Canadian Journal of Kidney Health and Disease最新文献

{"title":"Frequency of Routine Bloodwork Among Patients With Chronic Kidney Disease: A Narrative Review to Inform Appropriateness of Care.","authors":"Alessandro Cau, Caroline Stigant, Adeera Levin, Suneet Singh","doi":"10.1177/20543581261421899","DOIUrl":"10.1177/20543581261421899","url":null,"abstract":"<p><strong>Purpose of review: </strong>People living with chronic kidney disease (CKD), individuals receiving dialysis therapies, and those with both native and transplant kidneys undergo routine blood testing for regular follow-up and monitoring of CKD and its complications. There is a lack of evidence supporting the established frequency and utility of testing, which is largely based on historical practice and expert consensus. While early identification and correction of critical laboratory values can lead to improved clinical outcomes, surveillance bloodwork does not always lead to changes or improvements in patient care. As with all investigations, bloodwork has implications for patients, health care providers and our health care system, impacting costs and the environment. Frequent monitoring of highly variable laboratory values may also lead to overtreatment or undertreatment. The purpose of this review is to synthesize the existing evidence pertaining to current blood testing frequencies across the spectrum of patients with CKD to fully inform the appropriateness of care.</p><p><strong>Sources of information: </strong>The sources included published studies and available guidelines regarding the frequency of routine surveillance bloodwork in patients with CKD G3-5, including those receiving all types of dialysis therapies, and recipients of a kidney transplant.</p><p><strong>Methods: </strong>Information was gathered from database searches using a search strategy that included keywords related to bloodwork, lab work, frequency, chronic kidney disease, kidney transplant, and dialysis modalities. Reference lists of relevant studies were also screened.</p><p><strong>Key findings: </strong>There is a paucity of evidence underpinning monthly routine lab testing across the spectrum of patients with CKD. Five observational studies compared outcomes between in-center hemodialysis patients undergoing monthly bloodwork and those receiving less frequent bloodwork (every six weeks). Of those five studies, four demonstrated that it is safe to undergo less frequent testing. The totality of current data, while limited, suggests that for in-center hemodialysis patients, less frequent testing is a safe strategy. No such data exist for other dialysis or non-dialysis CKD populations. Evidence is needed to inform an appropriate testing frequency across the spectrum of patients with CKD to optimize care at the patient, provider, system, and planetary levels.</p><p><strong>Limitations: </strong>A formal systematic review was not undertaken, and therefore, there is a possibility of bias in the included studies.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261421899"},"PeriodicalIF":1.5,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12966577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147376123","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":"Implementation of a Novel Patient-Reported Outcome Measure for the Assessment of Symptoms in Children Living With Chronic Kidney Disease (PRO-Kid)-Program Report.","authors":"Banke Oketola, Karma Abukasm, Ke Fan Bei, Kelly Loverock, Kim Widger, Valerie Umaefulam, Leanne Dunne, Sarah Kirby, Rahul Chanchlani, Claire Adams, Adam Rapoport, Janis Dionne, Lorraine Hamiwka, Marie-Michele Gaudreault-Tremblay, Jean-Philippe Roy, Sara Davison, Allison Dart, Mina Matsuda-Abedini","doi":"10.1177/20543581261424742","DOIUrl":"https://doi.org/10.1177/20543581261424742","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose of the program: &lt;/strong&gt;Children with chronic kidney disease (CKD) experience significant physical and psychological symptoms, necessitating patient-reported outcome (PRO) measurement tools to quantify symptoms, and to improve communication between children with CKD and their health care providers. This study aimed to implement the novel PRO-Kid tool into pediatric CKD and dialysis programs in Canada.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Sources of information: &lt;/strong&gt;The PRO-Kid tool is a novel 14-item questionnaire that was developed and validated by our research team, in partnership with patients living with childhood-onset CKD and caregivers for children with G3-G5 CKD, including dialysis. PRO-Kid measures both the frequency and impact of CKD symptoms in children ages eight to 18 years. It showed strong internal consistency and validity, as demonstrated by a Cronbach alpha of .83 (95% confidence interval [CI], 0.78-0.88) for the frequency scale, and .84 (95% CI, 0.80-0.89) on the impact scale.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The PRO-Kid tool is being implemented in seven Pediatric Nephrology Programs across Canada. Guided by the Consolidated Framework for Implementation Research (CFIR), organizational readiness at each of the sites was assessed via surveys and focus groups. To date, the PRO-Kid tool (eight- to 18-year-old version) and site-specific toolkits have been implemented at three sites that were ready to launch (HSC, Winnipeg; BC Children's Hospital, Vancouver; and McMaster Children's Hospital, Hamilton). Implementation outcomes, such as the number of patients reached and patient and provider satisfaction, were evaluated using audits, surveys, and focus groups guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key findings: &lt;/strong&gt;The organizational readiness assessment identified different electronic medical records and preferences for paper-based data collection methods across sites as well as the need to translate the PRO-Kid tool into other languages. Preliminary evaluation revealed that PRO-Kid is easy to use and is satisfactory to both patients and health care providers. Local champions were identified as key facilitators of implementation efforts. PRO-Kid can help improve communication between children with CKD and their health care providers in identifying symptoms that may not otherwise come up (be disclosed) during clinical encounters. However, language and low reading levels are barriers for some children, and unavailability of clinical staff can limit the use of the tool at some sites.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications: &lt;/strong&gt;Local teams will be required to play crucial roles in integrating the use of the tool in clinical settings. To ensure the tool can be applied across diverse populations, the validation of PRO-Kid tool two to four years old, five to seven years old, and French versions are ongoing. The availability of different versions of the tool will ensure e","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261424742"},"PeriodicalIF":1.5,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12954019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147354035","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":"My Heart and CKD: Pathway to Implementing a Decision Aid for Patients With CKD and Coronary Artery Disease.","authors":"Julie N Babione, Pantea Javaheri, Denise Kruger, Todd Wilson, Winnie Pearson, Maureena Loth, Violet March, Wayne Gerber, Bryan J Har, Michelle M Graham, Stephen B Wilton, Krystina B Lewis, Matthew T James","doi":"10.1177/20543581251389602","DOIUrl":"https://doi.org/10.1177/20543581251389602","url":null,"abstract":"<p><strong>Background: </strong>Patients with chronic kidney disease (CKD) at times must decide whether to take an invasive approach to management of coronary artery disease (CAD), which involves procedures such as angiography, angioplasty, and surgery, versus attempt management with medications alone. <b><i>My Heart and CKD</i></b> is a decision aid to support shared decision-making (SDM) between patients and their care providers in these situations. This report describes the pathway to implement <b><i>My Heart and CKD</i></b> , and key learnings that have emerged through this process.</p><p><strong>Methods: </strong>Human-centered design was used to develop the decision aid while concurrently identifying design features that could facilitate its incorporation within patient-physician clinical encounters. Interviews exploring use of the decision aid with patients and care providers were qualitatively analyzed according to the theoretical domains framework to identify barriers and facilitators to implementation. Simulated encounters between patient and physicians were used for pre-clinical testing and to identify additional training and resources that could support effective implementation.</p><p><strong>Key findings: </strong>Implementation insights overlapped with decision-aid design input and influenced key design elements of <b><i>My Heart and CKD</i></b> as well as the development of implementation strategies to facilitate its clinical use. An overarching theme that influenced development and implementation was the concept that the decision aid be designed for use by patients and physicians together, to support the bidirectional communication and relationship building intended with SDM. This influenced design features to support varying use preferences and contexts, encompassing both digital and paper-based forms for use. Implementation considerations also influenced order and arrangement of content in <b><i>My Heart and CKD</i></b> to enhance integration of all stages of SDM into varying clinical environments. Additional training and implementation resources, including an accredited continuous medical education program for care providers, were identified as additional facilitators necessary to support implementation.</p><p><strong>Limitations: </strong>Clinical evaluation has not yet been completed.</p><p><strong>Implications: </strong><b><i>My Heart and CKD</i></b> is intended to support personalized, patient-centered care by providing patients with CKD and CAD and their care providers with tools to engage in SDM. Further research will evaluate the effectiveness of its implementation and impact on the quality of decision-making.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581251389602"},"PeriodicalIF":1.5,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12954009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147354038","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":"Proteinuria in Deceased Diabetic Donors and Kidney Transplant Outcomes.","authors":"Christie Rampersad, S Joseph Kim","doi":"10.1177/20543581261424568","DOIUrl":"https://doi.org/10.1177/20543581261424568","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Diabetes mellitus is increasingly common among deceased donors and may signal donor-derived kidney injury that affects post-transplant outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate whether donor proteinuria is associated with graft and patient outcomes after kidney transplantation from deceased donors with diabetes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Retrospective cohort study using a national transplant registry.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;United States; Scientific Registry of Transplant Recipients (SRTR), February 28, 2013-2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;9486 kidney-alone transplant recipients from deceased donors with diabetes in whom a pre-implantation (procurement) biopsy was performed and donor proteinuria status was available.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;Primary outcome: death-censored graft failure (DCGF). Secondary outcomes: all-cause graft failure (ACGF), death with graft function (DWGF), and delayed graft function (DGF). Exposure: donor proteinuria (present vs absent).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Kaplan-Meier analyses and multivariable Cox models (a priori covariables from a directed acyclic graph) assessed associations between donor proteinuria and time-to-event outcomes. Because proportional hazards were violated for DCGF, analyses were performed in two periods: an \"early\" cohort up to 2.5 years post-transplant and a landmarked cohort of recipients with functioning grafts at 2.5 years. Logistic regression evaluated DGF. Sensitivity analyses adjusted for donor insulin dependence (proxy for diabetes severity) and recipient characteristics; exploratory effect modification by biopsy glomerulosclerosis (GS) was assessed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Donor proteinuria was present in 54.9% of cases. In adjusted Cox models, donor proteinuria was not associated with early DCGF (&lt;2.5 years; HR 1.14, 95% CI: 0.99, 1.32) but was associated with increased risk of late DCGF &gt;2.5 years post-transplant (HR 1.36, 95% CI: 1.15, 1.62), with similar findings for ACGF. No associations were observed with DWGF or DGF. Results were consistent after adjustment for donor insulin dependence as a proxy for severity and recipient factors including diabetes status. The association between proteinuria and late graft failure was more pronounced in kidneys with lower GS, suggesting proteinuria may reflect chronic injury not well-captured by biopsy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Observational design with potential residual confounding. Because the cohort includes only kidneys that were actually transplanted, findings reflect outcomes among accepted organs and are not intended to guide offer acceptance or decline decisions. Donor proteinuria was recorded only as present or absent, without standardized measurement. This may have led to misclassification, prevented assessment of dose-response relationships, and likely made it harder to detect true associations. Registry constraints limited histologi","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261424568"},"PeriodicalIF":1.5,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12949268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147324502","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":"Person-Centered Integrated Kidney Care Narrative Review: A Model for Reduction of Health Care Carbon Emissions.","authors":"Bhavneet Kahlon, Bhavini Gohel, Sabrina Jassemi, Maoliosa Donald","doi":"10.1177/20543581251391264","DOIUrl":"https://doi.org/10.1177/20543581251391264","url":null,"abstract":"<p><strong>Purpose of review: </strong>Chronic kidney disease (CKD) is a resource-intensive and complex challenge to sustainable health care. The purpose of this narrative review is to describe how person-centered integrated care can support sustainable health care for this population, the strategies currently in place, and the gaps to consider. The findings may support the delivery and improvement of comprehensive support.</p><p><strong>Sources of information: </strong>Original peer-reviewed articles, website information, and Google Analytics were used to describe the current state of sustainable care strategies for CKD.</p><p><strong>Methods: </strong>We reviewed the available strategies to support sustainable care through a person-centered approach in Alberta, specifically examining strategies to support care for CKD. These strategies were mapped onto the Centre for Sustainable Healthcare's four principles of sustainable health care.</p><p><strong>Key findings: </strong>In Alberta, there are several strategies to support person-centered integrated care. These include resources for health care providers that support prevention and lean service delivery, as well as patient-facing tools to support patient self-care. Person-centered integrated care and sustainability within health care are mutually supportive; however, strategies are often created in silos. There is an opportunity to improve sustainability of kidney care with a comprehensive approach and planning around outcome measures.</p><p><strong>Limitations: </strong>While these strategies may have significant benefits, there is limited knowledge of direct impacts on outcomes. We used the data that were available and highlighted the need to measure the impact of health care strategies.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581251391264"},"PeriodicalIF":1.5,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12936362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147324504","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":"Kidney Transplantation in Advanced Octogenarians: The World's Oldest Kidney Transplant Recipient.","authors":"Albi Angjeli, Abdelhamid Aboghanem, Michelle M Nash, G V Ramesh Prasad","doi":"10.1177/20543581251414472","DOIUrl":"https://doi.org/10.1177/20543581251414472","url":null,"abstract":"<p><strong>Rationale: </strong>Kidney transplantation (KT) is the treatment of choice for end-stage kidney disease (ESKD) in all age groups. However, KT in octogenarians is a rare and unique event. We describe the evaluation and clinical course of the world's oldest kidney transplant recipient at 87 years, 262 days, as recognized by the Guinness Book of World Records.</p><p><strong>Presenting concern of patient: </strong>An 84-year-old Canadian retired real estate agent of Indian origin with ESKD due to diabetic nephropathy on hemodialysis presented to our center as a potential kidney transplant candidate. Comorbidities included hypertension, coronary artery disease, benign prostatic hyperplasia, and bilateral knee replacements. He was functional, independent, and extremely keen to undergo KT to further improve his quality of life.</p><p><strong>Diagnosis: </strong>Extensive pretransplant investigation revealed a reasonable state of health for all major organ systems. Multiple specialists were consulted prior to listing.</p><p><strong>Interventions: </strong>After 5 years on hemodialysis, he received a standard neurological determination of death donor kidney transplant.</p><p><strong>Outcomes: </strong>Graft function was immediate. Complications experienced in the first posttransplant year included two urinary tract infections-one with bacteremia; uncontrolled blood pressure and blood glucose, cytomegalovirus and BK viremia, and an inferior wall non-ST segment elevation myocardial infarction. In the second year, he developed a scrotal abscess. However, graft function remained stable with a serum creatinine concentration of 82 µmol/L at two years posttransplant.</p><p><strong>Teaching points: </strong>Successful KT in advanced octogenarians is possible. Appropriate patient selection is crucial. Extended screening for infection, cardiac and vascular disease, malignancy, and frailty including cognitive deficits is required. Plans for diabetes care and ensuring adequate social support including home care may mitigate complications. Willingness to investigate identified illnesses and seek assistance from other specialists may reduce but not necessarily prevent posttransplant complications. Neurological determination of death donor organs might be preferable for advanced octogenarian KT recipients even if those organs meet expanded criteria.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581251414472"},"PeriodicalIF":1.5,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12924977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147275790","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":"Integrating the Novel iCARE Estimated Glomerular Filtration Rate Equation for Youth Living With Type 2 Diabetes Into Care: Program Report.","authors":"Allison B Dart, J Grace Zhou, Elizabeth A C Sellers, Jill Hamilton, Sanjukta Basak, Paul Ryan, Giliana P Garcia Acevedo, Brianna Hunt, Melissa Del Vecchio, Jennifer Lopez, Onalee Alecio-Garcia, Chukwudumebi Onyiuke, Jacqueline Linklater, Valerie Umaefulam, Kalie Tommerdahl, Petter Bjornstad, Brandy A Wicklow","doi":"10.1177/20543581251413452","DOIUrl":"https://doi.org/10.1177/20543581251413452","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose of the program: &lt;/strong&gt;Youth living with type 2 diabetes (T2D) have high rates of early kidney disease and progression to kidney failure in early adulthood. Pediatric diabetes clinical practice guidelines have focused on screening for albuminuria and have not included recommendations for estimated glomerular filtration rate (eGFR) evaluation in children. In partnership with patients, families, and community partners, we are implementing a novel eGFR equation for youth with T2D into their diabetes care, with the aim of detecting youth with early kidney disease and providing appropriate interventions to slow disease progression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Sources of information: &lt;/strong&gt;The development of such a tool aligned with a priority-setting workshop in 2016, where early detection and prevention of kidney disease were identified as a key priority by people living with kidney disease. In response, our team developed the novel Improving renal Complications in Adolescents with type 2 diabetes through Research (iCARE) eGFR equation, which estimates kidney function over time in youth with T2D, and validated it in a cohort of youth in Colorado (US) and a secondary group of youth in Manitoba (Canada).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;To integrate the tool into clinical care, this study includes 4 separate phases. Phase 1: External validation of the iCARE eGFR equation in a cohort of children with obesity and T2D from Colorado, US, to assess the generalizability of the equation. Phase 2: Readiness Assessment of pediatric endocrinologists (a) quantitative survey in Canada (n = 40) and the United States (n = 75) to assess current practice for screening youth with T2D for diabetic kidney disease (DKD) and (b) qualitative focus groups (4 groups; 2 in Canada [n = 8] and 2 in the United States [n = 5]) to explore barriers and facilitators to implementation of the iCARE eGFR equation into the care for youth with T2D. Focus groups of youth living with T2D are underway and explore how youth and families wish to be educated regarding kidney health and what sources of information would be helpful to empower youth to ask about kidney health in clinical settings. Phase 3: Development and implementation of an iCARE eGFR equation toolkit, which will include the resources for providers and patient education materials and the inclusion of the novel eGFR equation into an app and local electronic medical record systems at 3 sites (Vancouver, Winnipeg, Toronto). Phase 4: Evaluation of the iCARE eGFR implementation toolkit, including audits at 3 centers in Canada, as well as patient and provider satisfaction surveys.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key findings: &lt;/strong&gt;Phase 1: The validation study confirmed that the iCARE eGFR performed better than previously published eGFR equations in youth living with obesity and T2D. Relevant metrics were the highest P30 (% of eGFR values that fall within 30% of the measured glomerular filtration rate [GFR]) and the lowest bias. Phase 2: S","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581251413452"},"PeriodicalIF":1.5,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12921172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147269835","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":"Sucralose as a Way to Enhance Regulatory T Cells, the SWEET Trial: Clinical Research Protocol.","authors":"Léa Bourguignon, Yannice Benazzouk, Elpida Bokou-Gianneli, Fabio Zani, Julianna Blagih, Caroline Lamarche","doi":"10.1177/20543581261418540","DOIUrl":"10.1177/20543581261418540","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Kidney transplantation is the most effective treatment for patients with end-stage kidney disease. Modern immunosuppressive treatment has prolonged graft survival and reduced transplant rejection. However, these immunosuppressive regimens are associated with multiple side effects, including increased infections and cancer risk, nephrotoxicity, and metabolic complications. Attaining transplant tolerance with minimal reliance on immunosuppressive drugs is considered the ultimate goal in transplantation. Regulatory T cells (Tregs) adoptive immunotherapy has been proposed as a strategy to achieve transplant tolerance. However, this approach is labor-intensive and expensive, limiting its large-scale applicability. There is, therefore, a need to develop methods that promote Treg-mediated tolerance &lt;i&gt;in vivo&lt;/i&gt;. Treg function and numbers are influenced by dietary components, and dietary interventions could provide a new therapeutic opportunity. Recently, our group demonstrated that sucralose supplementation, a commonly used sugar substitute (sweetener), reduces proinflammatory T-cell function and unpublished data indicating enhanced Treg frequencies. Building on this discovery, we propose to investigate the impact of sucralose on modulating T-cell populations and function in humans.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine whether sucralose supplementation increases circulating Treg frequencies and alters T-cell function and populations in healthy adults.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;This is a randomized, double-blind, placebo-controlled, crossover pilot trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;The study will be monocentric, at the Maisonneuve-Rosemont Hospital.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Twelve healthy adult volunteers (&gt;18 years of age), of both sexes, with no prior history of autoimmune disease or current treatments of immunomodulatory drugs. In addition, pregnant women will also be excluded from this study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;The primary outcome will be an alteration in circulating Treg frequency after sucralose supplementation. The secondary outcomes include modulation in the frequency of CD45&lt;sup&gt;+&lt;/sup&gt; cells, the frequency of CD4&lt;sup&gt;+&lt;/sup&gt; T-cell subsets, the differentiation of both CD4&lt;sup&gt;+&lt;/sup&gt; and CD8&lt;sup&gt;+&lt;/sup&gt; T cells, and T-cell function after antigen-specific and alloreactive challenges. Feasibility will also be evaluated, including adherence to visits, blood draw, ease of recruitment, percentage of study completion, and adherence to supplements. Exploratory outcomes in response to sucralose supplementation include changes in circulating metabolites and gut microbiome composition.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Participants will be randomly assigned to receive either a placebo or sucralose (5-7 mg/kg/day) for four weeks, separated by a two-week washout period. This will be followed by a crossover phase, where patients receiving sucralose will receive the placebo and vic","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261418540"},"PeriodicalIF":1.5,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12905097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146200345","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":"Revamping the KRESCENT Core Curriculum: The KRESCENT 2.0 Program Report.","authors":"Tarrah Wood, Veronica Kaye, Leanne Stalker, R Todd Alexander, Adeera Levin, Sunny Hartwig","doi":"10.1177/20543581251411222","DOIUrl":"10.1177/20543581251411222","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose of program: &lt;/strong&gt;Since its inception in 2005, the Kidney Research Scientist Core Education and National Training Platform (KRESCENT) core curriculum has undergone regular review and evolution to ensure it continues to meet trainee needs within their current research milieus. In 2021, the KRESCENT 2.0 Health Research Training Program (HRTP) was funded through the pilot Canadian Institutes of Health Research (CIHR) HRTP program. This program report describes the formal evaluation and redesign process of the KRESCENT curriculum subsequently undertaken by a small pan-Canadian team over a period of two years, leading to the establishment of the current KRESCENT 2.0 curriculum.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Sources of information: &lt;/strong&gt;KRESCENT archived curriculum-related documents, including de-identified trainee reviews, reports and meeting minutes; equity, diversity, and inclusion (EDI) documents, including consultancy agreements, accountability reviews, proposals and contracts, and other related files. Other resources included websites, journal articles and the Raising Interdisciplinary Scientist Excellence Learning Management System (RISE-LMS) online training platform.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Meeting minutes, consultancy, and curriculum-related documents were reviewed. Clarification of the process was provided through interviews with the senior KRESCENT consultant Dr Adeera Levin, past KRESCENT director Dr R. Todd Alexander, curriculum chair Dr Sunny Hartwig, members of the Patient Community Advisory Network (PCAN), and KRESCENT program manager Ms Julie Wysocki via in-person and virtual meetings as well as email correspondence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key findings: &lt;/strong&gt;The KRESCENT 2.0 curriculum represents a three-year process of evaluation, consultation, and redesign led by the KRESCENT executive team. Administrative, logistical, and strategic support was provided by the Kidney Foundation of Canada (KFoC). Vital insights and guidance in the curriculum reshaping process were provided by a dedicated pan-Canadian working group of 10 scientists and educators spanning multiple disciplines and jurisdictions. Curricular elements to be introduced, retained, discarded, or revitalized were identified by clear consensus in each instance. Key recommendations from EDI consultants Mr Ike Okofur and Ms Nadia McLaren led to the development of a summer undergraduate studentship program to support Black and Indigenous scholars interested in nephrology research. Consultation with existing KRESCENT patient partners led to the formalization of their contributions through the establishment of PCAN. The PCAN team was appointed a role in administering the KRESCENT 2.0 core curriculum to reinforce the importance of understanding and leveraging the lived experience of patients and their caregivers in all aspects of kidney health research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;KRESCENT is an established three-year kidney training program for a small cohort of ","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581251411222"},"PeriodicalIF":1.5,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12886729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146164234","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 Society of Nephrology Commentary on the Evolving Kidney Disease Improving Global Outcomes Adult Glomerulonephritis Guidelines.","authors":"Arenn Jauhal, Reem Mustafa, Anna Mathew, Louis Girard, Sean Barbour, Bhanu Prasad, Lavanya Bathini, Penelope Poyah, Stephan Troyanov, Ratna Samanta, Jocelyn Garland, Todd Fairhead, Michael Walsh, Heather Reich, Shih-Han Huang, Jenny Ng, Judith Marin, Michelle Hladunewich","doi":"10.1177/20543581251409874","DOIUrl":"10.1177/20543581251409874","url":null,"abstract":"<p><strong>Purpose of review: </strong>The purpose of this commentary is to address the challenges of implementing the evolving Kidney Disease Improving Global Outcomes (KDIGO) glomerulonephritis (GN) guidelines within the Canadian health care context, highlighting barriers to adoption of the guidelines and discussing contextual issues unique to Canada.</p><p><strong>Sources of information: </strong>The KDIGO 2021 guidelines with 2024 updates in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis and lupus nephritis, as well as the 2025 updated guideline for immunoglobulin A (IgA) nephropathy.</p><p><strong>Methods: </strong>A Canadian Society of Nephrology (CSN) working group with expertise in GN was formed, representing nephrologists, pathologists, pharmacists, and patient partners with geographic representation from across Canada. Recommendations and practice points were reviewed by member surveys, with discussions to reach consensus and frame the commentary.</p><p><strong>Key findings: </strong>The commentary highlights diagnostic investigations, the role of immune treatments for primary glomerular diseases, and the growing role of conservative kidney therapies.</p><p><strong>Limitations: </strong>A review of the quality of evidence was not undertaken. Implementation and uptake of the guidelines will vary across each province given drug availability and cost.</p><p><strong>Implications: </strong>The commentary aims to provide tailored guidance to enhance the care of Canadians living with glomerular disease.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581251409874"},"PeriodicalIF":1.5,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12886736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146164187","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}