Canadian Journal of Kidney Health and Disease最新文献

{"title":"Non-Tuberculous Mycobacterium Peritoneal Dialysis-Associated Peritonitis: A Case Report of <i>Mycobacterium neoaurum</i>.","authors":"Aubrey Maltz, Ali Hajar, Ryan D Cooper","doi":"10.1177/20543581261489228","DOIUrl":"10.1177/20543581261489228","url":null,"abstract":"<p><p>Peritoneal dialysis (PD) related peritonitis is a common cause for PD technique failure. In up to 20% of cases conventional cultures are negative, and nontuberculous mycobacteria are rarely identified as a cause. A 60-year-old man treated with peritoneal dialysis as kidney replacement therapy presented to care with two months of malaise, abdominal pain, and cloudy PD effluent. Effluent analysis demonstrated a marked neutrophil-predominant pleocytosis, but no organisms were identified on Gram stain or on initial cultures after 72 hours of incubation. He was admitted to the hospital and intraperitoneal vancomycin was initiated for presumed PD-associated peritonitis. After five days, his symptoms and neutrophil-predominant effluent pleocytosis persisted. Repeat effluent Gram stain identified a beaded, Gram-positive bacilli. Subsequent auramine rhodamine stain revealed acid-fast bacilli, ultimately speciating to <i>Mycobacterium neoaurum</i>; initial cultures ultimately demonstrated the same bacterium. Intraperitoneal vancomycin was changed to oral doxycycline and moxifloxacin, the PD catheter was removed, and the patient initiated intermittent hemodialysis. There was gradual improvement in presenting symptoms after changing antimicrobials. He was discharged on a 6-month course of doxycycline and moxifloxacin, with repeat clinic visits over 10 months showing resolution of weakness, increase in dry body weight, and no evidence of recurrent disease on cross-sectional imaging. Non-tuberculous mycobacteria PD peritonitis should be considered in patients with a subacute clinical course, initially negative effluent cultures, and lack of response to conventional antimicrobials. <i>M. neoaurum</i> has only rarely been associated with PD peritonitis; this case contributes to the evidence of this pathogen's association with implanted devices.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261489228"},"PeriodicalIF":1.6,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148954966","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":"Kidney Health for all: Caring for People, Protecting the Planet.","authors":"Raymond Vanholder, Dina Abdellatif, Augusto Cesar Soares Dos Santos, Ricardo Correa-Rotter, Natarajan Gopalakrishnan, Bill Wang, Stefanos Roumeliotis, Alessandro Balducci, Ágnes Haris, Manjusha Yadla, Li-Li Hsiao","doi":"10.1177/20543581261487735","DOIUrl":"10.1177/20543581261487735","url":null,"abstract":"<p><p>The current kidney care model - focused on late-stage disease and in-center hemodialysis - is unsustainable, because of costs, environmental burden, poor outcomes, and reduced quality of life. The seventy-eighth World Health Assembly's recognition of kidney disease as a serious health threat presents a critical opportunity to reshape kidney care. Aligned with this, the 2026 World Kidney Day theme, \"Kidney Health for All: Caring for People, Protecting the Planet\", calls for a systematic change. A sustainable model must prioritize early detection and prevention, reducing the need for kidney replacement therapy. Transplantation and home dialysis benefit people with kidney failure, environment and society. Dialysis itself must become more eco-friendly without compromising care quality, recognizing that planetary perturbations in turn affect kidney health. Conservative care should also be considered, particularly for elderly and frail patients, if quality of life may be worsened by dialysis initiation. Achieving this shift requires coordinated action across all affected groups; education and engagement of the public, policy makers and health professionals to raise awareness about the threat of kidney disease; and an urgent move toward patient-centered care.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261487735"},"PeriodicalIF":1.6,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13558914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148928958","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":"Emergency Department Utilization after Initiation of Intermittent Hemodialysis: A Retrospective Cohort Study in Regina, Saskatchewan.","authors":"Aarti Garg, Arghya Podder, Peter Smylie, Shirmin Kader, Ahmed M Soliman, Bhanu Prasad","doi":"10.1177/20543581261487723","DOIUrl":"10.1177/20543581261487723","url":null,"abstract":"<p><strong>Background: </strong>Emergency department (ED) use is common among patients with end-stage kidney disease (ESKD) initiating hemodialysis (HD), but potentially modifiable predictors of these visits remain poorly defined.</p><p><strong>Objective: </strong>To identify factors associated with ED visits among patients newly initiated on intermittent HD in Regina, Saskatchewan, Canada.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Regina General Hospital in Saskatchewan, Canada.</p><p><strong>Patients: </strong>360 incident adult patients who received at least 90 days of HD between January 1, 2018, and December 31, 2022.</p><p><strong>Measurements: </strong>Patients were followed for one year from dialysis initiation to capture the number and causes of all-cause ED visits.</p><p><strong>Methods: </strong>Multinomial logistic regression was used to examine associations between patient characteristics and ED utilization, categorized as no visits, a single visit, 2-3 visits, or >3 visits, with no visits as the reference group.</p><p><strong>Results: </strong>Half of the cohort (n=180, 50%) had at least one ED visit during the first year, totaling 453 encounters. Gastrointestinal (GI) complaints were the most common reason for presentation (14.1%), followed by fluid overload (11.5%) and cardiovascular causes (8.3%). Dialysis non-adherence was independently associated with ED utilization across all categories, with the strongest association for >3 visits (RRR 7.34, 95% CI 2.81-19.20, p<0.001). Arteriovenous fistula use at dialysis initiation was associated with a lower risk of a single ED visit (RRR 0.28, 95% CI 0.09-0.90, p=0.033). In contrast, age, sex, diabetes, hypertension, and cardiovascular disease were not independently associated with ED utilization.</p><p><strong>Limitations: </strong>This single-center, retrospective study is limited by generalizability and could not analyze non-adherence factors. ED visits were grouped broadly, without assessing severity or preventability. Although ED visits were more frequent during the winter months, we did not examine whether missed dialysis treatments also varied by season. The study period from 2018 to 2022 overlaps with the COVID-19 pandemic, which may have affected ED utilization, dialysis attendance, outpatient access, and patient health-seeking behavior. This limits direct comparison with studies conducted entirely before or after the pandemic.</p><p><strong>Conclusions: </strong>Early ED utilization among incident HD patients may be reduced by improving dialysis adherence, ensuring timely permanent vascular access placement, and better management of GI symptoms.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261487723"},"PeriodicalIF":1.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918469","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":"Implementing a Protocol for Incremental Hemodialysis in Incident Patients With Kidney Failure: A Quality Improvement Initiative.","authors":"Alexander Messina, Ali Taha, Alba Sanchez-Allakhverdieva, Noémie Laurier, Alexander Tom, Vicki Tan, Nancy Filteau, Jerrica McKinnon, Daniel Blum, Catherine Weber, Emilie Trinh","doi":"10.1177/20543581261478493","DOIUrl":"10.1177/20543581261478493","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Incremental hemodialysis (iHD), which adapts dialysis frequency to a patient's residual kidney function, may ease the transition to dialysis, improve quality of life, and reduce costs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;In our tertiary care center, we aimed to develop and implement an iHD protocol and to safely initiate 75% of eligible patients starting incident dialysis on iHD, defined as twice-weekly dialysis, over a two-year period. This project was a nephrology fellow-led quality improvement (QI) initiative conducted as part of the Canadian Society of Nephrology's Quality Improvement and Implementation Science national curriculum.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a QI study from November 1, 2022, to December 31, 2024. An iHD protocol was developed with input from key stakeholders. It included a patient information sheet, routine 24-hour urine collections, a nursing safety checklist integrated into the electronic medical record, and an alert system to identify patients on iHD for physician review. Patients were eligible for iHD if medically stable without indications for thrice-weekly dialysis, and able to comply with physician recommendations and complete required 24-hour urine collections. The primary outcome measure was the proportion of incident patients initiated on iHD. Balancing measures included reasons for iHD discontinuation, hospitalization and mortality rates, and duration on iHD, while process measures included completion rates of nursing checklists and urine collections.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 135 incident hemodialysis starts during the study period, 57 (42%) patients were deemed eligible for iHD, of which 44 (77%) were initiated on an incremental prescription (mean age 61 years). At the end of the study, 25% of patients remained on iHD, with a mean duration of 234 days on iHD. The most common reasons for transition to thrice-weekly hemodialysis were volume overload (54%) and inadequate clearance (33%). Five Plan-Do-Study-Act (PDSA) cycles led to refinements of the protocol, including increased frequency of nursing checklist, facilitated identification of patients on iHD, more frequent electrolyte monitoring, and multiple educational sessions with healthcare providers. Overall, the 24-hour urine collection completion rate by patients was 69%, while nursing checklist completion rates increased from 61% in the first 8 months to a 100% by study end. Mortality and dialysis-related hospitalization rates, excluding vascular access-related issues, were significantly lower in the incremental group than in the conventional group (mortality: 2.3% vs. 17.6%; hospitalization: 0.10 vs. 0.22 events per patient-year).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;A structured iHD protocol, refined through iterative PDSA cycles, enabled safe initiation of iHD in 77% of eligible patients in our center. This study illustrates how a systematic, QI-driven approach can guide other centers in adopting incre","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261478493"},"PeriodicalIF":1.6,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905090","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":"Weight-Management Services for Patients With Advanced Chronic Kidney Disease in Canada: A Survey of Nephrologists.","authors":"Victoria Chechulina, Kristin K Clemens, Amanda J Vinson, Michael Chiu, Ann Young, Louise Moist","doi":"10.1177/20543581261454465","DOIUrl":"10.1177/20543581261454465","url":null,"abstract":"<p><strong>Background: </strong>Obesity and chronic kidney disease (CKD) often coexist and compound the risk of adverse health outcomes including dysglycemia and accelerated CKD progression. Obesity also limits access to kidney transplantation. The objectives of this study were to (1) understand current weight-management practices in CKD centres across Canada and (2) describe the availability of weight-management services nationwide.</p><p><strong>Methods: </strong>We conducted a cross-sectional, quantitative, online survey of English-speaking nephrologists practicing in Canada in 2025. The 23-question survey was developed based on a literature review and the content expertise of investigators. It was reviewed by nephrologists to ensure clarity, appropriateness, and ease of completion. Survey questions focused on the availability of dietitian services, exercise supports, behavioural counselling, weight-management consultations, and use of weight-loss medications in kidney outpatient clinics and dialysis units (including hemodialysis and peritoneal dialysis). The survey was administered via Qualtrics and distributed through the Canadian Society of Nephrology to nephrologists who care for patients with advanced CKD.</p><p><strong>Results: </strong>Between April 7 and June 12, 2025, 56 valid and complete responses were received, an estimated 15% response rate. Respondents primarily practised in Ontario (36%), Quebec (20%), British Columbia (18%), and Alberta (14%), with fewer respondents from the Territories and Atlantic provinces. Clinicians reported initiating weight-management discussions with patients when they felt obesity was contributing to poor health or impacting eligibility for transplant. While almost all nephrologists reported having access to a dietitian, over 60% were uncertain about the specific role of the dietitian in weight management. Gaps in the availability and coordination of behavioural coaching, physiotherapy, and exercise services were frequently cited. Over 60% of nephrologists reported prescribing weight-loss medications despite limited evidence supporting their efficacy and safety in patients with advanced CKD.</p><p><strong>Conclusions: </strong>Weight management is a recognized health priority in patients with advanced CKD, yet there are gaps in management. The nephrology community would benefit from weight-management services that reduce morbidity and improve transplant access for patients with CKD.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261454465"},"PeriodicalIF":1.6,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13530542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872829","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":"Reusing Haemodialysis Reverse Osmosis Reject Water: A Case Report From a Sydney Metropolitan Hospital, Australia.","authors":"Winnie Yu-Wen Hsu, Brenda Huang, Samuel Lees, Helen Veros, Brendan Smyth, George Mangos, Alexandra Gallagher","doi":"10.1177/20543581261454460","DOIUrl":"10.1177/20543581261454460","url":null,"abstract":"<p><p>Dialysis services are among health care's most resource-intensive modalities, consuming large volumes of water and generating substantial greenhouse gas emissions. Water stewardship in health care is often overlooked despite growing global water scarcity. This case report details the design and implementation of a reverse osmosis reject water repurposing system for a 17-station, in-centre haemodialysis service in a metropolitan hospital in Sydney, Australia. With 100% capture efficiency, the system has reused over 1.33 mL of water, reducing emissions by 294.43 kg carbon dioxide equivalents (CO₂e) and saving AUD$3449, annually. This project is an example of a system-level success in lowering the environmental impacts of a vital health service, without compromising the quality of clinical care.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261454460"},"PeriodicalIF":1.6,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13494299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788372","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":"A Pilot Randomised Controlled Trial of a Targeted Dietary Approach to Potassium Management in Hemodialysis: A Clinical Research Protocol for the Evidence for Optimal Potassium Intake in Hemodialysis (EvoKe-HD) Study.","authors":"Amélie Bernier-Jean, Rémi Goupil, François Madore, Jessica Dawson, Roxanne Papineau, Allison Jaure, Catherine Clase","doi":"10.1177/20543581261476635","DOIUrl":"https://doi.org/10.1177/20543581261476635","url":null,"abstract":"<p><strong>Background: </strong>Hyperkalemia affects more than one in five patients receiving maintenance hemodialysis and remains a major contributor to arrhythmias and sudden cardiac death. Traditional potassium restriction has centered on limiting fruits and vegetables, even as emerging evidence challenges the assumption that all high-potassium foods pose equal risk. Meanwhile, awareness of potassium additives has grown, and recommendations to avoid additive-containing processed foods have been layered onto existing restrictions. Together, the uncertainties around long-standing to newer recommendations create guidance that is difficult for many patients to navigate.</p><p><strong>Objective: </strong>To describe the protocol for EvoKe-HD, a pilot randomised controlled trial evaluating the feasibility, acceptability and safety of a targeted dietary counselling strategy for potassium management in hemodialysis.</p><p><strong>Design: </strong>Two-arm, 1:1 randomised, parallel-group feasibility trial.</p><p><strong>Setting: </strong>Two dialysis units at the CIUSSS du Nord-de-l'Île-de-Montréal, Canada.</p><p><strong>Patients: </strong>Adults receiving thrice-weekly maintenance hemodialysis with elevated pre-dialysis serum potassium levels or receiving regular potassium binder therapy.</p><p><strong>Measurements: </strong>The primary feasibility outcome is the proportion of eligible patients who enrol and complete the 3-month assessment. The main exploratory clinical outcome is mean mid-week pre-dialysis serum potassium during follow-up. Secondary and exploratory outcomes include hyperkalemia events, potassium binder use, dialysate potassium adjustments, biochemical measures, dietary outcomes, patient-reported outcomes, and process evaluation measures.</p><p><strong>Methods: </strong>Participants are randomised to monthly targeted dietary counselling focused on reducing potassium additives and selected high-impact foods, or to monthly standard potassium-restriction counselling based primarily on total potassium content. Feasibility outcomes will be summarized with 95% confidence intervals. Mean follow-up serum potassium will be analysed using linear mixed-effects model adjusted for baseline potassium and sex, with a random intercept for participant.</p><p><strong>Results: </strong>Recruitment began in June 2025 and was completed in January 2026. The last study visit was completed in March 2026. Process evaluation interviews are expected to be completed in July 2026.</p><p><strong>Limitations: </strong>As a single-centre pilot feasibility trial, EvoKe-HD is not powered to evaluate definitive effects on serum potassium, hyperkalemia events, or other clinical outcomes.</p><p><strong>Conclusions: </strong>EvoKe-HD will assess whether a targeted potassium counselling strategy can be implemented in routine hemodialysis care and will provide feasibility and process evaluation data to inform the design of a larger trial.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261476635"},"PeriodicalIF":1.6,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13490776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788396","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":"Greenhouse Gas Emissions of Patient Transportation to Kidney Care - A Province-Level Retrospective Cohort Study.","authors":"Shannon N Wong, Charith Kalu Arachchillage, Lee Er, Tasleem Rajan, Caroline Stigant","doi":"10.1177/20543581261476609","DOIUrl":"https://doi.org/10.1177/20543581261476609","url":null,"abstract":"<p><strong>Background: </strong>Kidney care has increasingly understood environmental impacts, and patient transportation to care is recognized as one of its largest greenhouse gas (GHG) emissions sources.</p><p><strong>Objective: </strong>Our health region aims to reduce the environmental impact of kidney services while providing equitable care, hence assessment of transportation distances and associated emissions was undertaken.</p><p><strong>Design: </strong>A retrospective observational study was performed to determine round trip and yearly transportation distances from residence to corresponding kidney care setting.</p><p><strong>Setting: </strong>All registered kidney care services throughout British Columbia.</p><p><strong>Patients: </strong>All adult patients in a provincial registry who were receiving scheduled pre-dialysis, conservative management, and home and facility-based dialysis therapies, in 2023.</p><p><strong>Measurements: </strong>Yearly GHG emissions by modality were calculated by multiplying distance travelled by locally sourced emissions factors by vehicle type, then by frequency of care, as defined by local best practices.</p><p><strong>Methods: </strong>Transportation distances and emissions data were reported in median with interquartile range, for a base scenario of travel via gas car, and for four alternate hypothetical emissions lowering scenarios.</p><p><strong>Results: </strong>The cohort included 15,772 adult patients, with distance travelled to care in 2023 exceeding 17 million kilometres, and corresponding annual GHG emissions of 3873 tonnes of carbon dioxide equivalents. Significant variability existed in transportation distance and emissions both within and between care modalities. Home dialysis patients had the longest median round trip distances (and corresponding emissions) for home hemodialysis and peritoneal dialysis of 52.4 and 27.3 kilometres (11.5 and 6.0 kilograms carbon dioxide equivalents, respectively); whereas facility hemodialysis patients had the greatest annual median distances of 2265.2 kilometres and annual emissions of 498.1 kilograms. Combining all transportation to care emissions reductions scenarios resulted in a 62% reduction in GHG emissions.</p><p><strong>Limitations: </strong>Staff transportation was not considered, including that for supported home dialysis modalities, and public transit by light transport vehicle was assumed to follow the most direct road distance from residence to dialysis treatment facility.</p><p><strong>Conclusions: </strong>Patient transportation to kidney therapies in British Columbia has climate change impact considerations, and appropriate use of virtual care, home dialysis therapies, and various low emissions transportation options offer significant improvement opportunities.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261476609"},"PeriodicalIF":1.6,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13487102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788356","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":"Prognostic Performance of Ellipsoid Kidney Volume Measurement in a Computed Tomography-Heavy ADPKD Cohort: A Retrospective Observational Cohort Study.","authors":"Marwan Abdrabou, Ayub Akbari, Wael Shabana, Mohan Biyani, Gregory L Hundemer, Manish M Sood, Arlene B Chapman, Deena Fremont, Pierre Antoine Brown","doi":"10.1177/20543581261479801","DOIUrl":"10.1177/20543581261479801","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Accurate prognostic classification in autosomal dominant polycystic kidney disease is important for risk stratification and treatment decisions, including tolvaptan eligibility. Although the ellipsoid method has shown good performance for kidney volume measurement in magnetic resonance imaging cohorts, data from cohorts imaged predominantly with computed tomography remains limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the agreement between the ellipsoid and manual segmentation methods for kidney volume measurement in a computed tomography-heavy cohort of patients with autosomal dominant polycystic kidney disease, with a focus on prognostic classification and identification of high-risk disease.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Retrospective observational cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;The Ottawa Hospital Cystic Kidney Disease Clinic, a tertiary academic center in Ottawa, Ontario, Canada.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;One hundred fifty-one patients with autosomal dominant polycystic kidney disease who underwent cross-sectional abdominal imaging suitable for volumetric assessment between January 2018 and February 2022, including 107 computed tomography studies and 44 magnetic resonance imaging studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;Height-adjusted total kidney volume, Mayo Clinic Imaging Classification, and classification of high-risk disease (classes 1C-1E).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Height-adjusted total kidney volume was measured using both manual segmentation, the reference standard, and the ellipsoid method. Agreement in kidney volume measurement was assessed using intraclass correlation coefficients, Bland-Altman analysis, and mean percent difference. Agreement in Mayo Clinic Imaging Classification was assessed using weighted Cohen kappa. Diagnostic performance of the ellipsoid method for identifying high-risk disease was evaluated using sensitivity, specificity, positive predictive value, and McNemar testing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The ellipsoid method showed good concordance with manual segmentation height-adjusted total kidney volume measurement, with an intraclass correlation coefficient of 0.93 overall, 0.92 in the computed tomography subgroup, and 0.96 in the magnetic resonance imaging subgroup. The ellipsoid method underestimated kidney volume by a mean of 12.7%. Agreement in Mayo Clinic Imaging Classification was high, with a weighted Cohen kappa of 0.87, although 25.8% of cases were misclassified, most often to a lower risk class. For identification of high-risk disease, the ellipsoid method had a sensitivity of 83.0% and a specificity of 98.0% overall; in the computed tomography subgroup, sensitivity was 85.5% and specificity was 97.4%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Single-center design, use of a single reader, and cross-sectional analysis without longitudinal follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;In this computed tomography-heavy cohort, th","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261479801"},"PeriodicalIF":1.6,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13477545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758195","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":"Validation of a Pharmacist-Led Semaglutide Prescribing Algorithm for Type 2 Diabetes and Chronic Kidney Disease: Research Letter.","authors":"Maneka Sheffield, Emma Phelan, Natalie Ratajczak, Marisa Battistella, Karthik Tennankore, Ayodele Odutayo, Steven Soroka, Penelope Poyah, Keigan More, Heather Naylor, Natalie Kennie-Kaulbach, Daniel Rainkie, Jo-Anne Wilson","doi":"10.1177/20543581261476643","DOIUrl":"https://doi.org/10.1177/20543581261476643","url":null,"abstract":"<p><p>Diabetes is a leading cause of chronic kidney disease, yet gaps in the use of guideline-directed therapies persist in primary care. In 2025, our group developed and validated community pharmacist-led prescribing algorithms for individuals with an estimated glomerular filtration rate ≥30 mL/min/1.73 m², targeting angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, sodium-glucose cotransporter-2 inhibitors, and nonsteroidal mineralocorticoid receptor antagonists. To address the evolving therapeutic landscape, we developed and validated a semaglutide-specific algorithm to complement this approach. Algorithm development and validation followed Lynn's method. A two-part questionnaire per algorithm item assessed content and face validity, with nephrology clinicians (nephrologists and kidney pharmacists) and community pharmacists rating items using Likert scales. Content validity was measured using item-level (I-CVI) and scale-level (S-CVI/Ave) indices, while face validity was assessed by level of agreement to five statements per round. The algorithm was iteratively revised between rounds. Ten nephrology clinicians (five per round for three rounds) and 12 community pharmacists (six per round for two rounds) participated. For clinicians, the I-CVI ranged from 0.6 to 1.0, with an overall S-CVI/Ave of 0.89 across three rounds. Among pharmacists, all items met the prespecified content validity threshold for both rounds (I-CVI ≥0.83; P < 0.05). Face validity exceeded the 70% consensus threshold for both validator groups. This study adds a validated semaglutide-specific algorithm to our existing pharmacist-led care model, expanding a suite of algorithms to support uptake of disease-modifying therapies for individuals with type 2 diabetes and chronic kidney disease in primary care. Implementation and evaluation in Nova Scotia community pharmacy clinics are underway.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261476643"},"PeriodicalIF":1.6,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766323","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}