Canadian Journal of Kidney Health and Disease最新文献

{"title":"Perspectives Toward Kidney Transplantation Amongst Individuals With Kidney Failure in Canada: A Qualitative Study.","authors":"Cynthia Kendell, Jad Issa, Bethany Foster, Karthik Tennankore, Amanda J Vinson","doi":"10.1177/20543581261472120","DOIUrl":"https://doi.org/10.1177/20543581261472120","url":null,"abstract":"<p><strong>Introduction: </strong>An understanding of perspectives toward kidney transplant amongst individuals with kidney failure is integral to supporting treatment-related decision-making and preparing for life post-transplant, yet this has not been studied in a Canadian context. Therefore, the objective of this study was to examine the perspectives of individuals with kidney failure in Canada regarding kidney transplant.</p><p><strong>Methods: </strong>Adults (18-75y) from four Canadian provinces who either had initiated dialysis within the prior 6 months or were preemptively referred for kidney transplantation within the prior 3 months were recruited to participate in focus group discussions (FGDs) or individual interviews. Data were analyzed using inductive thematic analysis.</p><p><strong>Results: </strong>Fifteen individuals participated in one of four FGDs (n=13) or a semi-structured interview (n=2). Seven were on dialysis and eight were pre-dialysis (four and six of whom had been referred for transplant, respectively). Overall, participants expressed a clear preference for transplant compared to dialysis. Participants' willingness to consider transplant was influenced by their (1) <i>relationship with the healthcare team</i>, recognition of (2) <i>the necessity of treatment</i>, the (3) <i>potential to live a \"normal\" life</i>, and knowledge of (4) <i>others' experiences with transplant</i>. Despite a preference for transplant, participants expressed (5) <i>concerns regarding securing a living donor</i> and a sense of having (6) <i>a lack of control</i> over the transplant referral process.</p><p><strong>Conclusion: </strong>In this study, we evaluated perceptions towards kidney transplantation amongst individuals with kidney failure in Canada. Understanding potential concerns regarding future transplant may lead to improved patient-centered education, communication and psychosocial support strategies to empower patients to confidently make treatment-related decisions.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261472120"},"PeriodicalIF":1.6,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13469535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757940","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":"Management of BK Polyomavirus in a Kidney Transplant Recipient With Primary Myelofibrosis on JAK-2 Inhibition - A Case Report and Literature Review.","authors":"Laura Bywater, Justin Gill, David Nicholl","doi":"10.1177/20543581261473484","DOIUrl":"10.1177/20543581261473484","url":null,"abstract":"<p><p>The use of Janus Kinase (JAK) inhibitors with concomitant maintenance immunosuppressive therapy (IST) for the solid organ transplant (SOT) population presents significant challenges due to intensified immunosuppression resulting in an increased risk of opportunistic infections and malignancies coupled with limited clinical experience among transplant providers. A 48-year-old man presented with end-stage kidney disease secondary to IgA nephropathy requiring commencement of haemodialysis. He had a concurrent diagnosis of primary myelofibrosis (PMF), which did not require treatment at presentation. A year later, he underwent a living-donor kidney transplant from an HLA-identical sibling. The patient received induction IST with basiliximab and methylprednisolone, followed by standard maintenance therapy with tacrolimus and mycophenolate mofetil. The latter was reduced in dose due to underlying PMF. In the months following transplantation, he experienced worsening PMF parameters and was commenced on the JAK2 inhibitor, ruxolitinib. This was complicated by development of detectable BK Polyomavirus DNA (BKPyV-DNAemia), prompting adjustment of his immunosuppression regimen and dose reduction of ruloxlitinib. His course was further complicated by renal allograft rejection. Ruxolitinib was subsequently discontinued, and he transitioned to the second-generation JAK inhibitor fedratinib, which led to improvement in PMF parameters and stabilization of both graft function and BKPyV-DNAemia. This case highlights the therapeutic challenges inherent in integrating JAK inhibitors into established immunosuppression regimens in solid organ transplantation. It underscores the difficult balance between preserving graft tolerance and mitigating the risk of opportunistic infections such as BKPyV-DNAemia, while emphasising the need for close monitoring of net immunosuppression in this setting.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261473484"},"PeriodicalIF":1.6,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13428116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148653199","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":"Perioperative Care of Kidney Transplant Recipients: A Cross-Sectional Canadian Multidisciplinary Survey.","authors":"Ryan N McGinn, Jaswanth Gorla, Arezou Shahmoradi-Zavareh, Matthanja Bieze, Sonia Rodriguez-Ramirez, Anand Ghanekar, Marc Sicova, S Joseph Kim, Stuart A McCluskey","doi":"10.1177/20543581261474154","DOIUrl":"10.1177/20543581261474154","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The perioperative period is a critical phase for kidney transplantation. Emerging evidence indicates the potential utility of several perioperative strategies to support immediate graft function and patient outcomes. In other countries surveying only anesthesiologists, there is broad variation in the reported routine care for kidney transplant recipients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We sought to describe routine perioperative care for kidney transplant from a multidisciplinary perspective including perioperative clinicians (nephrologists, surgeons and anesthesiologists) caring for kidney transplant recipients in Canada.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;We created an evidence-informed qualitative and quantitative survey of routine perioperative practices using an iterative and collaborative process. The survey was reviewed by our multidisciplinary group and tested by 3 nephrologists, 3 surgeons and 3 anesthesiologists prior to circulation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;After research ethics board approval, an online survey was distributed via e-mail to all Canadian adult kidney transplant centers. Transplant directors were asked by e-mail to distribute the survey to transplant nephrologists, surgeons and anesthesiologists involved in the perioperative care of kidney transplant recipients at their center. Survey responses were collected electronically from January 13, 2025 to April 13, 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;We recorded all answers to our survey questions including multiple choice and free-text responses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We defined agreement as &gt;70% of respondents selecting the same response for a routine perioperative care question. Descriptive statistics were used to describe the variation across disciplines and across transplant centers in Canada.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Respondents included 18 nephrologists, 14 surgeons and 39 anesthesiologists representing all kidney transplant centers in Canada (n=18). We found several areas of agreement including preoperative hemoglobin optimization and transfusion targets, hemodynamic monitoring, immunosuppression and use of preoperative dialysis. Routine care was variable with respect to the use of diuretics, blood pressure targets and intravascular fluid.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;We were unable to link reported routine care practices with patient or graft outcomes. We also are unable to provide consensus recommendations for perioperative care based on this survey study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;We describe perioperative care for kidney transplantation by transplant nephrologists, surgeons and anesthesiologists in Canada. Some elements of care exhibit variation in practice while others show consistency between transplant clinicians and transplant hospitals. These findings identify priority areas of practice variation that may inform the design of future comparative studies and the development of evidence","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261474154"},"PeriodicalIF":1.6,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13408079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599431","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":"Repositioning the Canadian CKD Clinic Network Through Structured Input and World Café Dialogue: A Conference Report.","authors":"Selina Allu, Mila Tang, Monica C Beaulieu, Aminu K Bello, Micheli Bevilacqua, Helen Hoi-Lun Chiu, Kate Chong, Maoliosa Donald, Mark D Elliott, Meghan J Elliott, Manuel Escoto, Isabella Ethier, Janet Graham, Adeera Levin, Judith G Marin, Kelly Picard, Steven D Soroka, Christine A White, Cathy Woods, Tae Won Yi, Matthew T James","doi":"10.1177/20543581261470157","DOIUrl":"10.1177/20543581261470157","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose of program: &lt;/strong&gt;This conference report describes findings from activities to reposition the Canadian Chronic Kidney Disease (CKD) Clinic Network by identifying research priorities and actionable steps aligned with the 2024 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. The initiative aimed to identify priority actions to integrate clinical research and care through collaborative dialogue and community-driven planning.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Sources of information: &lt;/strong&gt;The 2024 KDIGO Clinical Practice Guideline for CKD served as the foundation to assess and prioritize relevant research areas. Insights were gathered through a national survey and a participatory workshop using World Café methodology.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;An anonymized online semi-structured survey was distributed to members of the Canadian CKD Clinic Network from April 4-14, 2025 to assess the perceived relevance and importance of the 2024 KDIGO CKD guideline research recommendations. This was followed by an in-person World Café workshop in May 2025 involving patients, clinicians, researchers, and administrators. Data collection included live graphic recording, table notes, and Post-it reflections, which were thematically analyzed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key findings: &lt;/strong&gt;The survey yielded responses from 80 network members, representing a 24% response rate. Survey results prioritized the need for research on: the impact of newer medications (SGLT2i, non-steroidal mineralocorticoid receptor antagonists) in patients intolerant of ACEi/ARB, implementation science to ensure uptake of proven therapies and symptom management, essential components for transition clinics for young people, tools for health literacy in different populations, strategies to prevent hyperkalemia, impact of medication deprescribing, effects of dietary restriction, and symptom identification, classification, and control. Attendees of the World Café (n=19) identified several network strengths, including its established relationships that drive national collaboration, willingness in knowledge sharing, and inclusion of the patient voice. Feedback emphasized the need for collaborative implementation and context-sensitive application of guidelines. The workshop also aligned the network's future direction with Learning Health System principles, which embed research into routine care delivery, supporting goals with provincial and national CKD strategies, deepening patient engagement, shared measurement tools, and local-to-national learning loops. Actionable steps identified included enhancing visibility through a public-facing website, anchoring activities to sustainable national platforms, and exploring additional partnerships and collaborative research opportunities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Only 24% of the CKD Clinic Network responded to the survey, and 19 members were present at the World Café, reflecting perspectives from only a small portion of the network. Ther","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261470157"},"PeriodicalIF":1.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497125","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":"Long-Term Risk for Scrotal Hydrocelectomy After Laparoscopic Living Donor Nephrectomy: A Population-Based Matched Cohort Study.","authors":"Amit X Garg, Anita Lloyd, Liane S Feldman, Rhiannon Lyons, Eric McArthur, Mauricio Monroy-Cuadros, Kyla L Naylor, Chris Nguan, Robert R Quinn, Pietro Ravani, Alp Sener, Jessica M Sontrop, Carol Wang, Matthew A Weir, Ngan N Lam","doi":"10.1177/20543581261468718","DOIUrl":"10.1177/20543581261468718","url":null,"abstract":"<p><strong>Background: </strong>An underappreciated complication of laparoscopic nephrectomy in male living kidney donors is testicular pain, swelling, and hydrocele development. A recent cohort study in Ontario, Canada, found that male donors had a higher rate of hydrocelectomy (7.7 vs. 0.1 events/1000 person-years) and scrotal ultrasounds (25.6 vs. 6.9 events/1000 person-years) than nondonors, when followed for a median of 9 years.</p><p><strong>Objective: </strong>To conduct a replication study in Alberta, Canada, examining the long-term risk of hydrocelectomy after laparoscopic living donor nephrectomy, comparing male donors to nondonors from the general population matched on baseline health indicators.</p><p><strong>Design: </strong>Population-based matched cohort study using linked healthcare databases.</p><p><strong>Setting: </strong>Alberta, Canada (April 1, 2002, to March 31, 2021).</p><p><strong>Patients: </strong>We matched 115 male kidney donors who underwent a laparoscopic nephrectomy with 1150 nondonors. The matching characteristics were age at cohort entry, date of cohort entry, rural residence, income, prior vasectomy, and prior inguinal hernia repair.</p><p><strong>Measure: </strong>ments: The primary outcome was a hydrocelectomy, and the secondary outcome was receipt of a scrotal ultrasound.</p><p><strong>Methods: </strong>Males were followed for a median of eight years, with a maximum follow-up of 19 years.</p><p><strong>Results: </strong>The rate of hydrocelectomy was higher in donors than in nondonors (3 of 115 [2.6%] vs. 1 of 1150 [0.1%]; 3.3 vs. 0.1 events/1000 person-years; <i>P</i> < 0.001). The rate of scrotal ultrasounds was also higher among donors than among nondonors (23.4 vs. 7.5 events/1000 person-years; <i>P</i> < 0.001).</p><p><strong>Limitations: </strong>A low event rate impeded a precise estimation of the risk of hydrocelectomy attributable to donation.</p><p><strong>Conclusions: </strong>In this population-based cohort study from Alberta, Canada, rates of hydrocelectomy and receipt of a scrotal ultrasound were significantly higher in males who underwent laparoscopic living donor nephrectomy than in male nondonors matched for age and other factors. Males considering living kidney donation should be informed of the risk of developing a symptomatic ipsilateral scrotal hydrocele in the years following laparoscopic nephrectomy.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261468718"},"PeriodicalIF":1.6,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13376493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576990","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":"Evaluation of Anemia Management in a Contemporary Population of Patients With Chronic Kidney Disease in Canada Since the Publication of Target Hemoglobin Trials: A Retrospective Observational Cohort Study.","authors":"Peter Birks, Mark Canney, Ognjenka Djurdjev, Dilshani Induruwage, Mohammad Atiquzzaman, Adeera Levin","doi":"10.1177/20543581261468720","DOIUrl":"10.1177/20543581261468720","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Guidelines for anemia management in chronic kidney disease (CKD) adopted a conservative approach in response to landmark clinical trials demonstrating lack of benefit and potential harm associated with higher hemoglobin targets. Although the findings have been applied to all CKD populations, the concordance between trial populations and those being treated in clinical practice has not been well described.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We sought to evaluate trends in hemoglobin distribution and erythropoiesis stimulating agent (ESA) use among adult patients with CKD, and compare their characteristics to those of participants from landmark hemoglobin target trials.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Retrospective observational cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;A provincial clinical information system was used to identify patients with CKD under the care of a nephrologist in British Columbia between April 1, 2007 and March 31, 2018.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Adult patients (over 18 years) with estimated glomerular filtration rate (eGFR) less than 45 mL/min/1.73m&lt;sup&gt;2&lt;/sup&gt; and a minimum of three hemoglobin values during follow-up. Patients were censored if they left the province, died, or started kidney replacement therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;Hemoglobin was measured in grams per litre (g/L) and treated as both a continuous and categorical variable. ESA use was defined as the proportion of patients who received at least one prescription for ESA therapy. The dose of ESA was quantified as an average monthly dose of epoetin alfa or darbepoetin alfa.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Descriptive statistics were used to compare characteristics of patients in the study population to those of trial participants including Trial to Reduce Cardiovascular Events with Aranesp Therapy (TREAT), Correction of Hemoglobin and Outcomes in Renal Insufficiency (CHOIR), and Cardiovascular Risk Reduction by Early Anemia Treatment with Epoetin Beta trial (CREATE). Polytomous logistic regression was used to estimate odds ratios (OR) of different hemoglobin levels across cohort years. The model was adjusted for age, sex, race, comorbid conditions, eGFR, proteinuria, etiology of CKD and iron parameters.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 29,033 patients were included in the analysis (mean age 71 years, 45% female, median eGFR 29 mL/min/1.73m&lt;sup&gt;2&lt;/sup&gt;). Average hemoglobin declined from 122 g/L in 2007 to 112.9 g/L in 2017 with a reduction in ESA use from 35% to 18%. The likelihood of patients having a hemoglobin below 90 g/L (versus 110-124 g/L) increased progressively over time (OR 5.3 in 2008; OR 16.2 in 2017). The proportion of patients meeting inclusion criteria for landmark trials ranged from 9% (TREAT) to 27% (CHOIR). Compared to trial participants, the study population had less comorbidities and received lower doses of ESA therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Measurement of hemoglobin","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261468720"},"PeriodicalIF":1.6,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13373397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469042","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 a High-Quality Living Kidney Donor Evaluation: A Delphi Survey and Consensus Conference Summary Report.","authors":"Seychelle Yohanna, Kyla L Naylor, Linnea Holtby, Jessica M Sontrop, Ahsan Alam, Brent Cheal, Christine Dipchand, Amit X Garg, Jagbir Gill, Steven Habbous, Jay Hingwala, Peggy John, Jessica King, Michael Koch, Ngan N Lam, Scott Morrison, Christine Pisapia, Marian Reich, Shaifali Sandal, Craig Settee, Terry Smith, Carrie Thibodeau, Lynn van der Linde, Carol Wang","doi":"10.1177/20543581261468728","DOIUrl":"10.1177/20543581261468728","url":null,"abstract":"<p><strong>Background: </strong>Many living kidney donors (LKDs) describe their evaluation process as the most difficult part of donating a kidney. The process is often lengthy, complex and inefficient, frequently requiring several months to complete. A more efficient and donor-centered evaluation may improve LKD experiences, reduce attrition, and encourage more individuals to donate.</p><p><strong>Methods: </strong>We employed a Delphi approach to define and select metrics of a high-quality LKD evaluation. Four multidisciplinary working groups were created in which LKDs (n=8), healthcare professionals (n=11), and administrators (n=3) collaborated to develop evidence and experience informed recommendations.</p><p><strong>Results: </strong>This work culminated in a national consensus conference held virtually in September 2024, which brought together over 100 LKDs, nurses, nephrologists, surgeons, researchers, and representatives from transplant organizations. Of the 42 recommendations evaluated through the e-Delphi process, 35 achieved consensus (≥75% agreement) across four domains. Ninety-two percent were supported by moderate-quality evidence, while 8% had no supporting evidence, reflecting the limited empirical data available for several aspects of donor evaluation processes. The recommendations clustered into four overarching themes included: (1) increasing donor numbers and evaluation efficiency (e.g., eligibility for donation determined within three to six months), (2) enhancing program resources and donor reimbursement (e.g., metrics on donor financial neutrality), (3) ensuring a donor-centered evaluation process (e.g., donor-centered metrics such as donor satisfaction), and (4) promoting consistency and evidence-based practice across programs (e.g., consistent evaluation nationally).</p><p><strong>Conclusion: </strong>Collectively, these recommendations provide a framework to guide quality improvement, benchmarking, and policy development, with implications for strengthening the LKD evaluation process worldwide.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261468728"},"PeriodicalIF":1.6,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13369398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148454771","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":"Risk of Inguinal Hernia Repair Following Laparoscopic Living Donor Nephrectomy: A Population-Based Cohort Study.","authors":"Rhiannon Lyons, Eric McArthur, Liane S Feldman, Ngan Lam, Kyla L Naylor, Chris Nguan, Doug Quan, Alp Sener, Jessica M Sontrop, Amit X Garg","doi":"10.1177/20543581261468713","DOIUrl":"10.1177/20543581261468713","url":null,"abstract":"<p><strong>Background: </strong>A prior study of living kidney donors demonstrated a substantially higher long-term risk of hydrocelectomy among male living kidney donors who underwent laparoscopic nephrectomy compared with nondonors. Given the potential shared anatomical pathways between hydrocele and indirect inguinal hernia formation, we aimed to evaluate the donation-attributable risk of inguinal hernia repair.</p><p><strong>Objective: </strong>To evaluate long-term rates of inguinal hernia repair in male living kidney donors compared to nondonors.</p><p><strong>Design and setting: </strong>Population-based, retrospective matched cohort study using linked health administrative databases from Ontario, Canada.</p><p><strong>Patients: </strong>848 male living kidney donors aged ≥18 years who underwent laparoscopic donor nephrectomy between April 1, 2002, and March 31, 2023, were matched (1:10) to 8480 healthy male nondonors based on age, cohort entry date, rurality, neighbourhood income, and prior vasectomy. Individuals with prior scrotal conditions or previous inguinal hernia repair were excluded.</p><p><strong>Measurements: </strong>The primary outcome was inguinal hernia repair.</p><p><strong>Methods: </strong>Risk was assessed using Cox proportional hazards models with robust variance. Cumulative incidence was estimated at key time points using Aalen-Johansen methods, treating death as a competing event. To contextualize the findings, incidence rates were also examined after other renal (e.g., nondonor nephrectomy, pyeloplasty) and abdominal surgeries.</p><p><strong>Results: </strong>Over a median follow-up of 8.8 years, 4.7% of donors (40 of 848) and 3.4% of nondonors (287 of 8480) underwent inguinal hernia repair. Donors had a modestly higher risk of undergoing inguinal hernia repair than nondonors (4.9 vs. 3.5 events per 1000 person-years; hazard ratio (HR) 1.40; 95% CI, 1.01-1.93; <i>P</i> = 0.043). The cumulative incidence of inguinal hernia repair after laparoscopic donor nephrectomy was comparable to that observed after other renal and abdominal surgeries.</p><p><strong>Limitations: </strong>This study relied on administrative data, which lacked information on hernia type (direct or indirect), laterality, pre-existing asymptomatic hernias, and key confounders such as body mass index and occupation. Donors may differ from nondonors in care-seeking behaviours and lifestyle factors, which could influence the observed risk.</p><p><strong>Conclusions: </strong>In contrast to the markedly higher risk of hydrocele repair, the donation-attributable risk of inguinal hernia repair in the years following laparoscopic donor nephrectomy appears modest, and in some comparisons was not evident. These findings support current counselling and selection practices for prospective donors, for which this outcome does not warrant specific consideration.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261468713"},"PeriodicalIF":1.6,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444570","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":"Barriers and Facilitators for Sodium-Glucose Cotransporter-2 Inhibitor Uptake and Implementation in Australia - Perspectives From Clinicians and Patients: An Interview Study.","authors":"Daniel V O'Hara, Tae Won Yi, Meg J Jardine, Rachael L Morton","doi":"10.1177/20543581261463450","DOIUrl":"10.1177/20543581261463450","url":null,"abstract":"<p><strong>Background: </strong>While sodium-glucose cotransporter-2 (SGLT2) inhibitors provide major benefits across multiple chronic diseases, clinician prescription and patient adherence rates remain low.</p><p><strong>Objective: </strong>To explore perspectives of clinician and patient stakeholders regarding barriers and facilitators for SGLT2 inhibitor use.</p><p><strong>Design: </strong>Semi-structured interviews, conducted as part of a larger project examining the type 2 diabetes mellitus (T2DM) standard of care.</p><p><strong>Setting: </strong>Australia.</p><p><strong>Participants: </strong>Clinicians involved in the care of people with T2DM, including primary care clinicians, endocrinologists, nephrologists, cardiologists, diabetes educators, and pharmacists; and adults with T2DM.</p><p><strong>Methods: </strong>Barriers and facilitators of SGLT2 inhibitor implementation were explored through the Consolidated Framework for Implementation Research. Analysis of interview transcripts was conducted in duplicate using a combination of framework and thematic analysis.</p><p><strong>Results: </strong>A total of 24 clinicians, and four people with T2DM, were interviewed between November 2021 and August 2023, including four primary care clinicians, four endocrinologists, four nephrologists, four cardiologists, four diabetes educators, and four pharmacists. Key findings included that clinicians miss opportunities to prescribe due to competing priorities and therapeutic inertia, and may find it difficult to educate and engage patients about SGLT2 inhibitor use. Patients require detailed education to understand benefits and adverse effect prevention, ideally with multimodal resources and staggered over time, and would benefit from general adherence coaching. Some clinicians were concerned about the risk of urinary tract infections despite reassuring safety data, and few provided genital hygiene advice to reduce SGLT2 inhibitor-associated genital mycotic infections. Better health system support could be achieved through additional cost reimbursement and support for multidisciplinary care access.</p><p><strong>Limitations: </strong>Most participants were from a single Australian state, New South Wales, which may not fully reflect experiences across Australia. Participation bias may under-represent those less engaged in SGLT2 inhibitor use.</p><p><strong>Conclusions: </strong>Clinicians are convinced about SGLT2 inhibitor benefits but require support to deliver evidence-based care, including effective patient education and engagement. These insights can help inform the design of interventions to maximise societal benefit from these effective medications.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261463450"},"PeriodicalIF":1.6,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13319567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367113","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":"Trends in Increased Infection Risk Deceased Organ Donors. A Two-Centre Retrospective Study.","authors":"Oscar A Fernández-García, Justin Co, Tanya Suandork, Murdoch Leeies, Karen Elizabeth Doucette","doi":"10.1177/20543581261463456","DOIUrl":"10.1177/20543581261463456","url":null,"abstract":"<p><strong>Background: </strong>Canadian regulatory standards require the label increased risk donor (IRD) be applied to donors with risk factors for hepatitis B (HBV), hepatitis C (HCV) and human immunodeficiency virus infection (HIV). This study aimed to assess trends in the rate of IRD and specific donor risk factors over time as well as the association with donor screening results for HBV, HCV and HIV.</p><p><strong>Methods: </strong>This was a retrospective study of deceased organ donors at 2 Canadian centers (University of Alberta Hospital and Transplant Manitoba) encompassing an overlapping period between 2013 and 2022. The proportion of IRD donations over time were analyzed with trend analysis. Trends for risk factors and their association with donor screening results were explored.</p><p><strong>Results: </strong>Overall, 332 of 1491 (22.3%) donors were categorized as IRD. A significant rising trend of IRD donors was documented for Alberta. Any donor drug use and overdose as cause of death increased during the study period and were strongly associated with HCV infection (OR 18.03 (6.34-51.2) p<0.001 and OR 6.48 (3.32-12.65) p<0.001). Donors classified as men who had sex with men (MSM) did not have an increased risk of HBV, HCV or HIV. Answers to some questions on the donor risk history were \"I don't know\" in up to 20% of specific questionnaire items.</p><p><strong>Conclusions: </strong>Our study demonstrates a rising proportion of IRD organ donations in 2 Canadian transplant centers. The regulatory requirements include variables not associated with HBV/HCV/HIV and do not capture others associated with risk in this cohort. The proportion of \"I don't know\" responses on the donor risk assessment highlights its limitations. This data may inform donor risk assessment in the Canadian setting and highlights the changing epidemiology of HBV/HCV/HIV in organ donors.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261463456"},"PeriodicalIF":1.6,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13305771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148343936","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}