Canadian Journal of Kidney Health and Disease最新文献

{"title":"Sucralose as a Way to Enhance Regulatory T Cells, the SWEET Trial: Clinical Research Protocol.","authors":"Léa Bourguignon, Yannice Benazzouk, Elpida Bokou-Gianneli, Fabio Zani, Julianna Blagih, Caroline Lamarche","doi":"10.1177/20543581261418540","DOIUrl":"10.1177/20543581261418540","url":null,"abstract":"<p><strong>Background: </strong>Kidney transplantation is the most effective treatment for patients with end-stage kidney disease. Modern immunosuppressive treatment has prolonged graft survival and reduced transplant rejection. However, these immunosuppressive regimens are associated with multiple side effects, including increased infections and cancer risk, nephrotoxicity, and metabolic complications. Attaining transplant tolerance with minimal reliance on immunosuppressive drugs is considered the ultimate goal in transplantation. Regulatory T cells (Tregs) adoptive immunotherapy has been proposed as a strategy to achieve transplant tolerance. However, this approach is labor-intensive and expensive, limiting its large-scale applicability. There is, therefore, a need to develop methods that promote Treg-mediated tolerance <i>in vivo</i>. Treg function and numbers are influenced by dietary components, and dietary interventions could provide a new therapeutic opportunity. Recently, our group demonstrated that sucralose supplementation, a commonly used sugar substitute (sweetener), reduces proinflammatory T-cell function and unpublished data indicating enhanced Treg frequencies. Building on this discovery, we propose to investigate the impact of sucralose on modulating T-cell populations and function in humans.</p><p><strong>Objective: </strong>To determine whether sucralose supplementation increases circulating Treg frequencies and alters T-cell function and populations in healthy adults.</p><p><strong>Design: </strong>This is a randomized, double-blind, placebo-controlled, crossover pilot trial.</p><p><strong>Setting: </strong>The study will be monocentric, at the Maisonneuve-Rosemont Hospital.</p><p><strong>Patients: </strong>Twelve healthy adult volunteers (>18 years of age), of both sexes, with no prior history of autoimmune disease or current treatments of immunomodulatory drugs. In addition, pregnant women will also be excluded from this study.</p><p><strong>Measurements: </strong>The primary outcome will be an alteration in circulating Treg frequency after sucralose supplementation. The secondary outcomes include modulation in the frequency of CD45<sup>+</sup> cells, the frequency of CD4<sup>+</sup> T-cell subsets, the differentiation of both CD4<sup>+</sup> and CD8<sup>+</sup> T cells, and T-cell function after antigen-specific and alloreactive challenges. Feasibility will also be evaluated, including adherence to visits, blood draw, ease of recruitment, percentage of study completion, and adherence to supplements. Exploratory outcomes in response to sucralose supplementation include changes in circulating metabolites and gut microbiome composition.</p><p><strong>Methods: </strong>Participants will be randomly assigned to receive either a placebo or sucralose (5-7 mg/kg/day) for four weeks, separated by a two-week washout period. This will be followed by a crossover phase, where patients receiving sucralose will receive the placebo and vic","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261418540"},"PeriodicalIF":1.5,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12905097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146200345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revamping the KRESCENT Core Curriculum: The KRESCENT 2.0 Program Report.","authors":"Tarrah Wood, Veronica Kaye, Leanne Stalker, R Todd Alexander, Adeera Levin, Sunny Hartwig","doi":"10.1177/20543581251411222","DOIUrl":"10.1177/20543581251411222","url":null,"abstract":"<p><strong>Purpose of program: </strong>Since its inception in 2005, the Kidney Research Scientist Core Education and National Training Platform (KRESCENT) core curriculum has undergone regular review and evolution to ensure it continues to meet trainee needs within their current research milieus. In 2021, the KRESCENT 2.0 Health Research Training Program (HRTP) was funded through the pilot Canadian Institutes of Health Research (CIHR) HRTP program. This program report describes the formal evaluation and redesign process of the KRESCENT curriculum subsequently undertaken by a small pan-Canadian team over a period of two years, leading to the establishment of the current KRESCENT 2.0 curriculum.</p><p><strong>Sources of information: </strong>KRESCENT archived curriculum-related documents, including de-identified trainee reviews, reports and meeting minutes; equity, diversity, and inclusion (EDI) documents, including consultancy agreements, accountability reviews, proposals and contracts, and other related files. Other resources included websites, journal articles and the Raising Interdisciplinary Scientist Excellence Learning Management System (RISE-LMS) online training platform.</p><p><strong>Methods: </strong>Meeting minutes, consultancy, and curriculum-related documents were reviewed. Clarification of the process was provided through interviews with the senior KRESCENT consultant Dr Adeera Levin, past KRESCENT director Dr R. Todd Alexander, curriculum chair Dr Sunny Hartwig, members of the Patient Community Advisory Network (PCAN), and KRESCENT program manager Ms Julie Wysocki via in-person and virtual meetings as well as email correspondence.</p><p><strong>Key findings: </strong>The KRESCENT 2.0 curriculum represents a three-year process of evaluation, consultation, and redesign led by the KRESCENT executive team. Administrative, logistical, and strategic support was provided by the Kidney Foundation of Canada (KFoC). Vital insights and guidance in the curriculum reshaping process were provided by a dedicated pan-Canadian working group of 10 scientists and educators spanning multiple disciplines and jurisdictions. Curricular elements to be introduced, retained, discarded, or revitalized were identified by clear consensus in each instance. Key recommendations from EDI consultants Mr Ike Okofur and Ms Nadia McLaren led to the development of a summer undergraduate studentship program to support Black and Indigenous scholars interested in nephrology research. Consultation with existing KRESCENT patient partners led to the formalization of their contributions through the establishment of PCAN. The PCAN team was appointed a role in administering the KRESCENT 2.0 core curriculum to reinforce the importance of understanding and leveraging the lived experience of patients and their caregivers in all aspects of kidney health research.</p><p><strong>Limitations: </strong>KRESCENT is an established three-year kidney training program for a small cohort of ","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581251411222"},"PeriodicalIF":1.5,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12886729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146164234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Canadian Society of Nephrology Commentary on the Evolving Kidney Disease Improving Global Outcomes Adult Glomerulonephritis Guidelines.","authors":"Arenn Jauhal, Reem Mustafa, Anna Mathew, Louis Girard, Sean Barbour, Bhanu Prasad, Lavanya Bathini, Penelope Poyah, Stephan Troyanov, Ratna Samanta, Jocelyn Garland, Todd Fairhead, Michael Walsh, Heather Reich, Shih-Han Huang, Jenny Ng, Judith Marin, Michelle Hladunewich","doi":"10.1177/20543581251409874","DOIUrl":"10.1177/20543581251409874","url":null,"abstract":"<p><strong>Purpose of review: </strong>The purpose of this commentary is to address the challenges of implementing the evolving Kidney Disease Improving Global Outcomes (KDIGO) glomerulonephritis (GN) guidelines within the Canadian health care context, highlighting barriers to adoption of the guidelines and discussing contextual issues unique to Canada.</p><p><strong>Sources of information: </strong>The KDIGO 2021 guidelines with 2024 updates in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis and lupus nephritis, as well as the 2025 updated guideline for immunoglobulin A (IgA) nephropathy.</p><p><strong>Methods: </strong>A Canadian Society of Nephrology (CSN) working group with expertise in GN was formed, representing nephrologists, pathologists, pharmacists, and patient partners with geographic representation from across Canada. Recommendations and practice points were reviewed by member surveys, with discussions to reach consensus and frame the commentary.</p><p><strong>Key findings: </strong>The commentary highlights diagnostic investigations, the role of immune treatments for primary glomerular diseases, and the growing role of conservative kidney therapies.</p><p><strong>Limitations: </strong>A review of the quality of evidence was not undertaken. Implementation and uptake of the guidelines will vary across each province given drug availability and cost.</p><p><strong>Implications: </strong>The commentary aims to provide tailored guidance to enhance the care of Canadians living with glomerular disease.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581251409874"},"PeriodicalIF":1.5,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12886736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146164187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HLA Experts' Perspectives on Precision Medicine and Molecular Matching in Kidney Transplantation: A Qualitative Study.","authors":"Lucy An, Aliya Affdal, Fabian Ballesteros, Marie-Françoise Malo, Savannah-Lou Cochran-Mavrikakis, Carina Sancho, Noémi Tousignant, Stirling Bryan, Paul Keown, Ruth Sapir-Pichhadze, Marie-Chantal Fortin","doi":"10.1177/20543581251412195","DOIUrl":"10.1177/20543581251412195","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Kidney transplantation is the best treatment for chronic kidney failure, but antibody-mediated rejection (AMR) is a major cause of kidney transplant loss. Human leukocyte antigen (HLA) molecular-compatibility-based organ allocation aims to reduce the risk of donor-specific antibody formation and thereby lower the risk of AMR. However, integrating molecular compatibility in organ allocation could introduce barriers to access, consequently raising ethical concerns.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective of this study was to gather perspectives of HLA professionals on molecular matching in kidney transplantation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Individual semi-structured interviews.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Canadian HLA laboratories.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;HLA laboratory directors or HLA professionals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Seven participants took part in semi-structured interviews between January and June 2024. The interviews were digitally recorded, transcribed, and analyzed using the qualitative description approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Participants reported positive feelings regarding the current allocation system but highlighted that HLA matching could be improved. They differed on whether kidney allocation should prioritize medical utility or fairness. While acknowledging the potential benefits of precision medicine in improving transplant outcomes, experts emphasized that its implementation confronts both scientific uncertainties and practical challenges, identifying logistical, financial, technological, and occupational barriers. They expressed concerns regarding decreased access to kidney transplantation for marginalized groups, recommending the adoption of mitigation measures. Regarding the kidney-paired donation program, experts supported integrating molecular matching as an optimizing tool to complement the current algorithm. Participants recommended that future implementation of molecular matching in Canada should involve nationwide collaboration, establishing a maximum wait time and appropriate selection criteria, additional research, adequate staffing and funding for HLA laboratories, as well as education of transplant professionals and patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The major limitation of this study is the small number of participants, all of whom were Canadian HLA professionals. Consequently, results may not be generalizable to transplant contexts in other countries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study highlights the complexities of integrating molecular matching into organ allocation, raising concerns about equity, feasibility, and implementation. While HLA experts agree on the importance of ensuring equity and timely access, their perspectives also underscore the challenges of implementation, such as the availability of timely high-resolution HLA typing, stakeholder buy-in, and the need for dedicated tools and applications.","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581251412195"},"PeriodicalIF":1.5,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12881328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146140979","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":"Increasing Access to Living Donor Kidney Transplantation: A Program Report.","authors":"Kyla L Naylor, Susan Q McKenzie, Seychelle Yohanna, Natalie M Zitoun, Amit X Garg","doi":"10.1177/20543581261418350","DOIUrl":"10.1177/20543581261418350","url":null,"abstract":"<p><strong>Purpose of program: </strong>The best treatment option for most patients with kidney failure is a transplant from a living kidney donor, yet multiple barriers prevent most patients from receiving one. The Living Donor Kidney Transplantation project within the Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD) Network aims to improve access to living donor kidney transplantation across Ontario and beyond by enhancing our understanding of the living kidney donor and kidney transplant processes and by implementing and evaluating patient-informed, evidence-based solutions.</p><p><strong>Sources of information: </strong>To achieve our goal of improving access to living donor kidney transplantation, our research draws on multiple sources, including (1) insights from patients, health care professionals, provincial and national kidney agencies, and researchers; (2) Ontario's administrative health care databases; (3) clinical trials; and (4) qualitative methodology (surveys, interviews, consensus meetings, Delphi process).</p><p><strong>Methods: </strong>Our research activities in Phase 2 (2022-2026) focus on four key projects:(1) High-quality living kidney donor evaluation: A national consensus conference to define a high-quality living kidney donor evaluation and associated metrics.(2) One-day donor assessment clinic: A streamlined donor evaluation clinic to improve the efficiency of the living kidney donor evaluation.(3) Transplant Ambassador Program: A peer-support program led by patient volunteers to support patients with kidney failure and living kidney donors.(4) Collaboration and equitable access to transplant: Collaboration with patients, health care professionals, and health system leaders to develop, implement, and evaluate solutions with a focus on equity.</p><p><strong>Key findings: </strong>Engaging with patients and knowledge users at every stage of our research has enabled the creation of high-quality research, resulting in actionable change. Our work has established 35 national consensus standards for a high-quality living kidney donor evaluation, demonstrated the scalability of a one-day living kidney donor evaluation clinic, expanded a peer-support program, and developed strong system partnerships.</p><p><strong>Limitations: </strong>Our work has primarily focused on improving access to living donor kidney transplantation in the province of Ontario. Equitable access to living donor kidney transplants remains a challenge, which we plan to continue focusing on in future iterations of our work.</p><p><strong>Implications: </strong>Our work highlights the vital role of patient-oriented research and the importance of involving patient volunteers in enhancing access to living kidney donation. Together, we remain committed to creating a Canadian system where everyone who needs a living donor kidney transplant can receive one fairly and without delay.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581261418350"},"PeriodicalIF":1.5,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12864666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146117961","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":"Beyond the Equation: A Call for Sustained Equity in Chronic Kidney Disease Care for Black Communities.","authors":"Devron J Swaby, Istvan Mucsi, Tabo Sikaneta, Bourne L Auguste","doi":"10.1177/20543581251413447","DOIUrl":"10.1177/20543581251413447","url":null,"abstract":"","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581251413447"},"PeriodicalIF":1.5,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12858786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146103428","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":"Randomized Controlled Trial of Intradialytic Cycling as Kidney Exercise Rehabilitation for Cardiac Stunning in Hemodialysis (TICKERS_HD): A Clinical Research Protocol.","authors":"Paul N Bennett, Jarrin D Penny, Christopher W McIntyre, Jessica Vanderlinden, Megan S Borkum, Gisell Castillo, David Collister, Bonnie Corradetti, Todd A Duhamel, Haley Farion, Emilie Ford, Eric Garcia, Ruth Getachew, Shilpanjali Jesudason, Mercedeh Kiaii, Richard Le Leu, Justin Presseau, Claudio Rigatto, Ashley K Seitz, Mitra Shirazi, Anita Soni, Krista Stewart, Brett Tarca, Karthik Tennankore, Nancy Verdin, Reid Whitlock, Ken Wilund, Stephanie Thompson, Jennifer M MacRae, Clara Bohm","doi":"10.1177/20543581251391112","DOIUrl":"10.1177/20543581251391112","url":null,"abstract":"<p><strong>Introduction: </strong>People with hemodialysis-dependent kidney failure experience significantly higher cardiovascular (CV) morbidity, mortality, symptom burden, and cognitive impairment compared to the general population. Hemodialysis-induced ischemia contributes to myocardial stunning, which worsens CV outcomes. Intradialytic cycling has the potential to mitigate cardiac stunning, but its effects have not been assessed in randomized controlled trials (RCTs).</p><p><strong>Methods: </strong>This multicenter RCT evaluates the impact of 12 weeks of intradialytic cycling on hemodialysis-induced myocardial stunning. The study will recruit 160 adults (80 intervention and 80 control) receiving maintenance hemodialysis at five Canadian centers and one Australian center. Outcome assessments are conducted at baseline, 12 weeks, and 16 weeks. An intervention implementation process evaluation is part of this study.</p><p><strong>Outcomes: </strong>The primary outcome is change in number of regional wall motion abnormalities (RWMAs) at peak hemodialysis stress from baseline to 12 weeks. Secondary outcomes include changes in cognitive function, hemodialysis recovery time, and symptom burden.</p><p><strong>Statistical analysis: </strong>Change in number of RWMAs at peak hemodialysis stress from baseline to 12 weeks are compared between study groups using an independent 2-tailed <i>t</i> test and using a Poisson generalized linear mixed model with study group as a fixed effect, and time and mean ultrafiltration rate as random effects.</p><p><strong>Conclusion: </strong>Compared with standard care, we anticipate that intradialytic cycling will decrease myocardial stunning, resulting in improved symptom burden, and functional and cognitive status. This trial provides critical evidence regarding the benefits and feasibility of exercise during hemodialysis, potentially informing clinical practice, and guidelines for hemodialysis care.<b>Trial registration number:</b> NCT04877041.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581251391112"},"PeriodicalIF":1.5,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12812203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146003129","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":"Eight Years of Canadian Real-World Assessment of Tolvaptan in Patients With Autosomal Dominant Polycystic Kidney Disease: The C-MAJOR Registry.","authors":"Philip McFarlane, Daniel G Bichet, Ahsan Alam, Suzy Bubolic, Annick Laplante","doi":"10.1177/20543581251404128","DOIUrl":"10.1177/20543581251404128","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Tolvaptan is the only approved treatment in Canada for slowing the progression of kidney enlargement and kidney function decline in people with autosomal dominant polycystic kidney disease (ADPKD). The Canadian Medical Assessment of Jinarc® Outcome Registry (C-MAJOR) registry evaluating long-term clinical outcomes of tolvaptan use was initiated in 2015, as per Health Canada requirements.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To describe the study design and methodology of the C-MAJOR registry, and present baseline patient and disease characteristics, time to and reasons for treatment and study discontinuation, time to kidney replacement therapy (KRT), and the long-term safety with tolvaptan.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;C-MAJOR is an ongoing, observational, non-interventional, multicenter registry study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Multicenter study at 24 polycystic kidney disease (PKD) clinics and centers across Canada.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;People with ADPKD treated with tolvaptan.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;The primary study objective was to assess the impact of tolvaptan on health-related quality of life (HRQoL) using patient-reported outcome measures. Secondary study outcomes included time to KRT; mortality rate, and time to and cause of death; markers of kidney function; treatment adherence; time to and reasons for treatment/study discontinuation; and incidence of adverse events. This analysis focused on summarizing baseline demographic, clinical, treatment, and safety data collected between 2015 and December 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Outcomes were summarized descriptively or using the Kaplan-Meier method for time-to-event data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 470 people with ADPKD enrolled and analyzed in C-MAJOR, the mean age at diagnosis and at tolvaptan initiation was 29.8 years and 44.4 years, respectively. Patients had a mean baseline total kidney volume of 2010.8 mL. Most patients (67%) had mild to moderate kidney dysfunction (chronic kidney disease [CKD] category G1-3a) and were at high risk of disease progression (Mayo class 1C-E) at baseline, with hypertension (85%) and hepatic cysts (72%) being common manifestations. Mean baseline patient-reported outcome scores were indicative of minimally impacted HRQoL, with mean ADPKD-Impact Scale scores of 1.6, 2.0, and 2.0 for the physical, fatigue, and emotional scales, respectively, and ADPKD Pain and Discomfort Scale scores of 1.8, 2.0, 1.4, and 2.1 for the Overall Pain and Discomfort, Dull Pain, Sharp Pain, and Discomfort severity scales, among others. Treatment and study discontinuation occurred in 29 and 27% of patients, respectively, with a mean time to discontinuation of 70.5 and 62.1 months. Adverse events were the primary reason for treatment (46%) and study (15%) discontinuations. During follow-up, 8% of patients progressed to KRT with a mean time to KRT of 82.5 months. Adverse events were reported in 93","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"13 ","pages":"20543581251404128"},"PeriodicalIF":1.5,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12799986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145987978","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":"Characterizing the Experiences and Educational Needs of Patients and Caregivers During the Kidney Transplant Process.","authors":"Michelle Ruhl, Ashley Burghall, Brianna Groot, Nicola Rosaasen, Kayla Flood, Keefe Davis, Natasha Minakakis, Jenny Wichart, Holly Mansell","doi":"10.1177/20543581251399080","DOIUrl":"10.1177/20543581251399080","url":null,"abstract":"<p><strong>Background: </strong>Kidney transplantation, a life-saving therapy for children with kidney disease, remains challenging to navigate for patients and families.</p><p><strong>Objective: </strong>To elucidate the experiences and educational needs of patients who have received a kidney transplant and their caregivers.</p><p><strong>Design: </strong>Qualitative descriptive study.</p><p><strong>Setting: </strong>One province in Canada (Saskatchewan).</p><p><strong>Patients: </strong>Patients who received a pediatric kidney transplant, transplant recipients and caregivers.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted via video or by phone and recorded and transcribed verbatim in this qualitative descriptive study. Qualitative content analysis was used to analyze the data. Decontextualization involved an inductive approach, whereby the text was coded and organized into categories and subcategories. Dedoose^® software was used to facilitate this process.</p><p><strong>Results: </strong>Twenty-three individuals participated, including 13 caregivers (aging in range from 20's to 60's) and 10 patients who had previously received a transplant (aging in range from adolescents to 40's). Three categories emerged from their experiences: (1) the impact of the transplant on the individual (subcategories social, mental health, physical, lifestyle, returning to normal and new life perspective); (2) transplant expectations (transplant as a cure, unexpected experiences); and (3) the need for support throughout the transplant process (practical support, mental health support, healthcare support, support through shared-lived experiences, and challenges related to finding a community). Regarding education, participants identified the need for personalized, age-appropriate education delivered in digestible formats, with clear expectations, timely reinforcement, and emotional support tailored to both patients and caregivers.</p><p><strong>Limitations: </strong>Participants were recruited from a single small center in Canada. Patient participants had received their transplant at least 5 years prior to participation in the study and were reflecting on their past experiences.</p><p><strong>Conclusion: </strong>Feeling prepared for the transplant journey impacts the transplant experience and kidney transplant education can facilitate care and clarify expectations. The insights gathered from the study will help inform the development of educational resources for patients and caregivers.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251399080"},"PeriodicalIF":1.5,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12745526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145862218","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":"Benefits and Challenges When Implementing Incremental Hemodialysis: A Qualitative Study of Patients and Providers.","authors":"Noémie Laurier, Chloe Wong-Mersereau, Shaifali Sandal, Antoine Przybylak-Brouillard, Ali Taha, Alexander Messina, Daniel Blum, Catherine Weber, Emilie Trinh","doi":"10.1177/20543581251399138","DOIUrl":"10.1177/20543581251399138","url":null,"abstract":"<p><strong>Background: </strong>In 2022, we implemented an incremental hemodialysis (iHD) protocol to initiate twice-weekly treatment for eligible patients. This patient-centered approach aims to ease the transition to dialysis and enhance quality of life. However, limited data exists on how iHD is experienced by patients and health care providers (HCPs).</p><p><strong>Objective: </strong>The aim of the study was to explore the benefits and challenges of iHD from patients' and HCPs' perspectives, and to generate practical considerations for its implementation.</p><p><strong>Study design: </strong>We conducted an exploratory descriptive qualitative study, guided by an interpretivist-constructivist paradigm, using semi-structured interviews (March-May 2024).</p><p><strong>Setting: </strong>The study was conducted in a tertiary care center.</p><p><strong>Participants: </strong>Participants included patients who were actively or had previously received iHD and HCPs caring for iHD patients.</p><p><strong>Methods: </strong>Interview data was analyzed thematically using inductive thematic analysis.</p><p><strong>Results: </strong>Ten patients and five HCPs were interviewed. Six major themes were identified: (1) better quality of life than conventional hemodialysis, (2) travel and financial benefits, (3) psychosocial and emotional impact similar to conventional hemodialysis, (4) coordination of care and logistics, (5) knowledge and training challenges, and (6) challenges when switching modality. Patients preferred iHD because it afforded them more time for participation in daily life activities. However, the start of a dialysis treatment remained \"traumatic\" for some patients. While HCPs recognized the greater quality of life for iHD patients, HCPs expressed a need for increased monitoring to ensure adequate care. Patients noticed an inconsistency in care coordination and reduced opportunities to see nephrologists. Some HCPs reported a lack of guidance on iHD. Finally, HCPs observed patients negotiating to stay on iHD even when it became unsafe.</p><p><strong>Limitations: </strong>The small sample size and single-center setting may limit the findings' transferability.</p><p><strong>Conclusions: </strong>IHD was shown to offer quality of life advantages. However, the transition to iHD remained emotionally challenging for patients. Patients often exhibited resistance when moving from twice-weekly to a thrice-weekly schedule. Logistical issues for HCPs and educational barriers must be addressed to optimize delivery of iHD.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251399138"},"PeriodicalIF":1.5,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12743795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145854713","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}