Canadian Journal of Kidney Health and Disease最新文献

{"title":"Postoperative Bilateral Renal Cortical Necrosis Secondary to Antiphospholipid Syndrome: A Case Report and Literature Review.","authors":"Sara S Jdiaa, Carmen Avila-Casado, Jorge Sanchez-Guerrero, Arenn Jauhal","doi":"10.1177/20543581251394300","DOIUrl":"10.1177/20543581251394300","url":null,"abstract":"<p><p>We report a case of biopsy-proven renal cortical necrosis in a 42-year-old man after bioprosthetic aortic valve replacement despite prophylactic anticoagulation. He had antiphospholipid syndrome with chronic thrombotic microangiopathy and triple-positive antibodies, leading to renal cortical necrosis manifested as severe non-reversible dialysis-dependent acute kidney injury. We identified 13 previously published reports of renal cortical necrosis due to antiphospholipid syndrome: 3 occurred postpartum, 2 after kidney transplantation, and 1 following salpingectomy for ectopic pregnancy.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251394300"},"PeriodicalIF":1.5,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12743794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145854689","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":"Response to the Letter to the Editor by Dr Koratala et al.","authors":"Guillaume Soret, Antonio Leidi, Thomas A Mavrakanas","doi":"10.1177/20543581251404700","DOIUrl":"10.1177/20543581251404700","url":null,"abstract":"","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251404700"},"PeriodicalIF":1.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12743785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145854700","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":"Establishing a National Quality Improvement Program for Nephrology Fellows: The Canadian Society of Nephrology Experience.","authors":"Jordan Thorne, Samuel A Silver, Daniel Blum, Gabrielle Cote, Isabelle Ethier, Kayla Flood, Claire Harris, Jay Hingwala, Priyanka Mysore, Emilie Trinh, Keigan More","doi":"10.1177/20543581251391889","DOIUrl":"10.1177/20543581251391889","url":null,"abstract":"<p><strong>Purpose of program: </strong>In 2021, the Canadian Society of Nephrology (CSN) sent a needs assessment survey to nephrology residents, fellows, and program directors that identified a significant gap in Quality Improvement (QI) training. In response, the CSN's Quality Improvement and Implementation Science (CSN-QUIS) committee launched a national nephrology fellow QI curriculum in 2022.</p><p><strong>Methods: </strong>The program integrates online learning with interactive virtual didactic sessions, including participation in a longitudinal QI project that is presented at the CSN Annual General Meeting (CSN AGM).</p><p><strong>Key findings: </strong>Since inception, the program has expanded to 13 nephrology training programs, including both adult and pediatric sites. Forty-one fellows have completed the full curriculum, with 76 trainees having completed at least one year and presented work at the CSN AGM. Feedback from participants has been overwhelmingly positive, particularly regarding the interactive format, real-world applicability, and national networking opportunities. Continuous fine-tuning of the curriculum itself has occurred in parallel with refinements made to session content, project scheduling, and presentation format based on learner input.</p><p><strong>Limitations: </strong>Barriers such as limited local QI mentorship have been mitigated through virtual faculty pairing, and resources such as software access and publication support have been provided to encourage project success.</p><p><strong>Implications: </strong>Herein, we report the development and initial experience of this national initiative, demonstrating that a structured, collaborative, and distributed QI curriculum is feasible, effective, and scalable across Canada.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251391889"},"PeriodicalIF":1.5,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12743831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145854680","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":"Prevalence of Chronic Kidney Disease in Latin America: A Systematic Review and Meta-analysis.","authors":"Víctor Juan Vera-Ponce, Joan A Loayza-Castro, Luisa Erika Milagros Vásquez-Romero, Fiorella E Zuzunaga-Montoya","doi":"10.1177/20543581251382479","DOIUrl":"10.1177/20543581251382479","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) represents a global health concern, with particular significance in Latin America due to socioeconomic inequalities and heterogeneous health care systems.</p><p><strong>Objective: </strong>To determine the prevalence of CKD in Latin American populations through a systematic review with meta-analysis.</p><p><strong>Design: </strong>Systematic review and meta-analysis of observational studies following the PRISMA guidelines.</p><p><strong>Setting: </strong>Twelve Latin American countries (Argentina, Brazil, Chile, Colombia, Cuba, Ecuador, El Salvador, Haiti, Mexico, Nicaragua, Panama, and Peru).</p><p><strong>Patients: </strong>A total of 72 486 participants from 21 observational studies reporting CKD prevalence in Latin American populations.</p><p><strong>Measurements: </strong>The CKD prevalence according to Kidney Disease: Improving Global Outcomes (KDIGO) or Kidney Disease Outcomes Quality Initiative (K/DOQI) criteria, stratified by age groups (<60-65 vs ≥60-65 years), sex, CKD categories (G1-G5), and country.</p><p><strong>Methods: </strong>Systematic search in PubMed, SCOPUS, Web of Science, and EMBASE databases. Observational studies using standardized CKD diagnostic criteria were included without language restrictions. A meta-analysis was conducted using random-effects models with a Freeman-Tukey double arcsine transformation. The risk of bias was assessed using the Munn et al tool. Meta-regressions examined temporal trends and the effects of sample size.</p><p><strong>Results: </strong>The pooled CKD prevalence was 17.14% (95% confidence interval [CI] = 13.40-21.23%) with high heterogeneity (I² = 99.5%). Age-stratified analysis revealed a prevalence of 11.66% (95% CI = 8.09%-15.79%) in younger adults and 28.29% (95% CI = 22.34%-34.64%) in older adults. Women showed a higher prevalence (19.23%) compared to men (16.75%). Country-specific estimates ranged from 7.26% in Ecuador to 27.14% in Haiti. Meta-regression showed no significant temporal trend (<i>P</i> = .178).</p><p><strong>Limitations: </strong>High between-study heterogeneity, most studies used single measurements rather than confirming chronicity, potential publication bias favoring higher prevalence studies, and limited representation from certain countries, which restricts generalizability.</p><p><strong>Conclusions: </strong>The prevalence of CKD in Latin America exhibits marked age-related differences, with consistently higher rates in older adults. These findings support the need for age-specific prevention strategies and standardized diagnostic approaches across the region.</p><p><strong>Trial registration: </strong>Not registered prospectively (limitation acknowledged).</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251382479"},"PeriodicalIF":1.5,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12712324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145803045","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":"Outcomes of Patients With Autosomal Dominant Polycystic Kidney Disease Prescribed SGLT2 Inhibitors in British Columbia: A Single-Arm Retrospective Cohort Study.","authors":"Alessandro Cau, Mark Elliott, Adeera Levin, Charith Karunarathna, Alexandra Romann, Ognjenka Djurdjev, Mohammad Atiquzzaman, Micheli Bevilacqua","doi":"10.1177/20543581251404101","DOIUrl":"10.1177/20543581251404101","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Autosomal dominant polycystic kidney disease (ADPKD) is the fourth leading cause of kidney failure in Canada and internationally. To date, patients with ADPKD have been excluded from trials of sodium-glucose cotransporter type 2 inhibitors (SGLT2i), which have been demonstrated to positively influence a wide range of kidney outcomes across the spectrum of chronic kidney disease (CKD). This exclusion was primarily due to theoretic safety concerns, particularly hastening disease progression due to vasopressin stimulation. As a result, there is a paucity of data on SGLT2i use among patients with ADPKD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To estimate the risk of kidney dysfunction with SGLT2i treatment among patients with ADPKD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Single-arm retrospective cohort study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting and patients: &lt;/strong&gt;Adult patients (≥18 years old) with CKD with a primary diagnosis of ADPKD in British Columbia, Canada who had been exposed to any drug formulation containing empagliflozin, dapagliflozin or canagliflozin.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods and measurements: &lt;/strong&gt;We retrieved existing data from the province wide registry of patients with kidney disease and performed manual chart reviews on patients with ADPKD who were prescribed an SGLT2i from January 1, 2014, to December 31, 2024. The primary outcome was acute kidney injury (AKI). Secondary outcomes included eGFR slope before and after SGLT2i initiation, magnitude of \"eGFR dip\" after starting SGLT2i as well as the incidence of genitourinary (GU) infections requiring hospital admission, emergency room visit and/or outpatient diagnosis and treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We included 17 patients on SGLT2i in our retrospective chart review with a median exposure of 20.89 months. While on an SGLT2i, one (6%) patient met criteria for AKI. Three patients (18%) had an eGFR dip of greater than 10% after starting an SGLT2i. Before SGLT2i initiation, the estimated eGFR slope was -0.2571 mL/min/1.73 m&lt;sup&gt;2&lt;/sup&gt;. After initiation, the slope was -0.1435 mL/min/1.73 m&lt;sup&gt;2&lt;/sup&gt; (&lt;i&gt;P&lt;/i&gt; = .48). Two patients (12%) had documentation of a urinary tract infection, neither of whom required hospitalization, or an emergency department visit.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The main limitation was the lack of a comparator group, thereby making it difficult to determine the true risk of AKI in our cohort of patients with ADPKD on SGLT2i. Other limitations include our retrospective study design and small sample size, which limits the generalizability of these results. The median exposure time of our cohort to SGLT2i was only 20.89 months and we had limited eGFR data beyond 2 years post-SGLT2i initiation. We did not have data on total kidney volume of these patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this cohort of 17 patients with ADPKD on SGLT2i, we did not observe any signs of adverse kidney outcomes and only two instances of GU infections","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251404101"},"PeriodicalIF":1.5,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12701218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145755327","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":"Proactive Prescription-Based Fluid Management Versus Usual Care in Critically Ill Patients on Kidney Replacement Therapy (Probe-Fluid): A Pilot Clinical Trial Protocol.","authors":"Alicia Shen, Josée Bouchard, Javier A Neyra, François Lamontagne, Jean-Maxime Côté, Edward G Clark, Bruno R da Costa, Martin Gallagher, Neill K J Adhikari, Samuel A Silver, Rita S Suri, Marlies Ostermann, Ary Serpa Neto, Rinaldo Bellomo, Sean M Bagshaw, Ron Wald, William Beaubien-Souligny","doi":"10.1177/20543581251391877","DOIUrl":"10.1177/20543581251391877","url":null,"abstract":"<p><strong>Background: </strong>Severe acute kidney injury (AKI) in the intensive care unit (ICU) is complicated by fluid accumulation, making fluid removal a central component of kidney replacement therapy (KRT). However, the optimal fluid management strategy in patients receiving KRT remains unknown, and practice varies widely.</p><p><strong>Objective: </strong>To assess the feasibility of conducting a multicentre randomized controlled trial comparing a protocol-based fluid-removal strategy with usual care in critically ill adult patients receiving KRT. The primary objective is to determine whether the intervention results in a difference in cumulative fluid balance from randomization to day five.</p><p><strong>Design: </strong>Open-label, multicentre, pilot randomized controlled trial.</p><p><strong>Setting: </strong>Centers in Canada, the United States, and Australia.</p><p><strong>Patients: </strong>We are enrolling 150 adults admitted to the ICU with AKI who have been receiving KRT for ≤48 hours or who are anticipated to commence KRT within the next 12 hours.</p><p><strong>Measurements: </strong>The primary outcome is the difference in cumulative fluid balance (mL) between treatment arms from randomization (day zero) to the end of day five. Secondary outcomes include feasibility metrics, patient outcomes, resource use, safety outcomes, and process measures.</p><p><strong>Methods: </strong>Participants are randomized 1:1 to receive either protocol-based fluid management or usual care. The intervention consists of a prescription template updated at least once daily by the attending care team, specifying a 24-hour fluid balance target, a prescription for fluid removal using KRT, and daily re-evaluation of fluid intake. The intervention is continued until day five post-randomization, KRT discontinuation due to kidney recovery, or ICU discharge.</p><p><strong>Limitations: </strong>The application of the intervention relies on the clinical judgment of the attending care team, which may affect the fidelity of the intervention. Usual care may differ between institutions, which may lead to variability. The treatment teams are unblinded, however the statistician will be blinded to group allocation.</p><p><strong>Conclusions: </strong>The Probe-Fluid pilot trial will provide important groundwork toward a future definitive multicentre randomized controlled trial comparing a protocol-based fluid management strategy with usual care in critically ill patients receiving KRT.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251391877"},"PeriodicalIF":1.5,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12696302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145755343","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":"Outcomes of Adopting a Higher Versus Lower Concentration of Hemodialysate Magnesium as a Center-Wide Policy (Dial-Mag): A Clinical Research Protocol of a Pragmatic, Registry-Based, Cluster Randomized Trial.","authors":"Lauren Killin, Clara Bohm, Claire Harris, Jennifer M MacRae, Nikhil Shah, Stephanie Thompson, Marcello Tonelli, Bin Luo, Jessica M Sontrop, Rey R Acedillo, Ahmed A Al-Jaishi, Sierra Anderson, John Antonsen, Amit Bagga, Eliot Beaubien, David Berry, Peter G Blake, Pierre A Brown, Joe Bueti, Christopher T Chan, Brenden Cote, Andrea C Cowan, Meaghan S Cuerden, Nicole E Day, Varun Dev, Miten Dhruve, Ognjenka Djurdjev, Laura Gregor, Swapnil Hiremath, Geena Joseph, Srinu Kammila, Mercedeh Kiaii, Eswar Kumar Kolusu, Eduardo Lacson, Andrea Mazurat, Amber O Molnar, Bharat Nathoo, Amy Nistico, Matthew J Oliver, Sanjay Pandeya, Malvinder S Parmar, David Perkins, Kathleen Quinn, Alexandra Romann, Joanna Sasal, Tanya Shulman, Samuel A Silver, Anurag Singh, Irina St Louis, Andrew Steele, Navdeep Tangri, Robert H Ting, Hans Vorster, Davinder B Wadehra, Ron Wald, Justin Walters, Reid H Whitlock, Shaoyee Yao, James Zacharias, Amit X Garg","doi":"10.1177/20543581251385011","DOIUrl":"10.1177/20543581251385011","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In individuals receiving hemodialysis, lower serum magnesium concentrations are associated with a higher risk of death and cardiovascular disease and more discomfort from muscle cramps. Small trials suggest that increasing serum magnesium by using a higher concentration of dialysate magnesium may be beneficial. This protocol outlines a large, randomized trial examining the effects of adopting a high versus low concentration of dialysate magnesium as a hemodialysis center-wide policy on the risk of mortality, major adverse cardiovascular events, and the burden of muscle cramps.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine whether implementing a dialysate magnesium concentration of 0.75 mmol/L versus ≤ 0.5 mmol/L as a hemodialysis center-wide policy, for up to 4 years, affects (1) the rate of all-cause mortality or major cardiovascular-related hospitalizations or (2) the level of discomfort individuals experience from muscle cramps.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Pragmatic, 2-arm, parallel-group, registry-based, open-label, 2-sided superiority cluster randomized trial. Hemodialysis centers were randomly allocated (1:1) to one of the 2 arms. The assignment was constrained by five center-level prognostic factors and stratified by province.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;137 hemodialysis centers in four Canadian provinces-Ontario, British Columbia, Alberta, and Manitoba. The trial period is from April 4, 2022, to March 31, 2026. Outcomes will be analyzed after March 31, 2026, using provincial health care databases and self-reported questionnaires.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Individuals who received maintenance hemodialysis at participating centers during the trial period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;Use of a dialysate magnesium concentration of either 0.75 mmol/L or ≤ 0.5 mmol/L as a center-wide policy during the trial period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;The two primary outcomes are (1) a composite of all-cause mortality or major cardiovascular-related hospitalization (a hospital admission with myocardial infarction, congestive heart failure, or ischemic stroke) recorded in large health care databases and (2) self-reported muscle cramps collected from questionnaires.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Using an intent-to-treat approach, the intervention effect on the instantaneous rate of the primary composite outcome will be analyzed using a stratified Cox proportional hazards model accounting for center-level clustering. The observation time will be censored for provincial emigration or the trial end date. Self-reported muscle cramps will be analyzed using a cumulative link (proportional odds) model. All models will be stratified by province and adjusted for the covariates used to constrain randomization.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The trial start date was delayed in some centers due to post-pandemic supply disruptions (including discontinued dialysate formulations); however, all ce","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251385011"},"PeriodicalIF":1.5,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12696322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145755340","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 New Multidisciplinary Model of Glomerulonephritis Care in Ontario: A Descriptive Program Report.","authors":"Arrti A Bhasin, Stephanie N Dixon, Lavanya Bathini, Nivethika Jeyakumar, Lima F Rodrigues, Yuguang Kang, Peter G Blake, Amit X Garg, Michelle A Hladunewich","doi":"10.1177/20543581251394082","DOIUrl":"10.1177/20543581251394082","url":null,"abstract":"<p><strong>Purpose of program: </strong>In 2018, Ontario Health (Ontario Renal Network) established a new multidisciplinary model of glomerulonephritis care to be available to all 27 Regional Renal Programs. This model of care was designed to fill existing gaps and ensure individuals with glomerulonephritis access to standardized, timely, and high-quality treatment close to home. This report describes the characteristics of individuals who received this care since it was established.</p><p><strong>Sources of information: </strong>Provincial administrative health care databases.</p><p><strong>Methods: </strong>This is a descriptive study of the characteristics of adults with a registered glomerulonephritis visit provided by a multidisciplinary care team in Ontario, Canada between April 1, 2019, and March 31, 2023. Individuals were excluded if they had evidence of a kidney transplant prior to their first registered visit.</p><p><strong>Key findings: </strong>A total of 6,926 individuals were included in the cohort. Every year since 2019, approximately 1,200 new individuals had a registered multidisciplinary visit. IgA nephropathy was the most common reported diagnosis at the first registered visit (1,407 of 6,926 [20.5%]). Over a median follow-up period of 2.7 years (interquartile range = 1.3-3.7) since their first registered visit, 420 individuals (6%) received kidney replacement therapy (maintenance dialysis or kidney transplant).</p><p><strong>Limitations: </strong>This description of individuals with registered visits underestimates the true prevalence of adults with glomerulonephritis in Ontario, as it does not capture those who did not register or who received more advanced disease management in other settings.</p><p><strong>Implications: </strong>The use of a new model of multidisciplinary glomerulonephritis care in Ontario, Canada is becoming well established. Ongoing analysis of administrative data will guide future healthcare planning and delivery.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251394082"},"PeriodicalIF":1.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12669530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145667204","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 Integration and Evaluation of the STrategic Optimization of Prescription Medication Use in Patients on HemoDialysis (STOPMed-HD) Intervention.","authors":"Angelina Abbaticchio, Madeline Theodorlis, Michelle S Cross, Abhijat Kitchlu, Jo-Anne Wilson, Laura Sills, Nairne Scott-Douglas, Elena Qirjazi, Marcello Tonelli, Alexandra DeBusschere, Jenny Wichart, Kimberly Defoe, Jennifer M MacRae, Caroline E Stigant, Dan J Martinusen, Alison J Cheung, Marisa Battistella","doi":"10.1177/20543581251393436","DOIUrl":"10.1177/20543581251393436","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;People undergoing hemodialysis (HD) take an average of 12 medications daily, with 93% prescribed at least one potentially inappropriate medication or dose. Polypharmacy is commonly defined as taking 5 or more medications per day; however, it can also refer to the use of inappropriate medication choices and doses. Polypharmacy can lead to serious health consequences, including drug-drug interactions, falls, and hospitalizations. Deprescribing, the process of stopping or gradually reducing the dose of a medication that may be causing harm or offers no benefit, can reduce polypharmacy among older adults. However, little research focuses on deprescribing in the HD population, and few tools exist to support deprescribing in HD. To address this gap, we developed and validated the STrategic Optimization of Medication Use in Patients on HemoDialysis (STOPMed-HD) intervention, a deprescribing toolkit which includes clinician-focused algorithms, monitoring forms, and evidence tables, and patient-facing information bulletins and videos. Co-developed with clinicians and patients, the toolkit reflects patient priorities and aligns with their deprescribing goals. This report describes the implementation and evaluation strategy of the STOPMed-HD intervention at 4 HD sites across Canada, and presents insights into barriers, facilitators, and key considerations for implementation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Knowledge mobilization and implementation methods: &lt;/strong&gt;Our knowledge mobilization and implementation strategy involves a collaborative approach to implement the evidence-based deprescribing toolkit. Our strategy prioritizes engagement with several key partners, including patients and clinicians, to support implementation and foster a culture of deprescribing within HD units across Canada. Clinician buy-in at participating sites was established during toolkit development, and we continue to support clinicians throughout implementation at their respective HD units. Diverse patient partners have been actively involved since the inception of the study, and ongoing patient engagement remains central. To explore facilitators and barriers to uptake, we conducted interviews with patients and clinicians who participated in the 6-month deprescribing intervention at the Toronto site. Interviews at other sites will be completed in the coming months. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework guided our data collection and analysis approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key findings and implementation considerations: &lt;/strong&gt;The 6-month deprescribing intervention has been implemented in Toronto, ON; Halifax, NS; Calgary, AB; and Victoria, BC. This report includes key barriers and facilitators identified from the Toronto site. Patient-level barriers include fear of withdrawal, medication dependence, disengagement, and lack of follow-up support, while facilitators include clear messaging about deprescribing and regular mo","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251393436"},"PeriodicalIF":1.5,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12665828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145660486","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 Role of Desmopressin in Kidney Biopsies: A Narrative Review.","authors":"Sheldon W Tobe, Raea Dobson","doi":"10.1177/20543581251366752","DOIUrl":"10.1177/20543581251366752","url":null,"abstract":"<p><p>Desmopressin is a vasopressin analogue. In addition to its antidiuretic effects, it is also a procoagulant. While it is indicated to reduce bleeding in a variety of situations, it is not currently being utilized broadly for kidney biopsies, a procedure where bleeding is the most common complication.</p><p><strong>Purpose of review: </strong>To discuss the evidence surrounding use of desmopressin for kidney biopsy.</p><p><strong>Sources of information: </strong>We conducted a search of MEDLINE (Ovid), Embase (Ovid), CENTRAL (Wiley), International Pharmaceutical Abstracts (Ovid), and Scopus databases.</p><p><strong>Methods: </strong>All identified trials were reviewed. Trials since the last systematic review in 2020 were organized in color-coded tables by efficacy, neutral results, or harm.</p><p><strong>Key findings: </strong>Studies are generally favorable in terms of efficacy data for reduced bleeding during kidney biopsies, with some safety concerns. More studies are still needed, but we believe desmopressin can be justified to reduce bleeding complications of kidney biopsy in the setting of chronic kidney disease (CKD).</p><p><strong>Limitations: </strong>Trials involved small sample sizes, single-center data, and were largely observational in nature.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251366752"},"PeriodicalIF":1.5,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12665823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145660410","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}