to ensure that QI activities are implemented in an ethically responsible manner. The existing institutional research board (IRB) framework has largely focused on reviewing the ethical suitability of traditional research projects, and it can be challenging to know if QI initiatives require formal ethics oversight. Several tools have been developed to assist in distinguishing between the two, such as the “A pRoject Ethics Community Consensus Initiative” tool. Our objective was to demonstrate how QI is distinct from research, to outline how QI-focused IRB process is used across Canada, and to develop a practical aid for clinicians embarking on QI-related projects.Sources of information:Publicly available institutional Web sites from academic and select nonacademic sites across Canada.Methods:Institutional Web sites across all academic centers within Canada were examined to determine local QI-specific ethics review processes. We have provided examples of QI processes from select community sites. We have developed a tool to assist clinicians navigate the ethical challenges of QI projects and to determine whether their project may require ethics approval.Key findings:This overview of the considerations of the research ethics approval process helps clinicians to determine whether IRB approval is required for QI studies. Examples of the current ethical processes employed in both academic and community institutions across Canada demonstrate the variability between centers. We have included examples of fictional nephrology-oriented QI initiatives to illustrate when ethics approval may be considered, along with a flowchart. This summary highlights the opportunity for QI-specific IRB review processes to be standardized across Canada, along with the need for creation of a separate stream with dedicated expertise for QI project review.Limitations:We did not do a formal environmental scan of the QI IRB review process in all hospital institutions across Canada.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-02-28T06:28:17Z
      DOI: 10.1177/20543581221077504
      Issue No: Vol. 9 (2022)
  • Results From a Physical Activity Intervention Feasibility Study With
           Kidney Inpatients

    • Authors: Kathryn Wytsma-Fisher, Manuel Ester, Stefan Mustata, Theresa Cowan, S. Nicole Culos-Reed
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Individuals with end-stage kidney disease requiring dialysis are often physically inactive, resulting in reduced physical functioning, increased frailty, and reduced quality of life. Furthermore, extended hospital stays and frequent readmissions are common, exacerbating health care costs. Physical activity may improve physical functioning, disability, and frailty but is not part of standard care of patients requiring dialysis. Research is required to determine the feasibility of implementing physical function assessments and physical activity programs in kidney inpatients requiring dialysis.Objective:To assess the feasibility and preliminary efficacy of an early-physical activity intervention (Move More study) in the care of kidney inpatients requiring dialysis. It was hypothesized that the intervention would be feasible with regards to administration and participation, meeting a priori feasibility criteria, and that kidney inpatients would benefit from participating.Design:Pilot study.Setting:Patient Unit 37, Foothills Medical Center, Calgary, AB, Canada.Patients:Kidney in-patients receiving dialysis.Measurements:Feasibility data were collected for recruitment, participation, assessment completion, physical activity completion, and adverse events. Participant and healthcare practitioner (HCP) satisfaction with the intervention was assessed using a questionnaire. Frailty and physical function were assessed by the kinesiologist at baseline and postintervention prior to hospital discharge.Methods:The study was a single-arm pilot intervention examining feasibility and preliminary efficacy. Kidney inpatients requiring dialysis were recruited to an individualized in-hospital physical activity intervention for the duration of their hospital stay. The intervention was led by a kinesiologist and supported by the clinical care team, including physiotherapists and nurse clinicians. Individualized exercise programs were created for patients to perform daily during their stay. These programs focused on strength, mobility, balance, and general movement and were tailored to each patient’s needs.Results:Thirty-six percent of eligible patients (n = 23/64) consented to participate in the Move More study, of whom 78% (n = 18/23) completed the intervention. The a priori level for consent to participate in the intervention was set at 60%. In addition, the a priori level for completion of assessments pre and postintervention was 50%. Ninety-five percent (n = 22/23) of preintervention assessments were completed compared to 65% of postintervention assessments. All participants who completed the survey (100%, n = 14/14) and most of the staff (77%, n = 24/31) reported being satisfied or very satisfied with the program. There were no adverse events related to the intervention. On average, Move More patients demonstrated improvements in frailty status and specific subsets of quality of life.Limitations:Firstly, as a feasibility study, the research was not powered to address the effectiveness of the intervention and lacked a comparison group to definitively link observed changes to the intervention itself. The voluntary nature of recruitment may have been biased toward ESKD inpatients with above-average motivation and baseline function. Furthermore, the small sample size from a single site limits the generalizability of findings. An additional limitation was the fact that postassessments were missed on a large number of patients, due to them being discharged prior to research staff knowing and being able to complete the assessments. Finally, studying the length of stay across the institution, as opposed to just the individual ward, would provide insight into hospitalization impact for these patients.Conclusions:The administration of and participation in a physical activity intervention for kidney inpatients requiring dialysis was initially not feasible primarily due to low recruitment and adherence challenges. The study was modified by including a research team member on the unit to increase recruitment efforts and support exercise adherence. The intervention impact includes potentially benefits on frailty and quality of life.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-02-26T11:02:40Z
      DOI: 10.1177/20543581221079958
      Issue No: Vol. 9 (2022)
  • Advancing a Paradigm Shift to Approaching Health Systems in the Field of
           Living-Donor Kidney Transplantation: An Opinion Piece

    • Authors: Shaifali Sandal, Anna Horton, Marie-Chantal Fortin
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.

      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-02-26T11:00:43Z
      DOI: 10.1177/20543581221079486
      Issue No: Vol. 9 (2022)
  • Telemonitoring and Case Management for Hypertensive and Remote-Dwelling
           Patients With Chronic Kidney Disease—The Telemonitoring for Improved
           Kidney Outcomes Study (TIKO): A Clinical Research Protocol

    • Authors: Ikechi G. Okpechi, Deenaz Zaidi, Feng Ye, Miriam Fradette, Kara Schick-Makaroff, Charlotte Berendonk, Abdullah Abdulrahman, Branko Braam, Anukul Ghimire, Vinash Kumar Hariramani, Kailash Jindal, Maryam Khan, Scott Klarenbach, Shezel Muneer, Jennifer Ringrose, Nairne Scott-Douglas, Soroush Shojai, Dan Slabu, Naima Sultana, Mohammed M. Tinwala, Stephanie Thompson, Raj Padwal, Aminu K. Bello
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Hypertension, together with poorly controlled blood pressure (BP) are known risk factors for kidney disease and progression to kidney failure as well as increased cardiovascular (CV) morbidity and mortality. Several studies in patients without kidney disease have demonstrated the efficacy of home BP telemonitoring (HBPT) for BP control.Objective:The primary aim of this study is to assess the mean difference in systolic BP (SBP) at 12 months, from baseline in remote dwelling patients with hypertension and chronic kidney disease (CKD) in Northern Alberta, Canada, comparing HBPT + usual care versus HBPT + a case manager. Other secondary objectives, including cost-effectiveness and acceptability of HBPT as well as occurrence of adverse events will also be assessed.MethodsDesign:This study is designed as a pragmatic randomized controlled trial (RCT) of HBPT plus clinical case management compared to HBPT with usual care.Setting:Peace River region in Northern Alberta Region, Canada.Patients:Primary care patients with CKD and hypertension.Measurements:Eligible patients will be randomized 1:1 to HBPT + BP case management versus HBPT + usual care. In the intervention arm, BP will be measured 4 times daily for 1 week, with medications titrated up or down by the study case manager until guideline targets (systolic BP [SBP]:
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-02-14T07:28:49Z
      DOI: 10.1177/20543581221077500
      Issue No: Vol. 9 (2022)
  • Program Report: Can-SOLVE CKD Network Presents an Inclusive Method for
           Developing Patient-Oriented Research Tools

    • Authors: Leah E. Getchell, Elisabeth Fowler, Marian Reich, Selina Allu, Chantal Boucher, Kevin Burns, Arlene Desjarlais, Audrey L’Esperance, Meghan Elliott, Helen Robinson-Settee, Helen Hoi-Lun Chiu, Norman D. Rosenblum, Craig Settee, Alicia Murdoch, Simone Dew, Amanda Green, Linnea Franson, Eva Bernstein, Dwight Sparkes, Catherine Turner, Nicolas Fernandez, Ruth Sapir-Pichhadze
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Purpose of program:Given the growing interest in patient-oriented research (POR) initiatives, there is a need to provide relevant training and education on how to engage with patients as partners on research teams.Sources of information:As part of its mandate to develop appropriate training materials, the patient-oriented renal research network, Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD), established a training and Mentorship Committee (TMC).Methods:The committee brings together a unique combination of Indigenous and non-Indigenous patient partners (including caregivers, family members, and living donors), researchers, as well as patient engagement and knowledge translation experts, combining a multitude of perspectives and expertise. Following an assessment of training needs within the network, the TMC undertook the co-development of 5 learning modules to address the identified gaps. Subsequently, the committee divided into working groups tasked with developing content using a consultive and iterative approach informed by the DoTTI framework for building web-based tools for patients. In addition, the TMC embodied the guiding principles of inclusiveness, support, mutual respect, and co-building as set out by the Patient Engagement Framework through the Strategy for Patient-Oriented Research (SPOR) of the Canadian Institutes of Health Research.Key findings:The 5 new modules include: A Patient Engagement Toolkit, Storytelling for Impact, Promoting Kidney Research in Canada (KidneyPRO), Wabishki Bizhiko Skaanj Learning Pathway, and Knowledge Translation. The TMC’s approach to developing these modules demonstrates how a diverse group of stakeholders working together can create tools to support high-quality POR. This also provides a roadmap for other health research entities interested in developing similar tools within their unique domains.Limitations:The landscape of patient engagement in research is constantly evolving. This underscores the need for sustained resources to keep POR tools and training relevant and up-to-date. Sustaining such resources may not be feasible for all research entities.Implications:Collaborative approaches integrating patients in the development of POR tools ensure the content is relevant and meaningful to patients. Broader adoption of such approaches has great potential to address existing gaps and enhance the Canadian POR landscape.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-02-12T10:33:06Z
      DOI: 10.1177/20543581221074566
      Issue No: Vol. 9 (2022)
  • Designing an App for Immunosuppression Adherence and Communication: A
           Qualitative Approach

    • Authors: Kara Schick-Makaroff, Laura Lagendyk, Bethany Foster, Ngan N. Lam, Branko Braam, Aminu Bello, Soroush Shojai, Kevin Wen
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Immunosuppression nonadherence may be the most important factor limiting long-term allograft survival.Objective:Following user-centered design, we explored the essential priorities and preferences of kidney transplant recipients and healthcare providers (HCP) to inform development of a smartphone app to improve immunosuppression adherence and communication.Design:A qualitative descriptive research design was used.Setting:The University of Alberta Hospital adult kidney transplant program in Edmonton, Canada.Participants:Participants were recruited by convenience sampling and included 32 kidney transplant recipients and 11 HCPs.Methods:Seven focus groups (5 with recipients and 2 with HCPs) were conducted to inform app development. Sessions were recorded, and transcripts were coded to elucidate themes.Results:App development to improve adherence was not a priority for HCP. Recipients prioritized choice: that all features be optional. Recipients preferred support while traveling; access to laboratory results; and use by younger or newly transplanted recipients. Both recipients and HCP preferred linkage to pharmacy; and self-management and accountability.For the app to improve communication, HCPs believed the priorities to be addressed included: clarity on scope of app; legal, ethical, and professional obligations; and charting. Both recipients and HCP prioritized HCP workload, and broader medication and health concerns. Healthcare providers preferred tech support; both recipients and HCPs preferred app access for nontransplant HCP.Limitations:Limitations include underrepresentation of physicians, recipients with racial/ethnic diversity, and potential selection bias of transplant recipients who perceived themselves to be adhering to immunosuppression medications.Conclusion:Future research is needed for the app to become a comprehensive, secure platform for broader communication between recipients and HCP, pharmacies, and nontransplant clinicians while streamlining HCP workload.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-01-31T08:52:06Z
      DOI: 10.1177/20543581211072330
      Issue No: Vol. 9 (2022)
  • Deriving Normative Data on 24-Hour Ambulatory Blood Pressure Monitoring
           for South Asian Children (ASHA): A Clinical Research Protocol

    • Authors: Samina Nazarali, Cal H. Robinson, Farah Khan, Tayler Pocsai, Dipika Desai, Russell J. De Souza, Girish Bhatt, Allison Dart, Janis Dionne, Salma Elmansy, Sujane Kandasamy, Scott A. Lear, Joyce Obeid, Rulan Parekh, Zubin Punthakee, Rajiv Sinha, Lehana Thabane, Gita Wahi, Michael Zappitelli, Sonia S. Anand, Rahul Chanchlani
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:The global prevalence of hypertension in children and adolescents has increased over the past 2 decades and is the strongest predictor of adult hypertension. South Asians have an increased prevalence of metabolic syndrome associated risk factors including abdominal obesity, diabetes, and hypertension. All these factors contribute to their increased cardiovascular disease burden. Accurate and early identification of hypertension in South Asian children is a necessary aspect of cardiovascular disease prevention. Ambulatory blood pressure monitoring (ABPM) is considered the gold-standard for pediatric blood pressure (BP) measurement. However, its utilization is limited due to the lack of validated normative reference data in diverse, multiethnic pediatric populations.Objective:The primary objective is to establish normative height-sex and age-sex-specific reference values for 24-h ABPM measurements among South Asian children and adolescents (aged 5-17 years) in Ontario and British Columbia, Canada. Secondary objectives are to evaluate differences in ABPM measurements by body mass index classification, to compare our normative data against pre-existing data from German and Hong Kong cohorts, and to evaluate relationships between habitual movement behaviors, diet quality, and ABPM measurements.Design:Cross-sectional study, quasi-representative sample.Setting:Participants will be recruited from schools, community centers, and places of worship in Southern Ontario (Greater Toronto and Hamilton area, including the Peel Region) and Greater Vancouver, British Columbia.Participants:We aim to recruit 2113 nonoverweight children (aged 5-17 years) for the primary objective. We aim to recruit an additional 633 overweight or obese children to address the secondary objectives.Measurements:Ambulatory BP monitoring measurements will be obtained using Spacelabs 90217 ABPM devices, which are validated for pediatric use. The ActiGraph GT3X-BT accelerometer, which has also been validated for pediatric use, will be used to obtain movement behavior data.Methods:Following recruitment, eligible children will be fitted with 24-h ABPM and physical activity monitors. Body anthropometrics and questionnaire data regarding medical and family history, medications, diet, physical activity, and substance use will be collected. Ambulatory BP monitoring data will be used to develop height-sex- and age-sex-specific normative reference values for South Asian children. Secondary objectives include evaluating differences in ABPM measures between normal weight, overweight and obese children; and comparing our South Asian ABPM data to existing German and Hong Kong data. We will also use compositional data analysis to evaluate associations between a child’s habitual movement behaviors and ABPM measures.Limitations:Bloodwork will not be performed to facilitate recruitment. A non-South Asian comparator cohort will not be included due to feasibility concerns. Using a convenience sampling approach introduces the potential for selection bias.Conclusions:Ambulatory BP monitoring is a valuable tool for the identification and follow-up of pediatric hypertension and overcomes many of the limitations of office-based BP measurement. The development of normative ABPM data specific to South Asian children will increase the accuracy of BP measurement and hypertension identification in this at-risk population, providing an additional strategy for primary prevention of cardiovascular disease.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-01-31T08:50:47Z
      DOI: 10.1177/20543581211072329
      Issue No: Vol. 9 (2022)
  • Abstracts of the 2nd Toronto Complement Conference: 2021 November 11-13

    • Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.

      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-01-27T06:15:02Z
      DOI: 10.1177/20543581211069286
      Issue No: Vol. 9 (2022)
  • Clinical Outcomes With Medium Cut-Off Versus High-Flux Hemodialysis
           Membranes: A Systematic Review and Meta-Analysis

    • Authors: Maryam Kandi, Romina Brignardello-Petersen, Rachel Couban, Celina Wu, Gihad Nesrallah
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:A novel medium cut-off (MCO) dialyzer (Theranova, Baxter Healthcare, Deerfield, IL, USA) enhances large middle molecule clearance while retaining selectivity for molecules>45 000 Da.Objective:We undertook a systematic review and meta-analysis evaluating clinical outcomes with MCO vs high-flux membranes.Methods:We searched MEDLINE, EMBASE, CINAHL, Cochrane Library, and Web of Science through July 2020, and gray literature sources from 2017. We included randomized (RS) and nonrandomized studies (NRS) comparing MCO and high-flux membranes in adults receiving maintenance hemodialysis. Pairs of reviewers performed study selection, data extraction, and risk of bias assessment in duplicate. We conducted random-effects pairwise meta-analyses to pool results across studies and used the Grading of Recommendations Assessment, Development and Evaluation approach to assess evidence certainty.Results:We identified 22 eligible studies (6 RS, 16 NRS; N = 1811 patients; patient-years = 1546). The MCO dialyzer improved (estimate; 95% confidence interval [CI]; certainty rating) quality of life (mean difference [MD] = 16.7/100 points; 6.9 to 26.4; moderate), Kidney Disease Quality of Life Instrument (KDQOL) subscales—burden (MD = 4.0; 1.1 to 6.9; moderate) and effects (MD = 5.4; 3.2 to 7.6; moderate), pruritus (MD = −4.4; −7.1 to −1.7; moderate), recovery time (MD = −420 minutes; −541 to −299; high), and restless legs syndrome (odds ratio = 0.39; 0.29 to 0.53; moderate). There was little to no difference in all-cause mortality (risk difference = −0.4%; −2.8 to 2.1; moderate) and serious adverse events (rate ratio = 0.63; 0.38 to 1.04; low). MCO dialysis reduced hospitalization (rate ratio = 0.48; 0.27 to 0.84; low), infection (rate ratio = 0.38; 0.17 to 0.85; moderate), hospitalization days (MD = −1.5 days; 95% CI, −2.22 to −0.78; moderate), erythropoiesis resistance index (MD = −2.92 U/kg/week/g/L; 95% CI, −4.25 to −1.6; moderate) and cumulative iron use over 12 weeks (MD = −293 mg; 95% CI, −368 to −218; moderate). We found with low certainty that MCO dialysis had little to no effect on KDQOL symptoms/problem list, pain, and physical health and moderate certainty that MCO dialysis likely has no effect on the KDQOL mental health composite.Conclusions:We found with predominantly moderate certainty that the MCO dialyzer improves several patient-important outcomes with no apparent risks or harms. More definitive studies are needed to better quantify the effects of MCO membranes on mortality, hospitalization, and other rare events.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-01-21T12:21:39Z
      DOI: 10.1177/20543581211067087
      Issue No: Vol. 9 (2022)
  • Effects of Medium Cut-Off Versus High-Flux Hemodialysis Membranes on
           Biomarkers: A Systematic Review and Meta-Analysis

    • Authors: Maryam Kandi, Romina Brignardello-Petersen, Rachel Couban, Celina Wu, Gihad Nesrallah
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Medium cut-off (MCO) membranes enhance large middle-molecule clearance while selectively retaining molecules>45 000 Da.Objectives:We undertook a systematic review and meta-analysis comparing the effects of MCO versus high-flux membranes on biomarkers.Methods:We searched MEDLINE, Embase, CINAHL, Cochrane Library, and Web of Science from January 2015 to July 2020, and gray literature sources from 2017. We included randomized (RS) and nonrandomized studies (NRS) comparing MCO and high-flux membranes in adults (>18 years) receiving maintenance hemodialysis. We performed study selection, data extraction, and quality appraisals in duplicate and used the Grading of Recommendations Assessment, Development, and Evaluation framework. Outcomes included solute removal (plasma clearance or dialysate quantitation), reduction ratios, and predialysis serum concentrations for a range of prespecified large middle molecules.Results:We identified 26 eligible studies (10 RS and 16 NRS; N = 1883 patients; patient-years = 1366.3). The mean difference (MD) for albumin removal was 2.31 g per session (95% confidence interval [CI], 2.79 to 1.83; high certainty), with a reduction in predialysis albumin of −0.12 g/dl (95% CI, −0.16 to −0.07; I2 = 0%; high certainty) in the first 24 weeks, returning to normal (MD = −0.02 g/dl, 95% CI, −0.07 to −0.03; I2 = 56%; high certainty) after 24 weeks. We also found with high certainty that MCO dialysis resulted in a large increase (standardized mean difference [SMD]> 2.0 for all) in β2-microglobulin, κ- and λ-free light chains, and myoglobin removal, resulting in moderate (SMD> 0.5) to large (SMD> 0.8) reductions in predialysis concentrations for all of these solutes. Medium cut-off dialysis increased the reduction ratio for tumor necrosis factor-alpha (TNF-α) by 7.7% (95% CI, 4.7 to 10.6; moderate certainty), and reduced predialysis TNF-α by SMD −0.48 (95% CI, −0.91 to −0.04; moderate certainty). We found with moderate certainty that MCO dialysis had little to no effect on predialysis interleukin-6 (IL-6) plasma concentrations. Medium cut-off dialysis reduced mRNA expression of TNF-α and IL-6 in peripheral leukocytes by MD −15% (95% CI, −19.6 to −10.4; moderate certainty) and −8.8% (95% CI, −10.2 to −7.4; moderate certainty), respectively.Conclusion:Medium cut-off dialysis increases the clearance of a wide range of large middle molecules and likely reduces inflammatory mediators with a concomitant transient reduction in serum albumin concentration. The net effect of MCO dialysis on large middle molecules could translate into important clinical effects.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-01-19T06:53:04Z
      DOI: 10.1177/20543581211067090
      Issue No: Vol. 9 (2022)
  • Trajectories of Nutritional Parameters Before and After Prescribed Oral
           Nutritional Supplements: A Longitudinal Cohort Study of Patients With
           Chronic Kidney Disease Not Requiring Dialysis

    • Authors: Michelle M. Y. Wong, Yuyan Zheng, Dani Renouf, Zainab Sheriff, Adeera Levin
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:The association between oral nutritional supplement use and nutritional parameters among patients with nondialysis chronic kidney disease (CKD-ND) with or at high risk of undernutrition/protein-energy wasting has not been previously studied. The definition of patient subgroups most likely to benefit from oral nutritional supplementation (ONS) is also an area where more research is needed.Objective:To assess nutritional parameter trajectories among patients with CKD-ND prescribed oral nutritional supplements in British Columbia, and to compare trajectories by nutritional phenotype.Design:Longitudinal cohort study, pre-post design.Setting:Multidisciplinary CKD clinics across British Columbia.Patients:A total of 3957 adult patients with CKD-ND, who entered multidisciplinary CKD clinics during 2010 to 2019, met criteria for oral nutritional supplement prescription based on dietitian assessment, and received ≥1 oral nutritional supplement prescription.Measurements:Longitudinal nutritional parameters, including body mass index (BMI), serum albumin, serum bicarbonate, serum phosphate, and neutrophil-to-lymphocyte ratio (NLR).Methods:Using linear mixed models, slopes for nutritional and inflammation parameters were assessed in the 2-year periods before and after the first oral nutritional supplement prescription. Hierarchical cluster analysis was applied to identify nutritional phenotypes using baseline data, and slope analysis was repeated by cluster.Results:In the pre-oral-nutritional-supplement period, declines in BMI (−0.87 kg/m2/year, 95% confidence interval [CI]: −0.99 to −0.75), albumin (−1.11 g/L/year, 95% CI: −1.27 to −0.95), and bicarbonate (−0.49 mmol/L/year; 95% CI: −0.59 to −0.39), and increases in NLR (+0.79/year; 95% CI: 0.60 to 0.98) and phosphate (+0.05 mmol/L/year; 95% CI: 0.04 to 0.06) were observed. Following oral nutritional supplement prescription, there were statistically significant increases in BMI slope (+0.91 kg/m2/year, P < .0001), albumin slope (+0.82 g/L/year, P < .0001), and phosphate slope (+0.02 mmol/L/year, P = .005), as well as a decline in NLR slope of −0.55/year (P < .0001). There was no significant change in bicarbonate slope. Cluster analysis identified 5 distinct phenotypes. The cluster with the highest mean baseline NLR and lowest mean BMI demonstrated the greatest number of improvements in nutritional parameter slopes in the post-oral-nutritional-supplement period.Limitations:Possibility of residual confounding. Data on dietary intake, muscle mass, and nutritional scoring systems were not available in the registry.Conclusions:Among patients with CKD-ND prescribed oral nutritional supplements, there were improvements in nutrition/inflammation parameters over time following the first ONS prescription. The heterogeneity in response to ONS by cluster subgroup suggests an individualized approach to nutritional management may be beneficial.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-01-13T11:53:23Z
      DOI: 10.1177/20543581211069008
      Issue No: Vol. 9 (2022)
  • Effect of a Perioperative Hypotension-Avoidance Strategy Versus a
           Hypertension-Avoidance Strategy on the Risk of Acute Kidney Injury: A
           Clinical Research Protocol for a Substudy of the POISE-3 Randomized
           Clinical Trial

    • Authors: Amit X. Garg, Meaghan Cuerden, Hector Aguado, Mohammed Amir, Emilie P. Belley-Cote, Keyur Bhatt, Bruce M. Biccard, Flavia K. Borges, Matthew Chan, David Conen, Emmanuelle Duceppe, Sergey Efremov, John Eikelboom, Edith Fleischmann, Landoni Giovanni, Peter Gross, Raja Jayaram, Mikhail Kirov, Ydo Kleinlugtenbelt, Andrea Kurz, Andre Lamy, Kate Leslie, Valery Likhvantsev, Vladimir Lomivorotov, Maura Marcucci, Maria José Martínez-Zapata, Michael McGillion, William McIntyre, Christian Meyhoff, Sandra Ofori, Thomas Painter, Pilar Paniagua, Chirag Parikh, Joel Parlow, Ameen Patel, Carisi Polanczyk, Toby Richards, Pavel Roshanov, Denis Schmartz, Daniel Sessler, Tim Short, Jessica M. Sontrop, Jessica Spence, Sadeesh Srinathan, David Stillo, Wojciech Szczeklik, Vikas Tandon, David Torres, Thomas Van Helder, Jessica Vincent, C. Y. Wang, Michael Wang, Richard Whitlock, Maria Wittmann, Denis Xavier, P. J. Devereaux
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:Most patients who take antihypertensive medications continue taking them on the morning of surgery and during the perioperative period. However, growing evidence suggests this practice may contribute to perioperative hypotension and a higher risk of complications. This protocol describes an acute kidney injury substudy of the Perioperative Ischemic Evaluation-3 (POISE-3) trial, which is testing the effect of a perioperative hypotension-avoidance strategy versus a hypertension-avoidance strategy in patients undergoing noncardiac surgery.Objective:To conduct a substudy of POISE-3 to determine whether a perioperative hypotension-avoidance strategy reduces the risk of acute kidney injury compared with a hypertension-avoidance strategy.Design:Randomized clinical trial with 1:1 randomization to the intervention (a perioperative hypotension-avoidance strategy) or control (a hypertension-avoidance strategy).Intervention:If the presurgery systolic blood pressure (SBP) is
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-01-08T07:10:55Z
      DOI: 10.1177/20543581211069225
      Issue No: Vol. 9 (2022)
  • Synthetic ACTH for Treatment of Glomerular Diseases: A Case Series

    • Authors: Arenn Jauhal, Bhanu Prasad, Mathieu Rousseau-Gagnon, Gabriel Ouellet, Michelle A Hladunewich
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Rationale:Synthetic adrenocorticotropic hormone (Tetracosactide) has been used in the treatment of refractory glomerular diseases. Literature surrounding the use of this medication is limited to small case series and there is conflicting data on the rate of adverse events associated with this medication.Presenting concerns of the patient:Glomerulonephritis not in remission after at least 6 months of treatment with conservative care. Stable doses of concurrent immunosuppression were permitted.Diagnoses:Membranous nephropathy, IgA nephropathy, minimal change disease, and focal and segmental glomerulosclerosis.Intervention:Intramuscular synthetic adrenocorticotropic hormone (Tetracosactide, Synacthen Depot) with doses of either 1 mg weekly or 1 mg twice weekly.Outcomes:Five of 12 patients had at least a partial remission with Tetracosactide. Median time to response was 6 months for responders. Five of the 12 patients had adverse events documented, 2 of which led to treatment discontinuation. No patients with focal and segmental glomerulosclerosis responded to treatment.Lessons Learned:Higher rate of adverse events than previously reported with synthetic adrenocorticotropic hormone and uncertain treatment efficacy.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-01-05T12:51:43Z
      DOI: 10.1177/20543581211066979
      Issue No: Vol. 9 (2022)
  • A Quantitative and Qualitative Study on Patient and Physician Perceptions
           of Nephrology Telephone Consultation During COVID-19

    • Authors: Seung Heyck Lee, Sonya Ramondino, Kerri Gallo, Louise M. Moist
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Background:COVID-19 required rapid adoption of virtual modalities to provide care for patients with a chronic disease. Care was initially provided by telephone, which has not been evaluated for its effectiveness by patients and providers. This study reports patients’ and nephrologists’ perceptions and preferences surrounding telephone consultation in a chronic kidney disease (CKD) clinic.Objective:To evaluate patient and physician perspectives on the key advantages and disadvantages of telephone consultations in a nephrology out-patient clinic setting.Design:Cross-sectional observational survey study.Setting:General nephrology clinic and a multidisciplinary kidney care clinic in London, Ontario, Canada.Participants:Patients with CKD who were fluent in English and participated in at least one telephone consultation with a nephrologist during the COVID-19 pandemic.Methods and measurements:Nephrologists’ and participants’ input facilitated the development of both patient and nephrologist surveys. Participants provided self-reported measures in 5 domains of satisfaction: user experience, technical quality, perceived effectiveness on well-being, perceived usefulness, and effect on interaction. Nephrologists provided self-reported measures within 6 categories: general experience, time management, medication changes, quality of care, job satisfaction, and challenges/strengths. Descriptive statistics were used to present data. Content analysis was performed on 2 open-ended responses.Results:Of the 372 participants recruited, 235 participated in the survey (63% response). In all, 79% of the participants were ≥65 years old and 91% were white. Telephone consultation was a comfortable experience for 68%, and 73% felt it to be a safer alternative during the pandemic. Although 65% perceived no changes to health care access, most reported spending less time and fewer resources on transit and parking. Disadvantages to telephone consultation included a lack of physical examination and reduced patient-physician rapport. Eleven of 14 nephrologists were surveyed, with most reporting confidence in the use of telephone consultation. Physician barriers to telephone consultation included challenges with communications and lack of technology to support telephone clinics.Limitations:Our survey included a majority of older, white participants, which may not be generalizable to other participants particularly those of other ages and ethnicity.Conclusion:Although both patients and nephrologists adapted to telephone consultations, there remain opportunities to further explore populations and situations that would be better facilitated with an in-person visit. Future research in virtual care will require measurement of health care outcomes and economics.Trial registration:Not applicable as this was a survey.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-01-05T12:50:03Z
      DOI: 10.1177/20543581211066720
      Issue No: Vol. 9 (2022)
  • Program Report: Nîsohkamâtowak—Helping Patients and Families Living
           With Kidney Disease in Northern Saskatchewan

    • Authors: Tiffany Blair, Paul Babyn, Gilbert Kewistep, Joanne Kappel, Rod Stryker, Vivian R. Ramsden, Cory Neudorf, Carmen Levandoski
      Abstract: Canadian Journal of Kidney Health and Disease, Volume 9, Issue , January-December 2022.
      Purpose of the Program:Nîsohkamâtowak, the Cree word for Helping Each Other, is an initiative to close gaps in kidney health care for First Nations and Métis patients, their families, and communities in northern Saskatchewan. Nîsohkamâtowak emerged from a collaboration between the Kidney Health Community Program and First Nations and Métis Health Services to find ways to deliver better care and education to First Nations and Métis people living with kidney disease while acknowledging Truth and Reconciliation and the Calls to Action.Sources of Information:This article describes how traditional Indigenous protocols and storytelling were woven into the Nîsohkamâtowak events, gathering of patient and family voices in writing and video format, and how this work led to a collaborative co-designed process that incorporates the Truth and Reconciliation: Calls to Action into kidney care and the benefits we have seen so far. The teachings of the 4 Rs—respect, reciprocity, responsibility, and relevance, were critical to ensuring that Nîsohkamâtowak reports and learning were shared with participants and the communities represented in this initiative.Methods:Group discussions and sharing circles were facilitated in several locations throughout northern and central Saskatchewan. Main topics of discussion were traditional medicines, residential schools impact, community and peer supports for kidney disease patients, and cultural safety education for health care providers.Key Findings:The general themes selected for improvement were education, support within the local community, traditional practices and cultural competency, and delivery of services. To address these gaps in kidney care, the following objectives were co-created with First Nations and Métis patients, families, and communities for Kidney Health to provide culturally appropriate education and resources, to ensure appropriate follow-up support to include strengthening connections to communities and other health authorities, to incorporate traditional practices into program design, and to ensure appropriate service delivery across the spectrum of care with a focus on screening and referral, which is strongly linked to coordination of care with local health centers.Implications:As a result of this work, the Kidney Health Community Program restructured the delivery of services and continues to work with Nîsohkamâtowak advisors on safety initiatives and chronic kidney disease awareness, prevention, and management in their respective communities. The Truth and Reconciliation and Calls to Action are honored to close the gaps in kidney care.Limitations:Nîsohkamâtowak is a local Kidney Health initiative that has the good fortune of having dedicated funding and staff to carry out this work. The findings may be unique to the First Nations and Métis communities and people who shared their stories. Truth and Reconciliation is an ongoing commitment that must be nurtured. Although not part of this publication, the effects of COVID-19 have made it difficult to further advance the Calls to Action, with more limited staff resources and the inability to meet in person as in the past.
      Citation: Canadian Journal of Kidney Health and Disease
      PubDate: 2022-01-05T01:10:10Z
      DOI: 10.1177/20543581211067071
      Issue No: Vol. 9 (2022)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Tel: +00 44 (0)131 4513762

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