Canadian Journal of Kidney Health and Disease最新文献

{"title":"Clinical Outcomes and Health Care Utilization in Patients with Advanced Chronic Kidney Disease not on Dialysis After the Onset of the COVID-19 Pandemic in Ontario, Canada.","authors":"Carol Wang, Yuguang Kang, Stephanie N Dixon, Nivethika Jeyakumar, K Scott Brimble, Amit X Garg, Peter G Blake, Therese A Stukel, Matthew J Oliver, Ahmed Al-Jaishi, Kristin K Clemens, Longdi Fu, Jane Ip, Susan McKenzie, Louise Moist, Amber O Molnar, Flory Muanda-Tsobo, Marian Reich, Pavel Roshanov, Samuel A Silver, Ronald Wald, Matthew A Weir, Kevin Yau, Ann Young, Kyla L Naylor","doi":"10.1177/20543581251350030","DOIUrl":"10.1177/20543581251350030","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic caused considerable disruption to health care services. Limited data exist on its impacts on clinical outcomes and health care utilization in patients with advanced chronic kidney disease (CKD).</p><p><strong>Objective: </strong>To compare the rates of all-cause mortality, cardiovascular-related hospitalizations, kidney-related outcomes, and health care utilization in patients with advanced CKD before and during the first 21 months of the COVID-19 pandemic.</p><p><strong>Design: </strong>Population-based, repeated cross-sectional study from March 15, 2017 to November 15, 2021, with follow-up until December 14, 2021 (preceding the Omicron variant).</p><p><strong>Setting: </strong>Linked administrative health care databases from Ontario, Canada.</p><p><strong>Participants: </strong>Adult patients with advanced CKD, defined as an estimated glomerular filtration rate <30 mL/min/1.73 m<sup>2</sup> (excluding patients receiving maintenance dialysis).</p><p><strong>Measurements: </strong>The pre-COVID-19 period was from March 15, 2017 to March 14, 2020 and the COVID-19 period was from March 15, 2020 to December 14, 2021. Poisson generalized estimating equations were used to predict post-COVID-19 patient outcomes and health utilization based on pre-COVID trends, estimating relative changes between the observed and expected outcomes. The multivariable model incorporated age group-sex interaction terms, a continuous variable denoting time in months to capture general trends, and pre-COVID month indicators to adjust for seasonal changes.</p><p><strong>Methods: </strong>Our primary outcome was all-cause mortality. Secondary outcomes included all-cause hospitalizations, non-COVID-19-related deaths and hospitalizations, intensive care unit (ICU) admissions, mechanical ventilation, and emergency room visits. We also examined cardiovascular-related hospitalizations, kidney-related outcomes, and ambulatory visits.</p><p><strong>Results: </strong>We included 101 688 adults with advanced CKD. The incidence of all-cause mortality was 147.4 (95% confidence interval [CI] = 145.1, 149.7) per 1000 person-years in the pre-COVID-19 period compared to 150.8 (95% CI = 147.9, 153.7) per 1000 person-years in the COVID-19 period. After adjustment, there was an 8% higher rate of all-cause mortality during the COVID-19 (adjusted relative rate [aRR] = 1.08, 95% CI = 1.03, 1.12). Non-COVID-19-related deaths did not increase substantially (aRR = 1.02, 95% CI = 0.97, 1.07). The COVID-19 period was associated with a lower rate of all-cause hospitalizations, ICU admissions, and emergency room visits. There were declines in long-term care admissions and non-nephrology physician visits in the first 3 months of the pandemic. In contrast, nephrology visits remained stable throughout the study period, including the first 3 months of the pandemic. Similarly, the monthly rates of acute kidney injury requiring dialysis initiation showed li","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251350030"},"PeriodicalIF":1.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12227879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574873","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":"Enablers and Barriers to Integrating Advance Care Planning in Chronic Kidney Disease Care in a Canadian Provincial Network.","authors":"Helen H L Chiu, John Duncan, Sherri Lynn Kensall, Yanchini Rajmohan, Sushila Saunders, Sarah Thomas, Salma Wadhwania, Gaylene Hargrove","doi":"10.1177/20543581251350891","DOIUrl":"10.1177/20543581251350891","url":null,"abstract":"<p><strong>Background: </strong>Individuals with advanced chronic kidney disease benefit from an integrated palliative approach to care through timely advance care planning and discussions about their goals of care. Despite literature and guidelines emphasizing the need for advance care planning in chronic kidney disease management, treatment-focused approach remains the norm, partly due to provider reluctance and discomfort in engaging in advance care planning conversations. In British Columbia (BC), the Integrated Palliative Nephrology (IPN) project was launched to enhance kidney health care provider engagement in advance care planning and goals of care discussions, to train kidney health care providers in the province to initiate serious illness conversations, and to develop standardized resources for patients and providers across a provincial renal network.</p><p><strong>Objective: </strong>As part of the quality improvement, this study highlights the barriers/challenges and enablers to engage in advance care planning for health care providers of adult patients with chronic kidney disease.</p><p><strong>Design: </strong>A multi-methods approach was used.</p><p><strong>Setting: </strong>British Columbia, Canada.</p><p><strong>Participants: </strong>Kidney health care providers who worked in nondialysis and dialysis care settings.</p><p><strong>Methods: </strong>Data were collected through semistructured surveys, individual interviews, and focus groups with health care providers across the province who care for patients with chronic kidney disease.</p><p><strong>Results: </strong>The results of a kidney health care provider survey (n = 90) showed self-reported improvements in knowledge of the integrated palliative approach and competency and comfort engaging in advance care planning discussions. The results of one-on-one interviews (n = 15) and focus groups (n = 32) with kidney health care providers showed that taking a relational approach with patients, enhancing provider comfort and competency with advance care planning, clarifying roles and responsibilities around who should engage in advance care planning conversation was beneficial to patient care. Supporting cohesion among care teams around the goal of advancing an integrated palliative approach, and offering mentorship and targeted education and resources for the kidney care team, can enable effective advance care planning discussions.</p><p><strong>Limitations: </strong>The study was limited by purposive sampling, a small sample size, and potential bias due to participant interests and settings.</p><p><strong>Conclusions: </strong>For kidney health care providers, targeted education and resources, clarity around roles and responsibilities, and long-term relationships with patients may help advance the cultural shift from treatment focus to integrating palliative care across the continuum of the illness journey.</p><p><strong>Trial registration: </strong>Not registered.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251350891"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12217565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144552386","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 Cycle Assessment: A Primer for Kidney Professionals.","authors":"Saba Yousafzai, Rehan Sadiq, Kasun Hewage, Andrea J MacNeill, Caroline E Stigant","doi":"10.1177/20543581251347165","DOIUrl":"10.1177/20543581251347165","url":null,"abstract":"<p><strong>Background: </strong>The growing emphasis on low-carbon, sustainable health care systems is driving the integration of environmental sustainability into clinical practice and research. This shift necessitates clinician literacy in health care sustainability, particularly in methodologies for assessing environmental impacts.</p><p><strong>Objective: </strong>To introduce health care professionals to life cycle assessment (LCA) as a tool for evaluating environmental impacts in clinical contexts and to illustrate its application through a case study on hemodialysis therapies.</p><p><strong>Design: </strong>A qualitative assessment of LCA methodology, including its fundamental principles, stages, and applications in health care.</p><p><strong>Setting: </strong>Hemodialysis materials were collected from In-Centre and Home Dialysis units at Vancouver General Hospital.</p><p><strong>Patients/sample/participants: </strong>No patients are directly involved in this work; samples of unused hemodialysis materials were collected for process assessment. The target audience is health care professionals, particularly those involved in kidney care, who need to interpret LCA results for informed decision-making.</p><p><strong>Methods: </strong>Overview of LCA, an internationally standardized methodology that evaluates the environmental impacts of products and processes over their entire life cycle, is presented. The 4 stages of LCA, the key environmental impact categories it assesses, and guidelines for appropriate interpretation and use are explored.</p><p><strong>Results: </strong>Life cycle assessment provides numerous midpoint data, mechanisms by which damages occur to endpoints, including human health and environments. The case study comparing home versus in-center hemodialysis demonstrates how LCA findings can inform decision-making in kidney care.</p><p><strong>Limitations: </strong>The interpretation of LCA results requires an understanding of its methodology and limitations. The accuracy of LCA outcomes depends on the quality and scope of data used in the assessment.</p><p><strong>Conclusions: </strong>As LCA is increasingly applied in clinical settings, health care professionals must develop the skills to critically evaluate and apply its findings. This primer equips kidney care professionals with essential knowledge of LCA methodology, supporting the integration of environmental sustainability into clinical practice.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251347165"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12214306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144552387","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":"Program Report-Transplant Manitoba Adult Kidney Program Cutting Costs, Not Corners: Value of Quality Improvement Initiatives.","authors":"Christie Rampersad, Aaron Trachtenberg, James Shaw, Nancy Dodd, Krista Maxwell, Martin Karpinski, Chris Wiebe, Peter Nickerson, Julie Ho","doi":"10.1177/20543581251341712","DOIUrl":"10.1177/20543581251341712","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Provision of high-quality, evidence-based patient care that is sustainable for our universal health system is a core Canadian Medical Education Directions for Specialists (CanMEDs) expectation. The Transplant Manitoba Adult Kidney Program (TMAKP) embraced this responsibility by addressing inefficiencies in its practices through multipronged quality improvement (QI) strategies, including reducing unnecessary interventions, implementing innovative strategies, and aligning clinical practices with emerging evidence. Using seamlessly embedded continuous QI and clinical research with a learning health system, the program achieved substantial cost savings and increased opportunities for deceased donor kidney transplantation. The purpose of this analysis is to measure the cost savings associated with these QI initiatives.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Sources of information: &lt;/strong&gt;Transplant Manitoba Adult Kidney Program database and quality metrics, Manitoba Health Physician's Manual (April 1, 2024), PubMed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;To quantify the potential cost savings, we employed a 3-pronged approach. For reduced testing, a cost-counting exercise was conducted using historical transplant activity (831 prevalent and 83 incident patients) to project number of tests avoided and direct costs per test. Second, cost savings for generic mycophenolic acid was presented as ratios of generic to brand name drug costs, and projected cost savings for prevalent patients receiving average dosing. Third, for increased kidney utilization, cost savings per kidney transplant were derived from published studies and extrapolated using predicted additional transplants. Net health care system savings across payers were assessed at a 1-year time horizon.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key findings: &lt;/strong&gt;The TMAKP reduced unnecessary testing, adopted generic medications, and implemented innovative strategies, achieving $2,530,026 in projected annual 1-year cost savings. These QI initiative savings augment the overall cost-effectiveness of kidney transplantation compared with dialysis. Implementing evidence-based protocols using personalized risk-stratified approaches to viral monitoring and novel donor-specific antibody surveillance strategies aligned testing with clinical risk while minimizing patient burden, highlighting the benefits of seamlessly integrating research with learning health systems. Programs for hepatitis C-viremic donor kidneys and age-targeted allocation increased transplant opportunities and optimized deceased donor organ use. Manitoba's initiatives demonstrate the importance of validation, stakeholder engagement, and iterative adaptation in driving sustainable improvements in transplantation care. Critically, this requires the foresight of health care administrative systems to invest in effective and ongoing QI and embed research with clinical practice, to improve patient and health system outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;This ana","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251341712"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12217574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144552388","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 Canadian Society of Nephrology Methods for Developing and Adapting Clinical Practice Guidelines: An Update.","authors":"Somaya Zahran, Anna Mathew, Tyrone G Harrison, Arenn Jauhal, Michelle A Hladunewich, Reem A Mustafa","doi":"10.1177/20543581251346074","DOIUrl":"10.1177/20543581251346074","url":null,"abstract":"<p><strong>Purpose of the review: </strong>In this article, we provide an update on the Canadian Society of Nephrology's (CSN) process of identifying candidate topics and subsequent development of guidelines and commentaries using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT methodology. We revise the process of adapting existing guidelines with the inclusion of Kidney Disease Improving Global Outcomes (KDIGO) practice points. We also describe challenges of implementing guidelines and suggest solutions to address this with description of the CSN approach to disseminating and implementing guidelines.</p><p><strong>Sources of information: </strong>The update reflects internal CSN documentation, stakeholder consultation for topic prioritization, and integration of methodological guidance from GRADE-ADOLOPMENT and international sources such as KDIGO.</p><p><strong>Methods: </strong>We reviewed and synthesized the CSN's current guideline-development process, which includes a detailed examination of internal documentation, meeting summaries, and publicly available methodological frameworks with specific focus on the application of the GRADE-ADOLOPMENT approach. We analyzed how recommendations and practice points from KDIGO are assessed for relevance, updated based on Canadian context, and integrated into the final commentary using GRADE Evidence-to-Decision (EtD) frameworks. We also examined how conflict of interest is managed, how working groups are structured, and how recommendations are prioritized. In addition, we explored the CSN's evolving strategies for dissemination and implementation, including stakeholder engagement, survey feedback, and use of knowledge-translation tools.</p><p><strong>Key findings: </strong>The CSN follows a transparent and rigorous process in guideline and commentary development. This comprehensive process considers the best-available evidence, balancing desirable and undesirable effects and patients' values, perspectives, and implications for the Canadian health care system including resources, equity, acceptability, and feasibility to maximize guideline implementation and advance the health of Canadians.</p><p><strong>Limitations: </strong>The CSN updated methods reflect the current process and may not be generalizable to other guideline organizations. The impact of CSN commentaries on clinical practice, decision-making, and policy uptake has not been formally evaluated, limiting our understanding of their contribution to health system improvement and patient outcomes.</p><p><strong>Implications: </strong>This review updates the CSN's processes for commentary working groups to identify relevant international guidelines, establish the level of agreement on included recommendations, incorporate perspectives of people with lived experience, and adjust the final product to the Canadian healthcare system before dissemination.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251346074"},"PeriodicalIF":1.6,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12214302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144552389","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":"Bayesian Analysis of Time-To-Event Data in a Cluster-Randomized Trial: Major Outcomes With Personalized Dialysate TEMPerature (MyTEMP) Trial.","authors":"Yongdong Ouyang, Bin Luo, Stephanie N Dixon, Ahmed A Al-Jaishi, P J Devereaux, Michael Walsh, Ron Wald, Merrick Zwarenstein, Sierra Anderson, Amit X Garg","doi":"10.1177/20543581251341710","DOIUrl":"10.1177/20543581251341710","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;MyTEMP was a cluster-randomized trial to assess the effect of using a personalized cooler dialysate compared to standard temperature dialysate for potential cardiovascular benefits in patients receiving maintenance hemodialysis in Ontario, Canada.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To conduct Bayesian analyses of the MyTEMP trial, which sought to determine whether adopting a center-wide policy of personalized cooler dialysate is superior to a standard dialysate temperature of 36.5°C in reducing the risk of a composite outcome of cardiovascular-related deaths or hospitalizations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Secondary analysis of a parallel-group cluster-randomized trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;In total, 84 dialysis centers in Ontario, Canada, were randomly allocated to the 2 groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Adult outpatients receiving in-center maintenance hemodialysis from dialysis centers participating in the trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;The primary composite outcome was cardiovascular-related death or hospital admission with myocardial infarction, ischemic stroke, or congestive heart failure during the 4-year trial period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;MyTEMP trial data were analyzed using Bayesian cause-specific parametric Weibull methods to model the survival time with 6 pre-defined reference priors of normal distributions on the log hazard ratio for the treatment effect (strongly enthusiastic, moderately enthusiastic, non-informative, moderately skeptical, skeptical, strongly skeptical). For each analysis, we reported the posterior mean, 2nd, 50th, and 98th percentiles of the treatment effects (hazard ratios) and 96% credible interval (CrI). We also reported the estimated posterior probabilities for different magnitudes of treatment effects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Regardless of priors, Bayesian analysis yielded consistent posterior means and a 96% CrI. The posterior distribution of the hazard ratio was concentrated between 0.95 and 1.05, indicating there was probably no substantial difference between the 2 trial arms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The interpretation of Bayesian methods highly depends on the prior distributions. In our study, the prior distributions were determined by 2 experts without a formal elicitation method. A formal elicitation is encouraged in future trials to better quantify experts' uncertainty about the treatment effect. In addition, we used cause-specific parametric Weibull methods to model survival time, as semi-parametric methods were not available in the standard Bayesian statistical software package at the time of analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our Bayesian analysis indicated that implementing personalized cooler dialysate as a center-wide policy is unlikely to yield meaningful benefits in reducing the composite outcome of cardiovascular-related deaths and hospitalizations, regardless of prior expectations, whethe","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251341710"},"PeriodicalIF":1.6,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12206259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526518","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":"Variation in Kidney Transplant Referral, Living Donor Contacts, Waitlisting, and Kidney Transplant Across Regional Renal Programs in Ontario, Canada: A Population-Based Cohort Study.","authors":"Kyla L Naylor, Seychelle Yohanna, Graham Smith, Amit X Garg, Lori Elliott, Gregory Knoll, S Joseph Kim, Matthew Weir","doi":"10.1177/20543581251346048","DOIUrl":"10.1177/20543581251346048","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Previous studies conducted in publicly and privately funded health care systems suggest that access to kidney transplants may vary depending on where a patient receives their kidney care. It is poorly understood whether variability exists across the key steps required to receive a kidney transplant in a publicly funded health care system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine whether there is variation across Ontario's regional renal programs (RRPs) in key steps completed toward receiving a kidney transplant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Population-based cohort study from November 1, 2017, to December 31, 2021, using linked administrative health care databases with a maximum follow-up of March 31, 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;This study includes 27 RRPs and independent health facilities in Ontario, Canada.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Patients approaching the need for dialysis and patients receiving maintenance dialysis with no recorded contraindication to kidney transplant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;Key steps toward receiving a kidney transplant, including (1) referred to a transplant center for an evaluation; (2) had a potential living donor contact a transplant center to be evaluated; (3) deceased donor waitlist activation; and (4) received a transplant from a living or deceased donor.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;For each step toward receiving a kidney transplant, we reported a unique incidence rate per 100 person-years with a 95% confidence interval (95% CI), presented by Ontario's RRPs, including the 27 RRPs and independent health facilities. We also presented results by 5 Ontario geographic regions. In an additional analysis, we examined the time to complete specific transplant steps.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We included 8319 individuals approaching the need for dialysis and 4869 individuals receiving maintenance dialysis. During follow-up, 2870 (34.5%) individuals approaching the need for dialysis initiated maintenance dialysis. In individuals approaching the need for dialysis, we found the rate of a potential living kidney donor contacting a transplant center to be evaluated varied more than 17-fold across RRPs from 0.67 (95% CI = 0.1, 4.8) to 11.7 (95% CI = 9.2, 14.9). In the dialysis cohort, the average number of steps completed toward receiving a kidney transplant varied almost 4-fold across RRPs from 11.7 (95% CI = 9.3, 14.8) to 44.0 (95% CI = 38.6, 50.1) steps per 100 person-years. The average rate of each step measured separately also varied widely, with the rate of referral to a transplant center for an evaluation (per 100 person-years) varying across RRPs from 6.0 (95% CI = 4.2, 8.5) to 47.9 (95% CI = 42.6, 53.8), the rate of a potential living kidney donor contacting a transplant center to be evaluated from 1.5 (95% CI = 0.78, 2.9) to 10.7 (95% CI = 7.9, 14.5), the rate of deceased donor waitlisting from 2.9 (95% CI = 1.9, 4.4) to 13.2 (95% CI = 11.0, 1","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251346048"},"PeriodicalIF":1.6,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526519","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":"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}