Canadian Journal of Kidney Health and Disease最新文献

{"title":"Diverting the Diagnosis: A Case Report of Hemodialysis Masking the Etiology of Hyperammonemia.","authors":"Adina Landsberg, Anukul Ghimire, Nicholas L Li, Tyrone G Harrison","doi":"10.1177/20543581251347154","DOIUrl":"10.1177/20543581251347154","url":null,"abstract":"<p><strong>Rationale: </strong>Hyperammonemia in patients receiving hemodialysis is uncommon but poses a significant clinical challenge due to the effective clearance of ammonia by dialysis, which can obscure the underlying cause. Recognizing atypical etiologies is crucial for appropriate management.</p><p><strong>Presenting concerns of the patient: </strong>A 59-year-old man being treated with hemodialysis presented with altered level of consciousness and recurrent hyperammonemia. Despite previous episodes of hyperammonemia, the etiology of his intermittently elevated ammonia remained unclear and was initially attributed to his kidney failure.</p><p><strong>Diagnoses: </strong>Initial assessments, including liver function tests, abdominal ultrasound, medication review, and genetic screening for urea cycle disorders, were unremarkable. Upon recurrence of symptoms with hyperammonemia, a computed tomography scan was performed which revealed a large portosystemic shunt between the splenic vein and right common iliac vein.</p><p><strong>Interventions: </strong>The patient underwent embolization of the identified portosystemic shunt.</p><p><strong>Outcomes: </strong>Following embolization of the shunt, the patient's hyperammonemia and encephalopathy resolved, with no further recurrences.</p><p><strong>Novel findings: </strong>This case illustrates the challenges of determining the etiology of hyperammonemia in patients treated with hemodialysis due to the dialysis clearance of ammonia. Portosystemic shunts cause hyperammonemia by bypassing the liver's ammonia-detoxification pathways, and their effects may be paradoxically exacerbated immediately after dialysis due to dialysis-related hemodynamic changes. We emphasize the importance of investigating hyperammonemia as a cause of altered level of consciousness among patients being treated with hemodialysis and considering anatomical shunting in the differential diagnosis.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251347154"},"PeriodicalIF":1.6,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12163263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301169","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":"Extranodal Marginal Zone Lymphoma Presenting as Acute Kidney Injury due to Cast Nephropathy: A Case Report.","authors":"Naphasorn Naruemon, Piriyaporn Iamsai, Piyapong Ounpanyo, Boonyarit Cheunsuchon, Thanawat Vongchaiudomchoke","doi":"10.1177/20543581251338434","DOIUrl":"10.1177/20543581251338434","url":null,"abstract":"<p><p>Acute kidney injury (AKI) in non-Hodgkin lymphoma has diverse etiologies. We report a case in which AKI due to light chain cast nephropathy was the initial manifestation of extranodal marginal zone lymphoma, occurring without systemic symptoms. A 64-year-old male presented with severe AKI without other symptoms. His physical examination and renal ultrasound were unremarkable. Renal biopsy revealed light chain cast nephropathy, and a subsequent bone marrow biopsy confirmed marginal zone lymphoma. The patient received R-CHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) for a total of six cycles. The patient had a partial response to lymphoma. However, his renal function did not improve, and ultimately he progressed to end-stage kidney disease, requiring maintenance hemodialysis. This case highlights extranodal marginal zone lymphoma presenting as AKI, emphasizing its unique renal-limited manifestation in the absence of systemic symptoms and the critical role of renal biopsy in diagnosing unexplained AKI.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251338434"},"PeriodicalIF":1.6,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12141795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246592","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 Aldosterone Blockade for Health Improvement Evaluation in End-Stage Renal Disease (ACHIEVE) Trial: Rationale and Clinical Research Protocol.","authors":"Michael Walsh, David Collister, Martin Gallagher, Patrick B Mark, Janak R de Zoysa, Jessica Tyrwhitt, Karthik Tennankore, Laura Sola, Gilmar Reis, Denis Xavier, Russell Villanueva, Wen J Liu, Camilo Félix, Li Zuo, Mustafa Arici, Vivekanand Jha, Ron Wald, Amanda Y Wang, Atiya R Faruqui, Fei Yuan, Shun Fu Lee, Alena Kuptsova, Courtney Christou, P J Devereaux","doi":"10.1177/20543581251348187","DOIUrl":"10.1177/20543581251348187","url":null,"abstract":"<p><strong>Background: </strong>The mineralocorticoid aldosterone may contribute to the risk of cardiovascular morbidity and mortality in patients receiving maintenance dialysis. Whether spironolactone, a mineralocorticoid receptor antagonist, improves outcomes for patients receiving maintenance dialysis is unclear.</p><p><strong>Objective: </strong>To assess the efficacy and safety of spironolactone in patients receiving maintenance dialysis.</p><p><strong>Design: </strong>Placebo-controlled, randomized controlled trial.</p><p><strong>Setting: </strong>Dialysis units.</p><p><strong>Patients: </strong>Patients receiving maintenance dialysis who are adherent to and able to tolerate spironolactone 25 mg daily during an open-label run-in period of at least 49 days were randomized to spironolactone 25 mg daily or matching placebo.</p><p><strong>Measurements: </strong>Randomized participants were followed for the primary outcome of cardiovascular death or hospitalization due to heart failure. Secondary outcomes include cause specific deaths, hospitalization due to heart failure, all-cause death, all-cause hospitalizations, and severe hyperkalemia. All deaths and possible hospitalizations for heart failure were adjudicated.</p><p><strong>Methods: </strong>Eligible participants received open-label spironolactone 25 mg daily for at least 7 weeks during a run-in period. Participants who tolerated and adhered to treatment were randomly allocated to continue spironolactone 25 mg daily or a matching placebo. We followed participants until trial close.</p><p><strong>Results: </strong>The trial began recruitment in 2018 and concluded recruitment in December 2024. Despite a reduced rate of recruitment during the global COVID-19 pandemic 3565 eligible participants were enrolled of whom 2538 were randomized to spironolactone or placebo from 143 dialysis programs.</p><p><strong>Limitations: </strong>Limited funding and the trial was stopped early due to futility to demonstrate an effect.</p><p><strong>Conclusions: </strong>ACHIEVE was designed as a large, simple trial to determine if spironolactone 25 mg daily prevents cardiovascular mortality and heart failure hospitalizations in patients with kidney failure receiving maintenance dialysis. ACHIEVE demonstrates the possibility of conducting large, international, investigator initiated randomized controlled trials for patients with kidney failure receiving dialysis.NCT03020303.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251348187"},"PeriodicalIF":1.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224378","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":"Lessons Learned About the Education Needs of Kidney Transplant Recipients: A Mixed-Method Study.","authors":"Michelle L Gabriel, Lucy Chen, Sharon Lee, Jenny Accettura, Emily E Campbell, Melanie Dissanayake, Teresa J Valenzano-Hacker, Michelle Nash, Lindita Rapi, Niki Dacouris, Weiqiu Yuan, Tiffany Thai","doi":"10.1177/20543581251338462","DOIUrl":"10.1177/20543581251338462","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Much of the literature on kidney transplant education focuses on educating recipients prior to transplant or in the early postoperative period. It is unknown whether the information provided is meaningful to patients or whether the importance of education topics changes with time.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We sought to identify the learning needs of patients post-kidney transplant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Our multidisciplinary team conducted a mixed-method study to better understand the learning needs of patients; what is important to them in the early postoperative period and a year after transplant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;One urban academic hospital performing kidney transplant in Ontario, Canada. Data were collected between September 2019 and March 2021, including during the COVID-19 pandemic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;A convenience sample of 20 participants in the post-kidney transplant clinic. Participants' mean age was 56 (SD ± 11) with 75% of participants male gender.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Twenty kidney transplant patients were recruited between 3 and 6 months post-transplant. Participants completed an initial demographic questionnaire. They completed the Learning Needs Inventory (LNI) and a one-on-one semi-structured interview at 2 time points: 3 to 6 months post-transplant and 12 to 18 months post-transplant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Patient interviews revealed that their access to a trustworthy health care team, support system, and reported challenges post-transplant shaped their ability to engage in learning. Patients shared that each aspect influences when and what topics were important to them, which allowed patients to obtain personalized education. A multidisciplinary team extending beyond physicians and nurses to include professionals such as pharmacists, dietitians, and social workers can best address patient-specific education needs post-transplant was highlighted in patients' comments. Patients revealed that their support system helps to develop self-reliance and support their transition after transplant to allow them to recover and manage challenges after transplant. Support systems varied from family, friends, colleagues and included social media and community organizations were helpful. Our study identified 3 realms of challenges post-transplant including: emotional, physical, and financial. Quantitative data showed significant findings on the level of importance regarding the use of alcohol, demonstrating a shift in median rating of \"not important at all\" to \"not very important\" (&lt;i&gt;P&lt;/i&gt; = .016). A significant effect (&lt;i&gt;P&lt;/i&gt; = .031) shifting the median rating of post-transplant dental care from of \"a little important\" to \"very important.\"&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The small convenience sample with only English-speaking patients used in this study may have affected our ability for generalizable results. Part of this study was com","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251338462"},"PeriodicalIF":1.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12134498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224358","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":"Lived Experiences of Sexual and Gender Minorities in Solid Organ Transplantation: A Best-Fit Framework Synthesis and Inductive Thematic Analysis.","authors":"Murdoch Leeies, Carmen Hrymak, David Collister, Emily Christie, Karen Doucette, Ogai Sherzoi, Tricia Carta, Ken Sutha, Cameron T Whitley, Tzu-Hao Lee, Matthew J Weiss, Sonny Dhanani, Julie Ho","doi":"10.1177/20543581251331703","DOIUrl":"10.1177/20543581251331703","url":null,"abstract":"<p><strong>Background: </strong>Organ and tissue donation and transplantation (OTDT) policies and practices lead to differential care for sexual and gender minorities (SGMs). The experiences of SGM patients and caregivers in the transplantation system have not been published. The perspectives of SGMs on how to best address existing inequities are not understood.</p><p><strong>Objective: </strong>To characterize the lived experiences of SGM patients and caregivers in solid-organ transplant health systems, as well as the perspectives and priorities of these individuals regarding SGM-relevant policies, practices and targets for system improvements.</p><p><strong>Methods: </strong>We conducted a series (N = 12) of one-on-one semi-structured interviews with a convenience sample of SGMs with lived experience of the OTDT system. We transcribed interviews verbatim and performed a formal qualitative analysis combining a best-fit framework synthesis and inductive thematic analysis.</p><p><strong>Results: </strong>We revealed novel targets for action to improve inclusive care in the transplantation system directly informed by the lived experiences of SGM patients and caregivers. Targets for improvement included (1) enhancements to shared decision-making between OTDT providers and patients, (2) transparent communication from OTDT organizations, (3) data-driven donor risk assessments, (4) expanded healthcare worker training, (5) inclusive physical care spaces, (6) recommendations for transgender and gender-diverse health system planning, (7) integrated sexual and reproductive healthcare services for transplant recipients, (8) increased SGM representation in medical education and care settings, (9) SGM and OTDT intersectional support networks, and (10) structural facilitation of SGM community advocacy efforts.</p><p><strong>Limitations: </strong>While thematic saturation was achieved with our sample, we recognize that not all SGM identities were represented. It remains likely that additional experiences, beliefs, and priorities exist in the SGM community.</p><p><strong>Conclusions: </strong>The emergent priorities and perspectives of SGMs with lived experience of transplant systems should inform patient-centered equitable health system advancements.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251331703"},"PeriodicalIF":1.6,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12126676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198259","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":"C-Reactive Protein Monitoring Identifies Urinary Tract Infections in Ambulatory Kidney Transplant Recipients.","authors":"Emily Wang, Abdelhamid Aboghanem, Niki Dacouris, Lindita Rapi, Sami Mahmud, Weiqiu Yuan, Rosane Nisenbaum, Michelle M Nash, G V Ramesh Prasad","doi":"10.1177/20543581251342428","DOIUrl":"10.1177/20543581251342428","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Urinary tract infections (UTI) are common in kidney transplant recipients (KTR). Although risk factors for UTI are well described, predicting symptomatic UTI with positive urine cultures in the first posttransplant year is challenging.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Our clinic routinely monitors serum highly sensitive C-reactive protein (CRP) as part of posttransplant care. We sought to define the role of CRP in identifying symptomatic UTI in KTR.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Nested case control study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;A large adult single-organ kidney transplant center in Toronto, Canada.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;We identified a nested cohort of 78 KTR who experienced a symptomatic UTI with positive urine cultures (cases) and compared them to a cohort of 78 KTR controls matched by time elapsed posttransplant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;Patient demographics, urine cultures, CRP, and kidney function during the first posttransplant year.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We identified a cohort of KTR transplanted between January 1, 2016, and December 31, 2019. A positive urine culture ordered only for clinical indication in the first posttransplant year identified KTR with a UTI defined &gt;10 &lt;sup&gt;5&lt;/sup&gt; colony forming units/mL. UTI cases were matched 1:1 to non-UTI controls transplanted immediately preceding or succeeding the UTI case. Bivariate comparisons were performed by &lt;i&gt;t&lt;/i&gt; test, Wilcoxon 2-sample test for continuous variables, chi-square, or Fisher's exact test as appropriate, with clinically significant variables entered into multivariable logistic regression models to determine associations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Older age, female sex, and the presence of a stent were each associated with a UTI. Immediately preceding UTI, eGFR (&lt;i&gt;P&lt;/i&gt; = .019), serum albumin (&lt;i&gt;P&lt;/i&gt; &lt; .0001), and hemoglobin (&lt;i&gt;P&lt;/i&gt; = .002) were lower, while serum CRP (&lt;i&gt;P&lt;/i&gt; &lt; .0001) and absolute neutrophils (&lt;i&gt;P&lt;/i&gt; = .03) were higher in cases than controls. However, in several multivariable models, only absolute CRP (&lt;i&gt;P&lt;/i&gt; = .001), change in CRP (&lt;i&gt;P&lt;/i&gt; = .005), female sex (&lt;i&gt;P&lt;/i&gt; &lt; .0001), and ureteric stent (&lt;i&gt;P&lt;/i&gt; = .008) consistently predicted a UTI. Each 5 mg/dL change between the 2 preceding CRP values predicted a 15% increased likelihood of UTI, while each 1 mg/dL in absolute CRP concentration was associated with a 5% risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Retrospective case-control design, single-center, small sample size. Hospital inpatients and patients with other infections, acute inflammatory conditions, or rejection were excluded. Urine infections may more easily be detected when patients visit the clinic frequently.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Routine ambulatory CRP monitoring in the first year may help identify subsequent symptomatic UTI in KTR, allow for the initiation of earlier therapy, and reduce patient morbidity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;What was known ","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251342428"},"PeriodicalIF":1.6,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12103657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141455","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 Kidney Transplant Recipients', Transplant Candidates', and Caregivers' Perspectives on Precision Medicine and Molecular Matching in Kidney Allocation: A Qualitative Analysis.","authors":"Fabian Ballesteros, Aliya Affdal, Mohamad Issa, Marie-Françoise Malo, Savannah-Lou Cochran-Mavrikakis, Carina Sancho, Stirling Bryan, Paul Keown, Ruth Sapir-Pichhadze, Marie-Chantal Fortin","doi":"10.1177/20543581251342440","DOIUrl":"10.1177/20543581251342440","url":null,"abstract":"<p><strong>Background: </strong>Antibody-mediated rejection (AMR) is an important cause of kidney transplant loss. A new strategy requiring application of precision medicine tools in transplantation considers molecular compatibility between donors and recipients and holds the promise of improved immunologic risk, preventing rejection and premature graft loss.</p><p><strong>Objective: </strong>The objective of this study was to gather patients' and caregivers' perspectives on molecular compatibility in kidney transplantation.</p><p><strong>Design: </strong>Individual semi-structured interviews.</p><p><strong>Setting: </strong>The Centre hospitalier de l'Université de Montréal (CHUM) and McGill University Health Centre (MUHC) kidney transplant programs.</p><p><strong>Participants: </strong>Kidney transplant candidates, kidney transplant recipients, and caregivers.</p><p><strong>Methods: </strong>Twenty-seven participants took part in semi-structured interviews between July 2020 and November 2021. The interviews were digitally recorded, transcribed, and analyzed using the qualitative description approach.</p><p><strong>Results: </strong>Participants had different levels of knowledge about the kidney allocation process. They expressed trust in the system and healthcare professionals. They indicated that a fair organ allocation system should strive to maximize graft survival as it would decrease the demand for deceased donor kidneys and allow more patients to access transplantation. Molecular matching and precision medicine were seen as important improvements in the kidney transplant allocation process given their potential to improve graft survival and decrease the need for retransplantation. However, participants were concerned about increased waiting times that may negatively impact some patients upon implementation of molecular matching. To address these concerns, participants suggested integrating safeguards in the form of maximum waiting time for molecularly matched kidneys.</p><p><strong>Limitations: </strong>This study was conducted in the province of Quebec most of the participants were white and highly educated. Consequently, the results could not be generalizable to other populations, including ethnic minorities.</p><p><strong>Conclusions: </strong>Molecular matching and precision medicine are viewed as promising technologies for decreasing the incidence of AMR and improving graft survival. However, further studies are needed to determine how to ethically integrate this technology into the kidney allocation scheme.</p><p><strong>Trial registration: </strong>Not registered.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251342440"},"PeriodicalIF":1.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141451","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":"How Can We Decrease Early Dialysis Initiation? An Interactive Quality Improvement Teaching Case for Health Care Providers and Narrative Review of Quality Improvement Methodology.","authors":"Khaled Lotfy, Epsita Shome-Vasanthan, Samuel A Silver, Tamara Glavinovic","doi":"10.1177/20543581251323947","DOIUrl":"10.1177/20543581251323947","url":null,"abstract":"<p><strong>Purpose of review: </strong>Quality improvement (QI) initiatives use a team-based approach to problem-solving clinical and health system issues. All QI initiatives require the coordinated efforts of health care professionals and other stakeholders to encourage the provision of evidence-based clinical care. Most clinicians understand the principles of QI but may lack the training necessary to undertake individual projects.</p><p><strong>Methods: </strong>An educational, nephrology-oriented clinical case was created based on the IDEAL study on timing of dialysis initiation, a prioritized quality indicator in several provinces. The case illustrates how to utilize commonly employed QI methodology and to provide a pragmatic framework for both developing and running a QI project. Core concepts addressed in this review include how to perform a QI chart audit, identification of a quality-of-care problem, engaging stakeholders, and how to conduct a root cause analysis that leads to selection of QI measures and change solutions. Last, plan-do-study-act (PDSA) cycles and interpretation of data using run charts are highlighted.</p><p><strong>Sources of information: </strong>PubMed and Google scholar were used as sources of published QI methodology.</p><p><strong>Key findings: </strong>This nephrology-oriented QI case highlights how a core set of QI principles and tools can be used to improve clinical care. This review demonstrates that determining clear goals, utilizing evidence-based guidance to improve timing of dialysis initiation, engaging the appropriate stakeholders, identifying a feasible and measurable change, and tracking if that change leads to improvement are essential components of all QI initiatives. The above framework can be utilized in a variety of clinical areas both within and beyond nephrology-specific care.</p><p><strong>Limitations: </strong>Considerations regarding QI-specific data analysis were not addressed as they were beyond the scope of this review.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251323947"},"PeriodicalIF":1.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12099089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141459","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":"Are Your Kidneys Ok? Detect Early to Protect Kidney Health.","authors":"Joseph A Vassalotti, Anna Francis, Augusto Cesar Soares Dos Santos, Ricardo Correa-Rotter, Dina Abdellatif, Li-Li Hsiao, Stefanos Roumeliotis, Agnes Haris, Latha A Kumaraswami, Siu-Fai Lui, Alessandro Balducci, Vassilios Liakopoulos","doi":"10.1177/20543581251338937","DOIUrl":"https://doi.org/10.1177/20543581251338937","url":null,"abstract":"<p><p>Early identification of kidney disease can protect kidney health, prevent kidney disease progression and related complications, reduce cardiovascular disease risk, and decrease mortality. We must ask \"<i>Are your kidneys ok</i>?\" using serum creatinine to estimate kidney function and urine albumin to assess for kidney and endothelial damage. Evaluation for causes and risk factors for chronic kidney disease (CKD) includes testing for diabetes and measurement of blood pressure and body mass index (BMI). This World Kidney Day, we assert that case-finding in high-risk populations, or even population-level screening, can decrease the burden of kidney disease globally. Early-stage CKD is asymptomatic and simple to test for and recent paradigm-shifting CKD treatments such as sodium glucose co-transporter-2 inhibitors dramatically improve outcomes and favor the cost-benefit analysis for screening or case-finding programs. Despite this, numerous barriers exist, including resource allocation, healthcare funding, healthcare infrastructure, and healthcare-professional and population awareness of kidney disease. Coordinated efforts by major kidney non-governmental organizations to prioritize the kidney health agenda for governments and aligning early detection efforts with other current programs will maximize efficiencies.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251338937"},"PeriodicalIF":1.6,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966443","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":"Infection Risks With Thymoglobulin Use for Delayed Graft Function in Deceased Donor Kidney Transplantation: Research Letter.","authors":"Mathew Kunthara, Greg A Knoll, David Massicotte-Azarniouch","doi":"10.1177/20543581251338402","DOIUrl":"https://doi.org/10.1177/20543581251338402","url":null,"abstract":"<p><p>Anti-thymocyte globulin (ATG) is often used when delayed graft function (DGF) occurs post-transplantation. The ATG may be associated with an increased risk of infections but may also decrease rejection risk in high-immunological risk recipients. The safety of ATG for the indication of DGF in low-immunological risk recipients has not been well characterized. We conducted a retrospective cohort study of deceased donor kidney transplant recipients deemed low-immunological risk and not planned for ATG induction, from June 2019 to June 2023 (N = 139). Participants switched to ATG post-transplant due to DGF (exposure; N = 68) were compared to those who did not receive ATG for induction (controls; N = 71 basiliximab only induction). Outcomes examined included BK, cytomegalovirus (CMV), and serious infection as well as acute rejection, graft loss, and death. Participants who received ATG for DGF, compared to controls, were older (63.9 vs 59.7 years), more often had diabetes as cause of kidney failure (45.5% vs 33.8%) were more often recipients of death determination by circulatory criteria donor (70.5% vs 30.9%) and extended criteria donor kidneys (48.5% vs 32.3%). There was no significant difference in the probability of BK (22.1% vs 21.1%, <i>P</i> = .89), CMV (20.6% vs 9.9%, <i>P</i> = .08), serious infections (44.1% vs 43.6%, <i>P</i> = .96), acute rejection, graft loss, or death. The use of ATG for DGF following kidney transplantation did not significantly increase infection risk nor did it improve graft outcomes. Further studies are needed to clarify the risk-benefit trade-off of using ATG for DGF.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251338402"},"PeriodicalIF":1.6,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953568","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}