Canadian Journal of Kidney Health and Disease最新文献

{"title":"Patient, Caregiver, and Provider Perspectives on Improving Provider-Patient Interactions in Hemodialysis: A Qualitative Study.","authors":"Melanie D Talson, Priscila Ferreira da Silva, Juli Finlay, Krista Rossum, Kaytlynn V Soroka, Michael McCormick, Arlene Desjarlais, Hans Vorster, Rachelle Sass, Matthew James, Manish M Sood, Allison Jaure, Neesh Pannu, Karthik Tennankore, Stephanie Thompson, Marcello Tonelli, Clara Bohm","doi":"10.1177/20543581241309986","DOIUrl":"https://doi.org/10.1177/20543581241309986","url":null,"abstract":"<p><strong>Background: </strong>Improving interactions between people receiving hemodialysis and health care providers of facility-based hemodialysis care is a top priority for patients, caregivers, and health care providers.</p><p><strong>Objective: </strong>To identify challenges for high-quality clinical interactions in facility-based hemodialysis care as well as potential solutions.</p><p><strong>Design: </strong>Multicentre qualitative study using focus groups and semi-structured interviews to elicit the perspectives of patients, caregivers, and health care providers.</p><p><strong>Setting: </strong>Five Canadian facility-based hemodialysis centers.</p><p><strong>Participants: </strong>English-speaking adults receiving facility-based hemodialysis for longer than 6 months, their caregivers, and hemodialysis health care providers.</p><p><strong>Methods: </strong>Between May 2017 and August 2018, focus groups and interviews with patients and their caregivers subsequently informed semi-structured interviews with providers. Data were analyzed using inductive thematic analysis with application of a grounded theory approach.</p><p><strong>Results: </strong>A total of 8 focus groups and 44 interviews were completed. Participants included 64 people receiving hemodialysis, 18 caregivers, and 31 health care providers. Communication between health care providers and patients was often characterized as <i>intersections</i> of care (unidirectional) rather than <i>interactions</i> (bidirectional). Challenges were grouped into 4 main themes as follows: (1) culture of care provision; (2) mistrust between patients and health care providers; (3) time constraints for clinical interactions, and (4) lack of collaboration and care coordination among health care team. Potential solutions were identified for each challenge.</p><p><strong>Limitations: </strong>Findings were limited to Canadian context, English-speaking adults, and individuals receiving facility-based hemodialysis in urban centers.</p><p><strong>Conclusions: </strong>Interactions between health care providers and people receiving dialysis are often unidirectional, where the patient is a passive recipient of ideas and information from the health care provider. To promote improved bidirectional interactions, team-based care that includes better tools to improve information transfer, better information regarding roles, and identity of health care team members and opportunities for all members of the health care team, including the people receiving dialysis, to provide input on care plans is required.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581241309986"},"PeriodicalIF":1.6,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11696963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930089","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":"Case Series of Infection-Related Glomerulonephritis in Quebec Indigenous Peoples.","authors":"Thomas Nodzynski, Zahra Sohani, Ajay Rajaram, Pierre Olivier Fiset, Chantal Bernard, Murray Vasilevsky, Catherine Weber","doi":"10.1177/20543581241309977","DOIUrl":"10.1177/20543581241309977","url":null,"abstract":"<p><strong>Rationale: </strong>Infection-related glomerulonephritis (IRGN) is an immune-mediated glomerulonephritis caused by extra-renal infectious diseases. There has been an important shift in epidemiology in recent years, with a significant proportion of adults affected. The incidence of IRGN is higher amongst Indigenous populations and especially in those with multiple comorbidities. Beginning in 2019, we observed several IRGN cases amongst adult Indigenous peoples referred to the McGill University Health Center (MUHC). The aim of this article is to describe the demographic, clinical, and outcome data of these individuals and highlight the heterogeneity of IRGN in this population through 2 illustrative cases.</p><p><strong>Presenting concerns of the patient: </strong>In total, 8 cases of IRGN were identified between 2019 and 2022. All patients presented with features of acute glomerulonephritis.</p><p><strong>Diagnoses: </strong>All patients had documented evidence of an infection that preceded their diagnosis of IRGN. IRGN was not the initial clinical diagnosis in all cases.</p><p><strong>Interventions: </strong>Half the patients received immunosuppression while the others received supportive care only.</p><p><strong>Outcomes: </strong>Four patients required initiation of hemodialysis at time of presentation and at 2 years of follow-up, 3 of the 4 remained hemodialysis-dependent.</p><p><strong>Teaching points: </strong>Our case series emphasizes the heterogenous clinical, laboratory, and pathological presentations that make the diagnosis of IRGN quite challenging. A high index of suspicion should be present when a patient presents with acute kidney injury, features of a glomerulonephritis, and an infection, especially those with multiple comorbidities and a preceding history of chronic kidney disease.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241309977"},"PeriodicalIF":1.6,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906636","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":"Outcomes Using a Standardized Provincial Childhood Nephrotic Syndrome Clinical Pathway.","authors":"Laura H Kim, Marisa Catapang, Nonnie Polderman, Robert Humphreys, Cherry Mammen, Eleonora Jugnauth, Douglas G Matsell","doi":"10.1177/20543581241304505","DOIUrl":"10.1177/20543581241304505","url":null,"abstract":"<p><strong>Background: </strong>In 2013, the British Columbia (BC) Childhood Nephrotic Syndrome Clinical Pathway (CNSCP) was developed to standardize the care of children with nephrotic syndrome (NS). In BC, children access nephrology care at BC Children's Hospital (BCCH) and multiple regional clinics.</p><p><strong>Objective: </strong>The primary objective was to compare induction therapy and clinical outcomes between BCCH and regional clinics since implementation of the CNSCP.</p><p><strong>Design setting and patients: </strong>This was a retrospective cohort study of children with NS in BC.</p><p><strong>Measurements and methods: </strong>We conducted a retrospective cohort study of children 1 to 17 years old with new-onset NS from 2013 to 2019 inclusive with minimum 12 months of follow-up. Children with non-minimal change disease, steroid resistance, incomplete induction therapy, or less than 6 months of pathway treatment within their first year post-diagnosis were excluded. Clinics were categorized as BCCH or regional (Surrey, Prince George, or Kelowna).</p><p><strong>Results: </strong>Sixty-nine patients were included, with 52 (75%) at BCCH and 17 (25%) at regional clinics. There were no significant between-group differences in age, sex, or clinical characteristics at time of diagnosis. Comparing BCCH and regional clinics, there was no difference in induction prednisone exposure (median 3400, interquartile range [IQR] 3331-3585 mg/m² vs 3492, IQR 3397-3644 mg/m², <i>P</i> = .167), annualized relapse rate (median 3.3, IQR 1.1-5.3 vs 2.3, IQR 0.5-4.2, <i>P</i> = .575), or development of frequently relapsing courses (50% vs 62%, <i>P</i> = .475). There was a similar number of first-year clinic visits (4.2 ± 1.2 vs 4.0 ± 1.8, <i>P</i> = .655) and dietitian-reviewed food records (67% vs 47%, <i>P</i> = .135, BCCH vs regional). More children at BCCH had a recommended ophthalmology surveillance visit (87% vs 59%, <i>P</i> = .01, BCCH vs regional).</p><p><strong>Limitations: </strong>Study limitations include small sample size and exclusion of children with complicated NS (ie, relapse during induction, steroid resistance).</p><p><strong>Conclusion: </strong>Since we implemented the CNSCP, children with NS received comparable care and had similar outcomes at BCCH and regional clinics without significant practice variation.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241304505"},"PeriodicalIF":1.6,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906637","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":"Canadian Highly Sensitized Patient Program Report: A 1000 Kidney Transplants Story.","authors":"M Khaled Shamseddin, Steven Paraskevas, Rahul Mainra, Kyle Maru, Bailey Piggott, Darlene Jagusic, Kathy Yetzer, Lakshman Gunaratnam, Christine Ribic, Joseph Kim, Sunita Singh, Stephanie Hoar, G V Ramesh Prasad, Melanie Masse, Isabelle Houde, Myriam Khalili, Kenneth West, Rob Liwski, Sean Martin, Nessa Gogan, Martin Karpinski, Mauricio Monroy-Cuadros, Sita Gourishankar, Olwyn Johnston, James Lan, Christopher Nguen, John Gill, Michel Pâquet","doi":"10.1177/20543581241306811","DOIUrl":"10.1177/20543581241306811","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Highly sensitized patients (HSPs) with kidney failure have limited access to kidney transplantation and poorer post-transplant outcomes. Prioritizing HSPs in kidney allocation systems and expanding the pool of deceased donors available to them has helped to reduce their wait times for transplant and enhanced post-transplant outcomes. The Canadian HSP Program was established by Canadian Blood Services in collaboration with provincial organ donation and transplantation programs throughout the country to increase transplant opportunities for transplant candidates needing very specific matches from deceased kidney donors. Highly sensitized patients in the Canadian Program are defined by a calculated panel-reactive antibody (cPRA) ≥95%. In this report, we describe the evolution and trajectory of the Canadian HSP Program and evaluate the national impact on the first 1000 kidney transplant cases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Source of information: &lt;/strong&gt;To allocate deceased donor kidney organs nationally to HSPs and report on the Canadian HSP Program's performance, Canadian Blood Services developed a national database registry known as the Canadian Transplant Registry (CTR) and an online reporting tool known as the Canadian HSP Program Data Dashboard.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The CTR, which collects HSPs' data for the purpose of matching potential donors to HSPs and as part of required national quality, safety, and efficiency performance measurements, was retrospectively reviewed. Due to the nature of using deidentified aggregate registry data, a patient consent form was not required. A Research Ethical Board (REB) application was also waived.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key findings: &lt;/strong&gt;In this article, we describe the historical development, initial deployment, and evolution of the Canadian HSP Program with a primary aim to increase the rate of deceased donor kidney transplantation. A secondary aim was to evaluate the national impact of the Canadian HSP Program on the first 1000 kidney transplant cases. Transplant candidates who have participated in the Canadian HSP Program and recipients who received transplants were predominantly females (average age 50 years, female 62%) with blood group O (47% of candidates, 42% of transplants). Seventy percent of all active transplant candidates enrolled in the HSP Program were in the hardest to match group (cPRA ≥99%), and only 22% of the transplant candidates with cPRA of 100% have received a transplant to date through the Program. The average times from first participation in the Canadian HSP Program to transplantation for cPRA ≥99% transplant recipients were significantly longer than for cPRA 95% to 98% recipients averaging 22 months versus 6 months, respectively. By the end of June 2024, the Canadian HSP Program had facilitated 1000 transplants, 613 of which were from interprovincial matches. The average (SD) cold ischemic time (CIT) was 14.5 (5.9) hours, with interprovincial transplants exhi","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241306811"},"PeriodicalIF":1.6,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11672600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142902577","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":"Incidence, Prediction, and Prevention of Fractures After Kidney Transplantation: A Systematic Review Protocol.","authors":"Andrea C Cowan, Karla Solo, Victoria Lebedeva, Yasaman Mohammadi Kamalabadi, Maha El-Shimy, Aayushi Joshi, Edith Ginika Olalike, Misa Tanaka, Adam G R Klotz, Hatoun Wahid Elazhary, Antonia Zhu, Adam Forster, Shafaz Veettil, Sachin G Nair, Maria Fernanda Servin Martinez, Dweeti Nayak, V Nikhila Priya, Catherine Wellan, Diana Maria Cespedes Arcani, Pavel S Roshanov","doi":"10.1177/20543581241306799","DOIUrl":"10.1177/20543581241306799","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Kidney transplant recipients are uniquely exposed to the disordered bone metabolism associated with chronic kidney disease beginning before transplantation followed by chronic corticosteroid use after transplantation. Previous efforts to synthesize the rapidly accruing evidence regarding estimation and management of fracture risk in kidney transplant recipients are outdated and incomplete.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To synthesize the evidence informing the overall incidence, patient-specific risk prediction, and methods of prevention of fractures in patient living with a kidney transplant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Three systematic reviews will address the following questions: What is the overall incidence of skeletal fracture after kidney transplantation (review 1)? Which prediction models and individual prognostic factors predict fracture in kidney transplant recipients (review 2)? and How effective are different antifracture interventions at preventing fracture or improving surrogate markers of bone health in kidney transplant recipients (review 3)?&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Cohort studies (reviews 1 and 2) and randomized trials (review 2) with a mean/median follow-up ≥12 months beginning after transplant. Review 3: randomized trials or new-user cohort studies with concurrent controls evaluating the effect of antifracture interventions including bisphosphonates, calcium supplementation, cinacalcet, denosumab, parathyroid hormone analogues, parathyroidectomy, raloxifene, romosozumab, steroid withdrawal or minimization protocols after kidney transplant, vitamin D (both active and nutritional), other antifracture interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Adult kidney transplant recipients in studies published after the year 2000.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;Review 1: incidence rate or cumulative risk of fracture. Review 2: For prediction models, measures of discrimination (eg, c-statistic), calibration (calibration curves, observed:expected ratios), and net benefit (ie, from decision curve analysis); for individual prognostic factors, relative measures of association with fractures. Review 3: measures of treatment effect on fractures and on surrogate markers of bone health (eg, bone mineral density, trabecular bone score).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We searched MEDLINE, Embase, and the Cochrane Library using subject headings and keywords related to kidney transplant and fractures. Pairs of reviewers will screen records independently in duplicate to identify studies relevant to one or more of the 3 reviews and categorize each study accordingly. Single reviewers will extract data and evaluate risk of bias for each included study using one of the following tools as appropriate: the Quality of Prognostic Studies tool, the Prediction model Risk Of Bias ASsessment tool, the Risk Of Bias In Non-randomised Studies-of Interventions tool, and the Cochrane Risk of Bias 2.0 tool. A second ","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241306799"},"PeriodicalIF":1.6,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11672528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142902578","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":"Prediction of Acute Kidney Injury After Cardiac Surgery With Combined Arterial and Venous Intrarenal Doppler.","authors":"Cameron Giles, Karel Huard, André Denault, William Beaubien-Souligny","doi":"10.1177/20543581241309976","DOIUrl":"10.1177/20543581241309976","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Acute kidney injury (AKI) occurs in up to 50% of cardiac surgical patients and is often hemodynamically mediated. Point-of-care ultrasound is a non-invasive tool that has the potential to characterize intrarenal hemodynamics and predict the risk of AKI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;We aimed to determine the predictive characteristics of intrarenal arterial and venous Doppler markers for postoperative AKI in cardiac surgical patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;This study is the secondary analysis of a prospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;This study is carried out in a care academic cardiac surgical center in Montreal, Quebec, Canada.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Adult patients undergoing cardiac surgery with the use of cardiopulmonary bypass.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;Point-of-care ultrasound assessments were performed preoperatively and at intensive care unit admission. Arterial measurements included the renal resistive index (RRI) and intrarenal artery velocity-time integral normalized to peak systolic velocity (VTI/PSV). Venous measurements included intrarenal venous flow (IRVF) pattern and renal venous stasis index (RVSI).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used area under the receiving operating characteristic curves (AUCs) with net reclassification index (NRI) and multivariable logistic regression to determine predictive characteristics for postoperative AKI. Furthermore, we used hierarchical clustering to identify potential groups with similar Doppler parameters and performed comparisons of patients' characteristics and outcomes between groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We included 136 patients with 47 (34.6%) developing postoperative AKI. At intensive care unit admission, arterial indices showed similar discrimination for the prediction of AKI (RRI: AUC = 0.64; 95% confidence interval (CI) = 0.55 to 0.74; and VTI/PSV: AUC = 0.67; 95% CI = 0.57 to 0.77). Venous Doppler indices including IRVF patterns (AUC = 0.64; 95% CI = 0.53 to 0.74) and RVSI (AUC = 0.60; 95% CI = 0.50 to 0.71) also showed similar performance. The combined model of RRI and IRVF pattern (AUC = 0.69; 95% CI = 0.59 to 0.78) improved the prediction of AKI compared to either RRI (NRI = 0.50; 95% CI = 0.17 to 0.84) or IRVF pattern (NRI = 0.38; 95% CI = 0.04 to 0.70) alone. Through hierarchical clustering, we identified 3 groups (1: low RRI, 2: high RRI/low RVSI, and 3: high RRI/high RVSI) with different patient characteristics and outcomes. The patient in group 3 had a higher risk of AKI and worse clinical outcomes compared with other groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Single-center design in cardiac surgical patients limits generalizability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Although more complex indices of intrarenal Doppler indices including the VTI/PSV and RVSI did not improve prediction of postoperative AKI, combining RRI and IRVF pattern improved risk prediction for AKI. Intrar","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241309976"},"PeriodicalIF":1.6,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11672484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142902579","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":"Unused Hemodialysis Acid Concentrate is Dollars and Dialysate Down the Drain: An Opinion Piece.","authors":"Anukul Ghimire, Karthik K Tennankore, George Vitale","doi":"10.1177/20543581241308631","DOIUrl":"10.1177/20543581241308631","url":null,"abstract":"","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241308631"},"PeriodicalIF":1.6,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11660271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876343","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":"Physical Frailty and Functional Status in Kidney Transplantation: A Systematic Review.","authors":"Priscilla Karnabi, David Massicotte-Azarniouch, Shawn Marshall, Greg A Knoll","doi":"10.1177/20543581241300777","DOIUrl":"10.1177/20543581241300777","url":null,"abstract":"<p><strong>Background: </strong>Frailty and functional decline are being recognized as important conditions in kidney transplant candidates. However, the ideal measures of functional status and frailty remain unknown as there is not a complete understanding of the relationship between these conditions and important post-transplant outcomes.</p><p><strong>Objective: </strong>The objective was to examine the association between different measures of frailty and functional status evaluated before or at the time of transplant with adverse clinical outcomes post-transplantation.</p><p><strong>Design: </strong>This study is a systematic review.</p><p><strong>Setting: </strong>Observational studies including cohort, case-control, or cross-sectional studies examining the effect of frailty and functional status on clinical outcomes. There were no restrictions on type of setting or country of origin.</p><p><strong>Patients: </strong>Adults who were waitlisted for kidney transplant or had received a kidney transplant.</p><p><strong>Measurements: </strong>Data including demographic information (eg, sample size, age, country), assessments of frailty or functional status and their domains, and outcomes including mortality, transplantation, graft loss, delayed graft function and hospital readmission were extracted.</p><p><strong>Methods: </strong>A search was performed in Medline, Embase, and Cochrane Central Register for Controlled Trials. Studies were included from inception to February 7, 2023. The eligibility of studies was screened by 2 independent reviewers. Data were presented by frailty/functional status instrument and clinical outcome. Point estimates and 95% confidence intervals from fully adjusted statistical models were reported or calculated from the raw data.</p><p><strong>Results: </strong>A total of 50 studies were identified, among which 36 unique instruments were found. Measurements of these instruments occurred mostly at time of kidney transplant, transplant evaluation, and waitlisting. The median sample size of studies was 457 patients (interquartile range = 183-1760). Frailty and lower functional status were associated with an increased risk for mortality. Similar trends were observed among other clinical outcomes such as graft loss and rehospitalization.</p><p><strong>Limitations: </strong>The heterogeneity in measurement instruments, study designs, and outcome definitions prevents pooling of the data. Selection bias and the validity of data collection could not be ascertained for some studies.</p><p><strong>Conclusion: </strong>Frailty and functional status measures are important predictors of post-kidney transplant outcomes. Further studies are needed to evaluate the best instruments to assess frailty and functional status, and importantly, interventional studies are needed to determine whether prehabilitation strategies can improve post-transplant outcomes.</p><p><strong>Registration prospero: </strong>CRD42016045251.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241300777"},"PeriodicalIF":1.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846023","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":"Primary Care Providers Barriers, Comfort and Awareness in Follow-up Care of Acute Kidney Injury Patients: A Comprehensive Survey on Current Practices.","authors":"Jean-Maxime Côté, William Beaubien-Souligny, Lauriane Hamel, Josée Bouchard","doi":"10.1177/20543581241304517","DOIUrl":"10.1177/20543581241304517","url":null,"abstract":"<p><strong>Background: </strong>Patients who experienced acute kidney injury (AKI) may benefit from dedicated care following hospital discharge. Most of these patients will be followed by primary care providers. There is a lack of data on current practices and comfort for these care providers when offering post-AKI care.</p><p><strong>Objective: </strong>We surveyed nurse practitioners and family physicians to assess their awareness, perceptions, practice patterns and comfort regarding post-AKI care.</p><p><strong>Design/setting: </strong>We distributed a web-based self-administered survey among clinicians from the Province of Quebec. We asked about their awareness and perceptions on how AKI should be disclosed and followed, the barriers encountered regarding the process of care following hospital discharge, and their level of comfort and expertise in offering dedicated post-AKI care. The survey integrated direct and scenario-based questions and was conducted from December 2022 to April 2023.</p><p><strong>Participants: </strong>We distributed the survey to practicing family physicians and nurse practitioners through the mailing list of the <i>Fédération des Médecins Omnipraticiens du Québec</i>, and the <i>Association des infirmières praticiennes spécialisées du Québec</i>, respectively. No incentives were provided.</p><p><strong>Methods: </strong>We conducted descriptive analyses and used chi-squared analysis to compare responses between family physicians and nurse practitioners and between hospital-based and cabinet-based practice.</p><p><strong>Results: </strong>The survey was opened by 779 potential participants. Of these, the response rate was 9% (70/779). Most participants were family physicians (79%) and dedicated 70% (±32) of their time in community outpatient clinics. Participants reported that 59% (±20) of all patients seen daily had at least 1 risk factor for AKI, whereas they estimated that 21% (±12) of recently discharged patients suffered from an AKI episode. The lack of awareness by the patient and lack of details on the discharge summary were the barriers most frequently reported impacting the overall process of care at follow-up. Most nurse practitioners (60%) and 33% of family physicians reported at least some levels of discomfort and lack of expertise when offering post-AKI.</p><p><strong>Limitations: </strong>The generalizability of our study is limited by its response rate. However, this is comparable with typical response rates seen in electronic surveys. The distribution was limited to a single province of Canada.</p><p><strong>Conclusions: </strong>We reported significant barriers regarding the hospital-to-community transition of care in patients who experienced AKI and the suboptimal comfort and expertise of primary care providers when offering dedicated post-AKI care. This reflects the need to improve communication, collaboration, and AKI training with primary care providers.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241304517"},"PeriodicalIF":1.6,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11639000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827338","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":"Randomized Trials Using Provincial Health Numbers for Group Assignment.","authors":"Amit X Garg, Stephanie N Dixon, Charlotte Ma, Erika Basile, Bin Luo, Magda Nunes De Melo, Amber O Molnar, Naveen Poonai, Michael J Schull, Samuel A Silver, Jessica M Sontrop, Merrick Zwarenstein, Pavel Roshanov","doi":"10.1177/20543581241304510","DOIUrl":"10.1177/20543581241304510","url":null,"abstract":"<p><strong>Purpose: </strong>Using data from Ontario, Canada, this report shows how provincial government-assigned health card numbers can be used for individual-level randomization in large pragmatic trials. We describe how health card numbers are assigned and analyze the distribution of health card digits in a trial setting. We then provide an example of how they can be used for randomization and discuss the methodological and practical considerations of the approach.</p><p><strong>Key findings: </strong>In Ontario, Canada, health card numbers are randomly generated and assigned without regard to the applicant's characteristics. The number is a 10-digit string connected with hyphens followed by a version code (ie, 1234-567-890-XX). The number is unique to each individual and assigned for life. Before assignment, some numbers within the 10 digits are altered using proprietary business rules. We demonstrate how to use certain digits for individual-level randomization and provide an example of how we will use the tenth digit for randomization in a large new trial of different dialysate bicarbonate concentrations. While this approach has many practical and methodological advantages, it does not allow for stratification. Before using this approach, teams should consider if it will affect the integrity of the randomization and the trial, which will be influenced by the setting and the type of intervention tested.</p><p><strong>Implications: </strong>Using provincial government-assigned health card numbers for pragmatic randomized trials appears viable, but the merits must be carefully considered on a trial-by-trial basis. The approach can streamline and reduce the cost of conducting such trials.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241304510"},"PeriodicalIF":1.6,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11624533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799419","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}