Canadian Journal of Kidney Health and Disease最新文献

{"title":"Ambulance Service Utilization by Kidney Transplant Recipients.","authors":"Kaveh Masoumi-Ravandi, Amanda Vinson, Aran Thanamayooran, Judah Goldstein, Thomas Skinner, Karthik Tennankore","doi":"10.1177/20543581251324587","DOIUrl":"10.1177/20543581251324587","url":null,"abstract":"<p><strong>Background: </strong>Compared with the general population, kidney transplant recipients (KTRs) frequently visit the emergency department (ED), but much less is known about the characteristics of ED presentations requiring ambulance transport and the impact on subsequent outcomes for KTRs.</p><p><strong>Objectives: </strong>To identify predictors of ambulance transport to the ED (ambulance-ED) and outcomes (graft failure and mortality) for those who experienced an ambulance-ED event in a cohort of KTRs.</p><p><strong>Design: </strong>Retrospective cohort study of incident, adult KTRs receiving a transplant from 2008 to 2020.</p><p><strong>Setting: </strong>Nova Scotia, Canada.</p><p><strong>Patients: </strong>Adult (≥18 years), Nova Scotian KTRs affiliated with the Atlantic Canada Multi-Organ Transplant Program.</p><p><strong>Measurements: </strong>Ambulance-ED events were captured for all transplant recipients (following the day of discharge from their initial transplant admission) using electronic records (provided by Emergency Health Services, the sole provider of emergency medical services for Nova Scotia). Ambulance-ED was defined as ambulance transport to the ED following a 911 call; interfacility transfers were excluded. Predictors of ambulance-ED included recipient, donor, immunological, and perioperative characteristics (pertaining to the initial admission for kidney transplantation). Outcomes included graft failure and mortality.</p><p><strong>Methods: </strong>Predictors of ambulance-ED were analyzed using a multivariable negative binomial regression model and reported using incidence rate ratios (IRRs) and 95% confidence intervals (CIs). The risk of death/graft failure for those with an ambulance-ED within 30 days of hospital discharge following transplantation was analyzed using an adjusted Cox survival analysis and reported using hazard ratios (HRs) and 95% CIs.</p><p><strong>Results: </strong>A total of 418 patients received a transplant during the study period. A total of 179 (42.8%) experienced one or more ambulance-ED events. Female sex (IRR = 1.60; 95% CI = 1.12-2.29), kidney failure secondary to diabetes (IRR = 2.52; 95% CI = 1.19-5.31), and donor age ≥45 (IRR = 1.50; 95% CI = 1.04-2.15) were all associated with ambulance-ED. There was no significant increase in the risk of death/graft failure for those that experienced ambulance-ED within 30 days of hospital discharge following transplantation (HR = 1.31; 95% CI = 0.44-3.94).</p><p><strong>Limitations: </strong>A limitation of this study was that ambulance-ED is not a perfect surrogate marker of acute care needs in a population. Important determinants of health such as living situation and socioeconomic status were not available in this data set.</p><p><strong>Conclusions: </strong>This study highlights the burden of ambulance use for KTRs and provides insight into the need for more optimal follow-up in certain patient subgroups who are at particularly high risk.</p","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251324587"},"PeriodicalIF":1.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient and Caregiver Perceptions on the Allocation Process and Waitlist, and Accepting a Less-Than-Ideal Kidney: A Canadian Survey.","authors":"Marie-Chantal Fortin, Fabian Ballesteros Gallego, Héloise Cardinal, Manpreet Kaur, Rahul Mainra, Sylvain Patoine, Nicola Rosaasen, Holly Mansell","doi":"10.1177/20543581251324608","DOIUrl":"10.1177/20543581251324608","url":null,"abstract":"<p><strong>Background: </strong>Transplanting less-than-ideal (LTI) kidneys could help optimize organ utilization, but little is known about how patients and caregivers perceive the allocation process, waitlist, or LTI kidneys.</p><p><strong>Objective: </strong>To explore the perspectives of patients and caregivers on the Canadian kidney transplant allocation process, waitlist, and LTI kidneys.</p><p><strong>Design: </strong>Electronic survey.</p><p><strong>Setting: </strong>Canada.</p><p><strong>Patients: </strong>Transplant recipients, candidates, and caregivers.</p><p><strong>Methods: </strong>A bilingual electronic national survey was administered from January to March 2024. The questionnaire contained sections on demographics, perceptions of organ allocation and acceptance, LTI kidneys, and educational preferences. Descriptive analysis was performed.</p><p><strong>Results: </strong>Two hundred fifty-one responses were analyzed, including patients (63%, n = 159), and caregivers (37%, n = 92), from 11 provinces and territories. Three-quarters (74%, n = 186) understood how patients are placed on the waiting list, and 65% (n = 162) understood how donor kidneys are allocated, but 72% (n = 181) and 68% (n = 171) wanted more information about the waitlist and donor kidney allocation criteria, respectively. Approximately 20% felt that the waitlist and allocation processes were not transparent. Awareness about the option to refuse a deceased donor kidney offer was high (69%, n = 174), yet nearly half of respondents (46%, n = 115) expressed concern about being disadvantaged if an offer for a deceased donor kidney was refused. One-third of participants (33%, n = 83) were open to accepting an LTI kidney.</p><p><strong>Limitations: </strong>Compared to the general population, more study participants were white, and the majority were educated and financially at ease. This limits the generalizability of the results.</p><p><strong>Conclusion: </strong>Enhanced communication is required to improve transparency and information about the allocation system and waitlist in Canada.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251324608"},"PeriodicalIF":1.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11967212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Flow of Living Kidney Donor Candidates Through the Evaluation Process: A Single-Center Experience in Ontario, Canada.","authors":"Steven Habbous, Beth Montesi, Christy Masse, Corinne Weernink, Sisira Sarma, Mehmet A Begen, Ngan N Lam, Christine Dipchand, Seychelle Yohanna, Dervla M Connaughton, Lianne Barnieh, Amit X Garg","doi":"10.1177/20543581251323964","DOIUrl":"10.1177/20543581251323964","url":null,"abstract":"<p><strong>Introduction: </strong>Tracking the evaluation process of living kidney donor candidates facilitates benchmarking and can inform process redesign to improve experiences with the evaluation and enable more living donor kidney transplantation.</p><p><strong>Methods: </strong>We reviewed the medical records for all living donor candidates who were actively undergoing evaluation at any time between January 1, 2013, and December 31, 2016, at the London Health Sciences Centre in London, Ontario, Canada. We abstracted information on demographic factors, the evaluation process, reasons for a delayed evaluation, reasons for an evaluation termination (eg, donation, decline, withdrawal, loss to follow-up), frequency and timing of evaluation testing, and recipient dialysis status.</p><p><strong>Results: </strong>Over time, the number of living donor kidney transplants increased from 22 in 2013 to 32 in 2016 (18% and 34% of which were pre-emptive, respectively). The median number of candidates coming forward doubled from 167 in 2013 (2 candidates per recipient) to 348 in 2016 (4 candidates per recipient). Median time from first contact until donation decreased from 12.8 months in 2013 to 7.1 months in 2016 (a 45% reduction). The time from computed tomography (CT) angiography until donation (n = 74) was a median of 75 (interquartile range [IQR] = 36, 180) days, the longest single step in the evaluation. Common reasons for delay included waiting for the referral of their intended recipient for transplant evaluation (11% of candidates) and a need for the donor candidate to lose weight (8% of candidates). Donors completed the main evaluation tests on a median of 5 different dates. Thirty-six recipients started dialysis after their living donor candidates' evaluation had been underway for at least 3 months.</p><p><strong>Conclusion: </strong>Tracking the steps and reasons for an inefficient living kidney donor evaluation process can be used for quality improvement, and efficiency improvements are expected to translate into improved outcomes and experiences.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251323964"},"PeriodicalIF":1.6,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Testicular Pain After Living Kidney Donation: Results From a Multicenter Cohort Study.","authors":"Amit X Garg, Liane S Feldman, Jessica M Sontrop, Meaghan S Cuerden, Jennifer B Arnold, Neil Boudville, Martin Karpinski, Scott Klarenbach, Greg Knoll, Charmaine E Lok, Eric McArthur, Matthew Miller, Mauricio Monroy-Cuadros, Kyla L Naylor, G V Ramesh Prasad, Leroy Storsley, Christopher Nguan","doi":"10.1177/20543581251324610","DOIUrl":"10.1177/20543581251324610","url":null,"abstract":"<p><strong>Background: </strong>Some men who donate a kidney have reported testicular pain after donation; however, attribution to donation is not clear as no prior studies included a comparison group of nondonors.</p><p><strong>Objective: </strong>To examine the proportion of male donors who reported testicular pain in the years after nephrectomy compared to male nondonors with similar baseline health characteristics.</p><p><strong>Design participants and setting: </strong>We enrolled 1042 living kidney donors (351 male) before nephrectomy from 17 transplant centers (12 in Canada and 5 in Australia) from 2004 to 2014. A concurrent sample of 396 nondonors (126 male) was enrolled. Follow-up occurred until November 2021.</p><p><strong>Measurements: </strong>Donors and nondonors completed the same schedule of measurements at baseline (before nephrectomy) and follow-up. During follow-up, participants completed a questionnaire asking whether they had experienced new pain in their eyes, hands, or testicles; those who experienced pain were asked to indicate on which side of the body the pain occurred (left or right). The pain questionnaire was completed by 290 of 351 male donors (83%) and 97 of 126 male nondonors (77%) a median of 3 years after baseline (interquartile range = 2-6).</p><p><strong>Methods: </strong>Inverse probability of treatment weighting on a propensity score was used to balance donors and nondonors on baseline characteristics. After weighting, the nondonor sample increased to a pseudo sample of 295, and most baseline characteristics were similar between donors and nondonors.</p><p><strong>Results: </strong>At baseline, donors (n = 290) were a mean age of 49 years; 83% were employed, and 80% were married; 246 (84.8%) underwent laparoscopic surgery and 44 (15.2%) open surgery; 253 (87.2%) had a left-sided nephrectomy and 37 (12.8%) a right-sided nephrectomy. In the weighted analysis, the risk of testicular pain was significantly greater among donors than nondonors: 51/290 (17.6%) vs 7/295 (2.3%); weighted risk ratio, 7.8 (95% confidence interval [CI] = 2.7 to 22.8). Donors and nondonors did not differ statistically in terms of self-reported eye pain or hand pain. Among donors, the occurrence of testicular pain was most often unilateral (92.2%) and on the same side as the nephrectomy (90.2%). Testicular pain occurred more often in donors who had laparoscopic vs open surgery: 48/246 (19.5%) vs 3/44 (6.8%) but was similar in those who had a left-sided vs right-sided nephrectomy: 44/253 (17.4%) vs 7/37 (18.9%).</p><p><strong>Limitations: </strong>Participants recalled their symptoms several years after baseline, and we did not assess the timing, severity, or duration of pain or any treatments received for the pain.</p><p><strong>Conclusion: </strong>Unilateral testicular pain on the same side of a nephrectomy is a potential complication of living kidney donation that warrants further investigation.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251324610"},"PeriodicalIF":1.6,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes and Healthcare Utilization in Patients Receiving Maintenance Dialysis After the Onset of the COVID-19 Pandemic in Ontario, Canada.","authors":"Kyla L Naylor, Nivethika Jeyakumar, Yuguang Kang, Stephanie N Dixon, Amit X Garg, Ahmed Al-Jaishi, Peter G Blake, Rahul Chanchlani, Longdi Fu, Ziv Harel, Jane Ip, Ahbijat Kitchlu, Jeffrey C Kwong, Gihad Nesrallah, Matthew J Oliver, Therese A Stukel, Ron Wald, Matthew Weir, Kevin Yau","doi":"10.1177/20543581251328077","DOIUrl":"10.1177/20543581251328077","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The impact of the COVID-19 pandemic on clinical outcomes and healthcare utilization in patients receiving maintenance dialysis is unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare the rates of clinical outcomes and healthcare utilization in patients receiving maintenance dialysis (in-center and home modalities) before and during the COVID-19 pandemic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Population-based, repeated cross-sectional study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Linked administrative healthcare databases from Ontario, Canada.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Adults receiving maintenance dialysis from March 15, 2017, to March 14, 2020 (pre-COVID-19 pandemic period) and from March 15, 2020, to March 14, 2023 (COVID-19 pandemic period).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;Our primary outcome was all-cause mortality. Our secondary outcomes included non-COVID-19-related mortality, all-cause hospitalizations (excluding elective surgeries), emergency room visits, intensive care unit admissions, and hospital admissions with mechanical ventilation. We also examined cardiovascular-related hospitalizations, kidney-related outcomes, and ambulatory visits.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used Poisson generalized estimating equations to model pre-COVID outcome trends and used these to predict post-COVID outcomes and to estimate the relative change (i.e., the ratio of the observed to the expected rate).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In 31 900 individuals receiving maintenance dialysis during the study period, the crude incidence rate (per 1000 person-years) of all-cause mortality was 165.0 in the pre-COVID-19 period, compared to 173.2 during the first year of the pandemic and 171.7 during the first 36 months of the pandemic. After adjustment, there was a statistically significant increase in all-cause mortality in 14 out of the 36 months of the COVID-19 period compared to the pre-COVID-19 period, with 494 recorded COVID-19-related deaths. However, when examining the overall all-cause mortality across the months, the adjusted relative rate (aRR) comparing the observed to expected all-cause mortality rate was not statistically significant in the first year of the pandemic (1.08, 95% CI: 1.00, 1.16) and the first 36 months of the pandemic (1.08, 95% CI: 0.99, 1.18) compared to the pre-pandemic period. The crude incidence rate of non-COVID-19-related mortality was 165.0 in the pre-COVID-19 period, compared to 163.3 during the first year of the pandemic and 157.7 during the first 36 months. After adjustment, there was no substantial change in the rate of non-COVID-19-related deaths in the first year of the pandemic (aRR 1.01, 95% CI: 0.94, 1.09), but there was a substantial decrease in all-cause hospitalization, with an aRR of 0.92 (95% CI: 0.88, 0.97), and a substantial decrease in emergency room visits and intensive care unit admissions; findings were consistent 36 months into the pandemic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/str","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251328077"},"PeriodicalIF":1.6,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining Referral for a Kidney Transplant Evaluation as a Quality Indicator: A Population-Based Cohort Study.","authors":"Kyla L Naylor, S Joseph Kim, Bin Luo, Carol Wang, Amit X Garg, Seychelle Yohanna, Darin Treleaven, Susan McKenzie, Jane Ip, Rebecca Cooper, Nadiyah Rehman, Gregory Knoll","doi":"10.1177/20543581251317009","DOIUrl":"10.1177/20543581251317009","url":null,"abstract":"<p><strong>Background: </strong>Quality indicators are required to identify gaps in care and to improve equitable access to kidney transplants. Referral to a transplant center for an evaluation is the first step toward receiving a kidney transplant, yet widespread reporting on this metric is lacking.</p><p><strong>Objective: </strong>The objective was to use administrative health care databases to examine multiple ways to define referral for a kidney transplant evaluation by varying clinical inclusion criteria, definitions for end of follow-up, and statistical methodologies.</p><p><strong>Design: </strong>This is a population-based cohort study.</p><p><strong>Setting: </strong>This study linked administrative health care databases in Ontario, Canada.</p><p><strong>Patients: </strong>Adults from Ontario, Canada, with advanced chronic kidney disease (CKD) between April 1, 2017, and March 31, 2018.</p><p><strong>Measurements: </strong>The primary outcome was the 1-year cumulative incidence of kidney transplant referral.</p><p><strong>Methods: </strong>We created several patient cohort definitions, varying patient transplant eligibility by health status (eg, whether patients had a recorded contraindication to transplant). We presented results by advanced CKD status (ie, patients approaching the need for dialysis vs receiving maintenance dialysis) and by method of cohort entry (ie, incident only vs prevalent and incident patients combined), resulting in 12 unique cohorts.</p><p><strong>Results: </strong>Sample size varied substantially from 414 to 4128 depending on the patient cohort definition, with the largest reduction in cohort size occurring when we restricted to a \"healthy\" (eg, no evidence of cardiovascular disease) group of patients. The 1-year cumulative incidence of transplant referral varied widely across cohorts. For example, in the incident maintenance dialysis population, the cumulative incidence varied more than 2-fold from 16.3% (95% confidence interval [CI] = 15.0%-17.7%) using our most inclusive cohort definition to 40.0% (95% CI = 36.0%-44.5%) using our most restrictive \"healthy\" cohort of patients.</p><p><strong>Limitations: </strong>Administrative data may have misclassified individuals' eligibility for kidney transplant.</p><p><strong>Conclusions: </strong>These results can be used by jurisdictions to measure transplant referral, a necessary step in kidney transplantation that is not equitable for all patients. Adoption of these indicators should drive quality improvement efforts that increase the number of patients referred for transplantation and ensure equitable access for all patient groups.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251317009"},"PeriodicalIF":1.6,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Process Evaluation Alongside a Cluster-Randomized Trial of a Multicomponent Intervention Designed to Improve Patient Access to Kidney Transplantation.","authors":"Seychelle Yohanna, Mackenzie Wilson, Kyla L Naylor, Amit X Garg, Jessica M Sontrop, Istvan Mucsi, Dimitri Belenko, Stephanie N Dixon, Peter G Blake, Rebecca Cooper, Lori Elliott, Esti Heale, Sara Macanovic, Rachel Patzer, Amy D Waterman, Darin Treleaven, Candace Coghlan, Marian Reich, Susan McKenzie, Justin Presseau","doi":"10.1177/20543581251323959","DOIUrl":"10.1177/20543581251323959","url":null,"abstract":"<p><strong>Background: </strong>In a cluster-randomized trial, we learned that a novel multicomponent intervention designed to improve access to kidney transplantation did not significantly increase the rate of completed steps toward receiving a kidney transplant. Alongside the trial, we conducted a process evaluation to help interpret our findings.</p><p><strong>Objective: </strong>To determine whether the intervention addressed targeted barriers to transplant and whether the implementation occurred as planned.</p><p><strong>Design: </strong>Mixed-methods process evaluation informed by implementation science theories.</p><p><strong>Setting: </strong>Chronic kidney disease (CKD) programs in Ontario, Canada. These programs, providing care to patients with advanced CKD, participated in the trial from November 1, 2017 to December 31, 2021 (either in the intervention or usual care group).</p><p><strong>Participants: </strong>Health care providers (eg, nurses, managers) at Ontario's 27 CKD programs.</p><p><strong>Methods: </strong>We conducted surveys (n = 114/162 [70.4%]) and semi-structured interviews (n = 17/26 [65.4%]) with providers in CKD programs in Ontario, Canada. In both the intervention-group and control-group surveys, using the Theoretical Domains Framework, we assessed perceived barriers to transplant and how barriers changed throughout the trial period. In the intervention-group surveys and interviews, using the normalization process theory, we assessed the extent to which the intervention was embedded into daily routines. In the intervention-group surveys, and by completing an implementation checklist, we assessed fidelity of implementation.</p><p><strong>Results: </strong>Perceived barriers to transplant did not substantially differ between providers in the intervention and usual care groups, and both groups reported disagreeing or feeling neutral that the targeted barriers impeded transplant access. Intervention-group providers reported that intervention activities were becoming a regular part of their work and that they engaged with its components. However, they also felt the intervention was complex and described needing more resources, a better execution plan, and more buy-in from frontline staff. Fidelity was high for administrative support, quality improvement teams, delivery of educational resources, and patient peer support. The use of performance reports was low.</p><p><strong>Conclusions: </strong>We identified several possible reasons why the intervention was unsuccessful. Improving access to kidney transplantation remains a high priority for health care systems. We will continue to foster a quality improvement culture, and our results will guide future interventions.</p><p><strong>Limitations: </strong>Two of the 13 intervention-group CKD programs did not participate in this evaluation.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT03329521.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251323959"},"PeriodicalIF":1.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Real-World Use of Semaglutide to Promote Weight Loss in Obese Adults With Hemodialysis: A Multicenter Cross-Sectional Descriptive Study.","authors":"Jodianne Couture, Pascale Robert, Marie-France Beauchesne, Gabriel Dallaire, Annie Lizotte, Jo-Annie Lafrenière, Julie Beauregard, Janique Doucet","doi":"10.1177/20543581251324588","DOIUrl":"10.1177/20543581251324588","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Obesity can be an issue for renal transplant eligibility. Semaglutide constitutes an interesting choice for obesity treatment, but little data exist regarding its efficacy and security among dialysis patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The co-primary endpoints of this study were to describe the change in body weight (%) and in body mass index (BMI) from the beginning and after 3, 6, and 12 months of treatment for participants who used semaglutide compared with a control group of non-users. Secondary endpoints included description of dosages used and reported adverse events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Multicenter cross-sectional descriptive study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Seven hemodialysis centers in Quebec and New Brunswick, Canada.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Adults receiving hemodialysis treatment with BMI of at least 30 kg/m&lt;sup&gt;2&lt;/sup&gt; were included.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;Weight as defined by the target body weight (kg) at the end of dialysis. Body mass index is defined by weight, kg/m&lt;sup&gt;2&lt;/sup&gt;.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;As a primary objective, we collected in records the body weights and calculated BMI at months 0, 3, 6, and 12 for participants with BMI of 30 kg/m&lt;sup&gt;2&lt;/sup&gt; or greater. The dosages of semaglutide and the mention of any adverse events were also collected from questionnaire to participants, to community drug stores, and from records.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 1286 patients received hemodialysis treatments in June 2023. Of these, 396 (31%) had a BMI of 30 kg/m&lt;sup&gt;2&lt;/sup&gt; or greater. Two hundred fifty-one participants were included in the study and 41 (16%) received semaglutide. The estimated treatment differences for the percentage change in body weight from baseline to 3, 6, and 12 months for semaglutide compared with the control group were -2.26%, 95% confidence interval (CI), -3.68 to -0.84, &lt;i&gt;P&lt;/i&gt; = .002; -0.94%, 95% CI, -2.17 to 0.29, &lt;i&gt;P&lt;/i&gt; = 0.135; and -0.64%; 95% CI, -2.04 to 0.76, &lt;i&gt;P&lt;/i&gt; = .370, respectively. The estimated treatment differences at 3, 6, and 12 months for BMI were -0.87 kg/m&lt;sup&gt;2&lt;/sup&gt;, 95% CI, -1.38 to -0.36, &lt;i&gt;P&lt;/i&gt; &lt; .001; -0.35 kg/m&lt;sup&gt;2&lt;/sup&gt;, 95% CI, -0.79 to 0.09, &lt;i&gt;P&lt;/i&gt; = .119; and -0.23 kg/m&lt;sup&gt;2&lt;/sup&gt;, 95% CI, -0.72 to 0.27, &lt;i&gt;P&lt;/i&gt; = .371, respectively. The estimated treatment difference in body weight and BMI change between the 2 groups was statistically significant at 3 months. A sensitivity analysis was carried out with all the participants of the semaglutide group who continued the treatment for 12 months (N = 15). The estimated treatment differences for the percentage change in body weight between this group and the control group were -3.04%, 95% CI, -5.18 to -0.89, &lt;i&gt;P&lt;/i&gt; = .006; -1.97%, 95% CI, -3.79 to -0.14, &lt;i&gt;P&lt;/i&gt; = .035; and -2.83%, 95% CI, -4.66 to -1.00, &lt;i&gt;P&lt;/i&gt; = .003 at 3, 6, and 12 months, respectively. The average body weight change between months 0 and 12 wa","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251324588"},"PeriodicalIF":1.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"They Know You Better Than the Transplant Team\": An Interpretive Description Study Exploring the Perspectives of Living Kidney Donors About Care Received From Family Physicians.","authors":"Katya Loban, Charo Rodriguez, Antoine Przybylak-Brouillard, Elie Fadel, Heather Badenoch, Peter Nugus, Ann Bugeja, Justin Gill, Marie-Chantal Fortin, Emilie Trinh, Scott McKay, Shaifali Sandal","doi":"10.1177/20543581251324548","DOIUrl":"https://doi.org/10.1177/20543581251324548","url":null,"abstract":"<p><strong>Background: </strong>Given the significant benefits of living donor kidney transplantation, the nephrology and transplant communities are augmenting efforts to increase living kidney donation. However, prior living kidney donors (LKDs) report suboptimal experiences and unmet care needs. The LKDs are healthy, and the vast majority have good outcomes post-donation. Thus, in clinical practice, their care is primarily assumed by practitioners, such as family physicians (FPs).</p><p><strong>Objective: </strong>This study aimed to better understand the integration of primary care in LKDs' donation trajectory from the point of view of the latter. Our specific research questions were: (1) How do LKDs perceive the role of FPs currently integrated into the donation trajectory? (2) What are their needs and expectations from their FPs?</p><p><strong>Design: </strong>An interpretive description methodology.</p><p><strong>Setting and participants: </strong>Canadian LKDs who donated a kidney prior to 2020.</p><p><strong>Methods: </strong>Qualitative interviews and inductive thematic analysis.</p><p><strong>Results: </strong>In our sample of 49 LKDs who donated between 2007 and 2020, 61.2% were women and 87.8% were white. Also, 87.8% and 83.7% were attached to an FP pre- and post-donation (1 by a nurse practitioner) with 16.3% reporting no regular FP post-donation. Although participants provided varying accounts, an overwhelming majority described challenges with timely access to needed care; lack of cohesive continuity of care; variability in the services offered by FPs; and challenges with coordination of care between providers. Many reported poor coordination and communication between FPs and donor teams. Most articulated the desire to see an expanded role for FPs. This included improvements in knowledge regarding living donor care, information and care brokerage, continuous integrative care, and mental and emotional support.</p><p><strong>Limitations: </strong>Limited transferability of our findings to other countries with variable payment structures.</p><p><strong>Conclusions: </strong>Our work suggests that improving LKD care requires developing care pathways that facilitate donor transition and care coordination between donor teams and primary care practitioners. Given the challenges being faced by primary care in Canada, we believe that pragmatic strategies to better support primary care practitioners and a stronger integration of primary care with the living kidney donation process are essential. In addition, strategies to better support the mental health of LKDs are also needed. The LKDs provide a valuable gift to our health systems and to patients with kidney failure. It is our responsibility to optimize their experiences and improve their care.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251324548"},"PeriodicalIF":1.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Unsupervised Clustering to Characterize Phenotypes Among Older Kidney Transplant Recipients: A Cohort Study.","authors":"Sareen Singh, Syed Sibte Raza Abidi, Syed Asil Ali Naqvi, Amanda J Vinson, Thomas A A Skinner, George Worthen, Samina Abidi, Kenneth A West, Karthik K Tennankore","doi":"10.1177/20543581251322576","DOIUrl":"https://doi.org/10.1177/20543581251322576","url":null,"abstract":"<p><strong>Background: </strong>Older kidney transplant recipients have inferior outcomes compared to younger recipients, and this risk may be compounded by donor characteristics.</p><p><strong>Objective: </strong>We applied an unsupervised machine learning clustering approach to group older recipients into similar phenotypes. We evaluated the association between each cluster and graft failure, and the impact of donor quality on outcomes.</p><p><strong>Design: </strong>This is a nationally representative retrospective cohort study.</p><p><strong>Setting and patients: </strong>Kidney transplant recipients aged ≥65 years identified from the Scientific Registry of Transplant Recipients (2000-2017).</p><p><strong>Measurements and methods: </strong>We used unsupervised clustering to generate phenotypes using 16 recipient factors. Donor quality was evaluated using 2 approaches, including the Kidney Donor Risk Index (KDRI). All-cause graft failure was analyzed using multivariable Cox regression.</p><p><strong>Results: </strong>Overall, 16 364 patients (mean age 69 years; 38% female) were separated into 3 clusters. Cluster 1 recipients were exclusively female; cluster 2 recipients were exclusively males without diabetes; and cluster 3 recipients were males with a higher burden of comorbidities. Compared to cluster 2, the risk of graft failure was higher for cluster 3 recipients (adjusted hazard ratio [aHR] = 1.25, 95% confidence interval [CI] = 1.19-1.32). Cluster 3 recipients of a lower quality (KDRI ≥1.45) kidney had the highest risk of graft failure (aHR = 1.74, 95% CI = 1.61-1.87) relative to cluster 2 recipients of a higher quality kidney.</p><p><strong>Limitations: </strong>This study did not include an external validation cohort. The findings should be interpreted as exploratory and should not be used to inform individual risk prediction nor be applied to recipients <65 years of age.</p><p><strong>Conclusions: </strong>In a national cohort of older kidney transplant recipients, unsupervised clustering generated 3 clinically distinct recipient phenotypes. These phenotypes may aid in complementing allocation decisions, providing prognostic information, and optimizing post-transplant care for older recipients.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251322576"},"PeriodicalIF":1.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}