Canadian Journal of Kidney Health and Disease最新文献

{"title":"Technical and Institutional Factors Affecting Specimen Adequacy and Complications in Ultrasound-guided Kidney Biopsy: A Retrospective Cohort Study.","authors":"Sydney Murray, Chance Dumaine, Chris Wall, Tamalina Banerjee, James Barton, Michael Moser","doi":"10.1177/20543581251336551","DOIUrl":"https://doi.org/10.1177/20543581251336551","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous ultrasound-guided kidney biopsy is a critical diagnostic tool with a higher rate of complications than most other biopsies. Our prior research identified technical factors that might improve outcomes.</p><p><strong>Objective: </strong>The objective was to measure the impact of these technical and institutional interventions on specimen adequacy and complication rates in kidney biopsies.</p><p><strong>Design: </strong>This is a retrospective cohort study comparing outcomes before and after intervention implementation.</p><p><strong>Setting: </strong>Two hospitals within a single health region in Saskatchewan serving a population of approximately 1 million.</p><p><strong>Patients: </strong>All adult percutaneous ultrasound-guided kidney biopsies performed on adult patients between 2012 to 2016 (n = 242, pre-implementation) and 2017 to 2021 (n = 338, post-implementation). Both native and transplant biopsies were included, while patients under 18, open biopsies, and biopsies of kidney masses were excluded.</p><p><strong>Measurements: </strong>Primary outcomes included specimen adequacy and biopsy complications (hematoma, hemoglobin drop, infection, and arteriovenous fistula formation).</p><p><strong>Methods: </strong>Technical recommendations included introducing the biopsy needle at a 60° angle, targeting a pole, and avoiding the vascular medulla. Institutional recommendations included microscopic screening for all biopsies, limiting the number of radiologists performing procedures, using a checklist, and restricting computed tomography (CT)-guided biopsies to exceptional cases. Multivariate regression analysis assessed biopsy outcomes before and after the recommendations, controlling for known confounders while at the same time refining factors associated with fewer complications and greater diagnostic yield.</p><p><strong>Results: </strong>The rate of non-diagnostic specimens decreased from 10.3% to 4.4% (<i>P</i> = .005), and complications decreased from 35.5% to 14.2% (<i>P</i> < .0001). Two or three passes yielded excellent diagnostic success, while 4 passes increased the risk of a complication. Multivariate analysis, after accounting for the collinearity of certain technical factors revealed that medulla avoidance and biopsies done after the implementation of the 2016 recommendations significantly reduced the risk of complications (odds ratio [OR] = 0.37, <i>P</i> < .001) and non-diagnostic biopsies (OR = 0.31, <i>P</i> = .002).</p><p><strong>Limitations: </strong>Retrospective design and novelty bias may be a cause of bias in this study. Because the institutional recommendations were followed for all biopsies, it was not possible to distinguish which recommendation was most associated with the improvements. Because our study was done in a single health region, it is not clear if they are generalizable to other programs.</p><p><strong>Conclusions: </strong>The technical and institutional interventio","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251336551"},"PeriodicalIF":1.6,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nephrologist's Perceptions of Risk of Severe Chronic Kidney Disease and Outpatient Follow-up After Hospitalization With AKI: Multinational Randomized Survey Study.","authors":"Dilaram Acharya, Tayler D Scory, Nusrat Shommu, Maoliosa Donald, Tyrone G Harrison, Jonathan S Murray, Simon Sawhney, Edward D Siew, Neesh Pannu, Matthew T James","doi":"10.1177/20543581251336548","DOIUrl":"https://doi.org/10.1177/20543581251336548","url":null,"abstract":"<p><strong>Background: </strong>Patients hospitalized with acute kidney injury (AKI) have variable risks for chronic kidney disease (CKD); however, there is limited knowledge about how this risk influences outpatient follow-up with nephrologists.</p><p><strong>Objective: </strong>This survey study examined the likelihood that nephrologists would recommend outpatient follow-up of patients with varying risk profiles for CKD after hospitalization with AKI and the effect of reporting the predicted risk of severe CKD on their decision-making.</p><p><strong>Design: </strong>A randomized survey study examining the impact of providing predicted risks of severe CKD on nephrologists' follow-up recommendations for patients with AKI.</p><p><strong>Setting: </strong>The study included nephrologists from the United States, the United Kingdom, and Canada between September and December 2023.</p><p><strong>Patients: </strong>Participants reviewed clinical vignettes of patients with AKI and varying risks of severe CKD (G4 or G5), using an externally validated prediction model.</p><p><strong>Measurements: </strong>The primary outcome was the likelihood of recommending nephrologist specialist follow-up for each case, scored on a 7-point Likert scale (1 = \"definitely not\" and 7 = \"definitely would\").</p><p><strong>Methods: </strong>Participants were randomized to receive a version of the survey either with or without the predicted risk of severe CKD included for each vignette. Responses were compared across categories of predicted risk (<10%, 10%-49%, and ≥50%) using generalized estimating equations.</p><p><strong>Results: </strong>Of the 203 nephrologists who participated, 73 (36%) were from the United Kingdom, 71 (35%) from Canada, and 45 (22%) from the United States. Mean (95% confidence interval [CI]) Likert scores increased from 4.01 (3.68, 4.34) for patients with a <10% predicted risk to 6.06 (5.76, 6.37) for those with a ≥ 50% predicted risk of severe CKD. Nephrologists were significantly less likely to recommend outpatient nephrology follow-up for patients with a <10% predicted risk of severe CKD when the risk was reported (mean difference = -0.71 [95% CI = -1.19, -0.23]), and significantly more likely to recommend follow-up for patients with a ≥50% predicted risk when the risk of severe CKD was reported (mean difference = 0.49 [95% CI = 0.04, 0.93]).</p><p><strong>Limitations: </strong>This study focuses on nephrologists from high-income countries and relies on hypothetical scenarios rather than real-world practices. Survey respondents may not be representative of all nephrologists, although consistent findings across diverse subgroups strengthen findings.</p><p><strong>Conclusions: </strong>When the predicted risk of severe CKD is reported, nephrologists are less likely to recommend follow-up for lower risk patients with AKI and more likely to recommend follow-up for higher risk patients, leading to better alignment of recommendations for outpatient follow-","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251336548"},"PeriodicalIF":1.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12046161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Life on the Line: Prioritizing Equity in Kidney Transplantation for Populations Marginalized by Race and Ethnicity.","authors":"Jagbir Gill, Reetinder Kaur","doi":"10.1177/20543581251331076","DOIUrl":"https://doi.org/10.1177/20543581251331076","url":null,"abstract":"","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251331076"},"PeriodicalIF":1.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12032458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Problems We Can-SOLVE: How Can-SOLVE CKD Network Implementation and Knowledge Mobilization Projects Are Reshaping Kidney Care in Canada.","authors":"Cathy Woods, Maoliosa Donald, Selina Allu, Michelle Hampson, Cynthia MacDonald, Heather Harris, Malcolm King, James Scholey, Adeera Levin, Matthew T James","doi":"10.1177/20543581251333206","DOIUrl":"https://doi.org/10.1177/20543581251333206","url":null,"abstract":"","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251333206"},"PeriodicalIF":1.6,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12032431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ambulance Service Utilization by Kidney Transplant Recipients.","authors":"Kaveh Masoumi-Ravandi, Amanda Vinson, Aran Thanamayooran, Judah Goldstein, Thomas Skinner, Karthik Tennankore","doi":"10.1177/20543581251324587","DOIUrl":"10.1177/20543581251324587","url":null,"abstract":"<p><strong>Background: </strong>Compared with the general population, kidney transplant recipients (KTRs) frequently visit the emergency department (ED), but much less is known about the characteristics of ED presentations requiring ambulance transport and the impact on subsequent outcomes for KTRs.</p><p><strong>Objectives: </strong>To identify predictors of ambulance transport to the ED (ambulance-ED) and outcomes (graft failure and mortality) for those who experienced an ambulance-ED event in a cohort of KTRs.</p><p><strong>Design: </strong>Retrospective cohort study of incident, adult KTRs receiving a transplant from 2008 to 2020.</p><p><strong>Setting: </strong>Nova Scotia, Canada.</p><p><strong>Patients: </strong>Adult (≥18 years), Nova Scotian KTRs affiliated with the Atlantic Canada Multi-Organ Transplant Program.</p><p><strong>Measurements: </strong>Ambulance-ED events were captured for all transplant recipients (following the day of discharge from their initial transplant admission) using electronic records (provided by Emergency Health Services, the sole provider of emergency medical services for Nova Scotia). Ambulance-ED was defined as ambulance transport to the ED following a 911 call; interfacility transfers were excluded. Predictors of ambulance-ED included recipient, donor, immunological, and perioperative characteristics (pertaining to the initial admission for kidney transplantation). Outcomes included graft failure and mortality.</p><p><strong>Methods: </strong>Predictors of ambulance-ED were analyzed using a multivariable negative binomial regression model and reported using incidence rate ratios (IRRs) and 95% confidence intervals (CIs). The risk of death/graft failure for those with an ambulance-ED within 30 days of hospital discharge following transplantation was analyzed using an adjusted Cox survival analysis and reported using hazard ratios (HRs) and 95% CIs.</p><p><strong>Results: </strong>A total of 418 patients received a transplant during the study period. A total of 179 (42.8%) experienced one or more ambulance-ED events. Female sex (IRR = 1.60; 95% CI = 1.12-2.29), kidney failure secondary to diabetes (IRR = 2.52; 95% CI = 1.19-5.31), and donor age ≥45 (IRR = 1.50; 95% CI = 1.04-2.15) were all associated with ambulance-ED. There was no significant increase in the risk of death/graft failure for those that experienced ambulance-ED within 30 days of hospital discharge following transplantation (HR = 1.31; 95% CI = 0.44-3.94).</p><p><strong>Limitations: </strong>A limitation of this study was that ambulance-ED is not a perfect surrogate marker of acute care needs in a population. Important determinants of health such as living situation and socioeconomic status were not available in this data set.</p><p><strong>Conclusions: </strong>This study highlights the burden of ambulance use for KTRs and provides insight into the need for more optimal follow-up in certain patient subgroups who are at particularly high risk.</p","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251324587"},"PeriodicalIF":1.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794697","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 Caregiver Perceptions on the Allocation Process and Waitlist, and Accepting a Less-Than-Ideal Kidney: A Canadian Survey.","authors":"Marie-Chantal Fortin, Fabian Ballesteros Gallego, Héloise Cardinal, Manpreet Kaur, Rahul Mainra, Sylvain Patoine, Nicola Rosaasen, Holly Mansell","doi":"10.1177/20543581251324608","DOIUrl":"10.1177/20543581251324608","url":null,"abstract":"<p><strong>Background: </strong>Transplanting less-than-ideal (LTI) kidneys could help optimize organ utilization, but little is known about how patients and caregivers perceive the allocation process, waitlist, or LTI kidneys.</p><p><strong>Objective: </strong>To explore the perspectives of patients and caregivers on the Canadian kidney transplant allocation process, waitlist, and LTI kidneys.</p><p><strong>Design: </strong>Electronic survey.</p><p><strong>Setting: </strong>Canada.</p><p><strong>Patients: </strong>Transplant recipients, candidates, and caregivers.</p><p><strong>Methods: </strong>A bilingual electronic national survey was administered from January to March 2024. The questionnaire contained sections on demographics, perceptions of organ allocation and acceptance, LTI kidneys, and educational preferences. Descriptive analysis was performed.</p><p><strong>Results: </strong>Two hundred fifty-one responses were analyzed, including patients (63%, n = 159), and caregivers (37%, n = 92), from 11 provinces and territories. Three-quarters (74%, n = 186) understood how patients are placed on the waiting list, and 65% (n = 162) understood how donor kidneys are allocated, but 72% (n = 181) and 68% (n = 171) wanted more information about the waitlist and donor kidney allocation criteria, respectively. Approximately 20% felt that the waitlist and allocation processes were not transparent. Awareness about the option to refuse a deceased donor kidney offer was high (69%, n = 174), yet nearly half of respondents (46%, n = 115) expressed concern about being disadvantaged if an offer for a deceased donor kidney was refused. One-third of participants (33%, n = 83) were open to accepting an LTI kidney.</p><p><strong>Limitations: </strong>Compared to the general population, more study participants were white, and the majority were educated and financially at ease. This limits the generalizability of the results.</p><p><strong>Conclusion: </strong>Enhanced communication is required to improve transparency and information about the allocation system and waitlist in Canada.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251324608"},"PeriodicalIF":1.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11967212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779221","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 Flow of Living Kidney Donor Candidates Through the Evaluation Process: A Single-Center Experience in Ontario, Canada.","authors":"Steven Habbous, Beth Montesi, Christy Masse, Corinne Weernink, Sisira Sarma, Mehmet A Begen, Ngan N Lam, Christine Dipchand, Seychelle Yohanna, Dervla M Connaughton, Lianne Barnieh, Amit X Garg","doi":"10.1177/20543581251323964","DOIUrl":"10.1177/20543581251323964","url":null,"abstract":"<p><strong>Introduction: </strong>Tracking the evaluation process of living kidney donor candidates facilitates benchmarking and can inform process redesign to improve experiences with the evaluation and enable more living donor kidney transplantation.</p><p><strong>Methods: </strong>We reviewed the medical records for all living donor candidates who were actively undergoing evaluation at any time between January 1, 2013, and December 31, 2016, at the London Health Sciences Centre in London, Ontario, Canada. We abstracted information on demographic factors, the evaluation process, reasons for a delayed evaluation, reasons for an evaluation termination (eg, donation, decline, withdrawal, loss to follow-up), frequency and timing of evaluation testing, and recipient dialysis status.</p><p><strong>Results: </strong>Over time, the number of living donor kidney transplants increased from 22 in 2013 to 32 in 2016 (18% and 34% of which were pre-emptive, respectively). The median number of candidates coming forward doubled from 167 in 2013 (2 candidates per recipient) to 348 in 2016 (4 candidates per recipient). Median time from first contact until donation decreased from 12.8 months in 2013 to 7.1 months in 2016 (a 45% reduction). The time from computed tomography (CT) angiography until donation (n = 74) was a median of 75 (interquartile range [IQR] = 36, 180) days, the longest single step in the evaluation. Common reasons for delay included waiting for the referral of their intended recipient for transplant evaluation (11% of candidates) and a need for the donor candidate to lose weight (8% of candidates). Donors completed the main evaluation tests on a median of 5 different dates. Thirty-six recipients started dialysis after their living donor candidates' evaluation had been underway for at least 3 months.</p><p><strong>Conclusion: </strong>Tracking the steps and reasons for an inefficient living kidney donor evaluation process can be used for quality improvement, and efficiency improvements are expected to translate into improved outcomes and experiences.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251323964"},"PeriodicalIF":1.6,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763055","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":"Testicular Pain After Living Kidney Donation: Results From a Multicenter Cohort Study.","authors":"Amit X Garg, Liane S Feldman, Jessica M Sontrop, Meaghan S Cuerden, Jennifer B Arnold, Neil Boudville, Martin Karpinski, Scott Klarenbach, Greg Knoll, Charmaine E Lok, Eric McArthur, Matthew Miller, Mauricio Monroy-Cuadros, Kyla L Naylor, G V Ramesh Prasad, Leroy Storsley, Christopher Nguan","doi":"10.1177/20543581251324610","DOIUrl":"10.1177/20543581251324610","url":null,"abstract":"<p><strong>Background: </strong>Some men who donate a kidney have reported testicular pain after donation; however, attribution to donation is not clear as no prior studies included a comparison group of nondonors.</p><p><strong>Objective: </strong>To examine the proportion of male donors who reported testicular pain in the years after nephrectomy compared to male nondonors with similar baseline health characteristics.</p><p><strong>Design participants and setting: </strong>We enrolled 1042 living kidney donors (351 male) before nephrectomy from 17 transplant centers (12 in Canada and 5 in Australia) from 2004 to 2014. A concurrent sample of 396 nondonors (126 male) was enrolled. Follow-up occurred until November 2021.</p><p><strong>Measurements: </strong>Donors and nondonors completed the same schedule of measurements at baseline (before nephrectomy) and follow-up. During follow-up, participants completed a questionnaire asking whether they had experienced new pain in their eyes, hands, or testicles; those who experienced pain were asked to indicate on which side of the body the pain occurred (left or right). The pain questionnaire was completed by 290 of 351 male donors (83%) and 97 of 126 male nondonors (77%) a median of 3 years after baseline (interquartile range = 2-6).</p><p><strong>Methods: </strong>Inverse probability of treatment weighting on a propensity score was used to balance donors and nondonors on baseline characteristics. After weighting, the nondonor sample increased to a pseudo sample of 295, and most baseline characteristics were similar between donors and nondonors.</p><p><strong>Results: </strong>At baseline, donors (n = 290) were a mean age of 49 years; 83% were employed, and 80% were married; 246 (84.8%) underwent laparoscopic surgery and 44 (15.2%) open surgery; 253 (87.2%) had a left-sided nephrectomy and 37 (12.8%) a right-sided nephrectomy. In the weighted analysis, the risk of testicular pain was significantly greater among donors than nondonors: 51/290 (17.6%) vs 7/295 (2.3%); weighted risk ratio, 7.8 (95% confidence interval [CI] = 2.7 to 22.8). Donors and nondonors did not differ statistically in terms of self-reported eye pain or hand pain. Among donors, the occurrence of testicular pain was most often unilateral (92.2%) and on the same side as the nephrectomy (90.2%). Testicular pain occurred more often in donors who had laparoscopic vs open surgery: 48/246 (19.5%) vs 3/44 (6.8%) but was similar in those who had a left-sided vs right-sided nephrectomy: 44/253 (17.4%) vs 7/37 (18.9%).</p><p><strong>Limitations: </strong>Participants recalled their symptoms several years after baseline, and we did not assess the timing, severity, or duration of pain or any treatments received for the pain.</p><p><strong>Conclusion: </strong>Unilateral testicular pain on the same side of a nephrectomy is a potential complication of living kidney donation that warrants further investigation.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251324610"},"PeriodicalIF":1.6,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751256","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":"Clinical Outcomes and Healthcare Utilization in Patients Receiving Maintenance Dialysis After the Onset of the COVID-19 Pandemic in Ontario, Canada.","authors":"Kyla L Naylor, Nivethika Jeyakumar, Yuguang Kang, Stephanie N Dixon, Amit X Garg, Ahmed Al-Jaishi, Peter G Blake, Rahul Chanchlani, Longdi Fu, Ziv Harel, Jane Ip, Ahbijat Kitchlu, Jeffrey C Kwong, Gihad Nesrallah, Matthew J Oliver, Therese A Stukel, Ron Wald, Matthew Weir, Kevin Yau","doi":"10.1177/20543581251328077","DOIUrl":"10.1177/20543581251328077","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The impact of the COVID-19 pandemic on clinical outcomes and healthcare utilization in patients receiving maintenance dialysis is unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare the rates of clinical outcomes and healthcare utilization in patients receiving maintenance dialysis (in-center and home modalities) before and during the COVID-19 pandemic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Population-based, repeated cross-sectional study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Linked administrative healthcare databases from Ontario, Canada.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Adults receiving maintenance dialysis from March 15, 2017, to March 14, 2020 (pre-COVID-19 pandemic period) and from March 15, 2020, to March 14, 2023 (COVID-19 pandemic period).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;Our primary outcome was all-cause mortality. Our secondary outcomes included non-COVID-19-related mortality, all-cause hospitalizations (excluding elective surgeries), emergency room visits, intensive care unit admissions, and hospital admissions with mechanical ventilation. We also examined cardiovascular-related hospitalizations, kidney-related outcomes, and ambulatory visits.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used Poisson generalized estimating equations to model pre-COVID outcome trends and used these to predict post-COVID outcomes and to estimate the relative change (i.e., the ratio of the observed to the expected rate).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In 31 900 individuals receiving maintenance dialysis during the study period, the crude incidence rate (per 1000 person-years) of all-cause mortality was 165.0 in the pre-COVID-19 period, compared to 173.2 during the first year of the pandemic and 171.7 during the first 36 months of the pandemic. After adjustment, there was a statistically significant increase in all-cause mortality in 14 out of the 36 months of the COVID-19 period compared to the pre-COVID-19 period, with 494 recorded COVID-19-related deaths. However, when examining the overall all-cause mortality across the months, the adjusted relative rate (aRR) comparing the observed to expected all-cause mortality rate was not statistically significant in the first year of the pandemic (1.08, 95% CI: 1.00, 1.16) and the first 36 months of the pandemic (1.08, 95% CI: 0.99, 1.18) compared to the pre-pandemic period. The crude incidence rate of non-COVID-19-related mortality was 165.0 in the pre-COVID-19 period, compared to 163.3 during the first year of the pandemic and 157.7 during the first 36 months. After adjustment, there was no substantial change in the rate of non-COVID-19-related deaths in the first year of the pandemic (aRR 1.01, 95% CI: 0.94, 1.09), but there was a substantial decrease in all-cause hospitalization, with an aRR of 0.92 (95% CI: 0.88, 0.97), and a substantial decrease in emergency room visits and intensive care unit admissions; findings were consistent 36 months into the pandemic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/str","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251328077"},"PeriodicalIF":1.6,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751255","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":"Defining Referral for a Kidney Transplant Evaluation as a Quality Indicator: A Population-Based Cohort Study.","authors":"Kyla L Naylor, S Joseph Kim, Bin Luo, Carol Wang, Amit X Garg, Seychelle Yohanna, Darin Treleaven, Susan McKenzie, Jane Ip, Rebecca Cooper, Nadiyah Rehman, Gregory Knoll","doi":"10.1177/20543581251317009","DOIUrl":"10.1177/20543581251317009","url":null,"abstract":"<p><strong>Background: </strong>Quality indicators are required to identify gaps in care and to improve equitable access to kidney transplants. Referral to a transplant center for an evaluation is the first step toward receiving a kidney transplant, yet widespread reporting on this metric is lacking.</p><p><strong>Objective: </strong>The objective was to use administrative health care databases to examine multiple ways to define referral for a kidney transplant evaluation by varying clinical inclusion criteria, definitions for end of follow-up, and statistical methodologies.</p><p><strong>Design: </strong>This is a population-based cohort study.</p><p><strong>Setting: </strong>This study linked administrative health care databases in Ontario, Canada.</p><p><strong>Patients: </strong>Adults from Ontario, Canada, with advanced chronic kidney disease (CKD) between April 1, 2017, and March 31, 2018.</p><p><strong>Measurements: </strong>The primary outcome was the 1-year cumulative incidence of kidney transplant referral.</p><p><strong>Methods: </strong>We created several patient cohort definitions, varying patient transplant eligibility by health status (eg, whether patients had a recorded contraindication to transplant). We presented results by advanced CKD status (ie, patients approaching the need for dialysis vs receiving maintenance dialysis) and by method of cohort entry (ie, incident only vs prevalent and incident patients combined), resulting in 12 unique cohorts.</p><p><strong>Results: </strong>Sample size varied substantially from 414 to 4128 depending on the patient cohort definition, with the largest reduction in cohort size occurring when we restricted to a \"healthy\" (eg, no evidence of cardiovascular disease) group of patients. The 1-year cumulative incidence of transplant referral varied widely across cohorts. For example, in the incident maintenance dialysis population, the cumulative incidence varied more than 2-fold from 16.3% (95% confidence interval [CI] = 15.0%-17.7%) using our most inclusive cohort definition to 40.0% (95% CI = 36.0%-44.5%) using our most restrictive \"healthy\" cohort of patients.</p><p><strong>Limitations: </strong>Administrative data may have misclassified individuals' eligibility for kidney transplant.</p><p><strong>Conclusions: </strong>These results can be used by jurisdictions to measure transplant referral, a necessary step in kidney transplantation that is not equitable for all patients. Adoption of these indicators should drive quality improvement efforts that increase the number of patients referred for transplantation and ensure equitable access for all patient groups.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251317009"},"PeriodicalIF":1.6,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718102","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}