Canadian Journal of Kidney Health and Disease最新文献

{"title":"Communication Experiences of Patients With Hearing Loss During Hemodialysis Treatment and the Potential Role of Communication Tools: A Qualitative Study.","authors":"Alex DeBusschere, Meaghan Lunney, Sonja Reid, Nancy Verdin, Shannan Love, Gillian Crysdale, Stephanie Thompson, David Nicholas, Tiffany Boulton, Kara Schick-Makaroff, Lorienne Jenstad, Sharon Straus, Jayna Holroyd-Leduc, Maoliosa Donald, Patti-Jo Sullivan, Tanis Howarth, Julie Evans, Marcello Tonelli","doi":"10.1177/20543581261454470","DOIUrl":"10.1177/20543581261454470","url":null,"abstract":"<p><strong>Background: </strong>People with hearing loss may have difficulty communicating with health care providers if not properly supported. Hearing loss is common among people with kidney failure. Outpatient hemodialysis centers may present communication barriers due to noisy machines and overlapping conversations. Tools, such as assistive listening devices, exist to help people with hearing loss communicate. If and how they should be used in the outpatient hemodialysis setting is unclear. Understanding the patient perspective is an important first step before implementing such solutions.</p><p><strong>Objective: </strong>Describe the communication-related experiences of patients with hearing loss when conversing with health care providers during hemodialysis treatment, focusing on perceptions about communication tools.</p><p><strong>Design: </strong>Qualitative descriptive.</p><p><strong>Setting: </strong>Outpatient hemodialysis centers in Calgary and Edmonton, Alberta, Canada.</p><p><strong>Participants: </strong>Adults with kidney failure receiving maintenance hemodialysis with self-reported hearing loss.</p><p><strong>Methods: </strong>Semi-structured individual interviews. Interviews were audio-recorded, transcribed, and abductively coded using a validated communication framework, a strategy to guide communication access in practice, and participants' experiences.</p><p><strong>Results: </strong>Fourteen patients participated between October 2023 and January 2024. Patient perceptions about communication tools varied. We identified three themes that describe these differences: (1) communication tools may be needed in transitional or clinically complex situations, (2) patients with their own resources may rely less on center-provided tools, and (3) awareness and self-advocacy for support varies across patients.</p><p><strong>Limitations: </strong>The major limitation of this study is the lack of representation from patients with language barriers and those belonging to the Deaf community or with overlooked hearing difficulties. Consequently, results may not be transferable to all patients with hearing loss in Alberta or elsewhere.</p><p><strong>Conclusions: </strong>Communication support needs are both person-specific and context-dependent, varying across and within patients. Not all patients that may benefit from communication tools will be comfortable asking or accepting help. Clinicians should routinely check in with patients about their communication needs and offer a variety of tools to accommodate as needed.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261454470"},"PeriodicalIF":1.6,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249252","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":"Overlap of PR3-Positive ANCA-Associated Vasculitis and Primary Focal Segmental Glomerulosclerosis: A Case Report, Patient Perspective, and Review of the Literature.","authors":"Adina Landsberg, Dale E Marzolf, Simon R Walker, Kim Cheema, Tyrone G Harrison","doi":"10.1177/20543581261454486","DOIUrl":"10.1177/20543581261454486","url":null,"abstract":"<p><p>Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and primary focal segmental glomerulosclerosis (FSGS) are distinct glomerular diseases that rarely occur together. When present concurrently, they may produce overlapping nephritic and nephrotic features that complicate diagnosis and management. We report a case of a 63-year-old man who presented with four weeks of progressive anasarca and several months of cognitive changes, blurry vision, and paresthesia. Investigations demonstrated nephrotic-range proteinuria (8.25 g per day), hypoalbuminemia, hematuria, acute kidney injury, and hypertension. Kidney biopsy demonstrated two concurrent pathologies: FSGS with complete podocyte foot process effacement and pauci-immune glomerulonephritis with focal active crescents. Serology confirmed proteinase 3 antibody (PR3)-ANCA positivity, establishing active AAV alongside primary FSGS. Treatment included pulse intravenous methylprednisolone followed by oral prednisone and rituximab for induction and maintenance of AAV. Because nephrotic syndrome persisted, calcineurin inhibitor therapy was initiated for steroid-resistant FSGS (cyclosporine followed by tacrolimus). Adjunctive antiproteinuric therapies included renin-angiotensin system blockade, sodium-glucose cotransporter-2 inhibition, and later a nonsteroidal mineralocorticoid antagonist. The patient eventually achieved partial remission with resolution of his nephrotic syndrome and undetectable PR3 titers. After 2.5 years of follow-up, kidney function stabilized at an estimated glomerular filtration rate (eGFR) of 29 mL/min/1.73 m² with persistent urine albumin-to-creatinine ratio (ACR) of 163 mg/mmol despite maximal antiproteinuric therapy. Long-term complications included diabetes mellitus related to immunosuppression. This case illustrates the rare coexistence of primary FSGS and PR3-positive AAV requiring simultaneous treatment, with differing responses to therapy. It highlights the challenges of assessing treatment response in dual glomerular pathology while balancing aggressive immunosuppression against systemic toxicity. Incorporation of the patient perspective in this case report highlights the lived experience and burden of managing concurrent FSGS and AAV.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261454486"},"PeriodicalIF":1.6,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13260775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249250","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":"Effects of Increasing the Concentration of Dialysate Magnesium on Cardiovascular Health: A Narrative Review.","authors":"Bryn Tannar, Hareth Al-Hellawi, Jessica M Sontrop, Rey R Acedillo, Ahmed A Al-Jaishi, Sierra Anderson, Amit Bagga, David Berry, Eliot Beaubien, Peter G Blake, Clara Bohm, Pierre Antoine Brown, Joe Bueti, Christopher T Chan, Brenden Cote, Andrea C Cowan, Nicole E Day, Varun Dev, Miten Dhruve, Laura Gregor, Claire Harris, Swapnil Hiremath, Geena Joseph, Srinu Kammila, Mercedeh Kiaii, Lauren Killin, Eswar Kumar Kolusu, Eduardo Lacson, Bin Luo, Jennifer M MacRae, Amber O Molnar, Bharat Nathoo, Matthew J Oliver, Sanjay Pandeya, Malvinder S Parmar, David Perkins, Kathleen Quinn, Joanna Sasal, Nikhil Shah, Tanya Shulman, Samuel A Silver, Anurag Singh, Andrew Steele, Irina St Louis, Navdeep Tangri, Robert H Ting, Stephanie Thompson, Marcello Tonelli, Hans Vorster, Davinder Wadehra, Ron Wald, Justin Walters, Shaoyee Yao, James Zacharias, Amit X Garg","doi":"10.1177/20543581261454463","DOIUrl":"10.1177/20543581261454463","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cardiovascular disease (CVD) accounts for nearly half of deaths among people receiving maintenance hemodialysis. Observational and interventional data suggest that higher serum magnesium, achieved through higher dialysate magnesium concentrations or oral supplementation, may improve cardiovascular outcomes and survival. This review synthesizes current evidence and provides context for an ongoing cluster-randomized trial that is testing whether a center-wide dialysate magnesium concentration of 0.75 mmol/L, versus ≤0.50 mmol/L, delivered as a policy and sustained for up to four years, reduces the risk of major cardiovascular-related hospitalizations.</p><p><strong>Sources of information: </strong>Peer-reviewed articles.</p><p><strong>Methods: </strong>We searched MEDLINE and EMBASE for observational and interventional studies evaluating serum or dialysate magnesium concentrations and cardiovascular outcomes in patients with chronic kidney disease and/or kidney failure. We appraised the methodological quality of interventional trials. This review is divided into four sections: (1) epidemiological associations between serum magnesium concentrations and CVD outcomes, (2) the impact of a higher concentration of dialysate magnesium on CVD outcomes, (3) the impact of oral magnesium supplementation on CVD outcomes, and (4) ongoing trials.</p><p><strong>Key findings: </strong>Twenty studies, including 10 randomized controlled trials, were reviewed. Systematic reviews and meta-analyses show that hypomagnesemia is associated with higher risks of cardiovascular events and all-cause mortality in hemodialysis. Interventional studies indicate that higher dialysate magnesium concentrations or oral supplementation can improve surrogate markers of vascular health, including less vascular calcification and stiffness. Higher dialysate concentrations may also lower cardiovascular mortality. Given encouraging but predominantly surrogate-based evidence, adequately powered randomized trials are warranted.</p><p><strong>Limitations: </strong>Most trials were small, single-center, and of short duration. They relied on surrogate endpoints, and there was heterogeneity in interventions and outcome measures.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261454463"},"PeriodicalIF":1.6,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13254138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Canadian Society of Nephrology Commentary on the 2025 Kidney Disease Improving Global Outcomes Clinical Practice Guidelines for Autosomal Dominant Polycystic Kidney Disease.","authors":"Matthew B Lanktree, Nick Ashawasega, Micheli Bevilacqua, Daniel G Bichet, Guillaume Bollée, Pierre-Antoine Brown, Louis Girard, Paul Goodyer, Jay Hingwala, Mathieu Lemaire, Philip McFarlane, Louise Moist, York Pei, Normand Proulx, Clara Schott, Steven Soroka, Caitlyn Vlasschaert, Nicholas Watkins, Ahsan Alam","doi":"10.1177/20543581261455635","DOIUrl":"10.1177/20543581261455635","url":null,"abstract":"<p><strong>Purpose of review: </strong>1) Provide a Canadian perspective on the 2025 Kidney Disease Improving Global Outcomes (KDIGO) Autosomal Dominant Polycystic Kidney Disease (ADPKD) guidelines; 2) identify challenges and nuances in applying these guidelines in Canada; 3) highlight shifts in expert practice points for Canadian care providers; 4) outline opportunities for research, knowledge translation, and quality improvement in Canada.</p><p><strong>Sources of information: </strong>The KDIGO 2025 Clinical Practice Guideline Update for the management of ADPKD, as well as a survey and discussion by Canadian experts in ADPKD.</p><p><strong>Methods: </strong>The co-chairs invited stakeholders from the Canadian ADPKD community to ensure national representation, including adult and pediatric clinicians, trainees, a genetic counselor, and a patient partner with an Indigenous perspective. Members were surveyed to identify key practice points. Subgroups reviewed issues and drafted discussion topics. All members reviewed the final draft.</p><p><strong>Key findings: </strong>The committee commented on recommendations with nuance for Canadian practitioners, especially on multidisciplinary care, challenges with genetic testing, and the use of CKD therapies like sodium-glucose transport protein 2 (SGLT2) inhibitors in ADPKD.</p><p><strong>Limitations: </strong>The committee relied on the evidence summaries produced by KDIGO and the experience and knowledge of committee members. The committee did not replicate or update the systematic reviews.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261455635"},"PeriodicalIF":1.6,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13237251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148197291","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":"Integrated, Community-Led, Culturally Safe Implementation of a Chronic Kidney Disease Detection Program for Indigenous Communities of Canada: The Kidney Check Program Report.","authors":"Somkanya Tungsanga, Cathy Woods, Selina Allu, Allison B Dart, Arsh K Jain, Lene Jorgensen, Michelle Hampson, Oksana Harasemiw, Marc Hébert, Joanne Kappel, Nicki Kirlin, Carmen Levandoski, Meg Lunney, Cynthia MacDonald, Ikechi G Okpechi, Leta Philp, Stacey Shmyr, Catherine Turner, David Collister, Harley Crowshoe, Heather Harris, Erin Hedin, Jocelyn Jones, Maureena Loth, Paul Komenda, Adeera Levin, Aminu K Bello","doi":"10.1177/20543581261447194","DOIUrl":"10.1177/20543581261447194","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose of program: &lt;/strong&gt;Indigenous peoples in Canada experience a disproportionate burden of chronic kidney disease (CKD) yet face systemic, geographic, and cultural barriers to early detection and care. The Kidney Check program was established as a national initiative to address this gap by providing community-led, culturally safe, and integrated chronic disease screening.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Sources of information: &lt;/strong&gt;Kidney Check builds on the success of the First Nations Community-Based Screening to Improve Kidney Health and Prevent Dialysis (FINISHED) study in Manitoba and was expanded through the Can-SOLVE CKD Network. This report summarizes updated data from April 2023 to March 2024, capturing the implementation of Kidney Check across five provinces: Alberta (AB), British Columbia (BC), Manitoba (MB), Ontario (ON), and Saskatchewan (SK). Data sources include provincial program records, training logs, process measures, referral data, patient and provider testimonials, and qualitative evaluations from community members, providers, and patient partners.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Kidney Check applies a standardized, mobile, point-of-care-testing (POCT)-based screening protocol for CKD, diabetes, and hypertension, adapted locally in collaboration with Indigenous communities. Implementation followed principles of Indigenous governance, data sovereignty (Ownership, Control, Access, Possession [OCAP]), and Two-Eyed Seeing, where both Western and Indigenous medicines and ways are acknowledged, respected, and practiced, with provincial adaptations tailored to local contexts. Information was synthesized across jurisdictions to identify process measures, barriers and facilitators to implementation, and early outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key findings: &lt;/strong&gt;Since program inception, thousands of Indigenous participants have been screened across more than 50 communities. AB and BC demonstrated scale-up through train-the-trainer and community-embedded models, training over 30 providers and screening &gt;700 participants in BC alone. Manitoba built on the FINISHED study to deliver screening in 10 communities, with nearly 700 participants screened. Ontario resumed screening in 2024, with &gt;250 participants screened across five regional renal programs. Saskatchewan launched Kidney Check in 2023, screening 230 participants, with early identification of intermediate- and high-risk individuals. Across sites, facilitators included strong community partnerships, local hiring, and integration with existing health services. Barriers included logistical challenges (equipment, travel, quality assurance and quality control [QA/QC]), staffing constraints, and sustainability concerns.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Variation in infrastructure, referral pathways, and data systems across provinces limits cross-jurisdictional comparability. Long-term outcome data (eg, CKD progression, cardiovascular events, mortality) are not yet available.&lt;/p&gt;&lt;p&gt;&lt;stro","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261447194"},"PeriodicalIF":1.6,"publicationDate":"2026-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13222395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148142843","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":"Association Between Sex and Kidney Transplant Referral, Living Donor Contacts, Waitlisting and Kidney Transplant: A Population-Based Cohort Study.","authors":"Kyla L Naylor, Natalie Zitoun, Graham Smith, Jaffa Romain, Amit X Garg, Kate Roberston-Hogg, Gregory Knoll, S Joseph Kim, Seychelle Yoahnna, Matthew Weir","doi":"10.1177/20543581261455328","DOIUrl":"10.1177/20543581261455328","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Studies from several jurisdictions suggest that compared to male individuals, female individuals are less likely to get placed on the waiting list for kidney transplantation and less likely to receive a transplant. However, we poorly understand where sex disparities arise within four key steps in the pathway to kidney transplant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To measure how sex influences key steps to kidney transplantation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;We conducted a population-based cohort study using linked administrative healthcare databases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Ontario, Canada.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;The study included people with kidney failure. This group comprised patients approaching the need for dialysis and those receiving maintenance dialysis from November 1, 2017, to December 31, 2021 (with follow-up to March 31, 2023). All patients had no recorded contraindications to receiving a kidney transplant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;We assessed patient access to four key steps toward kidney transplant: (1) referral to a transplant centre for assessment; (2) they had a potential living donor contact the transplant centre for evaluation; (3) addition to the deceased donor waitlist; and (4) transplantation from a living or deceased donor. We examined each step separately.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We compared male and female individuals on the four steps in the kidney transplant process, using the incidence rate and cumulative incidence function (95% confidence interval [CI]). We used Cox proportional hazards analysis to examine the association between sex (using male as the reference group) and each transplant step, adjusting for patient characteristics. We also examined if age (&lt;45, 45 to &lt;55, 55 to &lt;65, and 65 to 75 years) changed the relationship between sex and access to transplantation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We included 17,993 patients with kidney failure (11,076 male and 6,917 female individuals). Of these, 15,238 entered the cohort approaching the need for dialysis, and 2,755 entered already receiving maintenance dialysis. Over follow-up, 4,945 (32.5%) patients in the approaching the need for dialysis cohort started dialysis. Female individuals had a significantly lower rate of referral to a transplant centre for assessment than male individuals (9.35 vs 10.91 referrals per 100 person-years; adjusted hazard ratio [aHR] 0.86 [95% CI: 0.81, 0.92]). The disadvantage female individuals faced in transplant referral increased with age (age 65 to 75 years, aHR 0.73 [95% CI: 0.64, 0.84]; P-value for interaction &lt;0.001). After we adjusted for patient characteristics, we found no significant sex-based differences for any other step in the transplant process, including living donor contact, waitlisting, or transplant. For all outcomes, a significant interaction was found between age and sex (P-value for interaction &lt; 0.001). The kidney transplant access disadvan","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261455328"},"PeriodicalIF":1.6,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13221602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136433","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":"Aligning Practice With Guidelines: A Canadian National Survey and Canadian Society of Nephrology Commentary on the 2025 KDIGO Pediatric Nephrotic Syndrome Recommendations.","authors":"Seetha Radhakrishnan, Allison B Dart, Mallory L Downie, Silviu Grisaru, Anna Mathew, Reem A Mustafa, Cherry Mammen","doi":"10.1177/20543581261455537","DOIUrl":"10.1177/20543581261455537","url":null,"abstract":"<p><strong>Purpose of review: </strong>The purpose of this commentary is to review the 2025 Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guidelines on the management of childhood nephrotic syndrome (NS) within the Canadian context and based on current practices across the country.</p><p><strong>Sources of information: </strong>The KDIGO 2025 guideline on the management of childhood nephrotic syndrome as well as the KDIGO 2021 management of glomerular diseases, chapter 4 (NS in children) were main sources. The International Pediatric Nephrology Association clinical practice recommendations for the diagnosis and management of children with steroid sensitive NS and the recommendations for the diagnosis and management of children with steroid resistant NS were also used.</p><p><strong>Methods: </strong>The Canadian Society of Nephrology convened a working group of pediatric nephrologists with representation from across Canada. As part of the review, the working group conducted a survey of pediatric nephrology centres in Canada to better understand current practice in NS management. All members reviewed the recommendations and practice points, reaching consensus through discussion. Results from the survey as well as published literature from Canadian NS cohorts were used to develop commentary on the application of KDIGO recommendations in the Canadian context.</p><p><strong>Key findings: </strong>The authors agreed with most updated KDIGO recommendations and emphasized the benefits of standardizing disease and response type definitions, as well as prednisone induction protocols. However, areas in need of further clarity and standardization were highlighted including relapse treatment protocols, and choice of steroid sparing agents for frequently relapsing and steroid dependent patients.</p><p><strong>Limitations: </strong>A review of the quality of evidence was not undertaken.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261455537"},"PeriodicalIF":1.6,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13219935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136357","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":"Addition of a Home Hemodialysis Counseling Scenario to an Existing Formative Objective Structured Clinical Examination (OSCE) for Nephrology Fellows: A Research Letter.","authors":"Nupur Gupta, Megha R Joshi, Daniel Landry, Zain Mithani, Ross J Scalese, Amy N Sussman, Christina M Yuan","doi":"10.1177/20543581261450844","DOIUrl":"10.1177/20543581261450844","url":null,"abstract":"<p><strong>Background: </strong>Home hemodialysis (HHD) prevalence is low in the United States; thus, nephrology fellows may have limited HHD clinical experience and be hesitant to counsel suitable patients. We describe a formative HHD counseling simulation scenario, part of a previously described nephrology-specific formative Objective Structured Clinical Examination (OSCE) that assesses fellow counseling skills using validated assessment instruments.</p><p><strong>Methods: </strong>During a 20-minute simulation, fellow performance was assessed by a standardized patient using the Essential Elements of Communication-Global Rating Scale 2005 (EEC-GRS) and by faculty using an HHD-specific Mini-Clinical Evaluation Exercise (Mini-CEX). Overall, EEC-GRS and Mini-CEX scores were the primary outcome measures. After the simulation, fellows were surveyed anonymously regarding satisfaction with the scenario and HHD clinical experience/education. Program directors reported HHD curriculum components. Fellow performance was analyzed by training year.</p><p><strong>Results: </strong>Four programs (19 fellows: 10 first-year, nine second-year) participated. All had an HHD curriculum. Three offered HHD training courses but no HHD clinic. One had a longitudinal HHD clinic (two first-year and two second-year fellows) but did not offer a training course. There were no significant differences in overall EEC-GRS or Mini-CEX scores between first- and second-year fellows. No fellow had an unsatisfactory overall score. On the post-OSCE survey (37% response rate), six of seven (86%) responding fellows agreed/strongly agreed that the simulation increased their \"comfort in discussing HHD with a patient.\"</p><p><strong>Conclusion: </strong>This educational, formative HHD counseling scenario, part of a previously described OSCE, is a low-risk opportunity for fellows to practice patient communication skills and appears to increase fellow comfort in discussing HHD.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261450844"},"PeriodicalIF":1.6,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13219918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136315","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":"Tertiary Lymphoid Structure-Like Lymphocyte Aggregate Generation in Human and Mouse Hypokalaemic Nephropathy: Research Letter.","authors":"Takanori Komada, Satoko Komori, Tadayoshi Karasawa, Yoshiyuki Morishita, Noriyoshi Fukushima, Daisuke Nagata, Masafumi Takahashi","doi":"10.1177/20543581261450740","DOIUrl":"10.1177/20543581261450740","url":null,"abstract":"<p><p>Potassium (K⁺) is an essential ion that keeps the cells and organs functioning properly. Systemic K⁺ deficiency occasionally leads to kidney damage, known as hypokalaemic nephropathy (HN). Hypokalaemic nephropathy is commonly treated with K⁺ supplementation; however, the long-term prognosis of HN and the role of inflammation remain poorly understood. Here, we analysed five kidney biopsy samples from patients diagnosed with HN at a single centre. All five HN kidneys displayed T-cell infiltration, and three showed segregated T and B lymphocyte aggregates, suggesting the presence of tertiary lymphoid structures (TLSs). No patient progressed to kidney failure after K⁺ supplementation over 8.4 ± 3.4 years of follow-up. We also analysed a mouse model of experimental post-HN kidneys. After a low-K⁺ diet for six weeks, feeding a six-month recovery diet restored K⁺ levels and the kidney function of HN. Histologically, however, fibrosis and TLS-like aggregates developed in the post-HN kidneys, manifesting a positive correlation between them. Together, we identified TLS-like lymphocyte aggregates in human HN kidneys and mouse post-HN kidneys. Our study indicates that TLSs may reflect the risk of chronic kidney disease progression and contribute to a perpetuating inflammatory microenvironment in HN kidneys.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261450740"},"PeriodicalIF":1.6,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13219873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136423","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":"Advancing Equity, Diversity, Inclusion, and Accessibility in a Patient-Oriented Kidney Research Network: A Can-SOLVE CKD Program Report.","authors":"Keila Turino Miranda, Jocelyn Jones, Melanie D Talson, James Scholey, Julie Wysocki, Meghan J Elliott, Letitia Pokiak, Maria Torrejon, Heather Harris, Selina Allu","doi":"10.1177/20543581261455663","DOIUrl":"10.1177/20543581261455663","url":null,"abstract":"<p><strong>Purpose of program: </strong>Despite increasing recognition that equity, diversity, inclusion, and accessibility (EDIA) principles are essential to research and improving health outcomes, there is little data to guide the incorporation of these principles in a research network. Here, we outline a collaborative approach taken by our kidney Strategic for Patient-Oriented Research (SPOR) network, Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD), to better understand the application of EDIA in a kidney research network.</p><p><strong>Sources of information: </strong>An internal network audit of EDIA strengths and future directions.</p><p><strong>Methods: </strong>Between June 2023 and January 2024, Can-SOLVE CKD's EDIA working group completed a network-wide audit through seven virtual workshops, in which patient partners, research team members, and staff identified the network's existing EDIA strengths and needs for improvement. Responses were collected on the Mural platform in real-time. Repeated or agreed-upon comments were displayed as multiple identical entries. A thematic analysis was conducted to extract key themes to inform the EDIA mobilization plan moving forward.</p><p><strong>Key findings: </strong>We collated feedback from 49 network members (16 patient partners, 19 research team members, and 14 staff) that included 441 individual responses from seven workshops. The thematic analyses revealed three key strengths: the inclusion and promotion of Indigenous voices and ways of knowing, patient partner participation empowerment and leadership, and network-wide acceptance of EDIA principles. Future direction themes included: increasing diversity of perspectives by outreach to under-represented communities, challenging biases against patient-oriented research, and improving accommodations for patient partner participation.</p><p><strong>Limitations: </strong>This analysis only captures the perspectives of people who are already within the network. While our network includes diverse people, some demographics and their respective perspectives may be missing.</p><p><strong>Implications: </strong>Many of Can-SOLVE CKD's EDIA strengths can be attributed to a long-standing culture of meaningful inclusion of patient partners, strong leadership by Indigenous peoples and patient partners embedded in the network, as well as training, onboarding and compensation structures for patient partners. While current strategies have fostered a strong foundation, the next steps must ensure that inclusivity extends across all demographic populations and disciplinary boundaries. Participant suggestions, including grassroots outreach, hiring diverse leadership, and improving multilingual communication, demonstrate a willingness and readiness within the network to take actionable steps to further strengthen EDIA.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261455663"},"PeriodicalIF":1.6,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13201923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148041044","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}