Canadian Journal of Kidney Health and Disease最新文献

{"title":"Home Sweet Home: A Program Report on Promoting the Uptake of Home Dialysis.","authors":"Lucas James Churchill, Frances Reintjes, Robert Pauly, Nikhil Shah, Stephanie Thompson","doi":"10.1177/20543581241312625","DOIUrl":"10.1177/20543581241312625","url":null,"abstract":"<p><strong>Purpose of program: </strong>Canada's growing prevalence of people with kidney failure receiving kidney replacement therapy has necessitated the expansion of dialysis programs. Although facility-based hemodialysis is the predominant dialysis modality in Canada, it is substantially costlier than home dialysis (peritoneal or home hemodialysis). Initiatives to increase the uptake of home dialysis typically consist of didactic and experiential education. We describe a novel local initiative, Home Sweet Home (HSH), where individuals with lived experience of home dialysis and kidney health professionals share their experience and knowledge with participants in a clinic setting that has been set up to represent a metaphorical home. The aim of this report is to describe our HSH program and to evaluate its acceptability and reach for future scale and spread. We also explored home dialysis uptake among program participants.</p><p><strong>Sources of information: </strong>We collected feedback from attendees following each HSH event with anonymized surveys. We obtained clinical and demographic data and modality at follow-up from 2 linked databases, the Canadian Organ Replacement Register (CORR) and a regional clinical database, the Nephrology Information System (NIS).</p><p><strong>Methods: </strong>Reach was evaluated according to modality (i.e., the proportion of participants who were non-dialysis dependent vs the proportion receiving facility-based maintenance hemodialysis) and the proportion living remotely (defined as greater than 200 km from the event). We examined acceptability as the proportion who were interested in a home therapy (either peritoneal dialysis, home hemodialysis, or both) after attending the event. Demographic data and survey data were summarized with counts and percentages. Free text from surveys was collated and summarized. Participants were followed from the time of program attendance until June 21, 2022 or death.</p><p><strong>Key findings: </strong>A total of 291 participants attended HSH between 2015 and 2019. At the time of program attendance, 70% of participants had chronic kidney disease (CKD) not requiring dialysis (CKD G4-5ND) and 30% had CKD G5D on facility-based maintenance hemodialysis. Participants were primarily urban dwelling (ie, in Edmonton). After the event, 92% of participants indicated they were interested in a home dialysis modality. From the survey free text, participants commonly expressed that they valued the \"first-hand information\" and a \"real life perspective\" from HSH facilitators and the simulation helped to ease anxiety about home dialysis. Participants expressed a desire for longer HSH events with more opportunities to ask questions. At a median follow-up of 858 days (interquartile range = 353-1347), 18% of the cohort remained dialysis independent and 25% died. Of the remaining 167 participants, N = 41 (25%) were receiving a home dialysis modality (either peritoneal dialysis or home hemodial","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581241312625"},"PeriodicalIF":1.6,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969741","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":"Definitions of Hemodynamic Instability Related to Renal Replacement Therapy in Critically Ill Patients: A Systematic Review Protocol.","authors":"Jean Zhuo Wang, Lindsey Sikora, Peter Farrell, Swapnil Hiremath, Edward G Clark","doi":"10.1177/20543581241312631","DOIUrl":"https://doi.org/10.1177/20543581241312631","url":null,"abstract":"<p><strong>Background: </strong>Hemodynamic instability related to renal replacement therapy (HIRRT) is a common complication affecting critically ill patients that require renal replacement therapy (RRT). There is currently no consensus regarding the definition of HIRRT in critically ill patients. In this context, the impacts of HIRRT on clinical outcomes such as mortality or renal recovery in critically ill patients are unclear.</p><p><strong>Objective: </strong>The primary objective of this proposed systematic review is to evaluate the association between HIRRT and clinical outcomes, as reported within randomized control trials in the literature. The secondary objective of this systematic review is to compare rates of HIRRT, according to various definitions used by randomized controlled trials, across different RRT modalities used to treat critically ill patients, with the goal of paving the way toward a common definition of HIRRT for future research.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Measurements: </strong>The rates of HIRRT, mortality, and renal recovery will be reported according to each definition of HIRRT.</p><p><strong>Patients: </strong>Critically-ill adults with acute kidney injury admitted to intensive care units.</p><p><strong>Methods: </strong>The search strategy will be developed to identify articles in Medline, MEDLINE In-Process, EMBASE, and Cochrane CENTRAL Registry. We will include randomized control trials examining renal replacement therapy in critically ill patients. This will include intermittent hemodialysis (iHD), all forms of prolonged intermittent RRT (PIRRT), and continuous renal replacement therapy (CRRT). Only articles that report a definition of HIRRT and the rates of HIRRT will be included in our analysis. Two reviewers will independently screen all articles for inclusion and exclusion. Data extraction and quality assessment will be also performed in duplicate. All disagreements will be resolved through discussion or a third reviewer.</p><p><strong>Limitations: </strong>The heterogeneity in the definitions of HIRRT and outcome reporting may limit the ability to perform meta-analysis and perform comparisons in the rates of HIRRT between RRT modalities.</p><p><strong>Conclusions: </strong>This systematic review aims to assess the association between HIRRT and important clinical outcomes. In doing so, we will identify definitions of HIRRT within the current literature and the rates of HIRRT associated with these definitions. HIRRT can result in early discontinuation of dialysis, organ injury from hypoperfusion, and may negatively impact mortality and renal recovery in critically ill patients. This systematic review will synthesize the impact and frequency of HIRRT reported in the literature and, in doing so, may help determine the extent to which common definitions of HIRRT might be recommended for standardized use in future research related to HIRRT.</p><p><strong>Syste","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581241312631"},"PeriodicalIF":1.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11705320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945029","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, Caregiver, and Provider Perspectives on Improving Provider-Patient Interactions in Hemodialysis: A Qualitative Study.","authors":"Melanie D Talson, Priscila Ferreira da Silva, Juli Finlay, Krista Rossum, Kaytlynn V Soroka, Michael McCormick, Arlene Desjarlais, Hans Vorster, Rachelle Sass, Matthew James, Manish M Sood, Allison Jaure, Neesh Pannu, Karthik Tennankore, Stephanie Thompson, Marcello Tonelli, Clara Bohm","doi":"10.1177/20543581241309986","DOIUrl":"https://doi.org/10.1177/20543581241309986","url":null,"abstract":"<p><strong>Background: </strong>Improving interactions between people receiving hemodialysis and health care providers of facility-based hemodialysis care is a top priority for patients, caregivers, and health care providers.</p><p><strong>Objective: </strong>To identify challenges for high-quality clinical interactions in facility-based hemodialysis care as well as potential solutions.</p><p><strong>Design: </strong>Multicentre qualitative study using focus groups and semi-structured interviews to elicit the perspectives of patients, caregivers, and health care providers.</p><p><strong>Setting: </strong>Five Canadian facility-based hemodialysis centers.</p><p><strong>Participants: </strong>English-speaking adults receiving facility-based hemodialysis for longer than 6 months, their caregivers, and hemodialysis health care providers.</p><p><strong>Methods: </strong>Between May 2017 and August 2018, focus groups and interviews with patients and their caregivers subsequently informed semi-structured interviews with providers. Data were analyzed using inductive thematic analysis with application of a grounded theory approach.</p><p><strong>Results: </strong>A total of 8 focus groups and 44 interviews were completed. Participants included 64 people receiving hemodialysis, 18 caregivers, and 31 health care providers. Communication between health care providers and patients was often characterized as <i>intersections</i> of care (unidirectional) rather than <i>interactions</i> (bidirectional). Challenges were grouped into 4 main themes as follows: (1) culture of care provision; (2) mistrust between patients and health care providers; (3) time constraints for clinical interactions, and (4) lack of collaboration and care coordination among health care team. Potential solutions were identified for each challenge.</p><p><strong>Limitations: </strong>Findings were limited to Canadian context, English-speaking adults, and individuals receiving facility-based hemodialysis in urban centers.</p><p><strong>Conclusions: </strong>Interactions between health care providers and people receiving dialysis are often unidirectional, where the patient is a passive recipient of ideas and information from the health care provider. To promote improved bidirectional interactions, team-based care that includes better tools to improve information transfer, better information regarding roles, and identity of health care team members and opportunities for all members of the health care team, including the people receiving dialysis, to provide input on care plans is required.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581241309986"},"PeriodicalIF":1.6,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11696963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Series of Infection-Related Glomerulonephritis in Quebec Indigenous Peoples.","authors":"Thomas Nodzynski, Zahra Sohani, Ajay Rajaram, Pierre Olivier Fiset, Chantal Bernard, Murray Vasilevsky, Catherine Weber","doi":"10.1177/20543581241309977","DOIUrl":"10.1177/20543581241309977","url":null,"abstract":"<p><strong>Rationale: </strong>Infection-related glomerulonephritis (IRGN) is an immune-mediated glomerulonephritis caused by extra-renal infectious diseases. There has been an important shift in epidemiology in recent years, with a significant proportion of adults affected. The incidence of IRGN is higher amongst Indigenous populations and especially in those with multiple comorbidities. Beginning in 2019, we observed several IRGN cases amongst adult Indigenous peoples referred to the McGill University Health Center (MUHC). The aim of this article is to describe the demographic, clinical, and outcome data of these individuals and highlight the heterogeneity of IRGN in this population through 2 illustrative cases.</p><p><strong>Presenting concerns of the patient: </strong>In total, 8 cases of IRGN were identified between 2019 and 2022. All patients presented with features of acute glomerulonephritis.</p><p><strong>Diagnoses: </strong>All patients had documented evidence of an infection that preceded their diagnosis of IRGN. IRGN was not the initial clinical diagnosis in all cases.</p><p><strong>Interventions: </strong>Half the patients received immunosuppression while the others received supportive care only.</p><p><strong>Outcomes: </strong>Four patients required initiation of hemodialysis at time of presentation and at 2 years of follow-up, 3 of the 4 remained hemodialysis-dependent.</p><p><strong>Teaching points: </strong>Our case series emphasizes the heterogenous clinical, laboratory, and pathological presentations that make the diagnosis of IRGN quite challenging. A high index of suspicion should be present when a patient presents with acute kidney injury, features of a glomerulonephritis, and an infection, especially those with multiple comorbidities and a preceding history of chronic kidney disease.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241309977"},"PeriodicalIF":1.6,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes Using a Standardized Provincial Childhood Nephrotic Syndrome Clinical Pathway.","authors":"Laura H Kim, Marisa Catapang, Nonnie Polderman, Robert Humphreys, Cherry Mammen, Eleonora Jugnauth, Douglas G Matsell","doi":"10.1177/20543581241304505","DOIUrl":"10.1177/20543581241304505","url":null,"abstract":"<p><strong>Background: </strong>In 2013, the British Columbia (BC) Childhood Nephrotic Syndrome Clinical Pathway (CNSCP) was developed to standardize the care of children with nephrotic syndrome (NS). In BC, children access nephrology care at BC Children's Hospital (BCCH) and multiple regional clinics.</p><p><strong>Objective: </strong>The primary objective was to compare induction therapy and clinical outcomes between BCCH and regional clinics since implementation of the CNSCP.</p><p><strong>Design setting and patients: </strong>This was a retrospective cohort study of children with NS in BC.</p><p><strong>Measurements and methods: </strong>We conducted a retrospective cohort study of children 1 to 17 years old with new-onset NS from 2013 to 2019 inclusive with minimum 12 months of follow-up. Children with non-minimal change disease, steroid resistance, incomplete induction therapy, or less than 6 months of pathway treatment within their first year post-diagnosis were excluded. Clinics were categorized as BCCH or regional (Surrey, Prince George, or Kelowna).</p><p><strong>Results: </strong>Sixty-nine patients were included, with 52 (75%) at BCCH and 17 (25%) at regional clinics. There were no significant between-group differences in age, sex, or clinical characteristics at time of diagnosis. Comparing BCCH and regional clinics, there was no difference in induction prednisone exposure (median 3400, interquartile range [IQR] 3331-3585 mg/m² vs 3492, IQR 3397-3644 mg/m², <i>P</i> = .167), annualized relapse rate (median 3.3, IQR 1.1-5.3 vs 2.3, IQR 0.5-4.2, <i>P</i> = .575), or development of frequently relapsing courses (50% vs 62%, <i>P</i> = .475). There was a similar number of first-year clinic visits (4.2 ± 1.2 vs 4.0 ± 1.8, <i>P</i> = .655) and dietitian-reviewed food records (67% vs 47%, <i>P</i> = .135, BCCH vs regional). More children at BCCH had a recommended ophthalmology surveillance visit (87% vs 59%, <i>P</i> = .01, BCCH vs regional).</p><p><strong>Limitations: </strong>Study limitations include small sample size and exclusion of children with complicated NS (ie, relapse during induction, steroid resistance).</p><p><strong>Conclusion: </strong>Since we implemented the CNSCP, children with NS received comparable care and had similar outcomes at BCCH and regional clinics without significant practice variation.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241304505"},"PeriodicalIF":1.6,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Canadian Highly Sensitized Patient Program Report: A 1000 Kidney Transplants Story.","authors":"M Khaled Shamseddin, Steven Paraskevas, Rahul Mainra, Kyle Maru, Bailey Piggott, Darlene Jagusic, Kathy Yetzer, Lakshman Gunaratnam, Christine Ribic, Joseph Kim, Sunita Singh, Stephanie Hoar, G V Ramesh Prasad, Melanie Masse, Isabelle Houde, Myriam Khalili, Kenneth West, Rob Liwski, Sean Martin, Nessa Gogan, Martin Karpinski, Mauricio Monroy-Cuadros, Sita Gourishankar, Olwyn Johnston, James Lan, Christopher Nguen, John Gill, Michel Pâquet","doi":"10.1177/20543581241306811","DOIUrl":"10.1177/20543581241306811","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Highly sensitized patients (HSPs) with kidney failure have limited access to kidney transplantation and poorer post-transplant outcomes. Prioritizing HSPs in kidney allocation systems and expanding the pool of deceased donors available to them has helped to reduce their wait times for transplant and enhanced post-transplant outcomes. The Canadian HSP Program was established by Canadian Blood Services in collaboration with provincial organ donation and transplantation programs throughout the country to increase transplant opportunities for transplant candidates needing very specific matches from deceased kidney donors. Highly sensitized patients in the Canadian Program are defined by a calculated panel-reactive antibody (cPRA) ≥95%. In this report, we describe the evolution and trajectory of the Canadian HSP Program and evaluate the national impact on the first 1000 kidney transplant cases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Source of information: &lt;/strong&gt;To allocate deceased donor kidney organs nationally to HSPs and report on the Canadian HSP Program's performance, Canadian Blood Services developed a national database registry known as the Canadian Transplant Registry (CTR) and an online reporting tool known as the Canadian HSP Program Data Dashboard.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The CTR, which collects HSPs' data for the purpose of matching potential donors to HSPs and as part of required national quality, safety, and efficiency performance measurements, was retrospectively reviewed. Due to the nature of using deidentified aggregate registry data, a patient consent form was not required. A Research Ethical Board (REB) application was also waived.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key findings: &lt;/strong&gt;In this article, we describe the historical development, initial deployment, and evolution of the Canadian HSP Program with a primary aim to increase the rate of deceased donor kidney transplantation. A secondary aim was to evaluate the national impact of the Canadian HSP Program on the first 1000 kidney transplant cases. Transplant candidates who have participated in the Canadian HSP Program and recipients who received transplants were predominantly females (average age 50 years, female 62%) with blood group O (47% of candidates, 42% of transplants). Seventy percent of all active transplant candidates enrolled in the HSP Program were in the hardest to match group (cPRA ≥99%), and only 22% of the transplant candidates with cPRA of 100% have received a transplant to date through the Program. The average times from first participation in the Canadian HSP Program to transplantation for cPRA ≥99% transplant recipients were significantly longer than for cPRA 95% to 98% recipients averaging 22 months versus 6 months, respectively. By the end of June 2024, the Canadian HSP Program had facilitated 1000 transplants, 613 of which were from interprovincial matches. The average (SD) cold ischemic time (CIT) was 14.5 (5.9) hours, with interprovincial transplants exhi","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241306811"},"PeriodicalIF":1.6,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11672600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142902577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence, Prediction, and Prevention of Fractures After Kidney Transplantation: A Systematic Review Protocol.","authors":"Andrea C Cowan, Karla Solo, Victoria Lebedeva, Yasaman Mohammadi Kamalabadi, Maha El-Shimy, Aayushi Joshi, Edith Ginika Olalike, Misa Tanaka, Adam G R Klotz, Hatoun Wahid Elazhary, Antonia Zhu, Adam Forster, Shafaz Veettil, Sachin G Nair, Maria Fernanda Servin Martinez, Dweeti Nayak, V Nikhila Priya, Catherine Wellan, Diana Maria Cespedes Arcani, Pavel S Roshanov","doi":"10.1177/20543581241306799","DOIUrl":"10.1177/20543581241306799","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Kidney transplant recipients are uniquely exposed to the disordered bone metabolism associated with chronic kidney disease beginning before transplantation followed by chronic corticosteroid use after transplantation. Previous efforts to synthesize the rapidly accruing evidence regarding estimation and management of fracture risk in kidney transplant recipients are outdated and incomplete.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To synthesize the evidence informing the overall incidence, patient-specific risk prediction, and methods of prevention of fractures in patient living with a kidney transplant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Three systematic reviews will address the following questions: What is the overall incidence of skeletal fracture after kidney transplantation (review 1)? Which prediction models and individual prognostic factors predict fracture in kidney transplant recipients (review 2)? and How effective are different antifracture interventions at preventing fracture or improving surrogate markers of bone health in kidney transplant recipients (review 3)?&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Cohort studies (reviews 1 and 2) and randomized trials (review 2) with a mean/median follow-up ≥12 months beginning after transplant. Review 3: randomized trials or new-user cohort studies with concurrent controls evaluating the effect of antifracture interventions including bisphosphonates, calcium supplementation, cinacalcet, denosumab, parathyroid hormone analogues, parathyroidectomy, raloxifene, romosozumab, steroid withdrawal or minimization protocols after kidney transplant, vitamin D (both active and nutritional), other antifracture interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Adult kidney transplant recipients in studies published after the year 2000.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;Review 1: incidence rate or cumulative risk of fracture. Review 2: For prediction models, measures of discrimination (eg, c-statistic), calibration (calibration curves, observed:expected ratios), and net benefit (ie, from decision curve analysis); for individual prognostic factors, relative measures of association with fractures. Review 3: measures of treatment effect on fractures and on surrogate markers of bone health (eg, bone mineral density, trabecular bone score).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We searched MEDLINE, Embase, and the Cochrane Library using subject headings and keywords related to kidney transplant and fractures. Pairs of reviewers will screen records independently in duplicate to identify studies relevant to one or more of the 3 reviews and categorize each study accordingly. Single reviewers will extract data and evaluate risk of bias for each included study using one of the following tools as appropriate: the Quality of Prognostic Studies tool, the Prediction model Risk Of Bias ASsessment tool, the Risk Of Bias In Non-randomised Studies-of Interventions tool, and the Cochrane Risk of Bias 2.0 tool. A second ","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241306799"},"PeriodicalIF":1.6,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11672528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142902578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of Acute Kidney Injury After Cardiac Surgery With Combined Arterial and Venous Intrarenal Doppler.","authors":"Cameron Giles, Karel Huard, André Denault, William Beaubien-Souligny","doi":"10.1177/20543581241309976","DOIUrl":"10.1177/20543581241309976","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Acute kidney injury (AKI) occurs in up to 50% of cardiac surgical patients and is often hemodynamically mediated. Point-of-care ultrasound is a non-invasive tool that has the potential to characterize intrarenal hemodynamics and predict the risk of AKI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;We aimed to determine the predictive characteristics of intrarenal arterial and venous Doppler markers for postoperative AKI in cardiac surgical patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;This study is the secondary analysis of a prospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;This study is carried out in a care academic cardiac surgical center in Montreal, Quebec, Canada.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Adult patients undergoing cardiac surgery with the use of cardiopulmonary bypass.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;Point-of-care ultrasound assessments were performed preoperatively and at intensive care unit admission. Arterial measurements included the renal resistive index (RRI) and intrarenal artery velocity-time integral normalized to peak systolic velocity (VTI/PSV). Venous measurements included intrarenal venous flow (IRVF) pattern and renal venous stasis index (RVSI).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used area under the receiving operating characteristic curves (AUCs) with net reclassification index (NRI) and multivariable logistic regression to determine predictive characteristics for postoperative AKI. Furthermore, we used hierarchical clustering to identify potential groups with similar Doppler parameters and performed comparisons of patients' characteristics and outcomes between groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We included 136 patients with 47 (34.6%) developing postoperative AKI. At intensive care unit admission, arterial indices showed similar discrimination for the prediction of AKI (RRI: AUC = 0.64; 95% confidence interval (CI) = 0.55 to 0.74; and VTI/PSV: AUC = 0.67; 95% CI = 0.57 to 0.77). Venous Doppler indices including IRVF patterns (AUC = 0.64; 95% CI = 0.53 to 0.74) and RVSI (AUC = 0.60; 95% CI = 0.50 to 0.71) also showed similar performance. The combined model of RRI and IRVF pattern (AUC = 0.69; 95% CI = 0.59 to 0.78) improved the prediction of AKI compared to either RRI (NRI = 0.50; 95% CI = 0.17 to 0.84) or IRVF pattern (NRI = 0.38; 95% CI = 0.04 to 0.70) alone. Through hierarchical clustering, we identified 3 groups (1: low RRI, 2: high RRI/low RVSI, and 3: high RRI/high RVSI) with different patient characteristics and outcomes. The patient in group 3 had a higher risk of AKI and worse clinical outcomes compared with other groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Single-center design in cardiac surgical patients limits generalizability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Although more complex indices of intrarenal Doppler indices including the VTI/PSV and RVSI did not improve prediction of postoperative AKI, combining RRI and IRVF pattern improved risk prediction for AKI. Intrar","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241309976"},"PeriodicalIF":1.6,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11672484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142902579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unused Hemodialysis Acid Concentrate is Dollars and Dialysate Down the Drain: An Opinion Piece.","authors":"Anukul Ghimire, Karthik K Tennankore, George Vitale","doi":"10.1177/20543581241308631","DOIUrl":"10.1177/20543581241308631","url":null,"abstract":"","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241308631"},"PeriodicalIF":1.6,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11660271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical Frailty and Functional Status in Kidney Transplantation: A Systematic Review.","authors":"Priscilla Karnabi, David Massicotte-Azarniouch, Shawn Marshall, Greg A Knoll","doi":"10.1177/20543581241300777","DOIUrl":"10.1177/20543581241300777","url":null,"abstract":"<p><strong>Background: </strong>Frailty and functional decline are being recognized as important conditions in kidney transplant candidates. However, the ideal measures of functional status and frailty remain unknown as there is not a complete understanding of the relationship between these conditions and important post-transplant outcomes.</p><p><strong>Objective: </strong>The objective was to examine the association between different measures of frailty and functional status evaluated before or at the time of transplant with adverse clinical outcomes post-transplantation.</p><p><strong>Design: </strong>This study is a systematic review.</p><p><strong>Setting: </strong>Observational studies including cohort, case-control, or cross-sectional studies examining the effect of frailty and functional status on clinical outcomes. There were no restrictions on type of setting or country of origin.</p><p><strong>Patients: </strong>Adults who were waitlisted for kidney transplant or had received a kidney transplant.</p><p><strong>Measurements: </strong>Data including demographic information (eg, sample size, age, country), assessments of frailty or functional status and their domains, and outcomes including mortality, transplantation, graft loss, delayed graft function and hospital readmission were extracted.</p><p><strong>Methods: </strong>A search was performed in Medline, Embase, and Cochrane Central Register for Controlled Trials. Studies were included from inception to February 7, 2023. The eligibility of studies was screened by 2 independent reviewers. Data were presented by frailty/functional status instrument and clinical outcome. Point estimates and 95% confidence intervals from fully adjusted statistical models were reported or calculated from the raw data.</p><p><strong>Results: </strong>A total of 50 studies were identified, among which 36 unique instruments were found. Measurements of these instruments occurred mostly at time of kidney transplant, transplant evaluation, and waitlisting. The median sample size of studies was 457 patients (interquartile range = 183-1760). Frailty and lower functional status were associated with an increased risk for mortality. Similar trends were observed among other clinical outcomes such as graft loss and rehospitalization.</p><p><strong>Limitations: </strong>The heterogeneity in measurement instruments, study designs, and outcome definitions prevents pooling of the data. Selection bias and the validity of data collection could not be ascertained for some studies.</p><p><strong>Conclusion: </strong>Frailty and functional status measures are important predictors of post-kidney transplant outcomes. Further studies are needed to evaluate the best instruments to assess frailty and functional status, and importantly, interventional studies are needed to determine whether prehabilitation strategies can improve post-transplant outcomes.</p><p><strong>Registration prospero: </strong>CRD42016045251.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241300777"},"PeriodicalIF":1.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}