Canadian Journal of Kidney Health and Disease最新文献

{"title":"Volume Status Assessment by Lung Ultrasound in End-Stage Kidney Disease: A Systematic Review.","authors":"Aileen Kharat, Faissal Tallaa, Marc-Antoine Lepage, Emilie Trinh, Rita S Suri, Thomas A Mavrakanas","doi":"10.1177/20543581231217853","DOIUrl":"10.1177/20543581231217853","url":null,"abstract":"<p><strong>Purpose of review: </strong>Lung ultrasound is a noninvasive bedside technique that can accurately assess pulmonary congestion by evaluating extravascular lung water. This technique is expanding and is easily available. Our primary outcome was to compare the efficacy of volume status assessment by lung ultrasound with clinical evaluation, echocardiography, bioimpedance, or biomarkers. The secondary outcomes were all-cause mortality and cardiovascular events.</p><p><strong>Sources of information: </strong>We conducted a MEDLINE literature search for observational and randomized studies with lung ultrasound in patients on maintenance dialysis.</p><p><strong>Methods: </strong>From a total of 2363 articles, we included 28 studies (25 observational and 3 randomized). The correlation coefficients were pooled for each variable of interest using the generic inverse variance method with a random effects model. Among the clinical parameters, New York Heart Association Functional Classification of Heart Failure status and lung auscultation showed the highest correlation with the number of B-lines on ultrasound, with a pooled <i>r</i> correlation coefficient of .57 and .36, respectively. Among echocardiographic parameters, left ventricular ejection fraction and inferior vena cava index had the strongest correlation with the number of B-lines, with a pooled <i>r</i> coefficient of .35 and .31, respectively. Three randomized studies compared a lung ultrasound-guided approach with standard of care on hard clinical endpoints. Although patients in the lung ultrasound group achieved better decongestion and blood pressure control, there was no difference between the 2 management strategies with respect to death from any cause or major adverse cardiovascular events.</p><p><strong>Key findings: </strong>Lung ultrasound may be considered for the identification of patients with subclinical volume overload. Trials did not show differences in clinically important outcomes. The number of studies was small and many were of suboptimal quality.</p><p><strong>Limitations: </strong>The included studies were heterogeneous and of relatively limited quality.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"10 ","pages":"20543581231217853"},"PeriodicalIF":1.7,"publicationDate":"2023-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10750529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139039529","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":"Patient and Clinician Experiences With the Combination of Virtual and In-Person Chronic Kidney Disease Care Since the COVID-19 Pandemic.","authors":"Micheli Bevilacqua, Yuriy Melnyk, Helen Chiu, Janet Williams, Paul Watson, Brenda Lee, Palvir Dhariwal, Marlee McGuire, Julie Wei, Robin Chohan, Anne Logie, Michele Fryer, Dominik Stoll, Adeera Levin","doi":"10.1177/20543581231217833","DOIUrl":"https://doi.org/10.1177/20543581231217833","url":null,"abstract":"<p><strong>Background: </strong>Following onset of the COVID-19 pandemic, chronic kidney disease (CKD) clinics in BC shifted from established methods of mostly in-person care delivery to virtual care (VC) and thereafter a hybrid of the two.</p><p><strong>Objectives: </strong>To determine strengths, weaknesses, quality-of-care delivery, and key considerations associated with VC usage to inform optimal way(s) of integrating virtual and traditional methods of care delivery in multidisciplinary kidney clinics.</p><p><strong>Design: </strong>Qualitative evaluation.</p><p><strong>Setting: </strong>British Columbia, Canada.</p><p><strong>Participants: </strong>Patients and health care providers associated with multidisciplinary kidney care clinics.</p><p><strong>Methods: </strong>Development and delivery of semi-structured interviews of patients and health care providers.</p><p><strong>Results: </strong>11 patients and/or caregivers and 12 health care providers participated in the interviews. Participants reported mixed experiences with VC usage. All participants foresaw a future where both VC and in-person care was offered. A reported benefit of VC was convenience for patients. Challenges identified with VC included difficulty establishing new therapeutic relationships, and variable of abilities of both patients and health care providers to engage and communicate in a virtual format. Participants noted a preference for in-person care for more complex situations. Four themes were identified as considerations when selecting between in-person and VC: person's nonmedical context, support available, clinical parameters and tasks to be completed, and clinic operations. Participants indicated that visit modality selection is an individualized and ongoing process involving the patient and their preferences which may change over time. Health care provider participants noted that new workflow challenges were created when using both VC and in-person care in the same clinic session.</p><p><strong>Limitations: </strong>Limited sample size in the setting of one-on-one interviews and use of convenience sampling which may result in missing perspectives, including those already facing challenges accessing care who could potentially be most disadvantaged by implementation of VC.</p><p><strong>Conclusions: </strong>A list of key considerations, aligned with quality care delivery was identified for health care providers and programs to consider as they continue to utilize VC and refine how best to use different visit modalities in different patient and clinical situations. Further work will be needed to validate these findings and evaluate clinical outcomes with the combination of virtual and traditional modes of care delivery.</p><p><strong>Trial registration: </strong>Not registered.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"10 ","pages":"20543581231217833"},"PeriodicalIF":1.7,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10722955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138797199","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 Good and the Bad of SHROOM3 in Kidney Development and Disease: A Narrative Review.","authors":"Amy Paul, Allison Lawlor, Kristina Cunanan, Pukhraj S Gaheer, Aditya Kalra, Melody Napoleone, Matthew B Lanktree, Darren Bridgewater","doi":"10.1177/20543581231212038","DOIUrl":"https://doi.org/10.1177/20543581231212038","url":null,"abstract":"<p><strong>Purpose of review: </strong>Multiple large-scale genome-wide association meta-analyses studies have reliably identified an association between genetic variants within the <i>SHROOM3</i> gene and chronic kidney disease. This association extends to alterations in known markers of kidney disease including baseline estimated glomerular filtration rate, urinary albumin-to-creatinine ratio, and blood urea nitrogen. Yet, an understanding of the molecular mechanisms behind the association of SHROOM3 and kidney disease remains poorly communicated. We conducted a narrative review to summarize the current state of literature regarding the genetic and molecular relationships between SHROOM3 and kidney development and disease.</p><p><strong>Sources of information: </strong>PubMed, PubMed Central, SCOPUS, and Web of Science databases, as well as review of references from relevant studies and independent Google Scholar searches to fill gaps in knowledge.</p><p><strong>Methods: </strong>A comprehensive narrative review was conducted to explore the molecular mechanisms underlying SHROOM3 and kidney development, function, and disease.</p><p><strong>Key findings: </strong>SHROOM3 is a unique protein, as it is the only member of the SHROOM group of proteins that regulates actin dynamics through apical constriction and apicobasal cell elongation. It holds a dichotomous role in the kidney, as subtle alterations in SHROOM3 expression and function can be both pathological and protective toward kidney disease. Genome-wide association studies have identified genetic variants near the transcription start site of the <i>SHROOM3</i> gene associated with chronic kidney disease. SHROOM3 also appears to protect the glomerular structure and function in conditions such as focal segmental glomerulosclerosis. However, little is known about the exact mechanisms by which this protection occurs, which is why SHROOM3 binding partners remain an opportunity for further investigation.</p><p><strong>Limitations: </strong>Our search was limited to English articles. No structured assessment of study quality was performed, and selection bias of included articles may have occurred. As we discuss future directions and opportunities, this narrative review reflects the academic views of the authors.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"10 ","pages":"20543581231212038"},"PeriodicalIF":1.7,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10722951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138797201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report of Renal Calculi in a Child Receiving Imatinib for Acute Lymphoblastic Leukemia.","authors":"Alaa Bamahmud, Mohamed El-Sherbiny, Roman Jednak, Karl Muchantef, Sharon Abish, David Mitchell, Catherine Vezina, Indra R Gupta","doi":"10.1177/20543581231215849","DOIUrl":"https://doi.org/10.1177/20543581231215849","url":null,"abstract":"<p><strong>Rationale: </strong>Imatinib is used in the treatment of Philadelphia chromosome positive (Ph+) leukemias and has been reported to have a direct effect on bone physiology.</p><p><strong>Presentation: </strong>To report on a child with Ph+ acute lymphoblastic leukemia who presented with bilateral flank pain and gross hematuria.</p><p><strong>Diagnosis: </strong>She was diagnosed with obstructive kidney stones 101 days after commencing daily oral imatinib. Stone analysis revealed the presence of calcium phosphate.</p><p><strong>Interventions and outcome: </strong>The patient passed the stones spontaneously with medical therapy that included the use of thiazide, allopurinol, and potassium citrate, but she required temporary insertion of a double-J stent to relieve an obstruction.</p><p><strong>Novel findings: </strong>Imatinib inhibits receptor tyrosine kinases and stimulates the flux of calcium from the extracellular fluid into bone, resulting in hypocalcemia with a compensatory rise in parathyroid hormone that may result in phosphaturia and the formation of calcium phosphate stones. Given that kidney stones are rare events in children, we believe that monitoring for kidney stone formation needs to be performed in children receiving imatinib.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"10 ","pages":"20543581231215849"},"PeriodicalIF":1.7,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10722952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138797198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing a Formalized Risk-Based Approach to Determine Candidacy for Multidisciplinary CKD Care: A Descriptive Cohort Study.","authors":"Maoliosa Donald, Robert G Weaver, Michelle Smekal, Chandra Thomas, Robert R Quinn, Braden J Manns, Marcello Tonelli, Aminu Bello, Tyrone G Harrison, Navdeep Tangri, Brenda R Hemmelgarn","doi":"10.1177/20543581231215865","DOIUrl":"10.1177/20543581231215865","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The kidney failure risk equation (KFRE) can be used to predict progression to end-stage kidney disease in a clinical setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Evaluate implementation of a formalized risk-based approach in nephrologists' outpatient clinics and multidisciplinary chronic kidney disease (CKD) clinics to determine candidacy for multidisciplinary care, and the impact of CKD care selection on clinical outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Population-based descriptive cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Alberta Kidney Care South.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Adults attending or considered for a multidisciplinary CKD clinic between April 1, 2017, and March 31, 2019.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;&lt;i&gt;Exposure&lt;/i&gt;-The course of CKD care assigned by the nephrologist: management at multidisciplinary CKD clinic; management by a nephrologist or primary care physician. &lt;i&gt;Primary Outcome&lt;/i&gt;-CKD progression, defined as commencement of kidney replacement therapy (KRT). &lt;i&gt;Secondary Outcomes&lt;/i&gt;-Death, emergency department visits, and hospitalizations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We linked operational data from the clinics (available until March 31, 2019) with administrative health and laboratory data (available until March 31, 2020). Comparisons among patient groups, courses of care, and clinical settings with negative binomial regression count models and calculated unadjusted and fully adjusted incidence rate ratios. For the all-cause death outcome, we used Cox survival models to calculate unadjusted and fully adjusted hazard ratios.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 1748 patients for whom a KFRE was completed, 1347 (77%) remained in or were admitted to a multidisciplinary CKD clinic, 310 (18%) were managed by a nephrologist only, and 91 (5%) were referred back for management by their primary care physician. There was a much higher kidney failure risk among patients who remained at or were admitted to a multidisciplinary CKD clinic (median 2-year risk of 34.7% compared with 3.6% and 0.8% who remained with a nephrologist or primary care physician, respectively). None of the people managed by their primary care physician alone commenced KRT, while only 2 (0.6%) managed by a nephrologist without multidisciplinary CKD care commenced KRT. The rates of emergency department visits, hospitalizations, and death were lower in those assigned to management outside the multidisciplinary CKD clinics when compared with those managed in the multidisciplinary care setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The follow-up period may not have been long enough to determine outcomes, and potentially limited generalizability given variability of care in multidisciplinary clinics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our findings indicate that a portion of patients can be directed to less resource-intensive care without a higher risk of adverse events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration: &lt;/strong&gt;Not appli","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"10 ","pages":"20543581231215865"},"PeriodicalIF":1.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10693221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138476754","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":"Identification and Prioritization of Canadian Society of Nephrology Clinical Practice Guideline Topics With Multidisciplinary Stakeholders and People Living With Kidney Disease: A Clinical Research Protocol.","authors":"Brigitte H Baragar, Melissa Schorr, Nancy Verdin, Tania Woodlock, David A Clark, Gregory L Hundemer, Anna Mathew, Reem A Mustafa, Krista S Ryz, Tyrone G Harrison","doi":"10.1177/20543581231207142","DOIUrl":"https://doi.org/10.1177/20543581231207142","url":null,"abstract":"Background: Despite efforts to provide evidence-based care for people living with kidney disease, health care provider goals and priorities are often misaligned with those of individuals with lived experience of disease. Coupled with competing interests of time, resources, and an abundance of suitable guideline topics, identifying and prioritizing areas of focus for the Canadian nephrology community with a patient-oriented perspective is necessary and important. Similar priority-setting exercises have been undertaken to establish research priorities for kidney disease and to standardize outcomes for kidney disease research and clinical care; however, research priorities are distinct from priorities for guideline development. Inclusion of people living with health conditions in the selection and prioritization of guideline topics is suggested by patient engagement frameworks, though the process to operationalizing this is variable. We propose that the Canadian Society of Nephrology Clinical Practice Guideline Committee (CSN CPGC) takes the opportunity at this juncture to incorporate evidence-based prioritization exercises with involvement of people living with kidney disease and their caregivers to inform future guideline activities. In this protocol, we describe our planned research methods to address this. Objective: To establish consensus-based guideline topic priorities for the CSN CPGC using a modified Delphi survey with involvement of multidisciplinary stakeholders, including people living with kidney disease and their caregivers. Study design: Protocol for a Modified Delphi Survey. Setting: Pilot-tested surveys will be distributed via email and conducted using the online platform SurveyMonkey, in both French and English. Participants: We will establish a group of multidisciplinary clinical and research stakeholders (both within and outside CSN membership) from Canada, in addition to people living with kidney disease and/or their caregivers. Methods: A comprehensive literature search will be conducted to generate an initial list of guideline topics, which will be organized into three main categories: (1) International nephrology-focused guidelines that may require Canadian commentary, (2) Non-nephrology specific guidelines from Canada that may require CSN commentary, and (3) Novel topics for guideline development. Participants will engage in a multi-round Modified Delphi Survey to prioritize a set of “important guideline topics.” Measures: Consensus will be reached for an item based on both median score on the Likert-type scale (≥ 7) and the percentage agreement (≥ 75%); the Delphi process will be complete when consensus is reached on each item. Guideline topics will then be given a priority score calculated from the total Likert ratings across participants, adjusted for the number of participants. Limitations: Potential limitations include participant response rates and compliance to survey completion. Conclusions: We propose to incorporate","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"10 ","pages":"20543581231207142"},"PeriodicalIF":1.7,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10676059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138458027","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":"Association Between Arterial Stiffness and Measures of Autonomic Dysfunction in People With Chronic Kidney Disease.","authors":"Rachelle Davies, Natasha Wiebe, Andrew Brotto, Michael K Stickland, Branko Braam, Stephanie Thompson","doi":"10.1177/20543581231213798","DOIUrl":"https://doi.org/10.1177/20543581231213798","url":null,"abstract":"<p><strong>Background: </strong>Autonomic nervous system (ANS) dysfunction and vascular stiffness increase cardiovascular risk in people with chronic kidney disease (CKD). Chronic elevations in sympathetic activity can lead to increased arterial stiffness; however, the relationship between these variables is unknown in CKD.</p><p><strong>Objective: </strong>To explore the association between measures of autonomic function and arterial stiffness in patients with moderate-to-severe CKD.</p><p><strong>Methods: </strong>This study was a prespecified secondary analysis of a randomized controlled trial. This included the following measures: 24-hour ambulatory blood pressure (BP), carotid-femoral and carotid-radial pulse wave velocity (PWV), and postexercise heart rate recovery (HRR). We used mixed effect linear regression models with Bayesian information criteria (BIC) to assess the contribution of ANS measurements.</p><p><strong>Results: </strong>Forty-four patients were included in the analysis. Mean carotid-femoral and carotid-radial PWV were 7.12 m/s (95% CI 6.13, 8.12) and 8.51 m/s (7.90, 9.11), respectively. Mean systolic dipping, calculated as percentage change in mean systolic readings from day to night, was 10.0% (95% CI 7.79, 12.18). Systolic dipping was independently associated with carotid-radial PWV, MD -0.09 m/s (95% CI -0.15, -0.02) and had the lowest BIC.</p><p><strong>Conclusions: </strong>Systolic dipping was associated with carotid-radial PWV in people with moderate-to-severe CKD; however, there was no association with carotid-femoral PWV. Systolic dipping may be a feasible surrogate of ANS function, as the association with carotid-radial PWV was consistent with the minimal clinically important difference (MCID). Future studies are needed to define the relationship between ANS function, arterial stiffness, and CV events over time in people with CKD.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"10 ","pages":"20543581231213798"},"PeriodicalIF":1.7,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10664430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138458026","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":"Patient Care Gaps Prior to Maintenance Dialysis Initiation: A Population-Based Retrospective Study.","authors":"Amber O Molnar, Danielle M Nash, Jennifer Emblem, Sarah Bota, Eric McArthur, Bin Luo, Yaqing Liu, Amit X Garg, Peter G Blake, K Scott Brimble","doi":"10.1177/20543581231212134","DOIUrl":"https://doi.org/10.1177/20543581231212134","url":null,"abstract":"<p><strong>Background: </strong>Guidelines in Ontario, Canada, recommend timely referral for multidisciplinary kidney care to facilitate planned dialysis initiation. Many patients do not receive recommended multidisciplinary kidney care prior to dialysis.</p><p><strong>Objective: </strong>To better understand why this gap in pre-dialysis care exists, we conducted a study to describe the pathways by which patients initiate maintenance dialysis.</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Setting: </strong>Population-based, using health care administrative databases from Ontario, Canada.</p><p><strong>Patients: </strong>Adults initiating maintenance dialysis from April 2016 to March 2019.</p><p><strong>Measurements and methods: </strong>Patients were grouped based on whether they received recommended multidisciplinary kidney care prior to dialysis initiation (at least 1 year of care with at least 2 visits). For those who did not receive recommended care, we grouped patients as having no identified care gap or into the following groups: (1) lack of timely chronic kidney disease (CKD) screening, (2) late nephrology referral (<1 year), or (3) late or no referral for multidisciplinary kidney care among patients followed by a nephrologist for at least 1 year.</p><p><strong>Results: </strong>A total of 9216 patients were included with a mean (standard deviation) age of 66 (15) years, and 61.5% were male. Of the total, 896 (9.7%) patients died, 7671 (83.2%) remained on dialysis at 90 days, and 649 (7.0%) had stopped dialysis due to kidney function recovery within 90 days. Of the 9216 patients, 5434 (59%) had not received recommended multidisciplinary kidney care. Among those without recommended care, there were 2251 (41.4%) patients with no identified care gaps, 1351 (24.9%) patients with a lack of timely CKD screening, 359 (6.6%) patients with late nephrology referral, and 1473 (27.1%) patients with late or no referral for multidisciplinary kidney care.</p><p><strong>Limitations: </strong>We could not determine if patients were referred but declined multidisciplinary kidney care.</p><p><strong>Conclusions: </strong>More than half of patients had not received recommended multidisciplinary kidney care. Many patients experienced an acute decline in kidney function, which may not be preventable, but in others, there were missed opportunities for CKD screening or early referral to nephrology, or at the level of nephrology practice for early referral for multidisciplinary care. This work could be used to inform policies aimed at improving increased uptake of multidisciplinary kidney care prior to dialysis.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"10 ","pages":"20543581231212134"},"PeriodicalIF":1.7,"publicationDate":"2023-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10657522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138458028","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":"Precision Medicine in Diabetic Kidney Disease: A Narrative Review Framed by Lived Experience.","authors":"Mallory L Downie,&nbsp;Arlene Desjarlais,&nbsp;Nancy Verdin,&nbsp;Tania Woodlock,&nbsp;David Collister","doi":"10.1177/20543581231209012","DOIUrl":"10.1177/20543581231209012","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose of review: &lt;/strong&gt;Diabetic kidney disease (DKD) is a leading cause of chronic kidney disease (CKD) for which many treatments exist that have been shown to prevent CKD progression and kidney failure. However, DKD is a complex and heterogeneous etiology of CKD with a spectrum of phenotypes and disease trajectories. In this narrative review, we discuss precision medicine approaches to DKD, including genomics, metabolomics, proteomics, and their potential role in the management of diabetes mellitus and DKD. A patient and caregivers of patients with lived experience with CKD were involved in this review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Sources of information: &lt;/strong&gt;Original research articles were identified from MEDLINE and Google Scholar using the search terms \"diabetes,\" \"diabetic kidney disease,\" \"diabetic nephropathy,\" \"chronic kidney disease,\" \"kidney failure,\" \"dialysis,\" \"nephrology,\" \"genomics,\" \"metabolomics,\" and \"proteomics.\"&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A focused review and critical appraisal of existing literature regarding the precision medicine approaches to the diagnosis, prognosis, and treatment of diabetes and DKD framed by a patient partner's/caregiver's lived experience.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key findings: &lt;/strong&gt;Distinguishing diabetic nephropathy from CKD due to other types of DKD and non-DKD is challenging and typically requires a kidney biopsy for a diagnosis. Biomarkers have been identified to assist with the prediction of the onset and progression of DKD, but they have yet to be incorporated and evaluated relative to clinical standard of care CKD and kidney failure risk prediction tools. Genomics has identified multiple causal genetic variants for neonatal diabetes mellitus and monogenic diabetes of the young that can be used for diagnostic purposes and to specify antiglycemic therapy. Genome-wide-associated studies have identified genes implicated in DKD pathophysiology in the setting of type 1 and 2 diabetes but their translational benefits are lagging beyond polygenetic risk scores. Metabolomics and proteomics have been shown to improve diagnostic accuracy in DKD, have been used to identify novel pathways involved in DKD pathogenesis, and can be used to improve the prediction of CKD progression and kidney failure as well as predict response to DKD therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;There are a limited number of large, high-quality prospective observational studies and no randomized controlled trials that support the use of precision medicine based approaches to improve clinical outcomes in adults with or at risk of diabetes and DKD. It is unclear which patients may benefit from the clinical use of genomics, metabolomics and proteomics along the spectrum of DKD trajectory.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications: &lt;/strong&gt;Additional research is needed to evaluate the role of the use of precision medicine for DKD management, including diagnosis, differentiation of diabetic nephropathy from other etiologies of DKD and CKD, sh","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"10 ","pages":"20543581231209012"},"PeriodicalIF":1.7,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10619345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71420920","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":"Multidisciplinary Support To Access living donor Kidney Transplant (MuST AKT): A Clinical Research Protocol for a Pilot Randomized Controlled Trial to Increase Living Kidney Donation.","authors":"Anne-Marie Selzler,&nbsp;Parastoo Molla Davoodi,&nbsp;Scott Klarenbach,&nbsp;Ngan N Lam,&nbsp;Terry Smith,&nbsp;Abigail Ackroyd,&nbsp;Natasha Wiebe,&nbsp;Bonnie Corradetti,&nbsp;Sharron Ferdinand,&nbsp;Dorothy Iyekekpolor,&nbsp;Gordon Smith,&nbsp;Nancy Verdin,&nbsp;Aminu K Bello,&nbsp;Kevin Wen,&nbsp;Soroush Shojai","doi":"10.1177/20543581231205340","DOIUrl":"10.1177/20543581231205340","url":null,"abstract":"<p><strong>Background: </strong>Living donor kidney transplantation (LDKT) is the optimal treatment for eligible patients with kidney failure, although it is underutilized. Contextually tailored patient- and family-centered interventions may be effective to increase LDKT.</p><p><strong>Objective: </strong>We outline a protocol to test the feasibility of the Multidisciplinary Support To Access living donor Kidney Transplant (MuST AKT) intervention designed to increase LDKT.</p><p><strong>Design: </strong>Non-blinded single-center pilot randomized controlled trial with a qualitative interview component.</p><p><strong>Setting: </strong>Academic transplant referral center in Northern Alberta Region with a population of more than 2 million in its catchment area.</p><p><strong>Patients: </strong>English-speaking patients of the age range 18 to 75 years who are referred for kidney transplantation are eligible to participate.</p><p><strong>Measurements: </strong>Feasibility will be assessed by indicators of recruitment, retention, and completion rates, treatment fidelity, adherence to intervention, engagement in intervention, and acceptability.</p><p><strong>Methods: </strong>Participants will be randomly assigned 1:1 to either standard care (control) or the experimental group who receive standard care plus the MuST AKT intervention, a person-centered program designed to assist and enable the kidney transplant candidate to achieve what is required to receive an LDKT. The intervention consists of an introductory session and 4 intervention sessions delivered in-person or virtually.</p><p><strong>Limitations: </strong>Inferences cannot be drawn regarding the efficacy/effectiveness of the MuST AKT intervention. This study is non-blinded.</p><p><strong>Conclusions: </strong>This pilot study is the first step in our broader initiative to increase LDKT in our health care jurisdiction. The results of this study will be used to inform the development of a future definitive randomized controlled trial.</p><p><strong>Trial registration number: </strong>NCT04666545.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"10 ","pages":"20543581231205340"},"PeriodicalIF":1.7,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10619336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71420919","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}