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Canadian Journal of Kidney Health and Disease
Journal Prestige (SJR): 1.007  Citation Impact (citeScore): 2 Number of Followers: 8  Open Access journalISSN (Print) 2054-3581 - ISSN (Online) 2054-3581 Published by Sage Publications  [1176 journals]
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- The Feasibility and Effects of Self-Acupressure on Symptom Burden and
Quality of Life in Hemodialysis Patients: A Pilot RCT
Authors: Kristen Parker, Shauna Raugust, Becky Vink, Kuljit Parmar, Allan Fradsham, Marni Armstrong
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background:Symptom burden among long-term hemodialysis (HD) patients is high, and addressing symptoms has been identified as a key research priority by patients. Acupressure has shown some effectiveness in management of symptoms in patients with HD.Objective:The purpose of this study was to explore the feasibility and the effect of implementing a self-administered acupressure intervention on symptom burden and quality of life for in-center HD patients.Design:A pilot randomized controlled study.Setting:Two outpatient community HD clinics between in Calgary, Alberta, Canada.Patients or Sample or Participants:Patients on HD for at least 3 months and with at least one symptom score rated greater than moderate were eligible for the study.Methods:Participants were randomized into either the (1) self-acupressure + usual care or (2) usual care alone group. Participants in the acupressure group were given a wooden acupressure tool and taught how to self-administer protocol on 6 acupressure sites for the 4-weeek study duration. Feasibility outcomes were assessed through satisfaction surveys and attrition. Other outcomes included quality of life and symptom scores by validated questionnaires (EQ-5D-5L and Integrated Palliative Outcome Score—Renal [IPOS-Renal]).Results:Thirty-two participants were successfully enrolled in the study; acceptability was high with study completion at 98% in the intervention group and 82% adherence rate to the 4-week protocol. Participants in the intervention group reported an improved change score in quality of life (EQ-5D-5L Index Score change = +0.053; EQ-5D-5L visual analog scale score change = +6.7). Participants in the intervention group also reported improved symptom scores (IPOS-Renal overall change = −2.8).Limitations:Small sample size and intervention duration are limitations of this pilot study.Conclusions:The results from this study suggest that self-acupressure was acceptable and feasible in this sample of HD patients. Self-acupressure may have a role for supporting the management of symptoms in HD patients. These pilot results can be used to inform larger more definitive investigations.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-08-06T09:28:41Z
DOI: 10.1177/20543581241267164
Issue No: Vol. 11 (2024)
- Assessment of the Correlation Between Serum Phosphate Level and Muscle
Strength as Measured by Handgrip Strength in Patients Treated With
Hemodialysis
Authors: Dror Ben-Noach, Dina Levy, Michal Raz, Ronit Anbar, Doron Schwartz, Orit Kliuk-Ben Bassat
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background:Sarcopenia, commonly observed in patients treated with hemodialysis, correlates with low serum phosphate levels. Although normophosphatemia is desired, dietary phosphate restriction is difficult to achieve and may result in undesirable protein restriction.Objective:We aimed to evaluate whether hyperphosphatemia is associated with higher muscle strength in patients receiving hemodialysis treatment.Design:A single-center prospective observational study.Setting:Ambulatory prevalent patients undergoing hemodialysis treatments in a dialysis unit of a tertiary hospital.Patients:Participants included prevalent patients treated with hemodialysis. All patients were above 18 years. Only patients with residual kidney function below 200 mL/24 hours were included to avoid bias.Measurements:Muscle strength was measured by handgrip strength (HGS). Each patient repeated 3 measurements, and the highest value was recorded. Handgrip strength cutoffs for low muscle strength were defined as
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-08-06T09:20:40Z
DOI: 10.1177/20543581241267163
Issue No: Vol. 11 (2024)
- Characterizing Interventions Used to Promote Life Participation in Adults
on Peritoneal Dialysis Therapy: A Scoping Review
Authors: Alexia Kateb, Kaleigh McCarthy, Janine Farragher
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background:Living with kidney failure can interfere with life participation (ie, participation in valued life activities). Life participation has recently been identified as a top-priority health outcome of people on peritoneal dialysis therapy, but it is a relatively unexplored topic in peritoneal dialysis.Objective:The objective is to describe the interventions that have been used to promote life participation in the peritoneal dialysis population and highlight research gaps warranting further investigation.Design:A scoping review was conducted according to the Joanna Briggs Institute methodology.Setting:Six electronic databases (MEDLINE [OVID], EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, CINAHL Plus, SCOPUS) were searched.Patients:Adults aged 18+ years on peritoneal dialysis therapy.Measurements:Any dedicated scale or subscale that measured life participation as an isolated outcome.Methods:Title/abstract screening was completed independently after adequate inter-rater reliability (kappa> 0.8) was achieved among reviewers. Full-text review and data extraction were conducted in duplicate. Extracted data were analyzed using counts, percentages, and narrative synthesis to describe patterns in the literature.Results:After identifying 13 874 results, 17 studies met eligibility criteria. Eight studies were conducted within the past 5 years, with China as the most common study location. Only 2 studies investigated life participation as a primary study outcome. Eight studies targeted personal-physical barriers to life participation, 8 targeted multiple barriers, and 1 targeted an environmental-institutional barrier. Life participation was assessed within a subdomain of a broader quality of life assessment (The Kidney Disease Quality of Life [KDQOL]-36 or the 36-Item Short-Form Health Survey [SF-36]) in 11 studies. The majority of assessments captured life participation in all major domains of participation (self-care, work, and leisure).Limitations:Eligibility screening at title/abstract stage was not performed in duplicate; articles not available in English were excluded.Conclusions:Life participation has infrequently been prioritized as a health outcome in peritoneal dialysis (PD). Interventions have been narrow in focus given the range of challenges faced by people on PD and the holistic approaches used in other clinical populations. Future research should prioritize life participation as a key health outcome in PD and investigate the impact of interventions that address cognitive, affective, and environmental barriers to participation.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-07-31T06:22:44Z
DOI: 10.1177/20543581241263168
Issue No: Vol. 11 (2024)
- The Use of Kidneys With Lower Longevity From Deceased Donors to Improve
Access to Preemptive Renal Transplantation for Elderly Patients: A
Qualitative Study
Authors: Carina Sancho, Aliya Affdal, Fabián-Andrés Ballesteros Gallego, Marie-Françoise Malo, Savannah-Lou Cochran-Mavrikakis, Héloise Cardinal, John S. Gill, Marie-Chantal Fortin
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background:There is a gap between the number of patients waiting for a transplant and the number of kidneys available. Some deceased donor kidneys are currently nonutilized, as medical teams fear that they will experience suboptimal graft survival. However, these organs could provide an acceptable therapeutic option if they were allocated for preemptive kidney transplantation in elderly candidates.Objective:This project aims to gather patients’ perspectives on the allocation of kidneys with lower longevity for preemptive kidney transplantation in elderly patients.Design:Individual interviews.Setting:The Center hospitalier de l’Université de Montréal (CHUM) chronic kidney disease (CKD) clinic.Participants:Patients aged between 64 and 75 years with CKD G4-5 ND, followed at the CHUM and who have not initiated dialysis yet.Methods:Between March and July 2023, we conducted 14 individual interviews with patients aged between 64 and 75 years who had CKD G4-5 ND and were followed at the CHUM. The interviews were digitally recorded and transcribed. Thematic analysis was conducted.Results:Most participants were in favor of using kidneys with lower longevity to increase their access to transplantation, improve their quality of life, enable accelerated transplantation, and avoid dialysis. Patients also wanted to be engaged in the decision-making process, underlining the importance of informed consent. Although the use of kidneys with lower longevity offers the hope of returning to “normal” life, some patients were concerned about the risk of reduced graft survival and the need for a subsequent kidney transplant. In these cases, patients were interested in using mitigation strategies, such as prioritization for kidney transplantation from standard donors in case of early graft loss associated with receiving kidneys with lower longevity. They also recommended the development of a separate waiting list for patients consenting to preemptive transplantation with kidneys with lower longevity.Limitations:This study was conducted in only 1 nephrology clinic in the province of Quebec with French-speaking patients. Consequently, the results may not be generalizable to other populations, including ethnic minorities.Conclusion:The use of kidneys with lower longevity for preemptive kidney transplantation appears to be an interesting option for elderly kidney transplant candidates. However, patient information and participation in the decision-making process are essential. Moreover, organ donation organizations and transplant programs should develop a separate waitlist for transplant candidates who have preconsented to receive organ offers of deceased donor kidneys with lower longevity.Trial registration:Not registered.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-07-31T05:45:24Z
DOI: 10.1177/20543581241267165
Issue No: Vol. 11 (2024)
- Acute Kidney Injury in Neonates Admitted to a Low-Resource Neonatal
Intensive Care Unit in Lusaka, Zambia
Authors: Mavis Chishala, Sylvia Machona-Muyunda, Chisambo Mwaba
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background:Neonatal acute kidney injury (nAKI) has been reported to be common among neonates admitted to the Neonatal Intensive Care Unit (NICU) and is associated with increased mortality and prolonged duration of hospital stay. However, data on this entity from sub-Saharan Africa are scanty.Objectives:This study aimed to assess the burden, risk factors, and short-term outcomes of nAKI in neonates admitted to a low-resource NICU in Zambia.Design:The design of the study is a prospective cohort study.Setting:The setting of this study was the NICU at the Women and Newborn Hospital of the University Teaching Hospitals (WNBH-UTHs).Patients:In total, 322 neonates who were admitted to the NICU between November 2021 and December 2022.Methods:A serum creatinine was determined on all patients at admission (within 24 hours), at 72 hours and day 7. The modified neonatal Kidney Disease: Improving Global Outcome (KDIGO) Criteria were used to define nAKI. Data were extracted using a predesigned form and analyzed using SPSS. A P-value less than .05 was considered statistically significant.Results:The prevalence of nAKI was 13.7% (44/322). On multivariable regression analysis, antepartum hemorrhage (adjusted odds ratio [AOR] 5.58; 95% confidence interval [CI]: [1.62-19.13], P = .007), vomiting in the neonate (AOR 5.76; 95% CI: [1.10-30.32], P = .04), history of use of unit second-line antibiotics, meropenem (AOR 4.37; 95% CI: [1.97-9.69], P
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-07-26T05:09:30Z
DOI: 10.1177/20543581241263160
Issue No: Vol. 11 (2024)
- The Correlation of MicroRNA-21 With the Nephrin, Podocin, and Urinary
Albumin-Creatinine Ratio in Patients With Type 2 Diabetes and Albuminuria:
A Cross-Sectional Study
Authors: Pringgodigdo Nugroho, Tri Hadi Susanto, Maruhum Bonar, Aulia Rizka, Aida Lydia, Soekamto Koesno, Pradana Soewondo, Hamzah Shatri, Carissa Cornelia Chundiawan, Fidel Hermanto
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background:Diabetic kidney disease (DKD) is the most common and deranging microvascular complication of diabetes mellitus (DM). Podocytopathy is a key component of glomerular damage in DKD. Micro RNA-21 (miRNA-21) is an epigenetic regulator that plays a role in podocyte damage; however, the results of previous studies have not resolved the controversy about the role of miRNA-21 in the pathogenesis of DKD.Objective:The objective was to investigate the correlation between miRNA-21 levels and urinary nephrin, podocin, and urinary albumin-creatinine ratio (UACR) in patients with type 2 DM and albuminuria.Design:This is a cross-sectional study.Setting:This study was carried out in internal medicine outpatient clinic of Cipto Mangunkusumo Hospital Jakarta, Indonesia.Patients:This study consisted of 42 adults with type 2 DM and albuminuria.Measurements:The measurements include (1) Serum miRNA-21; (2) urinary podocin, nephrin, and albumin-creatinine ratio; and (3) serum miRNA-21 correlated to urinary podocin, nephrin, and albumin-creatinine ratio.Methods:The Spearman bivariate analysis to assess the correlation of miRNA-21 with nephrin, podocin, and UACR.Results:The mean relative expression of miRNA-21 was 0.069 (0.024), the median for nephrin, podocin, and UACR was 35.5 (15.75-51.25) ng/mL, 0.516 (0.442-0.545) ng/mL, and 150 (94.56-335.75) ng/mL, respectively. A correlation between miRNA-21 and nephrin was observed (r = 0.598; P < .0001). There was a correlation between miRNA-21 and UACR (r = 0.604; P < .0001). No correlation was found between miRNA-21 and podocin.Limitations:A lack of non-DM and non-albuminuric control population and small sample size. We could not exclude concurrent disease, and all other potential confounding variables, particularly those related to inflammation.Conclusions:The miRNA-21 can be considered an early biomarker for podocytopathy and albuminuria in DM, highlighting its potential for early diagnostic and therapeutic interventions. Further research is required to confirm these findings and explore their clinical applications, which could significantly alter management strategies for DKD.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-06-18T06:29:19Z
DOI: 10.1177/20543581241260948
Issue No: Vol. 11 (2024)
- Thymoquinone Nanoparticles (TQ-NPs) in Kidney Toxicity Induced by Ehrlich
Ascites Carcinoma (EAC): An In Vivo Study
Authors: Zakaria Eltahir, Maha Ibrahim, Muniera Y. Mohieldeen, Ammar Bayoumi, Samia M. Ahmed
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background:Cisplatin (Cis) is potent chemotherapy used to treating already many different types of cancer; however, it is found to correlate with nephrotoxicity and other adverse health consequences. Thymoquinone (TQ) is an antioxidant and anti-inflammatory molecule that may defend against the consequences of different chemotherapies. Thymoquinone uses, although, are negatively impacted by its weak solubility and inadequate biological availability.Objectives:This investigation examined the efficacy of a new nanoparticle (NP) absorbing TQ in an Ehrlich Ascites Carcinoma (EAC) mice model to address its low solubility, enhance its bioavailability, and protect against Cis-induced nephrotoxicity.Methods:Following 4 treatment groups were included in this research: (1) control, (2) EAC, (3) EAC + Cis + Thymoquinone nanoparticle (TQ-NP) treated, and (4) EAC + Cis-treated.Results:The study revealed that TQ-NP was efficacious in avoiding Cis-induced kidney problems in EAC mice, as well as restoring kidney function and pathology. Thymoquinone nanoparticle considerably reduced Cis-induced oxidative damage in renal tissue by augmenting antioxidant levels. According to tumor weight and histological investigation results, TQ-NP did not impair Cis’s anticancer efficacy.Conclusion:Thymoquinone nanoparticle might be used as a potential drug along with Cis anticancer therapy to reduce nephrotoxicity and other side effects while maintaining Cis anticancer properties.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-06-10T10:15:37Z
DOI: 10.1177/20543581241258812
Issue No: Vol. 11 (2024)
- Association of Glomerular Filtration Rate Decline With Clinical Outcomes
in a Population With Type 2 Diabetes
Authors: Scott W. Klarenbach, David Collister, Natasha Wiebe, Aminu Bello, Stephanie Thompson, Neesh Pannu
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background:While historical rate of decline in kidney function is informally used by clinicians to estimate risk of future adverse clinical outcomes especially kidney failure, in people with type 2 diabetes the epidemiology and independent association of historical eGFR slope on risk is not well described.Objective:Determine the association of eGFR slope and risk of clinically important outcomes.Design Setting and Patients:Observational population-based cohort with type 2 diabetes in Alberta.Measurement and Methods:An Alberta population-based cohort with type 2 diabetes was assembled, characterized, and observed over 1 year (2018) for clinical outcomes of ESKD, first myocardial infarction, first stroke, heart failure, and disease-specific and all-cause hospitalization and mortality. Kidney function was defined using KDIGO criteria using the most recent eGFR and albuminuria measured in the preceding 18 months; annual eGFR slope utilized measurements in the 3 years prior and was parameterized using three methods (percentiles, and linear term with and without missingness indicator). Demographics, laboratory results, medications, and comorbid conditions using validated definitions were described. In addition to descriptive analysis, odds ratios from fully adjusted logistic models regressing outcomes on eGFR slope are reported; the marginal risk of clinical outcomes was also determined.Results:Among 336 376 participants with type 2 diabetes, the median annual eGFR slope was −0.41 mL/min/1.73 m2 (IQR −1.67, 0.62). In fully adjusted models, eGFR slope was independently associated with many adverse clinical outcomes; among those with ≤10th percentile of slope (median −4.71 mL/min/1.73 m2) the OR of kidney failure was 2.22 (95% CI 1.75, 2.82), new stroke 1.23 (1.08, 1.40), heart failure 1.42 (1.27, 1.59), MI 0.98 (0.77, 1.23) all-cause hospitalization 1.31 (1.26, 1.36) and all-cause mortality 1.56 (1.44, 1.68). For every −1 mL/min/1.73 m2 in eGFR slope, the OR of outcomes ranged from 1.01 (0.98, 1.05 for new MI) to 1.09 (1.08, 1.10 for all-cause mortality); findings were significant for 10 of the 13 outcomes considered.Limitations:Causality cannot be established with this study design.Conclusions:These findings support consideration of the rate of eGFR decline in risk stratification and may inform clinicians and policymakers to optimize treatment and inform health care system planning.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-06-10T08:36:01Z
DOI: 10.1177/20543581241255781
Issue No: Vol. 11 (2024)
- Opportunities for Improving the Transplant Assessment and Education
Authors: Oshorenua Aiyegbusi, Sharon Gradin, Yanchini Rajmohan, Bingyue Zhu, Alexandra Romann, Helen Chiu, Jagbir Gill, Olwyn Johnston, Micheli Bevilacqua
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background:There are several steps patients and their health care providers must navigate to access kidney transplantation in British Columbia (BC).Objective:We explored perceptions and experiences with the pretransplant process across BC to determine where process improvements can be made to enhance access to transplantation.Design:Anonymous surveys were sent online and via post to health care providers (including nephrologists, registered nurses, and coordinators) and patients across BC.Setting:Kidney care clinics, transplant regional clinics, and provincial transplant centers in BC.Measurements:Surveys included Likert scale questions on the current pretransplant process and transplant education available in BC. The health provider survey focused on understanding the pretransplant process, knowledge, roles, and communication while the patient survey focused on patient education and experience of the pretransplant processes.Results:A total of 100 health care providers and 146 patients responded. Seventy-six percent of health care providers understood their role and responsibility in the pretransplant process, while only 47% understood others’ roles in the process. Fifty-nine percent of health care respondents felt adequately supported by the provincial donor and transplant teams. Seventy-one percent of registered nurses and 92% of nephrologists understood transplant eligibility. About 68% and 77% of nurses and nephrologists, respectively, reported having enough knowledge to discuss living donation with patients. Fifty percent of patients had received transplant education, of which 60% had a good grasp of the pretransplant clinical processes. Sixty-three percent felt their respective kidney teams had provided enough advice and tools to support them in finding a living donor. Fifty percent of patients reported feeling up to date with their status in the evaluation process.Limitations:This analysis was conducted between December 2021 and June 2022 and may need to account for practice changes that occurred during the COVID-19 pandemic. Responses are from a selection of health care providers, thus acknowledging a risk of selection bias. Furthermore, we are not able to verify patients who reported receiving formal transplant education from their health care providers.Conclusions:Exploring these themes suggests communication with regional clinics and transplant centers can be improved. In addition, patient and staff education can benefit from education on kidney transplantation and the pretransplant clinical processes. Our findings provide opportunities to develop strategies to actively address modifiable barriers in a patient’s kidney transplantation journey.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-05-31T09:51:30Z
DOI: 10.1177/20543581241256735
Issue No: Vol. 11 (2024)
- Association Between the Dialysate Bicarbonate and the Pre-dialysis Serum
Bicarbonate Concentration in Maintenance Hemodialysis: A Retrospective
Cohort Study
Authors: Amber O. Molnar, Lauren Killin, Sarah Bota, Eric McArthur, Stephanie N. Dixon, Amit X. Garg, Claire Harris, Stephanie Thompson, Karthik Tennankore, Peter G. Blake, Clara Bohm, Jennifer MacRae, Samuel A. Silver
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background:It is unclear whether the use of higher dialysate bicarbonate concentrations is associated with clinically relevant changes in the pre-dialysis serum bicarbonate concentration.Objective:The objective is to examine the association between the dialysate bicarbonate prescription and the pre-dialysis serum bicarbonate concentration.Design:This is a retrospective cohort study.Setting:The study was performed using linked administrative health care databases in Ontario, Canada.Patients:Prevalent adults receiving maintenance in-center hemodialysis as of April 1, 2020 (n = 5414) were included.Measurements:Patients were grouped into the following dialysate bicarbonate categories at the dialysis center-level: individualized (adjustment based on pre-dialysis serum bicarbonate concentration) or standardized (>90% of patients received the same dialysate bicarbonate concentration). The standardized category was stratified by concentration: 35, 36 to 37, and ≥38 mmol/L. The primary outcome was the mean outpatient pre-dialysis serum bicarbonate concentration at the patient level.Methods:We examined the association between dialysate bicarbonate category and pre-dialysis serum bicarbonate using an adjusted linear mixed model.Results:All dialysate bicarbonate categories had a mean pre-dialysis serum bicarbonate concentration within the normal range. In the individualized category, 91% achieved a pre-dialysis serum bicarbonate ≥22 mmol/L, compared to 87% in the standardized category. Patients in the standardized category tended to have a serum bicarbonate that was 0.25 (95% confidence interval [CI] = −0.93, 0.43) mmol/L lower than patients in the individualized category. Relative to patients in the 35 mmol/L category, patients in the 36 to 37 and ≥38 mmol/L categories tended to have a serum bicarbonate that was 0.70 (95% CI = −0.30, 1.70) mmol/L and 0.87 (95% CI = 0.14, 1.60) mmol/L higher, respectively. There was no effect modification by age, sex, or history of chronic lung disease.Limitations:We could not directly confirm that all laboratory measurements were pre-dialysis. Data on prescribed dialysate bicarbonate concentrations for individual dialysis sessions were not available, which may have led to some misclassification, and adherence to a practice of individualization could not be measured. Residual confounding is possible.Conclusions:We found no significant difference in the pre-dialysis serum bicarbonate concentration irrespective of whether an individualized or standardized dialysate bicarbonate was used. Dialysate bicarbonate concentrations ≥38 mmol/L (vs 35 mmol/L) may increase the pre-dialysis serum bicarbonate concentration by 0.9 mmol/L.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-05-30T12:10:40Z
DOI: 10.1177/20543581241256774
Issue No: Vol. 11 (2024)
- Reducing the Frequency of Surveillance Blood Work in Patients Treated With
Maintenance Hemodialysis: A Local Quality Improvement Initiative
Authors: Epsita Shome-Vasanthan, Sophia Chou, Juliya Hemmett, Jennifer MacRae, David Ward, Nathen Gallagher, Huda Al-Wahsh, Elena Qirjazi
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Introduction:There is little evidence on the ideal frequency of routine blood work in maintenance dialysis patients to manage complications, including anemia, mineral bone disease (MBD), and hyperkalemia. Recent quality improvement studies from Ontario showed no negative impacts when decreasing the frequency from monthly to every 6 weeks in conventional in-center hemodialysis (ICHD) patients. In December 2020, Alberta Kidney Care–South (AKC-S) reduced the frequency of routine blood work from every 6 weeks to every 8 weeks for ICHD patients.Objective:We aimed to assess the impact of reducing blood work frequency on patient outcomes.Methods:We compared prevalent AKC-S ICHD patients in 2 cohorts: (1) retrospective control (October 31, 2019-October 31, 2020) and (2) prospective intervention (December 1, 2020-December 1, 2021). Primary outcomes were true frequency of routine blood work, odds of patients being within target for anemia and MBD, and proportion of lab values of hyperkalemia. Furthermore, we compared hospitalizations and mortality.Results:A total of 972 patients in Calgary’s ICHD program were included, 787 in each period (with 602 patients overlapping both cohorts). The frequency of routine blood work decreased from every 39.5 days in the control period to every 54.2 days in the intervention period (P < .01). There was a reduction in the odds of phosphate values in targets (P = .02), and an increase in the odds of labs with hyperkalemia (>6.0 mmol/L) during the intervention period (P = .01). There was no significant change in the odds of being within the accepted targets during the intervention period compared with the control period for hemoglobin, Tsat, calcium, or parathyroid hormone (PTH). Fewer patients were hospitalized during the intervention period and the risk of death decreased as well, although additional factors such as the COVID-19 pandemic may have affected this. A cost-savings of $32 962 occurred from the reduced anemia and MBD blood work during the intervention period.Conclusions:When ICHD units in Calgary reduced routine blood work frequency from every 6 weeks to 8 weeks, there were no negative impacts on hospitalizations or deaths. A slightly lower proportion of phosphate values were within target, and a 0.7% increase in potassium values greater than 6 mmol/L was demonstrated. Our study suggests that blood work frequency in ICHD dialysis patients may be further reduced to every 8 weeks safely. Ultimately, additional pragmatic trials are needed to identify the optimal frequency of routine blood work.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-05-28T11:12:38Z
DOI: 10.1177/20543581241255784
Issue No: Vol. 11 (2024)
- Hemophagocytic Lymphohistiocytosis in a Remote Kidney Transplant Recipient
Triggered by HSV Infection With Complete Recovery: An Educational Case
Report
Authors: Anjana Gopal, S. Joseph Kim
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Rationale:Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disease characterized by excessive immune activation. It is more commonly seen in children but increasingly recognized in adults. Primary HLH relies on a genetic predisposition, whereas secondary HLH develops in the context of infections, malignancies, or autoimmune diseases. Hemophagocytic lymphohistiocytosis has been rarely described in patients on immunosuppressive therapy after kidney transplant. Here, we describe a case of HLH in a patient with a remote history of kidney transplant, triggered by a viral infection.Presenting Concerns:A 45-year-old female, with a kidney transplant in 2009 for IgA nephropathy, presented with fever, vomiting, and back pain of 1-week duration. She was on triple immunosuppression consisting of daily doses of prednisone 5 mg, azathioprine 100 mg, and tacrolimus extended release 1 mg, and a baseline creatinine of 130 µmol/L.Diagnosis:Initial investigations showed anemia, leukopenia, elevated serum creatinine, transaminitis, and markedly increased ferritin of 67 600 µg/L which prompted a bone marrow biopsy to rule out HLH. The bone marrow showed an increased proportion of CD68+ cells (macrophages) with more than 5 in 1000 hemophagocytic macrophages. Her soluble IL-2 receptor (CD25) level was 3406 pg/mL (606-2299 pg/mL) which was mildly elevated. She fulfilled 4 of the 8 criteria for HLH and with an H score was 223 which suggested a diagnosis of HLH with 96.9% probability. An extensive secondary workup for possible triggers for HLH led to a swab from genital ulcers that was positive for herpes simplex virus (HSV) type 2. The polymerase chain reaction (PCR) in the blood for HSV type 2 was also positive.Interventions:Given the diagnosis of HSV type 2 as the putative trigger for HLH, she was started on parenteral acyclovir for 2 weeks followed by oral valacyclovir for 2 more weeks. In the context of infection, the azathioprine was stopped while low-dose steroid and tacrolimus were continued.Outcomes:With the initiation of treatment for HSV infection, leukopenia, creatinine, and transaminases improved along with ferritin levels. At her 6-month follow-up, her blood counts and liver enzymes had normalized, and ferritin was 566 µg/L.Teaching points:Hemophagocytic lymphohistiocytosis is a rare disease in kidney transplant recipients with a high mortality rate. It can occur even in remote kidney transplant recipients so a high degree of suspicion is necessary to lead to a prompt diagnosis. Infections are common triggers for secondary HLH. Early identification and treatment of the triggering infection may improve outcomes.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-05-23T11:04:12Z
DOI: 10.1177/20543581241253921
Issue No: Vol. 11 (2024)
- Challenges to Implementing Environmentally Sustainable Kidney Care in
LMICs: An Opinion Piece
Authors: Divya Bajpai, Workagegnehu Hailu, Peace Bagasha, Onu Ugochi Chika, Ehab Hafiz, Elliot Koranteng Tannor, Eranga Wijewickrama, Robert Kalyesubula, Sabine Karam, Viviane Calice-Silva, Isabelle Ethier, Shaifali Sandal
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-05-21T05:55:14Z
DOI: 10.1177/20543581241246835
Issue No: Vol. 11 (2024)
- Mind the Gap in Kidney Care: Translating What We Know Into What We do
Authors: Valerie A. Luyckx, Katherine R. Tuttle, Dina Abdellatif, Ricardo Correa-Rotter, Winston W. S. Fung, Agnès Haris, Li-Li Hsiao, Makram Khalife, Latha A. Kumaraswami, Fiona Loud, Vasundhara Raghavan, Stefanos Roumeliotis, Marianella Sierra, Ifeoma Ulasi, Bill Wang, Siu-Fai Lui, Vassilios Liakopoulos, Alessandro Balducci
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages, it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary-care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-05-18T05:32:23Z
DOI: 10.1177/20543581241252506
Issue No: Vol. 11 (2024)
- Development and Validation of a Treatment Algorithm for Osteoarthritis
Pain Management in Patients With End-Stage Kidney Disease Undergoing
Hemodialysis
Authors: Mai Mohsen, Jordanne Feldberg, Angelina Abbaticchio, S. Vanita Jassal, Marisa Battistella
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background:Although osteoarthritis is common in the hemodialysis population and leads to poor health outcomes, pain management is challenged by the absence of clinical guidance. A treatment algorithm was developed and validated to aid hemodialysis clinicians in managing osteoarthritis pain.Objective:The objective was to develop and validate a treatment algorithm for managing osteoarthritis pain in patients undergoing hemodialysis.Design:A validation study was conducted based on Lynn’s method for content validation.Setting:To develop and validate a treatment algorithm, interviews were conducted virtually by the primary researcher with clinicians from various institutions across the Greater Toronto and Hamilton Area in Ontario.Patients:The treatment algorithm was developed and validated for the management of osteoarthritis pain in patients on hemodialysis. Patients were not involved in the development or validation of the tool.Measurements:The algorithm was measured for content and face validity. Content validity was measured by calculating the content validity index of each component (I-CVI) of the algorithm and the overall scale validity index (S-CVI). Face validity was assessed by calculating the percentage of positive responses to the face validity statements.Methods:A draft algorithm was developed based on literature searches and expert opinion and validated by interviewing nephrology and pain management clinicians. Through consecutive rounds of 1:1 interviews, content and face validity were assessed by asking participants to rate the relevance of each component of the algorithm and indicate their level of agreeability with a series of statements. Following each round, the I-CVI of the algorithm as well as the S-CVI was calculated and the percentage of positive responses to the statements was determined. The research team revised the algorithm in response to the findings. The final algorithm provides a stepwise approach to the non-pharmacologic and pharmacologic management of pain, including topical, oral, and opioid use.Results:A total of 18 clinicians from 7 institutions across the Greater Toronto and Hamilton Area were interviewed (10 pharmacists, 5 nurse practitioners, and 3 physicians). The average S-CVI of the algorithm across all 3 rounds was 0.93. At least 78% of participants provided positive responses to the face validity statements.Limitations:An algorithm was developed based on input from clinicians working in the province of Ontario, limiting the generalizability of the algorithm across provinces. In addition, the algorithm did not include the perspectives of primary care providers or patients/caregivers.Conclusions:An algorithm for the management of osteoarthritis pain in the hemodialysis population was developed and validated through expert review to standardize practices and encourage clinicians to use evidence-based treatments and address the psychosocial symptoms of pain. As the algorithm possesses a high degree of content and face validity, it may improve osteoarthritis pain management among patients undergoing hemodialysis. Future research will assess the implementation of the algorithm across hemodialysis settings.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-05-13T11:15:51Z
DOI: 10.1177/20543581241249365
Issue No: Vol. 11 (2024)
- “Weighing the Pros and Cons of Everything”: A Qualitative Descriptive
Study Exploring Perspectives About Living Donor Kidney Transplantation
From Parents of Chinese Canadian Pediatric Patients With Chronic Kidney
Disease
Authors: Sarah J. Pol, Enid K. Selkirk, Alameen Damer, Istvan Mucsi, Susan Abbey, Beth Edwards, Kenneth Fung, Jagbir Gill, Paula Neves, Suk Yin Ng, Rulan S. Parekh, Linda Wright, Minglin Wu, Samantha J. Anthony
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background:As of 2021, more than 6000 children and youth in Canada were living with end-stage kidney disease (ESKD), for which kidney transplantation is considered the preferred treatment by health professionals. Research shows that living donor kidney transplantation (LDKT) has superior allograft and recipient survival compared to deceased donor kidney transplantation (DDKT). However, in a pediatric setting, the choice of LDKT or DDKT is a summative consideration of factors weighed carefully by the patient’s family, health care team, and patient. Decision-making surrounding transplantation may be more complex for racial and ethnic minorities as culturally specific values and beliefs are interwoven within dominant understandings and concepts of health and accepted models of health care. For example, Chinese Canadians have an increased risk of ESKD, yet reduced access to LDKT compared to White patients, despite being the largest visible minority population in Canada.Objective:The objective of this qualitative study is to deepen our understandings of the decision-making process surrounding DDKT versus LDKT among parents of Chinese Canadian pediatric patients with chronic kidney disease (CKD).Design:Qualitative descriptive study design.Setting:The Nephrology Program at The Hospital for Sick Children in Toronto, Canada.Participants:Caregivers of Chinese Canadian patients with CKD, 18 years of age or older, and who spoke English, Cantonese, or Mandarin.Methods:One-on-one, semistructured interviews were conducted virtually, by a member of the research team and were audio-recorded and transcribed verbatim. Thematic analysis was used to explore participants’ shared experience.Results:Seven interviews were conducted with 6 mothers and 1 father of 6 Chinese Canadian pediatric patients with CKD: 4 patients had undergone a kidney transplant, and 2 were not yet listed for transplant. Analysis of data highlighted that cultural influences affected whether parents shared with others about their child’s illness and experience. The cultural understanding that it is inappropriate to burden others contributed to the creation of an isolating experience for participants. Cultural influences also impacted whether parents asked others to be a living donor as participants articulated this would place a physical burden on the living donor (e.g., potential risk to their health) and an emotional burden on the participant as they would be indebted to a willing donor. Ultimately, parents’ decision to choose DDKT or LDKT for their patient-child was a result of evaluating both options carefully and within an understanding that the ideal treatment choice reflected what was best for all family members.Limitations:Findings reflect experiences of a small sample from a single recruitment site which may limit transferability.Conclusions:Parents in this study felt that they had access to the necessary evidence-based information to make an informed decision about the choice of DDKT versus LDKT for their child. Participant narratives described feeling isolated within cultural communities of family and friends and participants’ suggestion of benefiting from increased support may guide future research directions. Practitioners can offer direct and indirect support to families, with recognition of the importance of cultural values and family-centered care on decision-making within families. Opportunities are needed for accessible, virtual social support platforms to increase parental feelings of culturally mediated peer support from parents who share similar experiences.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-05-10T09:02:29Z
DOI: 10.1177/20543581241249872
Issue No: Vol. 11 (2024)
- From Prophecy to Plate: How to Actualize a Planetary Menu for Kidney
Disease Nutrition
Authors: Dani Renouf, Michelle M. Y. Wong
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-05-06T08:14:55Z
DOI: 10.1177/20543581241244965
Issue No: Vol. 11 (2024)
- Pathways for Diagnosing and Treating CKD-Associated Pruritus: A Narrative
Review
Authors: Claudio Rigatto, David Collister, Alexandre Granger-Vallée, Louis Girard, Jay Hingwala, Angelo Karaboyas, Adeera Levin, Philip McFarlane, Ron Pisoni, Bhanu Prasad, Normand Proulx, Daniel Schwartz, Manish Sood, Rita Suri, Karthik Tennankore
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Purpose of Review:Chronic kidney disease (CKD)-associated pruritus is a common, persistent, and distressing itch experienced by patients across the CKD spectrum. Although the disorder is associated with adverse outcomes and poor health-related quality of life, it remains underdiagnosed and undertreated. The purpose of this narrative review is to offer health care providers guidance on how to effectively identify, assess, and treat patients with CKD-associated pruritus, with the goal of reducing symptom burden and improving patient-important outcomes, such as quality of life (QoL).Sources of Information:A panel of nephrologists and researchers from across Canada and the United States was assembled to develop this narrative review based on the best available data, current treatment guidelines, and their clinical experiences.Methods:A panel of nephrologists who actively care for patients with pruritus receiving dialysis from across Canada was assembled. Two researchers from the United States were also included based on their expertise in the diagnosis and management of CKD-associated pruritus. Throughout Spring 2023, the panel met to discuss key topics in the identification, assessment, and management of CKD-associated pruritus. Panel members subsequently developed summaries of the pertinent information based on the best available data, current treatment guidelines, and added information on their own clinical experiences. In all cases, approval of the article was sought and achieved through discussion.Key Findings:This narrative review provides pragmatic guidance addressing: (1) methods for screening CKD-associated pruritus, (2) assessing severity, (3) management of CKD-associated pruritus, and (4) suggested areas for future research. The panel developed a 3-pillar framework for proactive assessment and severity scoring in CKD-aP: systematic screening for CKD-associated pruritus (pillar 1), assessment of pruritus intensity (pillar 2), and understanding the impact of CKD-associated pruritus on the patient’s QoL (pillar 3). Management of CKD-associated pruritus can include ensuring optimization of dialysis adequacy, achieving mineral metabolism targets (ie, calcium, phosphate, and parathyroid hormone). However, treatment of CKD-associated pruritus usually requires additional interventions. Patients, regardless of CKD-associated pruritus severity, should be counseled on adequate skin hydration and other non-pharmacological strategies to reduce pruritus. Antihistamines should be avoided in favor of evidence-based treatments, such as difelikefalin and gabapentin.Limitations:A formal systematic review (SR) of the literature was not undertaken, although published SRs were reviewed. The possibility for bias based on the experts’ own clinical experiences may have occurred. Key takeaways are based on the current available evidence, of which head-to-head clinical trials are lacking.Funding:This work was funded by an arm’s length grant from Otsuka Canada Pharmaceutical Inc. (the importer and distributer of difelikefalin in Canada). LiV Medical Education Agency Inc. provided logistical and editorial support.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-04-26T05:37:00Z
DOI: 10.1177/20543581241238808
Issue No: Vol. 11 (2024)
- Perceptions and Information-Seeking Behavior Regarding COVID-19
Vaccination Among Patients With Chronic Kidney Disease in 2023: A
Cross-Sectional Survey
Authors: Omosomi Enilama, Cynthia MacDonald, Pearl Thompson, Umair Khan, Selina Allu, Mary Beaucage, Kevin Yau, Matthew J. Oliver, Michelle A. Hladunewich, Adeera Levin
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background:People living with chronic kidney disease (CKD) face an increased risk of severe outcomes such as hospitalization or death from COVID-19. COVID-19 vaccination is a vital approach to mitigate the risk and severity of infection in patients with CKD. Limited information exists regarding the factors that shape COVID-19 vaccine uptake, including health information-seeking behavior and perceptions, within the CKD population.Objective:The objectives were to describe among CKD patients, (1) health information-seeking behavior on COVID-19, (2) their capacity to comprehend and trust COVID-19 information from different sources, and (3) their perceptions concerning COVID-19 infection and vaccination.Design/Setting:Cross-sectional web-based survey administered in British Columbia and Ontario from February 17, 2023, to April 17, 2023.Participants:Chronic kidney disease G3b-5D patients and kidney transplant recipients (CKD G1T-5T) enrolled in a longitudinal COVID-19 vaccine serology study.Methods and Measurements:The survey consisted of a questionnaire that included demographic and clinical data, perceived susceptibility of contracting COVID-19, the ability to collect, understand, and trust information on COVID-19, as well as perceptions regarding COVID-19 vaccination. Descriptive statistics were used to present the data with values expressed as count (%) and chi square tests were performed with a significance level set at P ≤ .05. A content analysis was performed on one open-ended response regarding respondents’ questions surrounding COVID-19 infection and vaccination.Results:Among the 902 patients who received the survey via email, 201 completed the survey, resulting in a response rate of 22%. The median age was 64 years old (IQR 53-74), 48% were male, 51% were university educated, 32% were on kidney replacement therapies, and 57% had received ≥5 COVID-19 vaccine doses. 65% of respondents reported that they had sought out COVID-19-related information in the last 12 months, with 91% and 84% expressing having understood and trusted the information they received, respectively. Those with a higher number of COVID-19 vaccine doses were associated with having sought out (P =.017), comprehended (P < .001), and trusted (P =. 005) COVID-19-related information. Female sex was associated with expressing more concern about contracting COVID-19 (P = .011). Most respondents strongly agreed to statements regarding the benefits of COVID-19 vaccination. Respondents’ questions about COVID-19 infection and vaccination centered on 4 major themes: COVID-19 vaccination strategy, vaccine effectiveness, vaccine safety, and the impact of COVID-19 infection and vaccination on kidney health.Limitations:This survey was administered within the Canadian health care context to patients with CKD who had at least 1 COVID-19 vaccine dose. Race/ethnicity of participants was not captured.Conclusions:In this survey of individuals with CKD, COVID-19 information-seeking behavior was high and almost all respondents understood and trusted the information they received. Perceptions toward the COVID-19 vaccine and booster were mostly favorable.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-04-16T04:58:20Z
DOI: 10.1177/20543581241242550
Issue No: Vol. 11 (2024)
- Reclassification of Genetic Testing Results: A Case Report Demonstrating
the Need for Structured Re-Evaluation of Genetic Findings
Authors: Clara Schott, Samantha Colaiacovo, Cadence Baker, Matthew A. Weir, Dervla M. Connaughton
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Rationale:Alport Syndrome (AS) is a progressive genetic condition characterized by chronic kidney disease (CKD), hearing loss, and eye abnormalities. It is caused by mutations in the genes COL4A3, COL4A4, and COL4A5. Heterozygous mutations in COL4A4 and COL4A3 cause autosomal dominant Alport Syndrome (ADAS), and a spectrum of phenotypes ranging from asymptomatic hematuria to CKD, with variable extra-renal features. In the past, heterozygous mutations in these genes were thought to be benign, however recent studies show that about 30% of patients can progress to CKD, and 15% can progress to end stage kidney disease (ESKD).Presenting Concerns:We present a case of a woman who was noted to have microscopic hematuria pre-living kidney donation. Genetic testing revealed a heterozygous variant of uncertain significance (VUS) in the COL4A4 gene. VUSs are medically nonactionable findings and data show that VUSs can be detected in 41% of all patients who undergo clinical genetic testing. VUSs frustrate clinicians and patients alike. Although they cannot be used in medical decision-making, data suggest that reanalysis can result in the reclassification of a VUS over time.Diagnosis:Post-donation, the index patient had a higher than anticipated rise in serum creatinine, raising a concern for possible intrinsic kidney disease. Kidney biopsy was deemed high risk in the setting of a unilateral kidney thereby limiting possible diagnostic intervention to determine the cause of disease.Intervention:Re-evaluation of prior genetic testing results and reassessment of the previously identified VUS in COL4A4 was performed 5-years post-donation. These analyses, along with the addition of new phenotypic data and extended pedigree data, resulted in the reclassification of the previously identified VUS to a likely pathogenic variant.Outcomes:This case demonstrates the importance of structured, periodic re-evaluation of genetic testing results. With the ever-changing landscape of genetics in medicine, the interpretation of a VUS can be dynamic and therefore warrant caution in living kidney donor evaluations. Studies have shown that about 10% of VUSs can be upgraded to a pathogenic classification after an 18- to 36-month interval. Structured re-evaluation of genomic testing results has not yet been integrated into clinical practice and poses a unique challenge in living kidney donation.Novel findings:This case report highlights the variability of the ADAS phenotype caused by pathogenic heterozygous variants in the type 4 collagen genes. It supports the nomenclature change from a benign hematuria phenotype to ADAS, particularly when additional risk factors such as proteinuria, focal segmental glomerulosclerosis or glomerular basement membrane changes on kidney biopsy are present, or as in this case, evidence of disease in other family members.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-04-15T06:07:57Z
DOI: 10.1177/20543581241242562
Issue No: Vol. 11 (2024)
- Differences in Antihypertensive Medication Prescription Profiles Between
2009 and 2021: A Retrospective Cohort Study of CARTaGENE
Authors: Victoria Ivensky, Pitchou Zonga, Gabriel Dallaire, Louis-Charles Desbiens, Annie-Claire Nadeau-Fredette, Guy Rousseau, Rémi Goupil
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background:Although blood pressure (BP) control is critical to prevent cardiovascular diseases, hypertension control rates in Canada are in decline.Objective:To assess this issue, we sought to evaluate the differences in antihypertensive medication prescription profiles in the province of Quebec between 2009 and 2021.Design:This is a retrospective cohort study.Setting:We used data from the CARTaGENE population–based cohort linked to administrative health databases.Patients:Participants with any drug claim in the 6 months prior to the end of follow-up were included.Measurements:Guideline-recommended antihypertensive drug prescription profiles were assessed at the time of enrollment (2009-2010) and end of follow-up (March 2021).Methods:Prescriptions practices from the 2 time periods were compared using Pearson’s chi-square tests. A sensitivity analysis was performed by excluding participants in which antihypertensive drugs may not have been prescribed solely to treat hypertension (presence of atrial fibrillation/flutter, ischemic heart disease, heart failure, chronic kidney disease, or migraines documented prior to or during follow-up).Results:Of 8447 participants included in the study, 31.4% and 51.3% filled prescriptions for antihypertensive drugs at the beginning and end of follow-up. In both study periods, guideline-recommended monotherapy was applied in most participants with hypertension (77.9% vs 79.5%, P = .3), whereas optimal 2 and 3-drug combinations were used less frequently (62.0% vs 61.4%, P = .77, 51.9% vs 46.7%, P = .066, respectively). Only the use of long-acting thiazide-like diuretics (9.5% vs 27.7%, P < .001) and spironolactone as a fourth-line agent (8.3% vs 15.9%, P = .054) increased with time but nonetheless remained infrequent. Results were similar in the sensitivity analysis.Limitations:Specific indication of the prescribed antihypertensive medications and follow-up BP data was not available.Conclusions:Application of hypertension guidelines for the choice of antihypertensive drugs remains suboptimal, highlighting the need for education initiatives. This may be an important step to raise BP control rates in Canada.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-04-09T11:41:22Z
DOI: 10.1177/20543581241234729
Issue No: Vol. 11 (2024)
- Randomized Controlled Trial of the Effect of an Exercise Rehabilitation
Program on Symptom Burden in Maintenance Hemodialysis: A Clinical Research
Protocol
Authors: Emilie Ford, Krista Stewart, Eric Garcia, Monica Sharma, Reid Whitlock, Ruth Getachew, Krista Rossum, Todd A. Duhamel, Mauro Verrelli, James Zacharias, Paul Komenda, Navdeep Tangri, Claudio Rigatto, Jennifer M. MacRae, Clara Bohm
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background:People receiving hemodialysis experience high symptom burden that contributes to low functional status and poor health-related quality of life. Management of symptoms is a priority for individuals receiving hemodialysis but limited effective treatments exist. There is emerging evidence that exercise programming can improve several common dialysis-related symptoms.Objective:The primary aim of this study is to evaluate the effect of an exercise rehabilitation program on symptom burden in individuals receiving maintenance hemodialysis.Design:Multicenter, randomized controlled, 1:1 parallel, open label, prospective blinded end point trial.Setting:Three facility-based hemodialysis units in Winnipeg, Manitoba, Canada.Participants:Adults aged 18 years or older with end-stage kidney disease receiving facility-based maintenance hemodialysis for more than 3 months, with at least 1 dialysis-related symptom as indicated by the Dialysis Symptom Index (DSI) severity score>0 (n = 150).Intervention:Supervised 26-week exercise rehabilitation program and 60 minutes of cycling during hemodialysis thrice weekly. Exercise intensity and duration were supervised and individualized by the kinesiologist as per participant baseline physical function with gradual progression over the course of the intervention.Control:Usual hemodialysis care (no exercise program).Measurements:Our primary outcome is change in symptom burden at 12 weeks as measured by the DSI severity score. Secondary outcomes include change in modified DSI severity score (includes 10 symptoms most plausible to improve with exercise), change in DSI severity score at 26 and 52 weeks; time to recover post-hemodialysis; health-related quality of life measured using EuroQol (EQ)-5D-5L; physical activity behavior measured by self-report (Godin-Shepherd questionnaire) and triaxial accelerometry; exercise capacity (shuttle walk test); frailty (Fried); self-efficacy for exercise; and 1-year hospitalization and mortality.Methods:Change in primary outcome will be compared between groups by independent 2-tailed t test or Mann-Whitney U test depending on data distribution and using generalized linear mixed models, with study time point as a random effect and adjusted for baseline DSI score. Similarly, change in secondary outcomes will be compared between groups over time using appropriate parametric and nonparametric statistical tests depending on data type and distribution.Limitations:The COVID-19 pandemic restrictions on clinical research at our institution delayed completion of target recruitment and prevented collection of accelerometry and physical function outcome data for 15 months until restrictions were lifted.Conclusions:The application of an exercise rehabilitation program to improve symptom burden in individuals on hemodialysis may ameliorate common symptoms observed in individuals on hemodialysis and result in improved quality of life and reduced disability and morbidity over the long term. Importantly, this pragmatic study, with a standardized exercise intervention that is adaptable to baseline physical function, addresses an important gap in both clinical care of hemodialysis patients and our current knowledge.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-04-03T12:40:28Z
DOI: 10.1177/20543581241234724
Issue No: Vol. 11 (2024)
- The Association Between Intradialytic Symptom Clusters and Recovery Time
in Patients Undergoing Maintenance Hemodialysis: An Exploratory Analysis
Authors: Arrti A. Bhasin, Jennifer M. MacRae, Braden Manns, Kelvin C. W. Leung, Amber O. Molnar, Jason W. Busse, David Collister, K Scott Brimble, Christian G. Rabbat, Jessica Tyrwhitt, Andrea Mazzetti, Michael Walsh
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background:Individuals receiving hemodialysis often experience concurrent symptoms during treatment and frequently report feeling unwell after dialysis. The degree to which intradialytic symptoms are related, and which specific symptoms may impair health-related quality of life (HRQoL) is uncertain.Objectives:To explore intradialytic symptoms clusters, and the relationship between intradialytic symptom clusters with dialysis treatment recovery time and HRQoL.Design/setting:We conducted a post hoc analysis of a prospective cohort study of 118 prevalent patients receiving hemodialysis in two centers in Calgary, Alberta and Hamilton, Ontario, Canada.Participants:Adults receiving hemodialysis treatment for at least 3 months, not scheduled for a modality change within 6 weeks of study commencement, who could provide informed consent and were able to complete English questionnaires independently or with assistance.Methods:Participants self-reported the presence (1 = none to 5 = very much) of 10 symptoms during each dialysis treatment, the time it took to recover from each treatment, and weekly Kidney Disease Quality of Life 36-Item–Short Form (KDQoL-36) assessments. Principal component analysis identified clusters of intradialytic symptoms. Mixed-effects, ordinal and linear regression examined the association between symptom clusters and recovery time (categorized as 0,>0 to 2,>2 to 6, or>6 hours), and the physical component and mental component scores (PCS and MCS) of the KDQoL-36.Results:One hundred sixteen participants completed 901 intradialytic symptom questionnaires. The most common symptom was lack of energy (56% of treatments). Two intradialytic symptom clusters explained 39% of the total variance of available symptom data. The first cluster included bone or joint pain, muscle cramps, muscle soreness, feeling nervous, and lack of energy. The second cluster included nausea/vomiting, diarrhea and chest pain, and headache. The first cluster (median score: −0.56, 25th to 75th percentile: −1.18 to 0.55) was independently associated with longer recovery time (odds ratio [OR] 1.62 per unit difference in score, 95% confidence interval [CI]: 1.23-2.12) and decreased PCS (−0.72 per unit difference in score, 95% CI: −1.29 to −0.15) and MCS scores (−0.82 per unit difference in score, 95% CI: −1.48 to −0.16), whereas the second cluster was not (OR 1.24, 95% CI: 0.97-1.58; PCS 0.19, 95% CI −0.46 to 0.83; MCS −0.72, 95% CI: −1.50 to 0.06).Limitations:This was an exploratory analysis of a small data set from 2 centers. Further work is needed to externally validate these findings to confirm intradialytic symptom clusters and the generalizability of our findings.Conclusions:Intradialytic symptoms are correlated. The presence of select intradialytic symptoms may prolong the time it takes for a patient to recover from a dialysis treatment and impair HRQoL.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-03-26T05:51:22Z
DOI: 10.1177/20543581241237322
Issue No: Vol. 11 (2024)
- Impact of the 2021 CKD-EPI eGFR Equation on Kidney Care Referral Criteria
in Ontario, Canada: A Population-based Cross-sectional Study
Authors: Eric McArthur, Graham Smith, Manish M. Sood, Peter G. Blake, K. Scott Brimble, Flory T. Muanda, Amit X. Garg, Stephanie N. Dixon
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background:In some jurisdictions, individuals become eligible or recommended for referral for different types of kidney care using criteria based on their estimated glomerular filtration rate (eGFR). Historically, GFR was estimated with an equation developed in 2009, which included a Black race term. An updated, race-free equation was developed in 2021. It is unclear how adoption of the 2021 equation will influence the number of individuals meeting referral criteria to receive different types of kidney care.Objective:To develop population-based estimates on how the number of individuals meeting the eGFR-based referral criteria to receive three different types of kidney care (nephrologist consultation, care in a multi-care specialty clinic, kidney transplant evaluation) changes when the 2021 versus 2009 equation is used to calculate eGFR.Design:Population-based, cross-sectional study.Setting:Ontario, Canada’s most populous province with 14.2 million residents as of 2021. Less than 5% of Ontario’s residents self-identify as being of Black race.Patients:Adults with at least one outpatient serum creatinine measurement in the 2 years prior to December 31, 2021.Measurements:Referral criteria to 3 different types of kidney care: nephrologist consultation, multi-care specialty clinic, and evaluation for a kidney transplant. The eGFR thresholds used to define referral eligibility or recommendation for these kidney health services were based on guidelines from Ontario’s provincial renal agency.Methods:The number of individuals meeting referral criteria for the 3 different healthcare services was compared between the 2009 and 2021 equations, restricted to individuals not yet receiving that level of care. As individual-level race data were not available, estimates were repeated, randomly assigning a Black race status to 1%, 5%, and 10% of the population.Results:We had an outpatient serum creatinine measurement available for 1 048 110 adults. Using the 2009 equation, 37 345 individuals met the criteria to be referred to a nephrologist, 10 019 met the criteria to receive care in a multi-care specialty clinic, and 10 178 met the criteria to be referred for kidney transplant evaluation. Corresponding numbers with the 2021 equation (and the percent relative to the 2009 equation) were 26 645 (71.3%), 9009 (89.9%), and 8615 (84.6%) individuals, respectively. These numbers were largely unchanged when Black race was assumed in up to 10% of the population.Limitations:Referral criteria based solely on urine albumin-to-creatinine ratio were not assessed. Self-reported race data were unavailable.Conclusions:For healthcare planning, in regions where a minority of the population is Black, a substantial number of individuals may no longer meet referral criteria for different types of kidney healthcare following adoption of the new 2021 eGFR equation.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-03-23T11:12:08Z
DOI: 10.1177/20543581241229258
Issue No: Vol. 11 (2024)
- Advancing Community Care and Access to Follow-up After Acute Kidney Injury
Hospitalization: Design of the AFTER AKI Randomized Controlled Trial
Authors: Meha Bhatt, Eleanor Benterud, Taylor Palechuk, Coralea Bignell, Nasreen Ahmed, Kerry McBrien, Matthew T. James, Neesh Pannu
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background:Acute kidney injury (AKI) is a common complication among hospitalized patients with long-term implications including chronic kidney disease (CKD). Although models are available to predict the risk of advanced CKD after AKI, there is limited evidence regarding follow-up for patients with AKI after hospital discharge, resulting in variable follow-up care. A risk-stratified follow-up approach may improve appropriateness and efficiency of management for CKD among patients at risk of declining kidney function following AKI.Objective:The objective was to compare and evaluate the use of a risk-stratified approach to follow-up care vs usual care for patients with AKI after hospital discharge.Design:This study was a pragmatic randomized controlled trial.Setting:This study was conducted in 2 large urban hospitals in Alberta, Canada.Patients:Hospitalized patients with AKI (KDIGO stage 2 or 3) not previously under the care of a nephrologist, expected to survive greater than 90 days being discharged home.Measurements:We will evaluate whether guideline-recommended CKD care processes are initiated within 90 days, including statin use, angiotensin-converting enzyme inhibitor (ACEi)/angiotensin II receptor blocker (ARB) use in those with proteinuria or diabetes, and nephrologist follow-up if sustained eGFR
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-03-16T07:25:16Z
DOI: 10.1177/20543581241236419
Issue No: Vol. 11 (2024)
- Zinc Supplementation Trial in Pediatric Chronic Kidney Disease: Effects on
Circulating FGF-23 and Klotho
Authors: V. Belostotsky, S. A. Atkinson, G. Filler
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background:Zinc status, its role in bone metabolism and efficacy of deficiency correction has not been well studied in children with chronic kidney disease (CKD).Objectives:The primary objective was to investigate whether 3 months of oral zinc supplementation corrects zinc deficiency in children with CKD who have native or transplanted kidneys. The secondary objective was to compare circulating intact FGF-23 (iFGF-23), c-terminal FGF-23 (cFGF-23), and Klotho between zinc-sufficient and zinc-deficient children with CKD and to assess the relationship between circulating zinc, iFGF-23, cFGF-23, Klotho, bone biomarkers, copper, and phosphate excretion pre-supplementation and post-supplementation of zinc.Methods:Forty-one children (25 male and 16 female, age 12.94 ± 4.13 years) with CKD in native or transplanted kidneys were recruited through 2 pediatric nephrology divisions in Ontario, Canada. Of those, 14 patients (9 native CKD, 5 transplant CKD) with identified zinc deficiency (64% enrollment rate) received zinc citrate supplement for 3 months: 10 mg orally once (4-8 years) or twice (9-18 years) daily.Results:Zinc deficiency (plasma concentration < 11.5 µmol/L) was found in 22 patients (53.7%). A linear regression model suggested that zinc concentration reduced by 0.026 µmol/L (P = .04) for every 1-unit of estimated glomerular filtration rate (eGFR) drop. Zinc deficiency status was associated with higher serum iFGF-23; however, this was predominantly determined by the falling GFR. Zinc deficient and sufficient children had similar circulating c-FGF-23 and alpha-Klotho. Normalization of plasma zinc concentration was achieved in 8 (5 native CKD and 3 transplant CKD) out of 14 treated patients rising from 10.04 ± 1.42 to 12.29 ± 3.77 μmol/L (P = .0038). There were no significant changes in other biochemical measures in all treated patients. A statistically significant (P = .0078) rise in c-FGF-23 was observed only in a subgroup of 11 children treated with zinc but not receiving calcitriol.Conclusions:Zinc status is related to kidney function and possibly connected to bone metabolism in patients with CKD. However, it plays a minor role in fine-tuning various metabolic processes. In this exploratory non-randomized study, 3 months supplementation with zinc corrected deficiency in just over half of patients and only modestly affected bone metabolism in asymptomatic CKD patients.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-03-13T10:41:41Z
DOI: 10.1177/20543581241234723
Issue No: Vol. 11 (2024)
- Royal Jelly, A Super Food, Protects Against Celecoxib-Induced Renal
Toxicity in Adult Male Albino Rats
Authors: Hesham A. M. I. Khalifa, Naglaa Z. H. Eleiwa, Heba A. Nazim
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background:Celecoxib is a COX-2 nonsteroidal anti-inflammatory drug (NSAID). It is widely used for the treatment of osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.Objective:This study aimed to explore the effect of long-term administration of celecoxib on kidney of male albino rats, and to study the potential effect of treatment discontinuation on such tissues. The study also examined the alleged ameliorative effect of royal jelly (RJ).Methods:Fifty, male albino rats were divided into 5 equal groups; 10 each. Group 1: rats received no drug (control group). Group 2: rats received celecoxib (50 mg/kg/day, orally for 30 successive days). Group 3: rats received celecoxib (50 mg/kg/day, orally) and royal jelly (300 mg/kg/day, orally) for 30 successive days. Group 4: rats received celecoxib for 30 successive days, then rats were left untreated for another 30 days. Group 5: rats received celecoxib and RJ for 30 successive days, then rats were left untreated for another 30 days.Results:Long-term celecoxib administration caused significant elevation in kidney function tests, with ameliorative effects of RJ against celecoxib-induced renal toxicity.Conclusion:Long-term celecoxib administration caused renal toxicity in male albino rats, with ameliorative effects of RJ.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-03-11T06:36:16Z
DOI: 10.1177/20543581241235526
Issue No: Vol. 11 (2024)
- Nephrology Nurses: Essential Professionals in Sustainable Kidney Care
Authors: Sarah Thomas, Anita Kennett, Claire Fullerton, Helen Boyd
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Purpose:The increasing frequency of extreme climate events underscores the need for urgent action on climate change. The health care system contributes 4.6% of greenhouse gas emissions (GHGs) in Canada; thus, it is a major contributor to the country’s carbon footprint. Kidney care in particular can involve high amounts of waste (eg, plastic and consumable waste associated with dialysis, transportation, emissions, energy, and water consumption). Therefore, sustainability initiatives within the health care system, and especially in the context of kidney care, have great potential to make a positive impact on planetary health. Here, we outline ways in which nephrology nurses can expand our duty of care to the environment and incorporate sustainability into our work.Sources of information:A small advisory group of nephrology nurses in partnership with the Canadian Association of Nurses for the Environment (CANE) assessed ways that sustainable practices can be incorporated into nephrology nursing. Drawing on the Planetary Health Care model used by the Canadian Society of Nephrology: Sustainable Nephrology Action Planning (SNAP) committee, we assessed how the model could be adapted in the context of kidney care using 3 main actionable themes in their work: reducing the demand for health services, matching the supply of health services with demand, and reducing emissions from the supply of health services. We also reviewed and selected real-world examples of initiatives pursued by colleagues.Key findings:Through this established framework, we provide recommendations and case examples for nephrology nurses to expand our duty of care to the environment. We describe nursing-led strategies used in Canada to improve environmental sustainability in kidney programs and consider their applicability to other renal programs. In 1 case example, we show how a simple nurse-led initiative at a single dialysis clinic can lower plastic waste and associated costs by $2042.59 per year. More broadly, we provide recommendations and actions for nephrology nurses to improve environmental sustainability in kidney care.Limitations:Nurses in Canada have many responsibilities within limited timeframes, making it essential to choose sustainable practices that do not exacerbate burnout and high workloads. For sustainable practices to be successful, nurses must integrate them into their existing workflows.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-03-07T12:42:02Z
DOI: 10.1177/20543581241234730
Issue No: Vol. 11 (2024)
- Comparison of Acute Health Care Utilization Between Patients Receiving
In-Center Hemodialysis and the General Population: A Population-Based
Matched Cohort Study From Ontario, Canada
Authors: Kyla L. Naylor, Marlee Vinegar, Peter G. Blake, Sarah Bota, Bin Luo, Amit X. Garg, Jane Ip, Angie Yeung, Joanie Gingras, Anas Aziz, Carina Iskander, Phil McFarlane
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background:Patients receiving maintenance hemodialysis have multiple comorbidities and are at high risk of presenting to the hospital. However, the incidence and cost of acute health care utilization in the in-center hemodialysis population and how this compares with other populations is poorly understood.Objective:To determine the rate, pattern, and cost of emergency department visits and hospitalizations in patients receiving in-center hemodialysis compared with a matched general population.Design:Population-based matched cohort study.Setting:We used linked administrative health care databases from Ontario, Canada.Patients:We included 25 379 patients (incident and prevalent) receiving in-center hemodialysis between January 1, 2010, and December 31, 2018. Patients were matched on birth date (±2 years), sex, and cohort entry date using a 1:4 ratio to 101 516 individuals from the general population.Measurements:Our primary outcomes were emergency department visits (allowing for multiple visits per individual) and hospital admissions from the emergency department. We also assessed all-cause hospitalizations, all-cause readmissions within 30 days of discharge from the original hospitalization, length of stay for hospital admissions (including multiple visits per individual), and the financial cost of these admissions.Methods:We presented the rate, percentage, median (25th, 75th percentiles), and incidence rate per 1000 person-years for emergency department visits and hospitalizations. Individual-level health care costs for emergency department visits and all-cause hospitalization were estimated using resource intensity weights multiplied by the cost per weighted case.Results:Patients receiving in-center hemodialysis had substantially more comorbidities (eg, diabetes) than the matched general population. Eighty percent (n = 20 309) of patients receiving in-center hemodialysis had at least 1 emergency department visit compared with 56% (n = 56 452) of individuals in the matched general population, over a median follow-up of 1.8 years (25th, 75th percentiles: 0.7, 3.6) and 5.2 (2.5, 8.4) years, respectively. The incidence rate of emergency department visits, allowing for multiple visits per individual, was 2274 per 1000 person-years (95% confidence interval [CI]: 2263, 2286) for patients receiving in-center hemodialysis, which was almost 5 times as high as the matched general population (471 per 1000 person-years; 95% CI: 469, 473). The rate of hospital admissions from the emergency department and the rate of all-cause hospital admissions in the in-center hemodialysis population was more than 7 times as high as the matched general population (hospital admissions from the emergency department: 786 vs 101 per 1000 person-years; all-cause hospital admissions: 1056 vs 139 per 1000 person-years). The median number of all-cause hospitalization days per patient year was 4.0 (0, 16.5) in the in-center hemodialysis population compared with 0 (0, 0.5) in the matched general population. The cost per patient-year for emergency department visits in the in-center hemodialysis population was approximately 5.5 times as high as the matched general population while the cost of hospitalizations in the in-center hemodialysis population was approximately 11 times as high as the matched general population (emergency department visits: CAN$ 1153 vs CAN$ 209; hospitalizations: CAN$ 21 151 vs CAN$ 1873 [all costs in 2023 CAN$]).Limitations:External generalizability and we could not determine whether emergency department visits and hospitalizations were preventable.Conclusions:Patients receiving in-center hemodialysis have high acute health care utilization. These results improve our understanding of the burden of disease and the associated costs in the in-center hemodialysis population, highlight the need to improve acute outcomes, and can aid health care capacity planning. Additional research is needed to address the risk of hospitalization after controlling for patient comorbidities.Trial registration:This is not applicable as this is a population-based matched cohort study and not a clinical trial.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-03-05T06:57:05Z
DOI: 10.1177/20543581241231426
Issue No: Vol. 11 (2024)
- Thanks to Reviewers
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-02-27T06:12:12Z
DOI: 10.1177/20543581241234129
Issue No: Vol. 11 (2024)
- Implementation of a One-Day Living Kidney Donor Assessment Clinic to
Improve the Efficiency of the Living Kidney Donor Evaluation: Program
Report
Authors: Seychelle Yohanna, Kyla L. Naylor, Jessica M. Sontrop, Christine M. Ribic, Catherine M. Clase, Matthew C. Miller, Sunchit Madan, Richard Hae, Jasper Ho, Jian Roushani, Sarah Parfeniuk, Melodie Jansen, Sharon Shavel, Michelle Richter, Kimberly Young, Brooke Cowell, Shahid Lambe, Peter Margetts, Kevin Piercey, Vikas Tandon, Colm Boylan, Carol Wang, Susan McKenzie, Barb Longo, Amit X. Garg
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Purpose of program:A key barrier to becoming a living kidney donor is an inefficient evaluation process, requiring more than 30 tests (eg, laboratory and diagnostic tests), questionnaires, and specialist consultations. Donor candidates make several trips to hospitals and clinics, and often spend months waiting for appointments and test results. The median evaluation time for a donor candidate in Ontario, Canada, is nearly 1 year. Longer wait times are associated with poorer outcomes for the kidney transplant recipient and higher health care costs. A shorter, more efficient donor evaluation process may help more patients with kidney failure receive a transplant, including a pre-emptive kidney transplant (ie, avoiding the need for dialysis). In this report, we describe the development of a quality improvement intervention to improve the efficiency, effectiveness, and patient-centeredness of the donor candidate evaluation process. We developed a One-Day Living Kidney Donor Assessment Clinic, a condensed clinic where interested donor candidates complete all testing and consultations within 1 day.Sources of information:The One-Day Living Kidney Donor Assessment Clinic was developed after performing a comprehensive review of the literature, receiving feedback from patients who have successfully donated, and meetings with transplant program leadership from St. Joseph’s Healthcare Hamilton. A multistakeholder team was formed that included health care staff from nephrology, transplant surgery, radiology, cardiology, social work, nuclear medicine, and patients with the prior lived experience of kidney donation. In the planning stages, the team met regularly to determine the objectives of the clinic, criteria for participation, clinic schedule, patient flow, and clinic metrics.Methods:Donor candidates entered the One-Day Clinic if they completed initial laboratory testing and agreed to an expedited process. If additional testing was required, it was completed on a different day. Donor candidates were reviewed by the nephrologist, transplant surgeon, and donor coordinator approximately 2 weeks after the clinic for final approval. The team continues to meet regularly to review donor feedback, discuss challenges, and brainstorm solutions.Key findings:The One-Day Clinic was implemented in March 2019, and has now been running for 4 years, making iterative improvements through continuous patient and provider feedback. To date, we have evaluated more than 150 donor candidates in this clinic. Feedback from donors has been uniformly positive (98% of donors stated they were very satisfied with the clinic), with most noting that the clinic was efficient and minimally impacted work and family obligations. Hospital leadership, including the health care professionals from each participating department, continue to show support and collaborate to create a seamless experience for donor candidates attending the One-Day Clinic.Limitations:Clinic spots are limited, meaning some interested donor candidates may not be able to enter a One-Day Clinic the same month they come forward.Implications:This patient-centered quality improvement intervention is designed to improve the efficiency and experience of the living kidney donor evaluation, result in better outcomes for kidney transplant recipients, and potentially increase living donation. Our next step is to conduct a formal evaluation of the clinic, measuring qualitative feedback from health care professionals working in the clinic and donor candidates attending the clinic, and measuring key process and outcome measures in donor candidates who completed the one-day assessment compared with those who underwent the usual care assessment. This program evaluation will provide reliable, regionally relevant evidence that will inform transplant centers across the country as they consider incorporating a similar one-day assessment model.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-02-26T05:54:59Z
DOI: 10.1177/20543581241231462
Issue No: Vol. 11 (2024)
- Cardiovascular Risk in Patients With Glomerular Disease: A Narrative
Review of the Epidemiology, Mechanisms, Management, and Patient Priorities
Authors: Robert L. Myette, Caroline Lamarche, Ayodele Odutayo, Nancy Verdin, Mark Canney
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Purpose of review:Cardiovascular (CV) disease is a major cause of morbidity and mortality for patients with glomerular disease. Despite the fact that mechanisms underpinning CV disease risk in this population are likely distinct from other forms of kidney disease, treatment and preventive strategies tend to be extrapolated from studies of patients with undifferentiated chronic kidney disease (CKD). There is an unmet need to delineate the pathophysiology of CV disease in patients with glomerular disease, establish unique risk factors, and identify novel therapeutic targets for disease prevention. The aims of this narrative review are to summarize the existing knowledge regarding the epidemiology, molecular mechanisms, and management of CV disease in patients with common glomerular disease, highlight the patient perspective, and propose specific areas for future study.Sources of information:The literature for this narrative review was accessed using common research search engines, including PubMed, PubMed Central, Medline, and Google Scholar. Information for the patient perspective section was collected through iterative discussions with a patient partner.Methods:We reviewed the epidemiology, molecular mechanisms of disease, management approaches, and the patient perspective in relation to CV disease in patients with glomerulopathies. Throughout, we have highlighted the current knowledge and have discussed future research approaches, both clinical and translational, while integrating the patient perspective.Key findings:Patients with glomerular disease have significant CV disease risk driven by multifactorial, molecular mechanisms originating from their glomerular disease but complicated by existing comorbidities, kidney disease, and medication side effects. The current approach to risk stratification and treatment relies heavily on existing data from CKD patients, but this may not always be appropriate given the unique pathophysiology and mechanisms associated with CV disease risk in patients with glomerular disease. We highlight the need for ongoing glomerular disease-focused studies aimed to better delineate CV disease risk, while integrating the patient perspective.Limitations:This is a narrative review and does not represent a comprehensive and systematic review of the literature.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-02-23T06:20:39Z
DOI: 10.1177/20543581241232472
Issue No: Vol. 11 (2024)
- Large Kidney Cysts in HNF1B Nephropathy Mimicking Autosomal Dominant
Polycystic Kidney Disease
Authors: Nada Alamri, Matthew B. Lanktree
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Rationale:Hepatocyte nuclear factor 1 beta (HNF1B) nephropathy is a rare autosomal dominant monogenic kidney disease. We present a case mimicking autosomal dominant polycystic kidney disease (ADPKD), highlighting the phenotypic heterogeneity of HNF1B-related disease.Presenting concerns of the patient:A 37-year-old man presented with hypertensive urgency, accompanied by flank pain and abdominal distension. Despite the absence of familial kidney disease, imaging revealed large bilateral kidney cysts resembling ADPKD.Diagnosis:We initially suspected de novo ADPKD. However, negative genetic testing results for PKD1 and PKD2 led to a 43-gene cystic kidney sequencing panel which identified a deletion encompassing the entire HNF1B gene.Intervention:To alleviate discomfort caused by the kidney cysts, ultrasound-guided aspiration and foam sclerotherapy were performed. Tolvaptan, used for treating high-risk ADPKD, was not prescribed after confirming the diagnosis was HNF1B nephropathy.Outcomes:A diagnosis of HNF1B nephropathy was reached following gene panel testing. Abdominal symptoms improved following cyst aspiration and foam sclerotherapy.Novel findings:HNF1B nephropathy has a variable presentation but can lead to cysts appearing like ADPKD. A 43-gene cystic kidney sequencing panel identified the diagnosis in this uncertain case.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-02-16T06:13:37Z
DOI: 10.1177/20543581241232470
Issue No: Vol. 11 (2024)
- A Current State of the Art and Science of Exercise in Dialysis: A
Narrative Review
Authors: Megan Borkum, Adeera Levin, Joey Ficocelli, Lysa Wone, Mercedeh Kiaii
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Purpose of the review:The purpose of the review is to discuss current proven benefits and problems of integrating exercise in the care of people receiving dialysis by reviewing literature from the last few years and identifying important questions that still need to be asked and answered.Methods:A focused review and appraisal of the literature were done. Original peer-reviewed articles, review articles, opinion pieces and guidelines were identified from PubMed and Google Scholar databases. Only sources in English were accessed. Search terms “exercise” and “dialysis” were used to find active recruiting randomized trials in various clinical trial registry platforms.Key findings:Numerous studies have demonstrated the benefits of exercise training in individuals receiving dialysis, limited by factors such as short duration of follow-up and inconsistent adverse event reporting and outcomes selected. Notable gaps in exercise research in dialysis include ways to maintain programs and patient motivation, studies in peritoneal dialysis and home hemodialysis patients, and how best to define and measure outcomes of interest.Implications:This review summarizes the current state of exercise in people receiving dialysis and serves as a call to action to conduct large, randomized controlled trials to improve the quality of evidence needed to implement and sustain innovative, exercise interventions, and programs for this population.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-02-16T06:10:08Z
DOI: 10.1177/20543581241229253
Issue No: Vol. 11 (2024)
- Proton Pump Inhibitors Use in Kidney Transplant Recipients: A
Population-Based Study
Authors: James Kiberd, Robert R. Quinn, Pietro Ravani, Krista L. Lentine, Alix Clarke, Rachel Jeong, Labib Faruque, Ngan N. Lam
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background:Kidney transplant recipients are commonly prescribed proton-pump inhibitors (PPIs), but due to concern for polypharmacy, chronic use should be limited.Objective:The objective was to describe PPI use in kidney transplant recipients beyond their first year of transplant to better inform and support deprescribing initiatives.Design:We conducted a retrospective, population-based cohort study using linked health care databases.Setting:This study was conducted in Alberta, Canada.Patients:We included all prevalent adult, kidney-only transplant recipients between April 2008 and December 2017 who received their transplant between May 2002 and December 2017.Measurements:The primary outcome was ongoing or new PPI use and patterns of use, including frequency and duration of therapy, and assessment of indication for PPI use.Methods:We ascertained baseline characteristics, covariate information, and outcome data from the Alberta Kidney Disease Network (AKDN). We compared recipients with evidence of a PPI prescription in the 3 months prior to study entry to those with a histamine-2-receptor antagonist (H2Ra) fill and those with neither.Results:We identified 1823 kidney transplant recipients, of whom 868 (48%) were on a PPI, 215 (12%) were on an H2Ra, and 740 (41%) were on neither at baseline. Over a median follow-up of 5.4 years (interquartile range [IQR] = 2.6-9.3), there were almost 45 000 unique PPI prescriptions dispensed, the majority (80%) of which were filled by initial PPI users. Recipients who were on a PPI at baseline would spend 91% (IQR = 70-98) of their graft survival time on a PPI in follow-up, and nephrologists were the main prescribers. We identified an indication for ongoing PPI use in 54% of recipients with the most common indication being concurrent antiplatelet use (26%).Limitations:Our kidney transplant recipients have access to universal health care coverage which may limit generalizability. We identified common gastrointestinal indications for PPI use but did not include rare conditions due to concerns about the validity of diagnostic codes. In addition, symptoms suggestive of reflux may not be well coded as the focus of follow-up visits is more likely to focus on kidney transplant.Conclusions:Many kidney transplant recipients are prescribed a PPI at, or beyond, the 1-year post-transplant date and are likely to stay on a PPI in follow-up. Almost half of the recipients in our study did not have an identifiable indication for ongoing PPI use. Nephrologists frequently prescribe PPIs to kidney transplant recipients and should be involved in deprescribing initiatives to reduce polypharmacy.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-02-13T07:42:29Z
DOI: 10.1177/20543581241228723
Issue No: Vol. 11 (2024)
- KEeP ACTIVe Club Study: Kidney Transplant Recipients’ Experiences of a
Physical Activity and Social Interaction Virtual Group
Authors: Marie-Françoise Malo, Tania Janaudis-Ferreira, Aliya Affdal, Fabián-Andrés Ballesteros Gallego, Janie Boulianne-Gref, Marcelo Cantarovich, Elizabeth Ingram, Lloyd Mangahas, Catherine M. Tansey, Ruth Sapir-Pichhadze, Marie-Chantal Fortin
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background:It can be difficult for kidney transplant recipients (KTRs) to be physically active after their transplantation. Physical inactivity is a risk factor for cardiovascular disease, one of the leading cause of death among KTRs. To help KTRs start and maintain a physical activity routine, we developed the KEeP ACTIVe Club, a 6-month online intervention with access to a kinesiologist, a patient partner, and a private support group with an online platform (Facebook).Objective:The objective of this study was to capture the participants’ experiences of the KEeP ACTIVe Club.Design:Individual interviews.Setting:The Center hospitalier de l’Université de Montréal (CHUM) and the McGill University Health Center (MUHC) kidney transplant programs.Participants:Kidney transplant recipients who participated in the KEeP ACTIVe Club.Methods:Between October and December 2021, we conducted 11 individual semi-directed interviews with KTRs from 2 urban kidney transplant programs who participated in the KEeP ACTIVe Club. The interviews were digitally recorded and transcribed. Thematic analysis was conducted.Results:Participants’ principal motivation to participate in the KEeP ACTIVe Club was to improve their physical fitness following their transplant in a pandemic period. One of the main benefits of the KEeP ACTIVe Club was the improvement of participant’s self-confidence and the knowledge gained regarding exercises adapted to their reality as KTRs. However, the small number of participants and the schedules of classes offered were viewed as a pitfall of the current intervention. Finally, the peer mentoring and support gained by other participants were important and viewed as highly impactful aspects of the KEeP ACTIVe Club.Limitations:Only 11 of the 18 patients who participated in the KEeP ACTIVe Club took part in the interviews.Conclusion:Participants reported a positive experience with the KEeP ACTIVe Club. Peer mentoring and support gained from other participants seem to be essential aspects of the experience within the KEeP ACTIVe Club. This program is a good avenue to offer in post-transplant care to help KTRs to be more active and to connect with other patients.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-02-08T11:03:51Z
DOI: 10.1177/20543581241229254
Issue No: Vol. 11 (2024)
- Communicating About Precision Transplantation Tools
Authors: Blake Murdoch, Ruth Sapir-Pichhadze, Sonali Natasha de Chickera, Timothy Caulfield
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Purpose of review:Precision tools that ensure molecular compatibility can help prevent rejection and improve kidney transplantation outcomes. However, these tools will generate controversy because they are perceived to and can in fact impact equity in the ethics of allocation. They may also affect the extent to which physicians can advocate for their patient fiduciaries, as generally required by Canadian professional ethics and law.Sources of information:Electronic databases such as Google Scholar and PubMed were searched for peer-reviewed literature, and Google search engine was used to identify the news articles, jurisprudence, legal information, and other relevant websites cited.Methods:We discuss controversies precision transplantation tools will likely generate, consider what challenges will arise from their implementation, and provide recommendations of avenues and content for communication to address these issues.Key findings:Communication about the translation of new precision tools will be challenging as media portrayals of transplantation often focus on individual narratives about access to transplantation and fail to center the issues of utility, allocation, and rejection. Incomplete portrayals of this nature will need to be countered with explanations of how new precision tools can be of net benefit when implemented equitably, as maintaining trust in the donation and transplantation system is key.Limitations:Our manuscript focuses on precision medicine applications pertaining to the implementation of molecular compatibility in transplantation. Distinct communication content and avenues may need to be considered in other contexts.Implications:Clear, accurate, and strategic communication is key to managing translation of precision medicine tools. For this purpose, we provide detailed recommendations for stakeholder engagement, content, and avenues for communicating about precision transplantation tools.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-02-07T08:52:13Z
DOI: 10.1177/20543581241228737
Issue No: Vol. 11 (2024)
- Oral Nutritional Supplement Prescription and Patient-Reported Symptom
Authors: Michelle M. Y. Wong, Yuyan Zheng, Bingyue Zhu, Lee Er, Mohammad Atiquzzaman, Alexandra Romann, Dani Renouf, Zainab Sheriff, Adeera Levin
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background:Malnutrition and protein-energy wasting (PEW) are nutritional complications of advanced chronic kidney disease (CKD) that contribute to morbidity, mortality, and decreased quality of life. No previous studies have assessed the effect of oral nutritional supplements (ONSs) on patient-reported symptom burden among patients with non-dialysis CKD (CKD-ND) who have or are at risk of malnutrition/PEW.Objective:The objective of this study was (1) to quantify the associations between baseline nutritional parameters and patient-reported symptom scores for wellbeing, tiredness, nausea, and appetite and (2) to compare the change in symptom scores among patients prescribed ONS with patients who did not receive ONS in a propensity-score–matched analysis.Design:This study conducted observational cohort analysis using provincial registry data.Setting:This study was done in multidisciplinary CKD clinics in British Columbia.Patients:Adult patients>18 years of age with CKD-ND entering multidisciplinary CKD clinics between January 1, 2010-July 31, 2019 who had at least 2 Edmonton Symptom Assessment System Revised: Renal (ESASr:Renal) assessments.Measurements:The measurements include nutrition-related parameters such as body mass index (BMI), serum albumin, serum phosphate, serum bicarbonate, neutrophil-to-lymphocyte ratio (NLR), and ESASr:Renal scores (overall and subscores for wellbeing, tiredness, nausea, and appetite).Methods:Multivariable linear regression was applied to assess associations between nutritional parameters and ESASr:Renal scores. Propensity-score matching using the greedy method was used to match patients prescribed ONS with those not prescribed ONS using multiple demographic, comorbidity, health care utilization, and temporal factors. Linear regression was used to assess the association between first ONS prescription and change in ESASr:Renal overall score and subscores for wellbeing, tiredness, nausea, and appetite.Results:Of total, 2076 patients were included. Higher baseline serum albumin was associated with lower overall ESASr:Renal score (−0.20, 95% confidence interval [CI] = −0.40 to −0.01 per 1 g/L increase in albumin), lower subscores for tiredness (−0.04, 95% CI = −0.07 to −0.01), nausea (−0.03, 95% CI = −0.04 to −0.01), and appetite (−0.03, 95% CI = −0.06 to −0.01). Higher BMI was associated with higher overall ESASr:Renal score (0.32, 95% CI = 0.16 to 0.48 per 1 kg/m2 increase in BMI), higher symptom subscores for wellbeing (0.02, 95% CI = 0.00 to 0.04) and tiredness (0.05, 95% CI = 0.02 to 0.07). Higher baseline NLR was associated with higher overall score (0.21, 95% CI = 0.03 to 0.39 per 1 unit increase in NLR), higher symptom subscores for wellbeing (0.03, 95% CI = 0.01 to 0.05) and nausea (0.03, 95% CI = 0.02 to 0.05). In the propensity-score–matched analysis, there were no statistically significant associations between ONS prescription and change in overall ESASr:Renal (beta coefficient for change in ESASr:Renal = 0.17, 95% CI = −2.64 to 2.99) or for subscores for appetite, tiredness, nausea, and wellbeing.Limitations:Possible residual confounding. The ESASr:Renal assessments were obtained routinely only in patients with G5 CKD-ND and/or experiencing significant CKD-related symptoms.Conclusions:This exploratory observational analysis of patients with advanced non-dialysis CKD demonstrated BMI, serum albumin, and NLR were modestly associated with patient-reported symptoms, but we did not observe an association between ONS use and change in ESASr:Renal scores.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-02-07T08:47:18Z
DOI: 10.1177/20543581241228731
Issue No: Vol. 11 (2024)
- Assessing Discharge Communication and Follow-up of Acute Kidney Injury in
British Columbia: A Retrospective Chart Review
Authors: Peter Birks, Bader Al-Zeer, Daniel Holmes, Rami Elzayat, Mark Canney, Ognjenka Djurdjev, Tianyi Selena Shao, Yuyan Zheng, Samuel A. Silver, Adeera Levin
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background and objective:Acute kidney injury (AKI) affects up to 20% of hospitalizations and is associated with chronic kidney disease, cardiovascular disease, increased mortality, and increased health care costs. Proper documentation of AKI in discharge summaries is critical for optimal monitoring and treatment of these patients once discharged. Currently, there is limited literature evaluating the quality of discharge communication after AKI. This study aimed to evaluate the accuracy and quality of documentation of episodes of AKI at a tertiary care center in British Columbia, Canada.Methods, design, setting, patients, and measurements:This was a retrospective chart review study of adult patients who experienced AKI during hospital admission between January 1, 2018, and December 31, 2018. Laboratory data were used to identify all admissions to the cardiac and general medicine ward complicated by AKI defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria. A random sample of 300 AKI admissions stratified by AKI severity (eg, stages 1, 2, and 3) were identified for chart review. Patients were excluded if they required ongoing renal replacement therapy after admission, had a history of kidney transplant, died during their admission, or did not have a discharge summary available. Discharge summaries were reviewed for documentation of the following: presence of AKI, severity of AKI, AKI status at discharge, practitioner and laboratory follow-up plans, and medication changes.Results:A total of 1076 patients with 1237 AKI admissions were identified. Of the 300 patients selected for discharge summary review, 38 met exclusion criteria. In addition, AKI was documented in 140 (53%) discharge summaries and was more likely to be documented in more severe AKI: stage 1, 38%; stage 2, 51%; and stage 3, 75%. Of those with their AKI documented, 94 (67%) documented AKI severity, and 116 (83%) mentioned the AKI status or trajectory at the time of discharge. A total of 239 (91%) of discharge summaries mentioned a follow-up plan with a practitioner, but only 23 (10%) had documented follow-up with nephrology. Patients with their AKI documented were more likely to have nephrology follow-up than those without AKI documented (17% vs 1%). Regarding laboratory investigations, 92 (35%) of the summaries had documented recommendations. In summaries that included medications typically held during AKI, only about half made specific reference to those medications being held, adjusted, or documented a post-discharge plan for that medication. For those with nonsteroidal anti-inflammatory drugs (NSAIDs) listing, 64% of discharge summaries mentioned holding, and 9% mentioned a discharge plan. For those with angiotensin converting enzyme inhibitor (ACEi)/angiotensin II receptor blocker (ARB) listing, 38% mentioned holding these medications, and 46% mentioned a discharge plan. In summaries with diuretics listed, 35% mentioned holding, and 51% included a discharge plan.Conclusions and limitations:We found suboptimal quality and completeness of discharge reporting in patients hospitalized with AKI. This may contribute to inadequate follow-up and post-hospitalization care for this patient population. Strategies are required for increasing the presence and quality of AKI reporting in discharge summaries. Limitations include our definition of AKI based on lab criteria, which may have missed some of the injuries that met the criteria based on urine output. Another limitation is that our definition of AKI based on the highest and lowest creatinine during admission may have led to some overclassification. In addition, without outpatient laboratories, it is possible that we have not captured the true baseline creatinine in some patients.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-02-06T05:39:42Z
DOI: 10.1177/20543581231222064
Issue No: Vol. 11 (2024)
- Associated Factors and Outcomes of Acute Kidney Injury in COVID-19
Patients in Kenya
Authors: Susan Cheruiyot, Jacob Shabani, Jasmit Shah, Catherine Gathu, Ahmed Sokwala
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background:Corona Virus Disease 2019 (COVID-19), an infection caused by the SARS-CoV-2 virus, has been the largest global pandemic since the turn of the 21st century. With emerging research on this novel virus, studies from the African continent have been few. Corona Virus Disease 2019 has been shown to affect various organs including the lungs, gut, nervous system, and the kidneys. Acute kidney injury (AKI) is an independent risk factor for mortality and increases the health care burden for patients with persistent kidney dysfunction and maintenance dialysis. Sub-Saharan Africa has a high number of poorly controlled chronic illnesses, economic inequalities, and health system strains that may contribute to higher cases of kidney injury in patients with COVID-19 disease.Objectives:The objective of this study was to determine the incidence, associated factors, and outcomes of AKI in patients hospitalized with COVID-19 in Kenya.Methods:This retrospective cohort study included 1366 patients with confirmed COVID-19 illness hospitalized at the Aga Khan University Hospital in Nairobi, Kenya, between April 1, 2020 and October 31, 2021. Data were collected on age, sex, the severity of COVID-19 illness, existing pregnancy and comorbid conditions including human immunodeficiency virus (HIV), diabetes mellitus, hypertension, and functioning kidney transplant patients. Univariate analysis was carried out to determine the association of clinical and demographic factors with AKI. To determine independent associations with AKI incidence, a logistic regression model was used and the relationship was reported as odds ratios (ORs) with a 95% confidence interval (CI). The outcomes of AKI including the in-hospital mortality rate, renal recovery rate at hospital discharge, and the duration of hospital stay were reported and stratified based on the stage of AKI.Results:The median age of study patients was 56 years (interquartile range [IQR] = 45-68 years), with 67% of them being male (914 of 1366). The AKI incidence rate was 21.6% (n = 295). Patients with AKI were older (median age = 64 years vs 54 years; P < .001), majority male (79% of men with AKI vs 63.6% without AKI; P < .001), and likely to have a critical COVID-19 (OR = 8.03, 95% CI = 5.56-11.60; P < .001). Diabetes and hypertension, with an adjusted OR of 1.75 (95% CI = 1.34-2.30; P < .001) and 1.68 (95% CI = 1.27-2.23; P < .001), respectively, were associated with AKI occurrence in COVID-19. Human immunodeficiency virus, pregnancy, and a history of renal transplant were not significantly associated with increased AKI risk in this study. Patients with AKI had significantly higher odds of mortality, and this effect was proportional to the stage of AKI (OR = 11.35, 95% CI = 7.56-17.03; P < .001). 95% of patients with stage 1 AKI had complete renal recovery vs 33% of patients with stage 3 AKI. Of the patients with stage 3 AKI (n = 64), 10 underwent hemodialysis, with 1 recovery in renal function and 3 patients requiring ongoing dialysis after discharge.Conclusions:This study was conducted at a single private tertiary-level health care facility in Kenya and only up to the time of hospital discharge. It is one of the first large studies from sub-Saharan Africa looking at the associated factors and outcomes of AKI in COVID-19 and forms a foundation for further analysis on the long-term consequences of COVID-19 on the kidneys. A major limitation of the study is the lack of baseline pre-admission creatinine values for most patients; thus, the impact of chronic kidney disease/baseline creatinine values on the incidence of AKI could not be established.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-01-29T12:13:34Z
DOI: 10.1177/20543581241227015
Issue No: Vol. 11 (2024)
- Humoral Response Following 3 Doses of mRNA COVID-19 Vaccines in Patients
With Non-Dialysis-Dependent CKD: An Observational Study
Authors: Omosomi Enilama, Kevin Yau, Lee Er, Mohammad Atiquzzaman, Matthew J. Oliver, Marc G. Romney, Jerome A. Leis, Kento T. Abe, Freda Qi, Karen Colwill, Anne-Claude Gingras, Michelle A. Hladunewich, Adeera Levin
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background:Chronic kidney disease (CKD) is associated with a lower serologic response to vaccination compared to the general population. There is limited information regarding the serologic response to coronavirus disease 2019 (COVID-19) vaccination in the non-dialysis-dependent CKD (NDD-CKD) population, particularly after the third dose and whether this response varies by estimated glomerular filtration rate (eGFR).Methods:The NDD-CKD (G1-G5) patients who received 3 doses of mRNA COVID-19 vaccines were recruited from renal clinics within British Columbia and Ontario, Canada. Between August 27, 2021, and November 30, 2022, blood samples were collected serially for serological testing every 3 months within a 9-month follow-up period. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) anti-spike, anti-receptor binding domain (RBD), and anti-nucleocapsid protein (NP) levels were determined by enzyme-linked immunosorbent assay (ELISA).Results:Among 285 NDD-CKD patients, the median age was 67 (interquartile range [IQR], 52-77) years, 58% were men, 48% received BNT162b2 as their third dose, 22% were on immunosuppressive treatment, and COVID-19 infection by anti-NP seropositivity was observed in 37 of 285 (13%) patients. Following the third dose, anti-spike and anti-RBD levels peaked at 2 months, with geometric mean levels at 1131 and 1672 binding antibody units per milliliter (BAU/mL), respectively, and seropositivity rates above 93% and 85%, respectively, over the 9-month follow-up period. There was no association between eGFR or urine albumin-creatinine ratio (ACR) with mounting a robust antibody response or in antibody levels over time. The NDD-CKD patients on immunosuppressive treatment were less likely to mount a robust anti-spike response in univariable (odds ratio [OR] 0.43, 95% confidence interval [CI]: 0.20, 0.93) and multivariable (OR 0.52, 95% CI: 0.25, 1.10) analyses. An interaction between age, immunoglobulin G (IgG) antibody levels, and time was observed in both unadjusted (anti-spike: P = .005; anti-RBD: P = .03) and adjusted (anti-spike: P = .004; anti-RBD: P = .03) models, with older individuals having a more pronounced decline in antibody levels over time.Conclusion:Most NDD-CKD patients were seropositive for anti-spike and anti-RBD after 3 doses of mRNA COVID-19 vaccines and we did not observe any differences in the antibody response by eGFR.
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-01-29T12:02:22Z
DOI: 10.1177/20543581231224127
Issue No: Vol. 11 (2024)
- High-Throughput Computing to Automate Population-Based Studies to Detect
the 30-Day Risk of Adverse Outcomes After New Outpatient Medication Use in
Older Adults with Chronic Kidney Disease: A Clinical Research Protocol
Authors: Sheikh S. Abdullah, Neda Rostamzadeh, Flory T. Muanda, Eric McArthur, Matthew A. Weir, Jessica M. Sontrop, Richard B. Kim, Sedig Kamran, Amit X. Garg
Abstract: Canadian Journal of Kidney Health and Disease, Volume 11, Issue , January-December 2024.
Background:Safety issues are detected in about one third of prescription drugs in the years following regulatory agency approval. Older adults, especially those with chronic kidney disease, are at particular risk of adverse reactions to prescription drugs. This protocol describes a new approach that may identify credible drug-safety signals more efficiently using administrative health care data.Objective:To use high-throughput computing and automation to conduct 700+ drug-safety cohort studies in older adults in Ontario, Canada. Each study will compare 74 acute (30-day) outcomes in patients who start a new prescription drug (new users) to a group of nonusers with similar baseline health characteristics. Risks will be assessed within strata of baseline kidney function.Design and setting:The studies will be population-based, new-user cohort studies conducted using linked administrative health care databases in Ontario, Canada (January 1, 2008, to March 1, 2020). The source population for these studies will be residents of Ontario aged 66 years or older who filled at least one outpatient prescription through the Ontario Drug Benefit (ODB) program during the study period (all residents have universal health care, and those aged 65+ have universal prescription drug coverage through the ODB).Patients:We identified 3.2 million older adults in the source population during the study period and built 700+ initial medication cohorts, each containing mutually exclusive groups of new users and nonusers. Nonusers were randomly assigned cohort entry dates that followed the same distribution of prescription start dates as new users. Eligibility criteria included a baseline estimated glomerular filtration rate (eGFR) measurement within 12 months before the cohort entry date (median time was 71 days before cohort entry in the new user group), no prior receipt of maintenance dialysis or a kidney transplant, and no prior prescriptions for drugs in the same subclass as the study drug. New users and nonusers will be balanced on ~400 baseline health characteristics using inverse probability of treatment weighting on propensity scores within 3 strata of baseline eGFR: ≥60, 45 to
Citation: Canadian Journal of Kidney Health and Disease
PubDate: 2024-01-06T08:30:51Z
DOI: 10.1177/20543581231221891
Issue No: Vol. 11 (2024)
