Canadian Journal of Kidney Health and Disease最新文献

{"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":"https://doi.org/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}

{"title":"Technical and Institutional Factors Affecting Specimen Adequacy and Complications in Ultrasound-guided Kidney Biopsy: A Retrospective Cohort Study.","authors":"Sydney Murray, Chance Dumaine, Chris Wall, Tamalina Banerjee, James Barton, Michael Moser","doi":"10.1177/20543581251336551","DOIUrl":"https://doi.org/10.1177/20543581251336551","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Percutaneous ultrasound-guided kidney biopsy is a critical diagnostic tool with a higher rate of complications than most other biopsies. Our prior research identified technical factors that might improve outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective was to measure the impact of these technical and institutional interventions on specimen adequacy and complication rates in kidney biopsies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;This is a retrospective cohort study comparing outcomes before and after intervention implementation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Two hospitals within a single health region in Saskatchewan serving a population of approximately 1 million.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;All adult percutaneous ultrasound-guided kidney biopsies performed on adult patients between 2012 to 2016 (n = 242, pre-implementation) and 2017 to 2021 (n = 338, post-implementation). Both native and transplant biopsies were included, while patients under 18, open biopsies, and biopsies of kidney masses were excluded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;Primary outcomes included specimen adequacy and biopsy complications (hematoma, hemoglobin drop, infection, and arteriovenous fistula formation).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Technical recommendations included introducing the biopsy needle at a 60° angle, targeting a pole, and avoiding the vascular medulla. Institutional recommendations included microscopic screening for all biopsies, limiting the number of radiologists performing procedures, using a checklist, and restricting computed tomography (CT)-guided biopsies to exceptional cases. Multivariate regression analysis assessed biopsy outcomes before and after the recommendations, controlling for known confounders while at the same time refining factors associated with fewer complications and greater diagnostic yield.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The rate of non-diagnostic specimens decreased from 10.3% to 4.4% (&lt;i&gt;P&lt;/i&gt; = .005), and complications decreased from 35.5% to 14.2% (&lt;i&gt;P&lt;/i&gt; &lt; .0001). Two or three passes yielded excellent diagnostic success, while 4 passes increased the risk of a complication. Multivariate analysis, after accounting for the collinearity of certain technical factors revealed that medulla avoidance and biopsies done after the implementation of the 2016 recommendations significantly reduced the risk of complications (odds ratio [OR] = 0.37, &lt;i&gt;P&lt;/i&gt; &lt; .001) and non-diagnostic biopsies (OR = 0.31, &lt;i&gt;P&lt;/i&gt; = .002).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Retrospective design and novelty bias may be a cause of bias in this study. Because the institutional recommendations were followed for all biopsies, it was not possible to distinguish which recommendation was most associated with the improvements. Because our study was done in a single health region, it is not clear if they are generalizable to other programs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The technical and institutional interventio","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251336551"},"PeriodicalIF":1.6,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967296","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":"Nephrologist's Perceptions of Risk of Severe Chronic Kidney Disease and Outpatient Follow-up After Hospitalization With AKI: Multinational Randomized Survey Study.","authors":"Dilaram Acharya, Tayler D Scory, Nusrat Shommu, Maoliosa Donald, Tyrone G Harrison, Jonathan S Murray, Simon Sawhney, Edward D Siew, Neesh Pannu, Matthew T James","doi":"10.1177/20543581251336548","DOIUrl":"https://doi.org/10.1177/20543581251336548","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Patients hospitalized with acute kidney injury (AKI) have variable risks for chronic kidney disease (CKD); however, there is limited knowledge about how this risk influences outpatient follow-up with nephrologists.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This survey study examined the likelihood that nephrologists would recommend outpatient follow-up of patients with varying risk profiles for CKD after hospitalization with AKI and the effect of reporting the predicted risk of severe CKD on their decision-making.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;A randomized survey study examining the impact of providing predicted risks of severe CKD on nephrologists' follow-up recommendations for patients with AKI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;The study included nephrologists from the United States, the United Kingdom, and Canada between September and December 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Participants reviewed clinical vignettes of patients with AKI and varying risks of severe CKD (G4 or G5), using an externally validated prediction model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;The primary outcome was the likelihood of recommending nephrologist specialist follow-up for each case, scored on a 7-point Likert scale (1 = \"definitely not\" and 7 = \"definitely would\").&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Participants were randomized to receive a version of the survey either with or without the predicted risk of severe CKD included for each vignette. Responses were compared across categories of predicted risk (&lt;10%, 10%-49%, and ≥50%) using generalized estimating equations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 203 nephrologists who participated, 73 (36%) were from the United Kingdom, 71 (35%) from Canada, and 45 (22%) from the United States. Mean (95% confidence interval [CI]) Likert scores increased from 4.01 (3.68, 4.34) for patients with a &lt;10% predicted risk to 6.06 (5.76, 6.37) for those with a ≥ 50% predicted risk of severe CKD. Nephrologists were significantly less likely to recommend outpatient nephrology follow-up for patients with a &lt;10% predicted risk of severe CKD when the risk was reported (mean difference = -0.71 [95% CI = -1.19, -0.23]), and significantly more likely to recommend follow-up for patients with a ≥50% predicted risk when the risk of severe CKD was reported (mean difference = 0.49 [95% CI = 0.04, 0.93]).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;This study focuses on nephrologists from high-income countries and relies on hypothetical scenarios rather than real-world practices. Survey respondents may not be representative of all nephrologists, although consistent findings across diverse subgroups strengthen findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;When the predicted risk of severe CKD is reported, nephrologists are less likely to recommend follow-up for lower risk patients with AKI and more likely to recommend follow-up for higher risk patients, leading to better alignment of recommendations for outpatient follow-","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251336548"},"PeriodicalIF":1.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12046161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972669","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":"Life on the Line: Prioritizing Equity in Kidney Transplantation for Populations Marginalized by Race and Ethnicity.","authors":"Jagbir Gill, Reetinder Kaur","doi":"10.1177/20543581251331076","DOIUrl":"https://doi.org/10.1177/20543581251331076","url":null,"abstract":"","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251331076"},"PeriodicalIF":1.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12032458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978699","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 Problems We Can-SOLVE: How Can-SOLVE CKD Network Implementation and Knowledge Mobilization Projects Are Reshaping Kidney Care in Canada.","authors":"Cathy Woods, Maoliosa Donald, Selina Allu, Michelle Hampson, Cynthia MacDonald, Heather Harris, Malcolm King, James Scholey, Adeera Levin, Matthew T James","doi":"10.1177/20543581251333206","DOIUrl":"https://doi.org/10.1177/20543581251333206","url":null,"abstract":"","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251333206"},"PeriodicalIF":1.6,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12032431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963719","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}