Canadian Journal of Kidney Health and Disease最新文献

{"title":"Process Evaluation Alongside a Cluster-Randomized Trial of a Multicomponent Intervention Designed to Improve Patient Access to Kidney Transplantation.","authors":"Seychelle Yohanna, Mackenzie Wilson, Kyla L Naylor, Amit X Garg, Jessica M Sontrop, Istvan Mucsi, Dimitri Belenko, Stephanie N Dixon, Peter G Blake, Rebecca Cooper, Lori Elliott, Esti Heale, Sara Macanovic, Rachel Patzer, Amy D Waterman, Darin Treleaven, Candace Coghlan, Marian Reich, Susan McKenzie, Justin Presseau","doi":"10.1177/20543581251323959","DOIUrl":"10.1177/20543581251323959","url":null,"abstract":"<p><strong>Background: </strong>In a cluster-randomized trial, we learned that a novel multicomponent intervention designed to improve access to kidney transplantation did not significantly increase the rate of completed steps toward receiving a kidney transplant. Alongside the trial, we conducted a process evaluation to help interpret our findings.</p><p><strong>Objective: </strong>To determine whether the intervention addressed targeted barriers to transplant and whether the implementation occurred as planned.</p><p><strong>Design: </strong>Mixed-methods process evaluation informed by implementation science theories.</p><p><strong>Setting: </strong>Chronic kidney disease (CKD) programs in Ontario, Canada. These programs, providing care to patients with advanced CKD, participated in the trial from November 1, 2017 to December 31, 2021 (either in the intervention or usual care group).</p><p><strong>Participants: </strong>Health care providers (eg, nurses, managers) at Ontario's 27 CKD programs.</p><p><strong>Methods: </strong>We conducted surveys (n = 114/162 [70.4%]) and semi-structured interviews (n = 17/26 [65.4%]) with providers in CKD programs in Ontario, Canada. In both the intervention-group and control-group surveys, using the Theoretical Domains Framework, we assessed perceived barriers to transplant and how barriers changed throughout the trial period. In the intervention-group surveys and interviews, using the normalization process theory, we assessed the extent to which the intervention was embedded into daily routines. In the intervention-group surveys, and by completing an implementation checklist, we assessed fidelity of implementation.</p><p><strong>Results: </strong>Perceived barriers to transplant did not substantially differ between providers in the intervention and usual care groups, and both groups reported disagreeing or feeling neutral that the targeted barriers impeded transplant access. Intervention-group providers reported that intervention activities were becoming a regular part of their work and that they engaged with its components. However, they also felt the intervention was complex and described needing more resources, a better execution plan, and more buy-in from frontline staff. Fidelity was high for administrative support, quality improvement teams, delivery of educational resources, and patient peer support. The use of performance reports was low.</p><p><strong>Conclusions: </strong>We identified several possible reasons why the intervention was unsuccessful. Improving access to kidney transplantation remains a high priority for health care systems. We will continue to foster a quality improvement culture, and our results will guide future interventions.</p><p><strong>Limitations: </strong>Two of the 13 intervention-group CKD programs did not participate in this evaluation.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT03329521.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251323959"},"PeriodicalIF":1.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Real-World Use of Semaglutide to Promote Weight Loss in Obese Adults With Hemodialysis: A Multicenter Cross-Sectional Descriptive Study.","authors":"Jodianne Couture, Pascale Robert, Marie-France Beauchesne, Gabriel Dallaire, Annie Lizotte, Jo-Annie Lafrenière, Julie Beauregard, Janique Doucet","doi":"10.1177/20543581251324588","DOIUrl":"10.1177/20543581251324588","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Obesity can be an issue for renal transplant eligibility. Semaglutide constitutes an interesting choice for obesity treatment, but little data exist regarding its efficacy and security among dialysis patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The co-primary endpoints of this study were to describe the change in body weight (%) and in body mass index (BMI) from the beginning and after 3, 6, and 12 months of treatment for participants who used semaglutide compared with a control group of non-users. Secondary endpoints included description of dosages used and reported adverse events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Multicenter cross-sectional descriptive study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Seven hemodialysis centers in Quebec and New Brunswick, Canada.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Adults receiving hemodialysis treatment with BMI of at least 30 kg/m&lt;sup&gt;2&lt;/sup&gt; were included.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;Weight as defined by the target body weight (kg) at the end of dialysis. Body mass index is defined by weight, kg/m&lt;sup&gt;2&lt;/sup&gt;.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;As a primary objective, we collected in records the body weights and calculated BMI at months 0, 3, 6, and 12 for participants with BMI of 30 kg/m&lt;sup&gt;2&lt;/sup&gt; or greater. The dosages of semaglutide and the mention of any adverse events were also collected from questionnaire to participants, to community drug stores, and from records.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 1286 patients received hemodialysis treatments in June 2023. Of these, 396 (31%) had a BMI of 30 kg/m&lt;sup&gt;2&lt;/sup&gt; or greater. Two hundred fifty-one participants were included in the study and 41 (16%) received semaglutide. The estimated treatment differences for the percentage change in body weight from baseline to 3, 6, and 12 months for semaglutide compared with the control group were -2.26%, 95% confidence interval (CI), -3.68 to -0.84, &lt;i&gt;P&lt;/i&gt; = .002; -0.94%, 95% CI, -2.17 to 0.29, &lt;i&gt;P&lt;/i&gt; = 0.135; and -0.64%; 95% CI, -2.04 to 0.76, &lt;i&gt;P&lt;/i&gt; = .370, respectively. The estimated treatment differences at 3, 6, and 12 months for BMI were -0.87 kg/m&lt;sup&gt;2&lt;/sup&gt;, 95% CI, -1.38 to -0.36, &lt;i&gt;P&lt;/i&gt; &lt; .001; -0.35 kg/m&lt;sup&gt;2&lt;/sup&gt;, 95% CI, -0.79 to 0.09, &lt;i&gt;P&lt;/i&gt; = .119; and -0.23 kg/m&lt;sup&gt;2&lt;/sup&gt;, 95% CI, -0.72 to 0.27, &lt;i&gt;P&lt;/i&gt; = .371, respectively. The estimated treatment difference in body weight and BMI change between the 2 groups was statistically significant at 3 months. A sensitivity analysis was carried out with all the participants of the semaglutide group who continued the treatment for 12 months (N = 15). The estimated treatment differences for the percentage change in body weight between this group and the control group were -3.04%, 95% CI, -5.18 to -0.89, &lt;i&gt;P&lt;/i&gt; = .006; -1.97%, 95% CI, -3.79 to -0.14, &lt;i&gt;P&lt;/i&gt; = .035; and -2.83%, 95% CI, -4.66 to -1.00, &lt;i&gt;P&lt;/i&gt; = .003 at 3, 6, and 12 months, respectively. The average body weight change between months 0 and 12 wa","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251324588"},"PeriodicalIF":1.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656149","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":"\"They Know You Better Than the Transplant Team\": An Interpretive Description Study Exploring the Perspectives of Living Kidney Donors About Care Received From Family Physicians.","authors":"Katya Loban, Charo Rodriguez, Antoine Przybylak-Brouillard, Elie Fadel, Heather Badenoch, Peter Nugus, Ann Bugeja, Justin Gill, Marie-Chantal Fortin, Emilie Trinh, Scott McKay, Shaifali Sandal","doi":"10.1177/20543581251324548","DOIUrl":"https://doi.org/10.1177/20543581251324548","url":null,"abstract":"<p><strong>Background: </strong>Given the significant benefits of living donor kidney transplantation, the nephrology and transplant communities are augmenting efforts to increase living kidney donation. However, prior living kidney donors (LKDs) report suboptimal experiences and unmet care needs. The LKDs are healthy, and the vast majority have good outcomes post-donation. Thus, in clinical practice, their care is primarily assumed by practitioners, such as family physicians (FPs).</p><p><strong>Objective: </strong>This study aimed to better understand the integration of primary care in LKDs' donation trajectory from the point of view of the latter. Our specific research questions were: (1) How do LKDs perceive the role of FPs currently integrated into the donation trajectory? (2) What are their needs and expectations from their FPs?</p><p><strong>Design: </strong>An interpretive description methodology.</p><p><strong>Setting and participants: </strong>Canadian LKDs who donated a kidney prior to 2020.</p><p><strong>Methods: </strong>Qualitative interviews and inductive thematic analysis.</p><p><strong>Results: </strong>In our sample of 49 LKDs who donated between 2007 and 2020, 61.2% were women and 87.8% were white. Also, 87.8% and 83.7% were attached to an FP pre- and post-donation (1 by a nurse practitioner) with 16.3% reporting no regular FP post-donation. Although participants provided varying accounts, an overwhelming majority described challenges with timely access to needed care; lack of cohesive continuity of care; variability in the services offered by FPs; and challenges with coordination of care between providers. Many reported poor coordination and communication between FPs and donor teams. Most articulated the desire to see an expanded role for FPs. This included improvements in knowledge regarding living donor care, information and care brokerage, continuous integrative care, and mental and emotional support.</p><p><strong>Limitations: </strong>Limited transferability of our findings to other countries with variable payment structures.</p><p><strong>Conclusions: </strong>Our work suggests that improving LKD care requires developing care pathways that facilitate donor transition and care coordination between donor teams and primary care practitioners. Given the challenges being faced by primary care in Canada, we believe that pragmatic strategies to better support primary care practitioners and a stronger integration of primary care with the living kidney donation process are essential. In addition, strategies to better support the mental health of LKDs are also needed. The LKDs provide a valuable gift to our health systems and to patients with kidney failure. It is our responsibility to optimize their experiences and improve their care.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251324548"},"PeriodicalIF":1.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647354","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":"Using Unsupervised Clustering to Characterize Phenotypes Among Older Kidney Transplant Recipients: A Cohort Study.","authors":"Sareen Singh, Syed Sibte Raza Abidi, Syed Asil Ali Naqvi, Amanda J Vinson, Thomas A A Skinner, George Worthen, Samina Abidi, Kenneth A West, Karthik K Tennankore","doi":"10.1177/20543581251322576","DOIUrl":"https://doi.org/10.1177/20543581251322576","url":null,"abstract":"<p><strong>Background: </strong>Older kidney transplant recipients have inferior outcomes compared to younger recipients, and this risk may be compounded by donor characteristics.</p><p><strong>Objective: </strong>We applied an unsupervised machine learning clustering approach to group older recipients into similar phenotypes. We evaluated the association between each cluster and graft failure, and the impact of donor quality on outcomes.</p><p><strong>Design: </strong>This is a nationally representative retrospective cohort study.</p><p><strong>Setting and patients: </strong>Kidney transplant recipients aged ≥65 years identified from the Scientific Registry of Transplant Recipients (2000-2017).</p><p><strong>Measurements and methods: </strong>We used unsupervised clustering to generate phenotypes using 16 recipient factors. Donor quality was evaluated using 2 approaches, including the Kidney Donor Risk Index (KDRI). All-cause graft failure was analyzed using multivariable Cox regression.</p><p><strong>Results: </strong>Overall, 16 364 patients (mean age 69 years; 38% female) were separated into 3 clusters. Cluster 1 recipients were exclusively female; cluster 2 recipients were exclusively males without diabetes; and cluster 3 recipients were males with a higher burden of comorbidities. Compared to cluster 2, the risk of graft failure was higher for cluster 3 recipients (adjusted hazard ratio [aHR] = 1.25, 95% confidence interval [CI] = 1.19-1.32). Cluster 3 recipients of a lower quality (KDRI ≥1.45) kidney had the highest risk of graft failure (aHR = 1.74, 95% CI = 1.61-1.87) relative to cluster 2 recipients of a higher quality kidney.</p><p><strong>Limitations: </strong>This study did not include an external validation cohort. The findings should be interpreted as exploratory and should not be used to inform individual risk prediction nor be applied to recipients <65 years of age.</p><p><strong>Conclusions: </strong>In a national cohort of older kidney transplant recipients, unsupervised clustering generated 3 clinically distinct recipient phenotypes. These phenotypes may aid in complementing allocation decisions, providing prognostic information, and optimizing post-transplant care for older recipients.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251322576"},"PeriodicalIF":1.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Province-Wide Home Dialysis Program Review: Challenges, Strengths, and Future Strategies.","authors":"Megan Borkum, Micheli Bevilacqua, Alexandra Romann, Krishna Poinen, Sushila Saunders, Linda Turnbull, R Suneet Singh, Adeera Levin, Michael A Copland","doi":"10.1177/20543581251324560","DOIUrl":"https://doi.org/10.1177/20543581251324560","url":null,"abstract":"<p><strong>Purpose of review: </strong>British Columbia (BC) has a robust provincial kidney care program emphasizing patient-centered and goal-oriented dialysis care. Despite maintaining a home dialysis prevalence of approximately 30%, consistently above the national average, a review was conducted to examine intake and attrition rates and optimize these outcomes within a learning health system context.</p><p><strong>Sources of information: </strong>This review draws on published articles, program reports, and insights from the provincial kidney care program framework. Key components include funding models, multidisciplinary committees, administrative support, and comprehensive training resources for staff and patients.</p><p><strong>Methods: </strong>A structured analysis was conducted to evaluate factors influencing home dialysis rates. The approach focused on health care system dynamics, professional practices, and patient characteristics, emphasizing identifying barriers and opportunities for program optimization.</p><p><strong>Key findings: </strong>Challenges identified include ongoing biases among health care professionals and logistical barriers in remote areas. Future initiatives aim to standardize patient screening, promote home dialysis champions, adopt environmentally friendly practices, and expand peer support networks.</p><p><strong>Limitations: </strong>The review is constrained by potential regional variability within BC and limited generalizability to other provinces or countries. In addition, patient preferences and broader societal influences require further exploration.</p><p><strong>Implications: </strong>A systematic approach to assessing and optimizing home dialysis programs is essential. The findings highlight the need to address health care system barriers, improve professional education, and promote patient engagement to increase home dialysis uptake and sustainability.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251324560"},"PeriodicalIF":1.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647355","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":"Approximating the Proportion of Individuals With Kidney Failure Who Die Without Kidney Replacement Therapy in Ontario, Canada.","authors":"Andrea C Cowan, Nivethika Jeyakumar, Amit X Garg, Stephanie Dixon, Bin Luo, Peter G Blake","doi":"10.1177/20543581251323961","DOIUrl":"https://doi.org/10.1177/20543581251323961","url":null,"abstract":"<p><strong>Background: </strong>Quantifying the number and proportion of people with kidney failure (KF) who receive conservative kidney management is vital for health care system benchmarking and planning. It is not easy to ascertain this value precisely at the population level, but we can approximate it using information from different data sources to estimate the proportion of patients with advanced kidney disease who die without receiving dialysis or a transplant and should receive conservative kidney management.</p><p><strong>Objective: </strong>To approximate the proportion of people with KF in Ontario, Canada, who die without receiving kidney replacement therapy.</p><p><strong>Design: </strong>A review of unpublished provincial renal agency reports of 3 retrospective population-based cohorts combined with clinical interpretation.</p><p><strong>Patients: </strong>The 3 cohorts of people were: 1. those who died between January 1, 2013 and December 31, 2017, with an estimated glomerular filtration rate (eGFR) <10 mL/min/1.73 m² and no evidence of receiving kidney replacement therapy; 2. those who initiated outpatient maintenance dialysis or received a preemptive transplant in the same period; and 3. those with a sustained low eGFR ≤ 10 mL/min/1.73 m² between April 1, 2015 and March 31, 2018, and were followed for 1 year to determine if they started dialysis. In this last cohort, patients whose kidney function improved (evidence of an eGFR > 10 mL/min/1.73 m²) or who received a transplant during follow-up were excluded from the analysis.</p><p><strong>Measurements and methods: </strong>The 3 cohorts were derived at ICES and used linked health care databases for the province of Ontario, Canada. In 2016, Ontario had a population of about 14 million people. Two nephrologists reviewed the data to provide the clinical approximation.</p><p><strong>Results: </strong>There were 1891 individuals with KF who died without kidney replacement (the no KRT cohort). The median (25th, 75th percentile) eGFR prior to death was 7 (5, 8) mL/min/1.73 m². During the same period, 13 511 individuals started dialysis or received a preemptive kidney transplant (the KRT cohort). There were 7259 individuals in the low eGFR cohort; over the following year, 66% started dialysis, 20% died without dialysis, and 14% were alive without starting dialysis. The clinical approximation is that between 13 and 16% of people with KF die without receiving kidney replacement therapy.</p><p><strong>Limitations: </strong>The data reports lacked certain information to inform the clinical approximation. There was no information on the conversations health professionals had with people about kidney replacement therapy, any decisions made about receiving conservative care, or the circumstances that preceded death without kidney replacement therapy.</p><p><strong>Conclusions: </strong>After reviewing data from the 3 cohorts, we clinically approximate ","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251323961"},"PeriodicalIF":1.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647356","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":"Is Childhood IgA Nephropathy Different From Adult IgA Nephropathy? A Narrative Review.","authors":"Areefa Alladin-Karan, Susan M Samuel, Andrew W Wade, Pietro Ravani, Silviu Grisaru, Ngan N Lam, Kathryn A Bernie, Robert R Quinn","doi":"10.1177/20543581251322571","DOIUrl":"10.1177/20543581251322571","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose of the review: &lt;/strong&gt;Immunoglobulin A (IgA) nephropathy (IgAN) is the most common primary glomerular kidney disease. Children and adults are presumed to have the same disease and are treated similarly. However, there are differences between childhood IgAN and adult IgAN that may require unique treatment considerations, even after transition to adult nephrology services. A narrative review was conducted to compare childhood and adult IgAN and to describe the distinct characteristics of childhood IgAN. Reframing childhood IgAN can inform guideline recommendations unique to childhood IgAN, the development of targeted therapies, and clinical trial design.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Sources of information: &lt;/strong&gt;Medline and Embase were searched for reports on children and adults with IgAN published between January 2013 and December 2023 (updated May 2024). The search was not restricted by age group, outcomes reported, language, or study design. Randomized controlled trials (RCTs), observational studies, review articles, and nephrology conference abstracts were included. A total of 3104 reports were retrieved. Forty-seven reports (37 primary studies and 10 reviews) were included in the review. Two RCTs and 35 observational studies included a total of 45 085 participants (9223 children and 35 862 adults).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;Data were extracted for primary IgAN and not for IgA vasculitis-associated nephritis. Findings were described with no statistical comparisons due to variations in interventions and outcome definitions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key findings: &lt;/strong&gt;Gross hematuria was the obvious clinical difference between childhood IgAN and adult (60-88% vs 15-20%). Nephrotic syndrome was more common in children, approaching up to 44%, while &lt;18% of adults had nephrotic syndrome. Children were biopsied sooner (6 vs 15 months) and had more inflammatory kidney lesions (mesangial hypercellularity: 41-82% vs 38-64%; endocapillary hypercellularity: 39-58% vs 17-34%). Chronic kidney lesions were more prevalent in adults (segmental sclerosis: 62-77% vs 8-51%; interstitial fibrosis/tubular atrophy: 34-37% vs 1-18%). The use of immunosuppressive therapy was higher in children (46-84% vs 35-56%). Children were started on immunosuppressive therapy sooner than adults. Adults were more likely to be optimized with renin-angiotensin system inhibitors (87-94% vs 49-75%). Children had better kidney function than adults at diagnosis (estimated glomerular filtration rate of 90-128 vs 50-88 ml/min/1.73 m&lt;sup&gt;2&lt;/sup&gt;), and children also had better kidney survival, with kidney failure of 3.1% vs 13.4% at 5 years. Children had more risk alleles for IgAN and higher levels of mannose-binding lectin than adults.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;Most studies were retrospective and observational, with limited data on children and disease mechanisms. Data were not pooled for analysis because of important differences in definitions and measurements of baseline ","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251322571"},"PeriodicalIF":1.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11898040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613500","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":"Impact of Baseline Kidney Function on the Rate of Progressive Kidney Disease After Pregnancy: A Population-Based Cohort Study Research Protocol.","authors":"Lavanya Bathini, Nivethika Jeyakumar, Jessica Sontrop, Eric McArthur, Yuguang Kang, Bin Luo, Aminu Bello, David Collister, Sofia Ahmed, Padma Kaul, Erik Youngson, Branko Braam, Nir Melamed, Michelle Hladunewich, Amit X Garg","doi":"10.1177/20543581251318836","DOIUrl":"https://doi.org/10.1177/20543581251318836","url":null,"abstract":"<p><strong>Background: </strong>Better data are necessary to determine whether baseline level of kidney function affects the rate of progressive kidney disease following pregnancy.</p><p><strong>Objective: </strong>The objective was to determine whether the baseline (pre-pregnancy) estimated glomerular filtration rate (eGFR) modifies the association between becoming pregnant and the subsequent rate of progressive kidney disease.</p><p><strong>Design: </strong>Population-based cohort study using provincial administrative health care databases in Ontario and Alberta, Canada.</p><p><strong>Setting: </strong>The sample will be accrued from April 1, 2007, to March 31, 2023, in Ontario and from April 1, 2012, to March 31, 2023, in Alberta. Follow-up for study outcomes will occur until March 31, 2024.</p><p><strong>Participants: </strong>The pregnant group will include adult female residents of Ontario or Alberta with a record of a pregnancy of 20 to 46 weeks' gestation during the accrual period, and the non-pregnant group will include adult female residents with no prior record of pregnancy. The cohort entry dates in those in the pregnant group will be the estimated date of conception; the entry dates for those in the non-pregnant group will be randomly assigned following the distribution of dates in the pregnant group. To be eligible, individuals must be between 18 and 45 years old at cohort entry. They require at least 1 serum creatinine measurement within 2 years before entry and should not have received maintenance dialysis or a prior kidney transplant. Both groups will be categorized into one of 3 levels of baseline eGFR (≥60, 45-59, and <45 mL/min per 1.73 m²). Inverse probability of treatment weighting on a propensity score will be used to balance the pregnant and non-pregnant groups on baseline characteristics (including age, proteinuria, hypertension, and diabetes) within the 3 categories of baseline eGFR.</p><p><strong>Measurements: </strong>The primary outcome, progressive kidney disease, will be defined as a composite of a persistent ≥40% drop in eGFR from the baseline value, a new persistent eGFR <15 mL/min per 1.73 m², receipt of maintenance dialysis, or receipt of a kidney transplant. The secondary outcomes will be the components of the primary composite outcome examined separately and the annualized change in eGFR in mL/min per 1.73 m² from baseline.</p><p><strong>Methods: </strong>We will test for statistical interaction to determine whether the baseline category of eGFR modifies the rate of long-term progressive kidney disease after pregnancy. We hypothesize that a statistical interaction will be present. We will present weighted cause-specific hazard ratios (HRs) and cumulative incidence function (CIF) curves for up to 10 years of follow-up for the pregnant and non-pregnant groups stratified by each eGFR category. We will perform additional pre-specified analyses to confirm whether the findings are ro","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251318836"},"PeriodicalIF":1.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540377","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":"Shared Decision-Making Aid for Stroke-Prevention Strategies in Patients With Atrial Fibrillation Receiving Maintenance Hemodialysis (SIMPLIFY-HD): A Mixed-Methods Study.","authors":"Olivier Massé, Noémie Maurice, Yu Hong, Claudia Mercurio, Catherine Tremblay, Lysane Senécal, Amélie Bernier-Jean, Nicolas Dugré, Gabriel Dallaire","doi":"10.1177/20543581241311077","DOIUrl":"10.1177/20543581241311077","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Recent atrial fibrillation guidelines recommend shared decision-making between clinicians and patients when choosing stroke-prevention therapies. Although decision aids improve patients' knowledge and decisional conflicts, there is no decision aid for stroke-prevention strategies in people with atrial fibrillation receiving hemodialysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective was to develop and field test the first decision aid for Atrial Fibrillation in HemoDialysis (AFHD-DA) for stroke prevention in atrial fibrillation and hemodialysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;This is a sequential 3-phase mixed-methods study following the International Patient Decision Aid Standards and the Ottawa Decision Support Framework.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;This study was conducted in 2 ambulatory hemodialysis centers in Montreal and Laval (Canada).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Adults with atrial fibrillation receiving hemodialysis and clinicians (physicians, pharmacists, or nurse practitioners) involved in their care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In phase 1, we conducted systematic and 2 rapid reviews and formed the steering committee to pilot the first version of AFHD-DA. In phase 2, we refined the AFHD-DA through 4 rounds of focus groups and interviews, using a qualitative analysis of transcripts and a descriptive analysis of acceptability and usability scores. In phase 3, we field-tested the decision aid during 16 simulated clinical consultations. We assessed decisional conflict and patient knowledge using before-and-after paired &lt;i&gt;t&lt;/i&gt;-tests and compared the proportion of patients with high decisional conflict using McNemar's test. We used the Ottawa Hospital preparation for decision-making scale and participants' feedback to evaluate how AFHD-DA facilitated shared decision-making.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We enrolled 8 patients and 10 clinicians in phase 2. The predefined usability and acceptability thresholds (68 and 66, respectively) were reached. Theme saturation was achieved in the fourth round of focus groups and interviews. Four major themes emerged: acceptability, usability, decision-making process, and scientific value of the decision aid. Sixteen patients and 10 clinicians field-tested the decision aid in phase 3. In clinical settings, AFHD-DA significantly decreased the mean decisional conflict score from 41.0 to 13.6 (&lt;i&gt;P&lt;/i&gt; &lt; .001) and the proportion of patients with decisional conflicts from 81.3 to 18.8% (&lt;i&gt;P&lt;/i&gt; = .002). It improved the patients' mean knowledge score from 62.7 to 76.6 (&lt;i&gt;P&lt;/i&gt; = .001), and 81% of patients and 90% of clinicians felt highly prepared for decision-making. Clinical consultations lasted, on average, 21 minutes (standard deviation = 8).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The main limitations were the low quality of existing literature, the small number of participants, and the absence of a control group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581241311077"},"PeriodicalIF":1.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Pathological Characteristics of Non-AL Amyloidosis MGRS: A Single-Center Experience Over 10 Years.","authors":"Chunpeng Nie, Holly Lee, Kim Cheema, Peter Duggan, Sylvia McCulloch, Jason Tay, Paola Neri, Nizar J Bahlis, Victor H Jimenez-Zepeda","doi":"10.1177/20543581251318830","DOIUrl":"10.1177/20543581251318830","url":null,"abstract":"<p><strong>Objective: </strong>Monoclonal gammopathy of renal significance (MGRS) is a heterogeneous and relatively recently defined disorder that encompasses many kidney and hematologic pathologies. MGRS remains a rare disease and there is a need for more literature regarding its treatment and outcomes. In this study, we share our center's experience with MGRS including incidence of different kidney pathologies, clone type, kidney and hematologic response, and progression-free survival.</p><p><strong>Methods: </strong>Data from 35 patients diagnosed with MGRS excluding light-chain amyloidosis between 2013 and 2022 at a single Canadian tertiary care center were retrospectively analyzed. All cases required kidney biopsy. Initial treatment included regimens containing bortezomib, rituximab, or cyclosporine, or steroids only. Parameters studied included incidence of different kidney pathologies, clone type, depth of hematologic response, kidney survival (KS), overall survival (OS), and progression-free survival (PFS).</p><p><strong>Results: </strong>Out of 35 patients, there were 10 cases of monoclonal immunoglobulin deposition disease, 8 of proliferative glomerulonephritis with immune deposits, 5 of microtubular immune deposits including immunotactoid and types 1 and 2 cryoglobulinemic nephropathy, 3 of C3 glomerulonephritis, and 9 of other diagnoses. There were 21 cases with a plasma cell clone identified in bone marrow, 2 each of B cell and low-grade lymphoma, 1 atypical T cell clone, and 9 cases without an expanded clone on bone marrow biopsy. A total of 6 patients required kidney replacement therapy and 4 patients died; the median PFS was 59.3 months. Very good partial hematologic response or better was significantly associated with decreased proteinuria but not preserved eGFR. There was a non-significant trend toward better PFS with hematologic response.</p><p><strong>Conclusion: </strong>Our experience confirms that MGRS is a heterogeneous disease and adds to the literature concerning the diagnosis and treatment of MGRS. Successful treatment of the underlying hematologic disorder with targeted therapy is more likely to lead to an improvement in kidney function.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251318830"},"PeriodicalIF":1.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143481839","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}