Canadian Journal of Kidney Health and Disease最新文献

{"title":"The \"Real-World\" Effect of Anti-hyperglycemic Drugs on the Development of Chronic Kidney Disease in a Retrospective Cohort of Patients With Incident Diabetes: A Research Letter.","authors":"Anita Dahiya, Ming Ye, Jennifer E Vena, Grace Shen Tu, Jeffrey A Johnson, Dean T Eurich","doi":"10.1177/20543581251365364","DOIUrl":"10.1177/20543581251365364","url":null,"abstract":"<p><p>Recent clinical trials suggest benefit of anti-hyperglycemic drugs on kidney outcomes. However, there is a paucity of information available on the real-world impact.We aimed to study the real-world impact of anti-hyperglycemic drugs (metformin, sodium-glucose cotransporter-2 (SGLT-2) inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors, and glucagon-like peptide-1receptor (GLP-1R) agonists) using a cohort of patients with incident diabetes derived from the Alberta Tomorrow Project (ATP) database. A retrospective cohort was created from the ATP database using administrative data from October 1, 2000, to March 31, 2021. We examined the effect of anti-hyperglycemic medications including metformin (as a control), SGLT-2 inhibitors, DPP-4 inhibitors, and GLP-1R agonists on a composite kidney outcome including chronic kidney disease, kidney failure, dialysis, kidney transplant, and kidney-related death using a Cox-regression analysis. The study included 3001 patients with an incident diagnosis of diabetes. The average follow-up was 6.7 ± 4.6 years after diagnosis, and 628 (20.9%) patients reached the composite outcome with a mean of 5.6 ± 4.2 years to the first event. A total of 1749 (58.8%) patients were on metformin, 360 (12.0%) on SGLT-2 inhibitors, 313 (10.4%) on DPP-4 inhibitors, and 188 (6.3%) on GLP-1R agonists. Only the patients prescribed SGLT-2 inhibitors had a significant reduction in the composite outcome (hazard ratio (HR) 0.23, 95% CI 0.09-0.62, <i>P</i>-value = .003), and a dose-related effect was observed. Our study has shown that SGLT-2 inhibitors result in significant reduction of composite kidney outcomes, including chronic kidney disease, suggesting a renally protective effect over long term.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251365364"},"PeriodicalIF":1.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943901","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 KRESCENT 2.0 Health Research Training Platform Application Process: Program Report.","authors":"Veronica Kaye, Tarrah Wood, Jennifer Klein, Leanne Stalker, R Todd Alexander, Adeera Levin, Sunny Hartwig","doi":"10.1177/20543581251364309","DOIUrl":"10.1177/20543581251364309","url":null,"abstract":"<p><strong>Purpose of program: </strong>The Kidney Research Scientist Core Education and National Training Program (KRESCENT) was launched in 2005 to enhance kidney research capacity in Canada and foster knowledge translation across the 4 pillars of health research. This program report describes the pan-Canadian KRESCENT 2.0 Health Research Training Platform (HRTP) application process that was awarded a 5-year grant through the pilot Canadian Institutes of Health Research (CIHR) HRTP program, ensuring continuation of this capacity-building program in Canada.</p><p><strong>Sources of information: </strong>Grant application documents including meeting minutes, break out group summaries and recommendations, and Gantt timeline charts. Other resources included websites and journal articles.</p><p><strong>Methods: </strong>All application-related documents were reviewed. Clarification of process and timelines was provided through interviews with the Nominated Principal Applicant (NPA) Dr R. Todd Alexander, Principal Applicants (PAs) Drs Adeera Levin and Sunny Hartwig, Project Manager (PM) Dr Jenn Klein, members of the Patient Community Advisory Network (PCAN), and the Kidney Foundation of Canada Program (KFoC) Manager Ms. Julie Wysocki via in-person and virtual meetings as well as email correspondence.</p><p><strong>Key findings: </strong>The KRESCENT 2.0 HRTP application represents a 6-month pan-Canadian effort spearheaded by the NPA and a pan-Canadian team of PAs spanning multiple jurisdictions, disciplines, and sectors. Early engagement of stakeholders in the Canadian kidney research community, outstanding PM administrative support from the onset of the application process were identified as pivotal for the success of the application. Other essential factors for success included graphic design assistance to effectively communicate key and complex concepts, appointment of an EDI champion, engagement with a diverse group of collaborators, and strategic collaboration with other HRTP grant applicants to navigate the ambiguities of the pilot HRTP call. Indispensable, scrupulous final review of the complete application package was generously provided by Dr Robert Quinn (University of Alberta) prior to final grant submission to CIHR.</p><p><strong>Limitations: </strong>Unlike other funded HRTP applicants, KRESCENT is an established kidney training platform for a small cohort of trainees. Our results may not generalize well to HRTPs with large group cohorts or newly established HRTPs.</p><p><strong>Implications: </strong>This program report may provide valuable guidance for other groups seeking to successfully navigate the CIHR HRTP application process.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251364309"},"PeriodicalIF":1.5,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943973","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":"A Gap Analysis to Assess the Implementation of Environmentally Sustainable Kidney Care Strategies in Canada.","authors":"Isabelle Ethier, Shaifali Sandal, Ahmad Raed Tarakji, Bhavneet Kahlon, Ratna Samanta, Caroline Stigant","doi":"10.1177/20543581251365337","DOIUrl":"10.1177/20543581251365337","url":null,"abstract":"<p><strong>Background: </strong>There is growing interest in the nephrology community for environmentally sustainable kidney care (ESKC) to alleviate the environmental impact of kidney care services.</p><p><strong>Objective: </strong>This study aimed to assess the knowledge of Canadian kidney care providers regarding their program's ESKC strategies.</p><p><strong>Design setting participants measurements and methods: </strong>An electronic survey, created by the Canadian Society of Nephrology-Sustainable Nephrology Action Planning committee, was distributed to Canadian kidney care providers.</p><p><strong>Results: </strong>A total of 421 Canadian kidney care providers responded to the survey. Various degrees of implementation of ESKC practices across the country were reported, with higher proportions of respondents reporting the use of strategies related to medication stewardship, clinical care consumables, virtual care options, office consumables, office equipment, and general waste management. It also highlighted the lack of knowledge of kidney care providers about many areas related to ESKC practices, such as energy sourcing, reverse osmosis reject water savings, procurement and product sourcing, as well as policies within the kidney program and contact with environmentally sustainable officers. Knowledge of respondents about certain strategies was also dependent on their role within the unit (eg, nephrologist vs nurse vs management), with nephrologists being relatively more aware of strategies that directly involve them, such as medication stewardship. Finally, variation across provinces was noted in terms of the incorporation of climate change adaptation or preparedness and environmental planning strategies.</p><p><strong>Limitations: </strong>The overrepresentation of people working in academic centers, as well as those from Quebec and British Columbia, may affect the generalizability of results. As respondents may be affiliated with the same units, results reflect knowledge of the individuals regarding the strategies, rather than the presence or implementation of such strategies across units.</p><p><strong>Conclusions: </strong>The ESKC practices from various domains are incorporated at different levels across the country, and there are important gaps in providers' awareness of such strategies, depending on their role within the unit.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251365337"},"PeriodicalIF":1.5,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144943981","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":"Cardiometabolic Biomarkers and Prediction of Kidney Disease Progression: The eGFR Cohort Study.","authors":"Elizabeth L M Barr, Federica Barzi, Phillip Mills Kulkalgal, Maria Nickels, Sian Graham, Odette Pearson, Varuni Obeyesekere, Wendy E Hoy, Graham R D Jones, Paul D Lawton, Alex D H Brown, Mark Thomas, Ashim Sinha, Alan Cass, Richard J MacIsaac, Louise J Maple-Brown, Jaquelyne T Hughes Wagadagam","doi":"10.1177/20543581251363126","DOIUrl":"10.1177/20543581251363126","url":null,"abstract":"<p><strong>Background: </strong>Traditional markers modestly predict chronic kidney disease progression in Aboriginal and Torres Strait Islander people. Therefore, we assessed associations of cardiometabolic and inflammatory clinical biomarkers with kidney disease progression among Aboriginal and Torres Strait Islander people with and without diabetes.</p><p><strong>Objectives: </strong>To identify cardiometabolic and inflammatory clinical biomarkers that predict kidney disease progression in Aboriginal and Torres Strait Islander people.</p><p><strong>Design: </strong>Prospective observational cohort study.</p><p><strong>Setting: </strong>Northern Territory, Australia.</p><p><strong>Participants: </strong>Aboriginal and Torres Strait Islander participants of the estimated glomerular filtration rate (eGFR) study with (n = 218) and without diabetes (n = 278).</p><p><strong>Measurements: </strong>Baseline biomarkers (expressed as 1 standard deviation increase in logarithmic scale), plasma kidney injury molecule-1 (pKIM-1) (pg/ml), high-sensitivity troponin-T (hs-TnT) (ng/L), troponin-I (hs-TnI) (ng/L), and soluble tumor necrosis factor receptor-1 (sTNFR-1) (pg/ml) were assessed in 496 adults. Annual change in eGFR (ml/min/1.73 m²) and a composite kidney outcome (first of ≥30% eGFR decline with follow-up eGFR <60 ml/min/1.73 m², initiation of kidney replacement therapy or kidney disease-related death) over a median of 3 years.</p><p><strong>Methods: </strong>Linear regression estimated annual change in eGFR (ml/min/1.73 m²). Cox proportional hazards regression estimated hazard ratio (HR) and 95% CI for developing a combined kidney health outcome.</p><p><strong>Results: </strong>In individuals with diabetes, but not those without diabetes, higher baseline hs-TnT (-2.1 [-4.1 to -0.2], <i>P</i> = .033) and sTNFR-1 (-1.8 [-3.5 to -0.1], <i>P</i> = .039) predicted mean (95% CI) eGFR change, after adjusting for age, gender, baseline eGFR, and urinary albumin-to-creatinine ratio. Baseline variables explained 11% of eGFR decline variance; increasing to 27% (<i>P</i> < .001) with biomarkers. In diabetes, hs-TnT and hs-TnI were significantly associated with increased risk of kidney health outcomes.</p><p><strong>Limitations: </strong>Limitations included potential chronic kidney disease misclassification from single creatinine and albumin measurements, limited adjustment for covariates due to a small sample size, and short follow-up restricting long-term outcome assessment.</p><p><strong>Conclusions: </strong>Cardiovascular, kidney, and inflammatory biomarkers are likely associated with kidney function loss in diabetes, with particularly prominent associations for cardiac injury markers.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251363126"},"PeriodicalIF":1.5,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12358709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882246","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":"Building Resilience in Hemodialysis Care: A Program Report on the British Columbia Hemodialysis Emergency Support Team.","authors":"Sarah Thomas","doi":"10.1177/20543581251363124","DOIUrl":"10.1177/20543581251363124","url":null,"abstract":"<p><p>This program report describes the development and implementation of the Hemodialysis Emergency Support Team (HEST) in British Columbia, an initiative led by BC Renal in partnership with the province's 5 health authorities. The HEST was created in response to the growing risk of climate-related emergencies such as wildfires, floods, and water shortages, with the goal of ensuring continuity of care for patients receiving maintenance dialysis during service disruptions. The report outlines the provincial strategy behind HEST, including capacity building during non-emergency periods, strengthening of routine operations, and insights gained through simulation-based evaluations. Key outcomes include the achievement of provincial consensus, development of standardized staffing models, integration with existing emergency response frameworks, and the creation of rapid mobilization protocols. Beyond emergency response, HEST nurses also serve as mentors and clinical resources during non-emergency times, supporting local teams, sharing best practices, and helping build capacity within the hemodialysis unit. This dual role contributes to both emergency preparedness and long-term workforce sustainability.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251363124"},"PeriodicalIF":1.5,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12358702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144882245","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":"Mortality and Graft Failure With Medical Management Alone Versus Revascularization After Coronary Angiography Among Kidney Transplant Recipients: A Population-Based Study.","authors":"Labib I Faruque, Robert R Quinn, Pietro Ravani, Tyrone G Harrison, Brenda Hemmelgarn, Stephen Wilton, Alix Clarke, Matthew T James, Ngan N Lam","doi":"10.1177/20543581251358143","DOIUrl":"10.1177/20543581251358143","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;There are limited data on the outcomes following medical management alone versus revascularization (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]) after coronary angiography in kidney transplant recipients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective was to compare survival and graft loss in kidney transplant recipients treated with medical therapy alone versus coronary revascularization following coronary angiography.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;We conducted a retrospective, population-based cohort study using linked health care databases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;This study was conducted in Alberta, Canada.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;We included adult, kidney-only transplant recipients between January 1997 and March 2015 who survived at least 1-year post-transplant with a functioning graft and had a coronary angiography during follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;The outcomes were all-cause mortality, death-censored graft failure, death with a functioning graft, and all-cause graft failure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We ascertained baseline characteristics, covariate information, and outcome data from the Alberta Kidney Disease Network (AKDN) and Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) databases. We used Cox proportional hazards models to compare mortality and graft loss between recipients treated with medical management versus revascularization (PCI or CABG) following angiography.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We identified 142 kidney transplant recipients who received a coronary angiography: 69 (49%) were treated with medical management, and 73 (51%) were treated with revascularization (PCI n = 52, CABG n = 21). The median age was 60 years (interquartile range [IQR] 50-66), 76% were male, the median baseline estimated glomerular filtration rate (eGFR) was 54 mL/min/1.73 m&lt;sup&gt;2&lt;/sup&gt; (IQR 41-69), and the median follow-up was 5 years (IQR 2-8). Compared to medical management, recipients treated with revascularization did not have statistically higher risk of all-cause mortality (55% vs 62%; 80 vs 102 events/1000 person-years; adjusted hazard ratio [aHR] 1.32, 95% CI 0.86-2.02; &lt;i&gt;P&lt;/i&gt; = .21). There was no significant difference in death-censored graft failure between the two treatment groups (20% vs 22%; 33 vs 40 events/1000 person-years; aHR 1.22, 95% CI 0.58-2.58; &lt;i&gt;P&lt;/i&gt; = .60).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The clinical indications for medical management alone versus revascularization might influence the choice of these interventions. Due to the smaller sample size, we could not present the outcomes by PCI versus CABG. We also did not have complete data on blood pressure, body mass index, or medication usage which might have influenced our outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In kidney transplant recipients undergoing coronary angiography, the rate of mortality was more t","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251358143"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12319199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783576","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 Effect of Dialysate Bicarbonate Concentration or Oral Bicarbonate Supplementation on Outcomes in Patients on Maintenance Dialysis: A Systematic Review and Meta-Analysis.","authors":"Ashlee M Azizudin, Samuel A Silver, Amit X Garg, Zoe K Friedman, Andrea C Cowan, Catherine M Clase, Amber O Molnar","doi":"10.1177/20543581251356182","DOIUrl":"10.1177/20543581251356182","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Metabolic acidosis is a common complication of kidney failure that is treated with bicarbonate supplementation. The addition of bicarbonate to the dialysis solution and oral bicarbonate supplementation are used to treat metabolic acidosis in patients receiving dialysis, but the treatment approach that is best for patient health remains unknown.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The purpose of this study was to determine whether the concentration of dialysate bicarbonate or the use of oral bicarbonate supplementation alters the risk of mortality, hospitalizations, cardiovascular and nutritional outcomes, and laboratory measurements in patients treated with maintenance dialysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Systematic review and meta-analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Any country of origin.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Adult patients (≥18 years) receiving maintenance dialysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;Extracted data included demographic characteristics and outcomes such as mortality, hospitalizations, cardiovascular events, surrogate markers of nutrition, and pre-dialysis and post-dialysis levels of serum bicarbonate, pH, calcium, potassium, and parathyroid hormone.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We searched MEDLINE, Embase, CENTRAL, and Google Scholar through October 7, 2024 for studies examining dialysate bicarbonate concentration and/or oral bicarbonate supplementation in adults undergoing maintenance dialysis. Meta-analysis was performed for pre-dialysis serum bicarbonate and for pre-dialysis and post-dialysis calcium and potassium.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We identified 37 studies (n = 24,782 patients) with patients treated with hemodialysis (13 randomized trials, 10 non-randomized interventional studies, 14 observational studies) and 4 studies (n = 347 patients) with patients receiving peritoneal dialysis (3 randomized trials, 1 non-randomized interventional study). No randomized trials reported mortality or hospitalizations in hemodialysis patients. Studies reporting cardiovascular outcomes (n = 20) were small with inconsistent results. Most studies reporting nutritional outcomes (n = 21) reported no significant differences with dialysate bicarbonate concentration or oral bicarbonate supplementation but were small in sample size (largest study n = 200). Meta-analysis of parallel-group randomized trials comparing dialysate bicarbonate &gt;35 mmol/L with ≤35 mmol/L found a mean difference of 3.5 mmol/L (95% confidence interval [CI] -0.6 to 7.7) in pre-dialysis serum bicarbonate.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Non-English and gray literature were excluded. Most studies were small or observational in nature, and heterogeneity further limited the ability to perform meta-analysis of outcomes such as mortality, hospitalizations, and cardiovascular outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The evidence for the effect of higher vs lower dialysate bicarbonate concentration and oral","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251356182"},"PeriodicalIF":1.5,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774724","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":"Frequency, Management, and Outcomes of Outpatient Hyperkalemia: A Population-Based Cohort Study.","authors":"Michael Chiu, Nivethika Jeyakumar, Graham Smith, Danielle M Nash, Mohamed Abou El Hassan, Dana Bailey, Peter Catomaris, Kika Veljkovic, Louise Moist, Amit X Garg, Arsh K Jain","doi":"10.1177/20543581251356568","DOIUrl":"10.1177/20543581251356568","url":null,"abstract":"<p><strong>Background: </strong>Hyperkalemia is a potentially life-threatening condition, with guidelines recommending urgent treatment when the serum potassium level is greater than 6.0 mmol/L. However, these recommendations are inconsistent, leading to diverse approaches to patient care.</p><p><strong>Objectives: </strong>The primary objectives were to use population-based datasets to determine how often outpatient hyperkalemia (K > 6.2 mmol/L) occurs and how frequently patients present to the emergency department (ED) within 24 hours of the hyperkalemia report. Secondary objectives were to compare the characteristics of patients who had an ED encounter to those who did not, assess clinical outcomes within 7 days of the hyperkalemia report, and describe the initial potassium result within 24 hours of an ED encounter.</p><p><strong>Design: </strong>Retrospective cohort study using linked population-based datasets at ICES.</p><p><strong>Setting: </strong>Ontario, Canada from January 1, 2007, to December 24, 2021.</p><p><strong>Patients: </strong>Adult patients (≥18 years) not on dialysis with an outpatient hyperkalemia result >6.2 mmol/L who were identified through flagged and urgently communicated results from outpatient laboratories.</p><p><strong>Measurements: </strong>Emergency department encounters within 24 hours following an outpatient serum potassium report >6.2 mmol/L. Outcomes included all-cause mortality, cardiovascular mortality, arrhythmias, cardiac arrest in the ED, hospitalizations, and new dialysis starts within 7 days of the hyperkalemia report.</p><p><strong>Methods: </strong>Administrative healthcare data were linked with laboratory results to compare baseline characteristics, medication use, healthcare utilization, and clinical outcomes for all patients. Standardized differences were used for comparisons.</p><p><strong>Results: </strong>There were over 65 million serum potassium measurements and 57 607 individuals with an outpatient hyperkalemia value >6.2 mmol/L. Of these, 7469 (13.0%) individuals had an ED encounter within 24 hours. Individuals with an ED encounter had more comorbidities, higher medication use, and more prior healthcare utilization. Within 7 days of the hyperkalemia report, 675 of the 57 607 individuals (1.2%) had died. Where data were available, the first potassium value within 24 hours of an ED encounter was 1.5 mmol/L (± SD 1.3) lower, on average, than the initial outpatient potassium value.</p><p><strong>Limitations: </strong>All-cause mortality may not be attributable to the hyperkalemia result. Sudden cardiac death, which is more specific to hyperkalemia, is not completely captured in our data sources. Data for medications are limited to patients 65 years of age and older.</p><p><strong>Conclusions: </strong>Outpatient hyperkalemia is common. Despite guidelines recommending urgent treatment for patients with serum potassium levels >6.2 mmol/L, most are not referred to the ED.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251356568"},"PeriodicalIF":1.5,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774721","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":"Interventions to Reduce the Risk of Hypocalcemia After Parathyroidectomy for People With Advanced Chronic Kidney Disease: A Systematic Review.","authors":"Adina Landsberg, Nicole K Brockman, Emir Sevinc, Caitlin McClurg, Meghan J Elliott, Louis-Philippe Girard, Matthew T James, Alexander A Leung, Neesh I Pannu, Meghann Pasternak, Paul E Ronksley, Marcello Tonelli, Tyrone G Harrison","doi":"10.1177/20543581251358144","DOIUrl":"10.1177/20543581251358144","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;People with advanced chronic kidney disease (CKD) and secondary hyperparathyroidism (sHPT) refractory to medical therapy often require surgical parathyroidectomy. Severe and prolonged hypocalcemia immediately following parathyroidectomy for sHPT is often termed \"hungry bone syndrome\" (HBS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To systematically review the effect of pre-operative interventions on post-operative hypocalcemia, HBS, and other related outcomes in patients with CKD and sHPT undergoing parathyroidectomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;This is a systematic review study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Diverse study designs conducted in any country.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Adult patients with CKD complicated by sHPT undergoing parathyroidectomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;Post-operative hypocalcemia, HBS, symptomatic hypocalcemia, and other related outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We searched Ovid MEDLINE, Embase, and Cochrane Controlled Trials Registry from inception until June 2024 for trials and observational studies of adults with CKD and sHPT that evaluated pre-operative interventions aimed at reducing the risk of hypocalcemia following parathyroidectomy. After 2 phases of study screening conducted in duplicate, we extracted data on study design, patient characteristics, interventions, and outcomes. Hypocalcemia was defined as serum calcium &lt;2.1 mmol/L and HBS as calcium &lt;2.1 mmol/L for ≥4 days post-operatively. We evaluated the risk of bias and completed a narrative synthesis of the available literature across intervention types.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We identified 3616 studies; 35 underwent full-text review, and 9 met final eligibility criteria. Interventions included pre-operative calcitriol (n = 2), pre-operative cinacalcet (n = 3), pre-operative alkaline phosphatase (ALP) measurement to guide intravenous (IV) calcium administration (n = 3), and pre-operative pamidronate (n = 1). All studies reported on at least one of: median/mean post-operative calcium (n = 7), incidence of post-operative hypocalcemia (n = 3), HBS (n = 1), and symptomatic hypocalcemia (n = 4). Interventions that reported on the risk of post-operative hypocalcemia included pre-operative pamidronate (n = 1, 37 participants, odds ratio [OR] = 0.003, 95% confidence interval [CI] = 0.000-0.072) and IV calcium guided by pre-operative ALP (n = 1, 271 participants, OR = 0.292, 95% CI = 0.175-0.488). There were insufficient data to meta-analyze study-specific effects for any intervention or outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Our study was limited by significant heterogeneity in outcome reporting, which resulted in substantial outcome reporting bias and prevented pooled analyses. Furthermore, no randomized control trials met our inclusion criteria, which limited assessment of publication bias.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Pre-operative risk factors for HBS have been established in patient","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251358144"},"PeriodicalIF":1.5,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12314243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774722","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":"Point-of-Care Ultrasonography and Worsening of Renal Function in Acute Heart Failure: A Cohort Study.","authors":"Guillaume Soret, Antonio Leidi, Alexandre Leszek, Christophe Marti, Sebastian Carballo, Jérôme Stirnemann, Olivier Grosgurin, Jean-Luc Reny, Thomas A Mavrakanas","doi":"10.1177/20543581251328069","DOIUrl":"10.1177/20543581251328069","url":null,"abstract":"<p><strong>Introduction: </strong>The goal of this study was to investigate the association between worsening renal function (WRF) and central venous pressure, right ventricular function, and lung fluid overload assessed by point-of-care ultrasound (POCUS) in hospitalized patients with acute heart failure (AHF).</p><p><strong>Methods: </strong>This was a prospective cohort study including AHF adult inpatients, conducted in Geneva University Hospitals from October 2019 to March 2020. The primary outcome was WRF, defined by an increase in creatinine of ≥1.5 times from baseline value or an increase of ≥0.3 mg/dL between admission and day 4 to 6. Expert ultrasonographers used POCUS to examine lungs, inferior vena cava during spontaneous expiration (IVCe), and tricuspid annular plane systolic excursion (TAPSE) at admission.</p><p><strong>Results: </strong>A total of 43 patients were included in the study. A total of 8 patients (19%) developed WRF during the study period (between October 8, 2019 and March 16, 2020), of whom 4 were in the higher quartile of lung fluid overload, 2 had TAPSE <14 mm, and 4 had IVCe ≥ 21 mm. In uni- and multi-variate logistic regression model, neither admission IVCe nor TAPSE was associated with WRF. However, lung congestion, as assessed by the number of B-lines, was significantly associated with WRF (odds ratio [OR] per quartile = 2.47, 95% confidence interval [CI] = 1.01 to 5.86, <i>P</i> = .04). This result remained statistically significant after adjustment for daily diuretic dose in mg/kg (OR = 2.98, 95% CI = 1.11 to 8.00, <i>P</i> = .03).</p><p><strong>Conclusion: </strong>This study showed that lung congestion as assessed by POCUS was associated with WRF in AHF patients, whereas IVCe and TAPSE were not. Due to the small number of participants, our results need to be prospectively validated in future adequately powered clinical trials.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251328069"},"PeriodicalIF":1.5,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774723","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}