This commentary highlights the need for caution when applying findings from sodium-glucose cotransporter-2 inhibitor trials to children with congenital anomalies of the kidney and urinary tract. It emphasizes that safety considerations must be tailored to specific patient phenotypes in this population. The authors call for careful evaluation of how these medications might affect children with unique structural kidney issues differently than adults.
Researchers followed 22 survivors of a rare blood disorder called immune-mediated thrombotic thrombocytopenic purpura for one year to understand why many experience long-term memory and thinking problems. The study found that even after the disease was in remission, patients had persistent leakage in the blood-brain barrier and progressive loss of brain volume and nerve fibre integrity. These ongoing vascular issues were linked to lower cognitive scores, suggesting that brain injury in this condition continues to evolve long after the initial medical emergency has passed.
Bennett PN, Penny JD, McIntyre CW, Vanderlinden J, Borkum MS, Castillo G, Collister D, Corradetti B, Duhamel TA, Farion H, Ford E, Garcia E, Getachew R, Jesudason S, Kiaii M, Leu RL, Presseau J, Rigatto C, Seitz AK, Shirazi M, Soni A, Stewart K, Tarca B, Tennankore K, Verdin N, Whitlock R, Wilund K, Thompson S, MacRae JM, Bohm C
This protocol describes an ongoing randomized controlled trial investigating whether 12 weeks of cycling during hemodialysis sessions can reduce heart muscle stress and injury, known as myocardial stunning. Researchers will use ultrasound to monitor heart wall motion and assess whether this exercise improves cognitive function, recovery time, and overall symptoms for patients. The study aims to provide evidence on the benefits and feasibility of intradialytic exercise to help inform future clinical care guidelines.
This commentary discusses the ongoing debate regarding whether a functioning arteriovenous fistula should be surgically closed after a patient receives a successful kidney transplant. The authors explore the potential benefits of closing the access, such as reducing the workload on the heart, weighed against the risks of losing a proven site for dialysis should the transplant fail in the future. The article provides clinical perspectives on managing vascular access in the post-transplant period.
Whitley MJ, Wang JX, Chapman J, de Vries APJ, Chandran S, Glennon CM, Madariaga HM, Carroll RP, Booth J, Concepcion B, Couzi L, De Serres SA, Doyle A, Forbes S, Gleadle JM, Griffin S, Gunaratnam L, Gupta G, Ho J, Hughes P, Isbel N, Jegatheesan DK, Jones G, Kuypers D, Lee B, Lim W, Mason P, Meneghini M, Owoyemi I, Rao S, Salama A, Sharif A, Thaunat O, Thuraisingham R, Wyburn K, Yabu JM, Jambusaria-Pahlajani A, Bottomley MJ, Arron ST
An international panel of transplant nephrologists used a structured survey process to develop standardized recommendations for managing immunosuppression in kidney transplant recipients who develop skin cancer. The experts reached a consensus on when to modify medications based on the severity and frequency of squamous cell carcinoma and prioritized the adjustment of specific drugs like azathioprine. These guidelines aim to reduce the variation in clinical practice and improve the prevention of further skin cancers while maintaining the health of the transplanted kidney.
Dial-Mag Investigator Writing Committee*, Killin L, Bohm C, Harris C, MacRae JM, Shah N, Thompson S, Tonelli M, Luo B, Sontrop JM, Acedillo RR, Al-Jaishi AA, Anderson S, Antonsen J, Bagga A, Beaubien E, Berry D, Blake PG, Brown PA, Bueti J, Chan CT, Cote B, Cowan AC, Cuerden MS, Day NE, Dev V, Dhruve M, Djurdjev O, Gregor L, Hiremath S, Joseph G, Kammila S, Kiaii M, Kumar Kolusu E, Lacson E Jr, Mazurat A, Molnar AO, Nathoo B, Nistico A, Oliver MJ, Pandeya S, Parmar MS, Perkins D, Quinn K, Romann A, Sasal J, Shulman T, Silver SA, Singh A, Louis IS, Steele A, Tangri N, Ting RH, Vorster H, Wadehra DB, Wald R, Walters J, Whitlock RH, Yao S, Zacharias J, Garg AX
This protocol describes an ongoing study across 137 Canadian hemodialysis centres to determine if using a higher concentration of magnesium in dialysis fluid reduces the risk of death, heart disease, and muscle cramps. Researchers are comparing a centre-wide policy of high magnesium dialysis fluid against a lower concentration over a four-year period. The study uses provincial health databases and patient questionnaires to track long-term cardiovascular outcomes and patient comfort.
Researchers compared records from a major pediatric transplant centre in Ontario to provincial health databases to determine if administrative data can accurately identify children who received organ transplants. They found that using specific hospital procedure codes correctly identified over 90 percent of kidney, liver, heart, and lung transplants performed between 1991 and 2011. These results confirm that administrative health data is a reliable tool for conducting large-scale research on health outcomes in pediatric transplant recipients.
This publication presents a debate on whether remote monitoring technology effectively extends the amount of time patients can remain on peritoneal dialysis. The author argues against the position that remote monitoring provides a clear benefit for technique survival, highlighting the lack of robust evidence to support its routine use for this purpose. This discussion is part of a series examining the role of digital health tools in managing home dialysis therapies.
Researchers used advanced imaging to study how hemodialysis affects blood flow to the heart muscle in thirteen patients with and without coronary artery disease. They found that dialysis caused a significant reduction in heart muscle perfusion and led to temporary wall motion abnormalities, even in patients without existing artery blockages. In patients with coronary artery disease, these heart stresses were more severe and persisted longer after the dialysis session ended.
In 2018, Ontario established a new multidisciplinary care model to provide standardized and timely treatment for patients with glomerulonephritis across the province. A review of nearly 7,000 patients treated under this model found that IgA nephropathy was the most common diagnosis and that six percent of participants eventually required dialysis or a kidney transplant. This new approach to specialized kidney care is becoming well established and will help inform future healthcare planning in Ontario.
Researchers in Ontario, Canada, studied whether a newer type of dialysis called expanded hemodialysis could improve the quality of life and symptom burden for patients compared to standard treatment. Using a specialized digital tool to track patient experiences, the study found that expanded hemodialysis significantly improved energy levels, sleep quality, and physical pain, though these benefits decreased when patients returned to standard treatment. The findings suggest that this specialized dialysis filter provides durable relief for common symptoms and more consistent well-being for those on long-term dialysis.
Yau K, Ray JG, Jeyakumar N, Luo B, Abdullah S, Dixon SN, Wing S, Clemens KK, Castrillon-Ramirez F, Udell JA, Meraz-Munoz A, Young A, Harel Z, Perl J, Leiter LA, Garg AX, Cherney DZI, Wald R
This study compared the cardiovascular outcomes of patients with chronic kidney disease in Ontario who started taking either glucagon-like peptide-1 receptor agonists or dipeptidyl peptidase-4 inhibitors. Researchers found that those using glucagon-like peptide-1 receptor agonists had a lower risk of major heart-related events, primarily driven by a reduction in cardiovascular deaths. These benefits were consistent across all stages of kidney disease and were not affected by the use of other heart-protective medications.
Researchers reviewed nineteen studies to determine if a blood marker called soluble urokinase plasminogen activator receptor can predict complications following surgery. The analysis found that higher levels of this marker are likely associated with a greater risk of developing acute kidney injury and other postoperative issues. While the marker shows promise for identifying high-risk patients, the current evidence is limited by small study sizes and inconsistent reporting across the existing research.
Researchers in Ontario, Canada, found that men who donated a kidney through laparoscopic surgery had a significantly higher risk of requiring scrotal surgery later in life compared to men who did not donate. Over a 20-year period, nearly 14 percent of donors underwent surgery to treat fluid collection in the scrotum, most commonly a procedure called a hydrocelectomy. These findings highlight a specific long-term surgical risk for male living kidney donors that may occur several years after the initial donation.
Researchers in Ontario evaluated the accuracy of hospital diagnostic codes for identifying lithium toxicity by comparing them to actual blood laboratory results. The study found that while these codes were moderately effective at identifying patients with high lithium levels, they sometimes flagged patients whose levels were below the toxic threshold. These findings help clarify how reliably health database records can be used to track and study lithium-related complications in the healthcare system.
Researchers conducted a large clinical trial in Canada and Australia to determine if daily fish-oil supplements could reduce heart-related complications in adults receiving hemodialysis. The study found that patients taking fish oil had a significantly lower rate of serious cardiovascular events, including heart attacks, strokes, and cardiac deaths, compared to those taking a placebo. These findings suggest that fish-oil supplementation is a safe and effective way to improve heart health in the hemodialysis population.
This review examines the technical challenges of using bioimpedance to estimate fluid levels in patients receiving hemodialysis, focusing on how different electrode setups and body shapes can lead to measurement errors. The authors demonstrate that standard wrist-to-ankle measurements often underestimate fluid volume in individuals with higher body fat, whereas measuring the limbs and trunk separately provides more accurate results. They suggest that using 3D body scans to account for individual body shape could significantly improve the accuracy of these fluid assessments in clinical practice.
Researchers analyzed data from nearly 150,000 individuals to compare how well two common urine tests, the albumin-creatinine ratio and the protein-creatinine ratio, predict future health risks. The study found that the albumin-creatinine ratio was a more accurate predictor of kidney failure and cardiovascular events, particularly in high-risk groups such as those with diabetes or existing kidney disease. These results suggest that the albumin-creatinine ratio is the preferred tool for diagnosing and monitoring patients at risk for kidney-related complications.
Researchers interviewed patients with advanced chronic kidney disease to understand their experiences and challenges with weight management, particularly as obesity can be a barrier to receiving a kidney transplant. The study identified key themes including gaps in healthcare support, the influence of social circles, and how current health status limits weight loss efforts. These findings highlight the need for healthcare providers to offer more patient-centred support and address unmet needs regarding weight loss in the kidney disease community.
This review examines the significant health disparities and high rates of chronic kidney disease faced by approximately 480 million Indigenous people worldwide due to the ongoing impacts of colonialism, systemic racism, and poverty. The authors describe how geographic isolation and a lack of culturally safe care create barriers to early detection and life-saving treatments like dialysis or transplantation. The publication provides policy recommendations and strategies for healthcare systems to deliver more responsive, equitable kidney care to Indigenous communities across the globe.
This study examined how frequently patients with kidney disease in Ontario, Canada, receive recommended blood tests for bone health and how well their mineral levels are controlled. Researchers found significant gaps in monitoring and control across all stages of kidney disease, even among those receiving dialysis. Maintaining these laboratory values within target ranges was associated with a lower risk of bone fractures and major heart-related events.
This is a protocol for an ongoing study that describes the design of a research project using high-performance computing to screen millions of potential drug combinations for harmful interactions in older adults. Researchers will use health records from Ontario to compare patients taking two specific medications against those taking only one, tracking over 70 different health outcomes such as hospitalizations and mortality. This automated approach aims to identify dangerous drug-drug interactions much faster than traditional methods to improve prescribing safety and inform regulatory decisions.
This protocol describes an ongoing study to determine if a virtual monitoring platform can reduce emergency department visits and hospitalizations for patients with advanced chronic kidney disease. Participants in the intervention group use wireless devices to track blood pressure, weight, and oxygen levels, while also completing weekly symptom surveys through a mobile tablet. The study aims to improve the safety and coordination of care during the high-risk period before a patient begins dialysis.
In this study, researchers tracked over 300 high-risk kidney transplant recipients across seven Canadian centres to evaluate how cytomegalovirus is managed during the first year after surgery. Although all patients received preventative antiviral medication, one-third still developed the virus, and many experienced complications such as low blood cell counts, other infections, or the need for hospitalisation. These findings highlight that current prevention strategies are often insufficient for high-risk patients and are frequently associated with significant side effects and healthcare costs.
This study compared the frequency of a specific surgical complication, called anterior vitrectomy, during cataract surgeries performed by trainee residents versus experienced surgeons. By analyzing data from nearly 5,000 procedures, researchers found that residents had a higher incidence of this complication compared to experienced surgeons. These findings suggest that enhanced surgical training, mentorship, and simulation-based learning could be beneficial in reducing complications and improving patient safety during eye surgery.
This study used an animal model to investigate how different sodium levels in dialysis fluid affect the protective lining of blood vessels and blood flow in small vessels. Researchers found that hemodialysis itself causes injury to this vessel lining and reduces blood flow, but these harmful effects were significantly worse when a high-sodium dialysis fluid was used. These findings suggest that high sodium concentrations during treatment may lead to more severe and lasting damage to the circulatory system.
This economic evaluation used data from a large clinical trial linked with health databases in Alberta to compare the costs and health outcomes of starting dialysis early versus waiting for standard clinical triggers in critically ill patients with severe acute kidney injury. While waiting to start dialysis was slightly more expensive, it resulted in better quality of life and longer survival for patients over the long term. The findings suggest that a standard approach to starting dialysis is more cost-effective in the Canadian healthcare system than an accelerated approach.
Researchers studied children with X-linked hypophosphatemic rickets who switched from conventional treatment to a newer medication called burosumab to see how it affected their kidney health. While the medication successfully improved phosphate levels in the blood, some children developed high levels of calcium in their urine or new calcium deposits in the kidneys. These findings suggest that children using this therapy require regular monitoring of their urine and kidney ultrasounds to detect these potential complications early.
Kavanagh D, Bomback AS, Vivarelli M, Nester CM, Remuzzi G, Zhao MH, Wong EKS, Wang Y, Krishnan I, Schuhmann I, Trapani AJ, Webb NJA, Meier M, Israni RK, Smith RJH, APPEAR-C3G investigators
Researchers tested a new oral medication called iptacopan in adults with C3 glomerulopathy, a rare and serious kidney disease caused by an overactive immune system. The study found that patients taking iptacopan experienced a 35 per cent reduction in urine protein levels after six months compared to those taking a placebo. The treatment was generally well tolerated with no serious safety concerns or infections related to the immune-targeting mechanism.
In this population-based study of over 16,000 cancer patients in Ontario, researchers found that nearly one-third of patients receiving immune checkpoint inhibitors developed acute kidney injury within four years, though the risk was actually lower than for those receiving other types of chemotherapy. Factors such as male sex, pre-existing diabetes or kidney disease, and the use of anti-inflammatory drugs were associated with a higher risk of kidney injury. While only a small fraction of patients who stopped treatment due to kidney injury were later restarted on the medication, those who were re-challenged experienced better overall survival despite a high rate of recurring kidney issues.
Du A, Lemay K, Bagga A, Bhola PT, Brown PA, Colaiacovo S, Charames GS, Lemaire M, Lanktree MB, Schenkel L, Peña LG, Riddell S, Watkins N, Young T, Yu W, Bell K, Kim RH, Connaughton DM, Ontario Health Provincial Genetics Program Renal Genetics Expert Group
An expert group in Ontario developed a standardized framework and expanded gene panels to improve the diagnosis of inherited kidney diseases, which account for a significant portion of chronic kidney disease cases. The initiative established clear eligibility criteria and evidence-based testing guidelines to ensure patients across the province have equitable access to genetic services. This framework aims to integrate genetic testing into routine clinical care to facilitate earlier diagnosis and more personalized treatment strategies for patients with kidney disease.
This review examines the development of sorbent peritoneal dialysis technologies, which are portable or wearable devices designed to clean and reuse dialysis fluid. Researchers evaluated five different systems, finding that several could effectively remove waste products like urea and creatinine in human or animal trials, often using less sugar to achieve fluid removal than standard dialysis. While these technologies offer the potential for increased patient mobility and more efficient treatment, their specific role as either a supplement to or a replacement for traditional peritoneal dialysis is still being determined.
Adeyemo S, Crews DC, Lentine KL, Zisman-Ilani Y, Lincoln KD, Flores GM, Bunnapradist S, Ferrey AJ, Reddy UG, Muzaale AD, Rule AD, Saunders M, Garg AX, Le TH, Rhee CM, Kalantar-Zadeh K, Al Ammary F
This study examined outcomes for nearly 100,000 patients in the United States who were added to the kidney transplant waiting list before starting dialysis. While Black and Hispanic patients now receive kidneys from deceased donors at rates similar to White patients, they remain significantly less likely to receive a transplant from a living donor and are more likely to require dialysis while waiting. These findings highlight persistent racial and ethnic disparities in access to the most effective treatment for advanced kidney disease.
Clemens KK, Cowan A, Dixon S, Naylor K, Weir MA, Thain J, Khan T, Silver S, Molnar AO, Sultan N, Holden RM, Hiremath S, Wald R, Kitchlu A, Arnold J, Field B, Garg AX
This is a protocol for an ongoing pilot study that will assess the feasibility of conducting a larger trial to determine if the medication denosumab can prevent bone fractures in patients receiving hemodialysis. Researchers will recruit at least 60 high-risk patients across Ontario to evaluate how well the study procedures work and whether the treatment can be safely integrated into routine care. The findings will help determine if a full-scale study is possible to test a new strategy for reducing the high rate of fragility fractures in this population.
Researchers described two cases of Kimura disease, a rare inflammatory condition causing skin swelling and lymph node enlargement, successfully treated with the immunosuppressant medication mycophenolate mofetil. In both instances, including one patient who also had the kidney condition membranous nephropathy, the medication led to a significant reduction in symptoms and allowed for a decrease in steroid use. These findings suggest that mycophenolate mofetil may be an effective and well-tolerated option for managing this rare disease when other treatments are insufficient.
This publication provides a comprehensive overview of the clinical considerations and best practices for managing patients on maintenance hemodialysis who are undergoing surgical procedures. It addresses critical perioperative factors, including the timing of dialysis sessions, fluid and electrolyte management, and the prevention of cardiovascular complications during the surgical period. The review serves as a guide for clinicians to optimize patient safety and improve surgical outcomes in this high-risk population.
Walsh M, Collister D, Gallagher M, Mark PB, de Zoysa JR, Tyrwhitt J, Tennankore K, Reis G, Xavier D, Liu WJ, Zuo L, Wang AY, Félix C, Sola L, Arici M, Villanueva R, Jha V, Précoma D, Rabbat CG, Alavudeen SS, Faruqui AR, López-Flecher M, Pyne L, Wald R, Yuan F, Balasubramanian K, Lee SF, Kuptsova A, Christou C, Devereaux PJ, ACHIEVE Investigators
Researchers conducted a large international trial to determine if the medication spironolactone could reduce the risk of heart failure or cardiovascular death in patients receiving long-term dialysis. The study was stopped early for futility after finding no significant difference in heart-related deaths or hospitalizations between patients taking spironolactone and those taking a placebo. These results suggest that daily use of this specific medication does not provide the expected cardiovascular benefits for the maintenance dialysis population.
Researchers reviewed over 40 studies to determine if the amount of bicarbonate in dialysis fluid or taken as oral supplements affects health outcomes for patients on maintenance dialysis. While higher bicarbonate levels in the dialysis fluid slightly increased blood bicarbonate levels before treatment, there was not enough high-quality evidence to determine the impact on mortality, hospitalizations, or heart health. The findings indicate that the most effective approach for managing acid levels in dialysis patients remains uncertain due to the small size and inconsistent results of existing studies.
Researchers analyzed over 65 million potassium measurements in Ontario and found that while severe high potassium is common in outpatients, only thirteen percent of these individuals visited an emergency department within twenty-four hours. Patients who did go to the emergency department typically had more health conditions and higher medication use, and their potassium levels were significantly lower upon arrival than their initial outpatient test. Despite guidelines recommending urgent care for these high levels, most patients were managed in the community, and about one percent of the total group died within one week of the test result.
Researchers analyzed data from a large clinical trial to determine how the medication empagliflozin affects quality of life and healthcare costs for people with chronic kidney disease. The study found that patients taking the medication experienced a slight improvement in quality-adjusted life years and significant reductions in costs related to hospital admissions, other medications, and the management of kidney failure. These findings suggest that the treatment is highly likely to be cost-effective across a wide range of patients, including those with and without diabetes.
A study of older adults in Ontario found that taking the antibiotic clarithromycin while also using certain blood pressure medications, known as angiotensin receptor blockers, was associated with a higher risk of hospital visits for high potassium levels and acute kidney injury compared to taking azithromycin. This risk of high potassium was even greater for individuals with pre-existing reduced kidney function. These findings suggest a significant drug interaction occurs because clarithromycin interferes with the body's ability to transport and eliminate these blood pressure medications through the liver.
This review examines various healthcare models designed to integrate genetic testing into standard kidney care, such as specialized kidney genetics clinics and multidisciplinary variant review boards. The authors identify key barriers to the widespread adoption of these tests and propose strategies like virtual consultations and mainstreaming genetic testing directly into nephrology clinics to improve patient access. By establishing practical and scalable frameworks, these models aim to make genetic diagnosis a routine part of managing kidney disease to ensure more equitable and precise care.
Researchers found that genetic factors account for approximately half of the individual variation in how effectively peritoneal dialysis removes excess fluid from the body. By analyzing the genomes of over 2,700 participants, the study identified several specific genes associated with fluid removal and used mouse models to demonstrate how one of these genes regulates the process. These findings help explain why some patients respond differently to peritoneal dialysis and identify potential biological pathways for improving treatment.
Researchers found that patients who had significantly lower kidney function scores when measured by cystatin C compared to creatinine three months after hospital discharge were at a much higher risk for future health problems. This discrepancy was linked to a nearly twofold increase in the risk of death and kidney failure, as well as a higher likelihood of being hospitalized for heart failure. These findings suggest that comparing these two common blood tests can help doctors better identify which patients face the highest risk of complications following a hospital stay.
This study followed patients receiving maintenance dialysis in Ontario, Canada, to determine if surviving COVID-19 led to worse health outcomes over the following two years. Researchers found that those who survived the first 90 days after infection did not have a higher risk of death, hospitalization, or heart disease compared to similar patients who were never infected. However, experiencing a second COVID-19 infection later on was linked to an increased risk of death.
Wang C, Kang Y, Dixon SN, Jeyakumar N, Scott Brimble K, Garg AX, Blake PG, Stukel TA, Oliver MJ, Al-Jaishi A, Clemens KK, Fu L, Ip J, McKenzie S, Moist L, Molnar AO, Muanda-Tsobo F, Reich M, Roshanov P, Silver SA, Wald R, Weir MA, Yau K, Young A, Naylor KL
Researchers in Ontario, Canada, found that deaths among people with advanced chronic kidney disease increased by eight per cent during the first 21 months of the COVID-19 pandemic. Despite this increase in mortality, hospital admissions and emergency room visits for these patients actually decreased, suggesting a significant disruption in how they accessed medical care. Interestingly, visits to kidney specialists remained stable throughout the pandemic, and there was no significant change in the number of patients needing to start urgent dialysis.
This study examined whether inpatient rehabilitation within the first six months of starting dialysis could improve physical function and survival for adults aged 66 and older in Ontario, Canada. Researchers found that while patients significantly improved their physical independence scores during rehabilitation, they experienced similar rates of death and nursing home admission over the following year compared to those who did not receive rehabilitation. Although those who underwent rehabilitation had slightly higher hospitalisation rates, the findings suggest that such programmes can help restore physical function in older patients beginning dialysis.
This study examined a specific type of kidney cancer characterized by a fibrous, muscular structure in three patients with tuberous sclerosis complex, a genetic condition. Researchers discovered that these tumours can contain areas that look like a different type of growth called a hemangioblastoma, but they share the same underlying genetic markers related to the tuberous sclerosis pathway. Identifying this unique appearance is important for doctors to ensure patients receive an accurate diagnosis and appropriate monitoring, as these specific tumours appear to grow slowly and behave less aggressively.
Researchers re-analysed data from a large Canadian trial to determine if using cooler dialysis fluid reduces cardiovascular deaths or hospitalizations for patients on hemodialysis. Using advanced Bayesian statistical methods, they confirmed that tailoring dialysis temperature is unlikely to provide meaningful heart health benefits, regardless of whether the initial expectations were optimistic or skeptical. These findings reinforce the original study results showing that a centre-wide policy of personalized cooler dialysate does not improve patient outcomes.
Researchers examined the steps required to receive a kidney transplant across different regional renal programs in Ontario, Canada, and found significant geographic disparities in access. Patients in Northern Ontario were much less likely to be referred for transplant evaluation, find potential living donors, or be placed on the deceased donor waitlist compared to those in Toronto. These findings highlight that even within a publicly funded health care system, a patient's location can greatly influence their ability to receive a kidney transplant.
Yau K, Ray JG, Jeyakumar N, Luo B, Abdullah S, McArthur E, Dixon SN, Wing S, Clemens KK, Castrillon-Ramirez F, Udell JA, Meraz-Munoz A, Young A, Harel Z, Perl J, Sridhar VS, Ni H, Yi TW, Leiter LA, Garg AX, Cherney DZI, Wald R
Researchers compared adults with chronic kidney disease who started taking either glucagon-like peptide 1 receptor agonists or dipeptidyl peptidase 4 inhibitors to see how these medications affected healthcare use. The study found that patients starting glucagon-like peptide 1 receptor agonists had a ten percent lower risk of visiting the emergency department or being admitted to the hospital for any cause. These findings suggest that this class of medication may help reduce the overall burden of acute healthcare needs for people living with impaired kidney function.
This scoping review examined seventeen studies on non-drug and non-surgical weight loss strategies for adults with advanced chronic kidney disease and obesity. Researchers found that programs combining significant calorie restriction with regular coaching led to the most weight loss, averaging seven kilograms over the short term. While these dietary and exercise interventions appeared safe, more information is needed regarding their long-term effectiveness and how patients perceive these programs.
Researchers analyzed over 150,000 surgical procedures in patients receiving maintenance hemodialysis to see if the dialysis dose delivered just before surgery affected survival. They found that patients who received a lower dose of dialysis than their usual average in the session immediately preceding surgery had a significantly higher risk of death within 30 days. These findings suggest that maintaining or potentially increasing the dialysis dose before a surgical procedure may be important for improving patient safety.
Yang SS, Malaga G, Lazo-Porras M, Busta-Flores P, Del Carmen Rotta-Rotta A, Roshanov PS, Sessler DI, Bessissow A, Schricker T, Tagalakis V, Heels-Ansdell D, Pettit S, Devereaux PJ
Researchers developed a tool to predict which patients are most likely to experience dangerously low blood pressure after undergoing noncardiac surgery. By analyzing data from over 40,000 patients across 14 countries, they created a model that can estimate this risk before surgery using either a comprehensive list of variables or a simplified four-item version. Identifying these high-risk patients early may help clinicians intervene sooner to prevent complications like heart or kidney injury.
Researchers analyzed nine blood biomarkers related to blood vessel health in nearly 1,500 patients to predict the risk of heart failure following a hospital stay. They identified three distinct patient groups based on these markers, finding that those with a vascular injury profile had more than double the risk of heart failure compared to those with a repair profile. Adding these biomarkers to standard clinical information significantly improved the accuracy of identifying patients at high risk for heart failure or death within three years.
Marcucci M, Chan MTV, Painter TW, Efremov S, Aguado HJ, Astrakov SV, Kleinlugtenbelt YV, Patel A, Cata JP, Amir M, Kirov M, Leslie K, Duceppe E, Borges FK, de Nadal M, Tandon V, Landoni G, Likhvantsev VV, Lomivorotov V, Sessler DI, Martínez-Zapata MJ, Xavier D, Fleischmann E, Wang CY, Meyhoff CS, Wittmann M, Torres D, Highton D, Jacka M, B V, Zarnke K, Sidhu RS, Oriani G, Ayad S, Minear S, Weaver TE, Ruetzler K, Brusasco C, Parlow JL, Maxwell E, Miller S, Mrkobrada M, Bhatt KSC, Rahate P, Kowark A, De Blasio G, Ofori SN, Conen D, Srinathan S, Szczeklik W, Jayaram R, Ellerkmann RK, Momeni M, Copland I, Vincent J, Balasubramanian K, Li Z, Wang MK, Li D, McGillion MH, Kurz A, Sharma M, Short TG, Devereaux PJ, cogPOISE-3 Trial Investigators and Study Groups
Researchers compared two strategies for managing blood pressure in high-risk patients undergoing noncardiac surgery to see if avoiding low blood pressure or avoiding high blood pressure better protected brain health. The study found no significant difference between the two approaches in the rates of postoperative delirium or cognitive decline one year after surgery. While the strategy focused on avoiding low blood pressure did successfully reduce the number of patients who required treatment for hypotension, it did not lead to better neurocognitive outcomes.
This article discusses the importance of advancing research into the interconnected health of the heart, kidneys, and metabolic system for people who have received a kidney transplant. It highlights the need for integrated care and specialized study designs to address the unique risks this population faces regarding cardiovascular and metabolic complications.
This study analyzed data from over 240,000 kidney transplant recipients in the United States to determine if combining body mass index with body surface area better predicts health outcomes than using body mass index alone. Researchers found that patients classified as having obesity by both measurements had the highest risk of transplant complications, including delayed organ function and graft loss. These findings suggest that incorporating body surface area into pre-transplant evaluations could help clinicians more accurately identify high-risk patients than current standard assessments.
This report describes a newborn diagnosed with a rare genetic condition called pseudohypoaldosteronism type 1B, which causes the body to be resistant to the hormone aldosterone. The infant experienced severe electrolyte imbalances, including dangerously high potassium levels and salt wasting, which were linked to a newly discovered mutation in a gene responsible for sodium transport. Managing the condition was challenging due to the complex diagnostic process and the difficulty of maintaining stable salt and potassium levels in the blood.
Lebel A, Chanchlani R, Cockovski V, Dart A, Fleming AJ, Garg AX, Jeyakumar N, Kim K, Kitchlu A, McArthur E, Nash D, Nathan PC, Parekh RS, Pearl R, Pole J, Ramphal R, Reid J, Schechter-Finkelstein T, Sung L, Wald R, Wang S, Wong P, Zappitelli M
Researchers in Ontario, Canada, tracked over 10,000 childhood cancer survivors to determine their risk of developing long-term kidney problems or high blood pressure. The study found that survivors were twice as likely to develop these conditions compared to other hospitalized children and nearly five times as likely compared to the general pediatric population. These findings highlight the importance of monitoring heart and kidney health in survivors to prevent serious late complications.
This study used a rat model to investigate how the progression of chronic kidney disease affects the liver's ability to break down medications. Researchers found that key liver enzymes responsible for drug metabolism were significantly reduced very early in the disease process, even before significant shifts in gut bacteria or the buildup of waste products in the blood occurred. These findings suggest that kidney disease may impair drug clearance much earlier than previously recognized, potentially impacting how medications should be dosed as kidney function declines.
Researchers validated a tool designed to predict the risk of blood clots after abdominal, urologic, or gynecologic surgery by analyzing data from over 11,000 patients. The tool uses three simple factors—age, body mass index, and history of previous blood clots—to successfully categorize patients into low, medium, and high-risk groups for developing postoperative complications. This validated instrument is now available as an online resource to help clinicians make evidence-based decisions regarding the use of blood-thinning medications after surgery.
To improve patient safety during transitions from hospital to home, researchers implemented a quality improvement initiative aimed at ensuring discharge summaries were completed within 48 hours. While the team successfully reduced the average time to complete these summaries from 53 to 38 hours, they found that meeting the strict 48-hour deadline often resulted in less editing and review by senior physicians and trainees. This suggests that while administrative targets for speed can be met, they may inadvertently reduce the time spent on clinical documentation quality and medical education.
This report describes the treatment of a 33-year-old man with polycystic kidney disease who developed Hodgkin's lymphoma in the chest. Doctors prioritized treating the cancer while carefully adjusting chemotherapy doses as his kidney function declined, successfully achieving remission without the immediate need for dialysis. Three years later, as his kidney function continued to worsen, he successfully underwent a kidney transplant and removal of his original kidneys.
Wing S, Ray JG, Yau K, Jeyakumar N, Abdullah S, Luo B, Cherney DZI, Harel Z, Hundemer GL, Mavrakanas TA, Molnar AO, Odutayo A, Perl J, Young A, Charytan D, Weir M, Wald R
A study of older adults in Ontario, Canada, found that starting a sodium-glucose cotransporter 2 inhibitor was associated with a lower risk of developing high potassium levels in those already taking medications that affect the renin-angiotensin-aldosterone system. Patients who began this new treatment were also less likely to stop their existing blood pressure and kidney-protective medications. These findings suggest that adding this class of drugs may help manage a common side effect of standard kidney and heart treatments in routine clinical practice.
In a study of 125 adults aged 50 and older with chronic kidney disease, researchers found that genetic testing identified a specific cause of disease in 38% of patients. The highest success rate for diagnosis occurred in those aged 50 to 54, with various forms of glomerular disease being the most common findings. These genetic results led to changes in medical treatment and clinical management, suggesting that age alone should not be a barrier to accessing genetic testing for kidney disease.
Patients receiving maintenance dialysis often experience faster and more severe cognitive decline compared to those with advanced kidney disease who are not on dialysis. This review explores how both hemodialysis and peritoneal dialysis can cause structural and functional brain changes, leading to symptoms ranging from short-term confusion and brain fog to long-term loss of cognitive ability. The authors examine the underlying biological mechanisms of this decline and discuss potential medical interventions to protect brain health in this population.
Staibano P, Garg AX, Chan MTV, Polanczyk CA, Ackland GL, MacNeil SD, Patel A, Xie M, Zhang H, Au M, Bhandari M, Parpia S, Busse JW, Heels-Ansdell DM, van der Woerd B, Gupta MK, Choi DL, Salepci E, Young JE, Devereaux PJ
Researchers found that nearly twelve percent of patients undergoing major head and neck surgery experienced heart muscle injury, a rate that doubled in patients aged seventy-five and older. Most of these heart injuries occurred without typical symptoms and would have been missed without routine blood testing for troponin levels. Patients who experienced this injury had a significantly higher risk of death within thirty days of surgery and stayed in the hospital longer than those without heart complications.
Researchers analyzed data from a large clinical trial to determine if closing the left atrial appendage during heart surgery benefited patients with varying levels of kidney function. The study found that the procedure significantly reduced the risk of stroke without increasing major bleeding or other serious complications, regardless of the patient's kidney health. These results suggest that this surgical intervention is a safe and effective way to prevent strokes in patients with chronic kidney disease and atrial fibrillation.
By performing genetic sequencing on over 200 families where children were born with kidney and urinary tract malformations, researchers identified potential new disease-causing genes in nearly 20% of the cases. The study focused on identifying new mutations that appear in a child but are not present in either parent, highlighting specific genes like SOX13 and CHD1L as likely contributors to these birth defects. These findings expand the understanding of the genetic causes underlying congenital kidney disease and may improve future diagnostic accuracy for affected families.
Pan Y, Vlasschaert C, Rao V, Akwo EA, Hixson JE, Uddin MM, Yu Z, Kim DK, Bick A, Kestenbaum B, Chong M, Paré G, Rauh M, Levin A, Lash JP, Kurella Tamura M, Cohen DL, He J, Hamm L, Deo R, Bhat Z, Rao P, Xie D, Natarajan P, Kelly TN, Robinson-Cohen C, Lanktree MB, Canadian Study of Prediction of Death, Dialysis and Interim Cardiovascular Events (CanPREDDICT) and Chronic Renal Insufficiency Cohort (CRIC) Study Investigators
Researchers analyzed blood samples from over 5,000 patients with chronic kidney disease to identify specific age-related genetic mutations in blood cells known as clonal hematopoiesis of indeterminate potential. They found that patients with certain types of these mutations had a 36 per cent higher risk of experiencing major heart-related events, such as strokes or heart failure, regardless of their diabetes status or severity of kidney disease. The study also suggests that a specific genetic variation in the interleukin-6 receptor may help lower this increased cardiovascular risk.
Lam D, Scaria A, Andrade J, Badve SV, Birks P, Bota SE, Campain A, Djurdjev O, Garg AX, Harel Z, Hemmelgarn B, Hockham C, James MT, Jardine MJ, Levin A, McArthur E, Ravani P, Shao S, Sood MM, Tan Z, Tangri N, Whitlock R, Gallagher M, Jun M, Ha JT
A large study of over 38,000 adults in Canada and Australia found that the blood thinner apixaban is a safe and effective alternative to warfarin for people with atrial fibrillation and various stages of chronic kidney disease. Patients taking apixaban had a similar or lower risk of stroke, death, and major bleeding compared to those taking warfarin, regardless of their level of kidney function. These findings support the use of apixaban in routine clinical practice for patients with reduced kidney function who are not on dialysis.
Researchers tracked the evaluation process for living kidney donor candidates at a Canadian transplant centre to identify barriers to donation. While the time from initial contact to donation decreased significantly over four years, delays were often caused by waiting for the recipient's referral or the donor's need for weight loss. Monitoring these evaluation steps provides a framework for quality improvement to help more patients receive a transplant before they require dialysis.
This study reviewed the medical investigations performed for children with tuberous sclerosis complex who were referred to a specialized clinic at a Canadian hospital. Researchers identified gaps in the recommended health monitoring and surveillance for these patients, highlighting areas where care could be improved.
Naylor KL, Jeyakumar N, Kang Y, Dixon SN, Garg AX, Al-Jaishi A, Blake PG, Chanchlani R, Fu L, Harel Z, Ip J, Kitchlu A, Kwong JC, Nesrallah G, Oliver MJ, Stukel TA, Wald R, Weir M, Yau K
Researchers in Ontario, Canada, compared the health outcomes of over 31,000 dialysis patients before and during the first three years of the COVID-19 pandemic. While death rates were significantly higher during specific months of the pandemic, the overall mortality rate over the entire 36-month period was not substantially higher than expected. Interestingly, hospitalizations and emergency room visits decreased during the pandemic, yet there was no corresponding increase in deaths unrelated to COVID-19.
Garg AX, Feldman LS, Sontrop JM, Cuerden MS, Arnold JB, Boudville N, Karpinski M, Klarenbach S, Knoll G, Lok CE, McArthur E, Miller M, Monroy-Cuadros M, Naylor KL, Prasad GVR, Storsley L, Nguan C
A study of over 1,000 participants in Canada and Australia found that nearly 18 percent of men who donated a kidney experienced new testicular pain after surgery, compared to only two percent of healthy non-donors. The pain was almost always on the same side as the kidney removal and occurred more frequently following laparoscopic procedures than open surgeries. These findings suggest that unilateral testicular pain is a specific potential complication of living kidney donation that should be discussed during the donor consent process.
Le A, Paré G, Devereaux PJ, Quazi I, Mao S, Chong M, Heels-Ansdell D, Duceppe E, Wang MK, Patel A, Tiboni M, Magloire P, Garg AX, Ofori SN, Conen D, Spence J, Belley-Côté E, Beck C, McIntyre WF, Whitlock R, Healey JS, Pettit S, Borges FK, VISION Investigators
Researchers investigated whether genetic risk scores could help predict heart injury in patients undergoing non-cardiac surgery. They found that genetic markers for type 2 diabetes and blood sugar levels were linked to an increased risk of postoperative heart injury, while markers for other conditions like coronary artery disease were not. These findings suggest that a patient's genetic predisposition to metabolic issues may play a role in heart complications following surgery.
Researchers used health databases in Ontario to evaluate different ways of measuring how often patients with advanced kidney disease are referred for transplant evaluations. The study found that referral rates varied significantly depending on how patient eligibility and health status were defined, with referral occurring in as few as 16% or as many as 40% of patients across different groups. Establishing a standardized way to track these referrals is an essential step toward improving equal access to kidney transplants and identifying gaps in patient care.
Researchers conducted a process evaluation using surveys and interviews with healthcare providers to understand why a recent program failed to increase patient access to kidney transplantation in Ontario. They found that while many parts of the program were successfully integrated into daily routines, staff felt the intervention was too complex and lacked sufficient resources and frontline buy-in. These insights into implementation challenges will help guide the design of future strategies to improve transplant rates.
Researchers analyzed health records from three large groups of patients in Ontario to estimate how many people with kidney failure die without starting dialysis or receiving a transplant. The study found that approximately one in six individuals with kidney failure dies without these treatments, highlighting a significant group that likely receives conservative medical management. These findings are important for health care planning and ensuring that resources are available for patients who choose not to pursue intensive kidney replacement therapies.
Jeong R, Bagshaw SM, Ghamarian E, Harvey A, Joannidis M, Kirkham B, McAuley D, Ostermann M, Quenot JP, Young PJ, Wald R, STandard vs. Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) Investigators
Researchers analyzed data from a large clinical trial to determine if waiting longer to start dialysis in critically ill patients with severe acute kidney injury affected their recovery. The study found that longer delays in starting dialysis were not associated with an increased risk of death, though there was a potential link between longer delays and a higher likelihood of remaining dependent on dialysis at 90 days. These findings suggest that for patients without urgent medical needs, a strategy of waiting to see if the kidneys recover naturally does not appear to worsen survival outcomes.
Bathini L, Jeyakumar N, Sontrop J, McArthur E, Kang Y, Luo B, Bello A, Collister D, Ahmed S, Kaul P, Youngson E, Braam B, Melamed N, Hladunewich M, Garg AX
This protocol describes an ongoing study to determine if a woman's kidney function before pregnancy influences the risk of developing progressive kidney disease later in life. Researchers will compare long-term kidney health between pregnant and non-pregnant women in Ontario and Alberta using provincial health databases. The study aims to clarify how different levels of pre-pregnancy kidney function affect the likelihood of significant declines in kidney health or the eventual need for dialysis or transplantation.
This review examines common causes of hemodialysis catheter dysfunction, such as blood clots and fibrin buildup, and discusses various strategies to maintain catheter health. The authors highlight that using specific lock solutions like thrombolytics or citrate, choosing symmetrical catheter tips, and implementing comprehensive care protocols can significantly reduce the risk of catheter failure. Identifying high-risk patients based on factors like sex and previous catheter issues is essential for creating personalized care plans and improving treatment outcomes.
This report summarizes a conference dedicated to developing six new pragmatic clinical trials designed to improve the quality of care for patients receiving hemodialysis. Researchers, health care providers, and patient partners collaborated on study designs that will test interventions such as different blood pressure targets and dialysis fluid compositions within routine clinical settings. The initiative aims to increase the number of high-quality randomized trials in nephrology to better support evidence-based treatment decisions.
This report highlights that high-volume hemodiafiltration reduces the risk of death from all causes and cardiovascular issues compared to standard hemodialysis in adults with kidney failure. The findings suggest that this advanced form of dialysis may offer superior long-term survival benefits for patients requiring kidney replacement therapy.
A study of nearly one million surgeries in Alberta, Canada, found that patients with advanced kidney disease spent significantly more time in the hospital following major surgery compared to those with normal kidney function. Patients receiving dialysis had the longest hospital stays and were nearly four times more likely to be discharged to a facility with 24-hour nursing care rather than returning home. These findings demonstrate that the severity of preoperative kidney disease is strongly linked to a loss of independence and a longer recovery period after surgical procedures.
Balthazard R, Drouin-Engler RM, Bertrand S, Zine-Eddine F, Li J, Tastet O, Daigneault A, Mamane VH, Ortega-Delgado GG, Sreng Flores AM, Kaufmann DE, Major P, House AA, Létourneau-Guillon L, Arbour N, Keezer MR, Larochelle C
In this study, researchers examined blood markers of inflammation and brain cell injury in adults with tuberous sclerosis complex to identify indicators of disease activity. They found that patients with this genetic condition had higher levels of specific inflammatory proteins and markers of brain cell activation compared to healthy individuals, with certain proteins specifically linked to active epilepsy and the presence of kidney tumours. These findings suggest that these blood markers could eventually help clinicians monitor disease progression and identify new targets for treating complications like seizures and kidney growths.
This study surveyed patients and health care providers to understand the impact of restrictions on showering for individuals using central venous catheters for hemodialysis. While many clinics advise against showering to prevent infections, the researchers found that most patients strongly desire to shower and many already do so despite medical advice. Health care providers expressed a willingness to change their recommendations if evidence from a high-quality study could demonstrate that showering does not increase the risk of serious bloodstream infections.
Roshanov PS, Walsh MW, Garg AX, Cuerden M, Lam NN, Hildebrand AM, Lee VW, Mrkobrada M, Leslie K, Chan MTV, Borges FK, Wang CY, Xavier D, Sessler DI, Szczeklik W, Meyhoff CS, Srinathan SK, Sigamani A, Villar JC, Chow CK, Polanczyk CA, Patel A, Harrison TG, Fielding-Singh V, Cata JP, Parlow J, de Nadal M, Devereaux PJ
In this study, researchers analyzed data from over 45,000 patients to determine how preoperative kidney function, measured by the estimated glomerular filtration rate, predicts heart-related complications after major noncardiac surgery. They found that lower kidney function was a powerful predictor of heart injury, cardiac arrest, or death within 30 days of surgery, with the risk being particularly high for younger patients compared to older patients with the same level of kidney impairment. These findings suggest that including precise kidney function measurements and considering the patient's age could significantly improve the accuracy of surgical risk calculators.
This study developed a method to convert scores between two common tools used to measure the severity of Crohn’s disease, the Patient-Reported Outcome 2 and the Harvey-Bradshaw Index. By analysing data from a large clinical trial, researchers found that the two measures are highly correlated and established a simple mathematical equation to estimate one score from the other. These findings help clinicians and researchers better compare results across different types of clinical trials and apply research data to real-world patient care.
Researchers compared blood pressure levels during and after noncardiac surgery among patients on dialysis, patients with kidney disease not requiring dialysis, and patients with normal kidney function. The study found that patients receiving dialysis experienced more frequent and severe episodes of low blood pressure both during the operation and for 48 hours following the procedure. These findings suggest that patients on dialysis face unique hemodynamic challenges during the surgical period that may contribute to their higher risk of complications.
This article provides an overview of the design and statistical challenges unique to cluster-randomized trials, where entire groups rather than individuals are assigned to specific treatments. It explains how these studies can protect against the mixing of treatment effects in certain settings while highlighting the specific vulnerabilities clinicians must consider when interpreting the results. This guide serves as an educational resource to help medical professionals accurately evaluate the quality and findings of research involving institutional policies or care processes.
This study examined long-term brain health in adults with a rare condition called complement-mediated thrombotic microangiopathy who were in remission and receiving treatment to block the complement system. Researchers used magnetic resonance imaging and specialized testing to find that these patients had more white matter abnormalities and higher rates of depression, memory issues, and concentration difficulties compared to healthy individuals. These neurological and cognitive changes persisted for at least one year, suggesting that the condition may have lasting effects on the brain even when the primary disease is stable.
Researchers analyzed data from a large clinical trial to determine if the kidney and heart benefits of the medication empagliflozin differed for patients with chronic kidney disease who were frail, had multiple health conditions, or took many medications. The study found that empagliflozin consistently reduced the risk of kidney disease progression and hospitalizations across all groups, regardless of their level of frailty or the number of other health issues they faced. These results suggest that the medication is safe and effective for a wide range of patients, including those with complex health needs.
Researchers evaluated the impact of a specialized kidney genetics clinic in Canada by providing genetic testing to 300 patients with chronic kidney disease who met specific referral criteria. The study found that using a standardized testing process identified a genetic cause for kidney disease in one-third of the families, with results typically delivered within three months of assessment. These genetic findings frequently led to changes in clinical management, though the researchers noted a significant delay of over ten years between a patient's initial kidney disease diagnosis and their eventual genetic evaluation.
Researchers reviewed 60 studies involving over 10,000 adults with chronic kidney disease and found that genetic testing provided a clear diagnosis for 40% of patients. The likelihood of finding a genetic cause was highest in those with cystic kidney disease or a family history of kidney problems. Importantly, the genetic results led to a change in the original diagnosis for 17% of patients and influenced treatment decisions or family screening in several cases.
Researchers developed a new concentrated solution containing icodextrin and dextrose for use in the abdominal cavity to improve the removal of excess salt and water. Testing in animals and a small group of humans showed that this solution removed significantly more sodium and fluid than standard peritoneal dialysis fluids without causing serious side effects or tissue damage. This approach may eventually offer a new way to manage fluid overload in patients with kidney or heart failure.
Shamseddin MK, Paraskevas S, Mainra R, Maru K, Piggott B, Jagusic D, Yetzer K, Gunaratnam L, Ribic C, Kim J, Singh S, Hoar S, Prasad GVR, Masse M, Houde I, Khalili M, West K, Liwski R, Martin S, Gogan N, Karpinski M, Monroy-Cuadros M, Gourishankar S, Johnston O, Lan J, Nguen C, Gill J, Pâquet M
The Canadian Highly Sensitized Patient Program was established to improve transplant opportunities for patients who are difficult to match with deceased kidney donors due to high levels of antibodies. An analysis of the first 1000 transplants facilitated by the program showed that while it successfully enabled access to surgery for many, those with the highest sensitivity levels faced significantly longer wait times and more frequent interprovincial organ sharing. This national initiative demonstrates that sharing a larger pool of donors across provinces can provide life-saving options for patients who might otherwise never receive a compatible organ.
This is a protocol for a series of three systematic reviews designed to evaluate the frequency of bone fractures, the accuracy of risk prediction models, and the effectiveness of various treatments in adult kidney transplant recipients. Researchers will analyze existing studies to determine how often fractures occur after transplantation and which patient factors or medications, such as vitamin D or bisphosphonates, best help in preventing bone loss. This work aims to provide an updated evidence base for managing bone health in patients who are at high risk due to prior kidney disease and long-term steroid use.
Kotwal SS, Perkovic V, Jardine MJ, Kim D, Shah NA, Lin E, Coggan S, Billot L, Vart P, Wheeler DC, de Boer IH, Zhang H, Hou FF, Sugawara Y, Marion J, Lewis RJ, Berry LR, McGlothlin A, Jha V, De Nicola L, Gorriz JL, Heerspink HJL, GKPTN and CAPTIVATE Investigators
This report describes the design of an ongoing global registry and an associated adaptive platform clinical trial aimed at identifying new treatments for people with chronic kidney disease. The registry tracks patient health and outcomes across multiple countries to identify eligible participants for the trial, which will test various medications and combinations to slow the decline of kidney function. The study uses an innovative trial structure that allows researchers to efficiently evaluate multiple therapies simultaneously using a shared placebo group.
Researchers in Ontario, Canada, demonstrated that the unique ten-digit health card numbers assigned to residents can be used as a tool for randomizing participants in large-scale clinical trials. By using specific digits from these randomly generated numbers to assign treatment groups, investigators can simplify the trial process and reduce costs. While this method is efficient for real-world pragmatic trials, it does not allow for grouping participants by specific characteristics and should be evaluated based on the needs of each individual study.
Researchers in Ontario, Canada, studied older adults taking low-dose methotrexate to see if also taking the antibiotic trimethoprim-sulfamethoxazole increased the risk of death compared to taking a cephalosporin antibiotic. While the risk of death within 30 days was similar between the two groups, patients prescribed trimethoprim-sulfamethoxazole had a higher risk of being hospitalized for any cause or for persistent infections. These findings suggest that while the combination may not be more lethal in the short term, it is associated with a higher rate of serious illness requiring hospital care.
This review examines advanced magnetic resonance imaging techniques that allow for the non-invasive assessment of kidney function, blood flow, and tissue oxygenation without the need for radiation or contrast dyes. These innovative methods, including specialized sodium and phosphorus imaging, can detect early signs of kidney scarring and metabolic changes that traditional blood and urine tests might miss. These tools are particularly promising for children with kidney disease or transplants, as they enable safe and repeated monitoring of the entire organ over time.
This study of nearly 200,000 adults in Ontario, Canada, found that obesity is highly prevalent among people with kidney disease and is associated with more health complications and socioeconomic disparities. Patients with a high body mass index and advanced kidney disease were less likely to receive a kidney transplant, although those who did undergo transplantation experienced fewer post-surgical complications. Interestingly, a higher body mass index appeared to be associated with a lower risk of death in the final stages of kidney disease, a phenomenon known as the obesity paradox.
Elphick EH, Manera KE, Viecelli AK, Craig JC, Cho Y, Ju A, Shen JI, Wilkie M, Anumudu S, Boudville N, Chow JS, Davies SJ, Gooden P, Harris T, Jain AK, Liew A, Matus-Gonzalez A, Amir N, Nadeau-Fredette AC, Nguyen T, Wang AY, Ponce D, Quinn R, Jaure A, Johnson DW, Lambie M, SONG-PD Technique Survival Workshop Investigators
In an international consensus workshop involving patients, caregivers, and health professionals, researchers sought to standardise how the success of peritoneal dialysis is measured and reported. The participants recommended replacing negative terms like "technique failure" with neutral language such as "transfer to haemodialysis" to better reflect the patient experience. This report proposes a clear, consistent definition for this outcome to ensure that future clinical trials can be easily compared and remain relevant to both patients and clinicians.
This case report describes the successful management of a patient who required a colostomy while receiving peritoneal dialysis for kidney failure. Although intestinal stomas are sometimes considered a risk for dialysis complications like infection, placing the stoma and the dialysis catheter on opposite sides of the abdomen allowed the patient to continue his treatment safely. The procedure improved the patient's independence and quality of life without causing major complications during follow-up.
Harel Z, Smyth B, Badve SV, Blum D, Beaubien-Souligny W, Silver SA, Clark E, Suri R, Mavrakanas TA, Sasal J, Prasad B, Eikelboom J, Tennankore K, Rigatto C, Prce I, Madore F, Mac-Way F, Steele A, Zeng Y, Sholzberg M, Dorian P, Yan AT, Sood MM, Gladstone DJ, Tseng E, Kitchlu A, Walsh M, Sapir D, Oliver MJ, Krishnan M, Kiaii M, Wong N, Kotwal S, Battistella M, Acedillo R, Lok C, Weir M, Wald R
Researchers conducted a pilot study in Canada and Australia to see if it is feasible to run a large trial comparing warfarin, apixaban, and no anticoagulation in patients on dialysis with atrial fibrillation. The study successfully met its goals for patient recruitment and treatment adherence, despite challenges posed by the pandemic. These results demonstrate that a larger, definitive trial can be conducted to determine the safest and most effective way to prevent strokes in this high-risk population.
This pre-specified sub-study of a large international trial compared two different strategies for managing blood pressure in patients undergoing noncardiac surgery. Researchers found that a strategy focused on avoiding low blood pressure, which involved pausing certain blood pressure medications and maintaining higher targets during surgery, did not reduce the risk of acute kidney injury compared to a strategy focused on avoiding high blood pressure. These findings were consistent even among patients who had pre-existing chronic kidney disease.
Interviews with patients at a Canadian kidney care centre revealed that while telemedicine was highly valued for its convenience, many found it easier to build trust and personal connections during in-person visits. Most participants expressed a preference for a hybrid care model that combines virtual and face-to-face appointments, particularly if their health condition were to worsen. Patients also indicated a preference for video consultations over telephone calls to enhance the quality of their interactions with healthcare providers.
In this phase 2 clinical trial, researchers tested whether ravulizumab, a medication that blocks a specific part of the immune system called the complement system, could help adults with IgA nephropathy. Patients receiving ravulizumab experienced a 30% greater reduction in protein leakage in their urine compared to those receiving a placebo after six months of treatment. The medication was well tolerated, with safety results similar to the placebo group, and showed potential in helping to stabilize kidney function.
Researchers followed patients from the EMPA-KIDNEY trial for an additional two years after they stopped taking the study medication to see if the benefits of empagliflozin persisted. The study found that patients originally assigned to take empagliflozin continued to have a lower risk of kidney disease progression and cardiovascular death compared to those in the placebo group, even after the trial ended. These findings suggest that the protective effects of this medication on the heart and kidneys can last for at least a year after the treatment is discontinued.
Researchers compared three Canadian provincial health systems to understand why some regions perform more living donor kidney transplants than others. The study found that provinces with centralized coordination and formal resource sharing, such as British Columbia and Ontario, were more effective at delivering transplant services than decentralized systems. These findings suggest that better coordination between governing health organizations can improve access to living donor kidney transplantation and help reduce the burden of kidney failure.
In older adults with chronic kidney disease, starting oral antiviral medications for herpes at higher doses was associated with a nearly fourfold increased risk of acute kidney injury compared to lower doses. While the overall absolute risk of a serious kidney event remained low at less than one percent, the risk was significantly higher when measured using hospital laboratory data rather than diagnostic codes alone. These findings suggest that careful dose adjustment of these medications is important for patient safety in the context of reduced kidney function.
Slominska A, Gaudio K, Shamseddin MK, Lam NN, Ho J, Vinson A, Mainra R, Hoar S, Fortin MC, Kim SJ, DeSerres S, Prasad GVR, Weir MA, Cantarovich M, Sandal S
This study conducted an environmental scan of adult kidney transplant programs across Canada to understand how they manage patients whose kidney transplants are failing. Researchers found significant variations and gaps in care, particularly regarding psychological support, structured preparation for returning to dialysis, and multidisciplinary care. The findings highlight a lack of standardized protocols and a need for evidence-based guidelines to improve outcomes for this complex patient group.
This protocol describes an ongoing study in three Canadian provinces to evaluate pregnancy outcomes in women who have previously donated a kidney. Researchers will use administrative health records to compare the risk of high blood pressure, pre-eclampsia, and infant complications between living donors and a matched group of healthy nondonors. The findings will help transplant centres provide better counselling and follow-up care for female kidney donors of childbearing age.
This study evaluated a program in the United Kingdom that provided primary care physicians with graphical reports of their patients' kidney function over time to help identify those with progressive disease. While the intervention did not significantly reduce the number of patients who were referred to kidney specialists late in their disease course, the trial provided important data on the challenges of implementing new tools in busy clinical settings. These findings offer valuable insights for designing future systems to improve the early identification and management of chronic kidney disease.
This study followed nearly 800 patients on maintenance dialysis in Ontario who survived the first 30 days of a COVID-19 infection to understand their long-term health outcomes. Researchers found that these survivors faced high rates of death, reinfection, and hospitalizations for heart-related issues for more than a year following their initial illness. Patients who required intensive care during their first infection or who later became reinfected were at a significantly higher risk of death.
This study explored how kidney tubular cells protect themselves from damage caused by natural killer cells, which are immune cells that contribute to injury during kidney transplantation and periods of restricted blood flow. Researchers discovered that tubular cells express specific proteins that act as "off switches" for natural killer cells, and that removing these proteins significantly increased immune cell attacks on the kidney cells. These findings suggest that these proteins serve as a natural defense system to limit organ damage during inflammation and could be a target for future therapies to improve transplant outcomes.
Robinson CH, Jeyakumar N, Luo B, Askenazi D, Deep A, Garg AX, Goldstein S, Greenberg JH, Mammen C, Nash DM, Parekh RS, Silver SA, Thabane L, Wald R, Zappitelli M, Chanchlani R
A study of over 4,000 children in Ontario who survived acute kidney injury found that they were four times more likely to experience major kidney-related health issues over the following decade compared to similar hospitalized children. These survivors faced significantly higher risks of developing chronic kidney disease, requiring long-term dialysis, and experiencing high blood pressure. The findings suggest that children who recover from acute kidney injury require better long-term monitoring to detect and manage these complications early.
Verret M, Lalu M, Sessler DI, Borges FK, Roshanov PS, Turgeon AF, Neveu X, Ramsay T, Szczeklik W, Tandon V, Patel A, Biccard B, Devereaux PJ, Fergusson DA
This study analyzed red blood cell transfusion practices in over 39,000 adults undergoing noncardiac surgery across multiple countries. Researchers found that while transfusion rates declined over six years and most patients were treated using restrictive strategies, there was significant unexplained variation in practices depending on the specific hospital and country. These findings highlight that a patient's likelihood of receiving a transfusion is influenced not only by their hemoglobin levels and health status but also by local clinical culture.
A study of over 15,000 transplant recipients in Ontario, Canada, found that these patients had a six times higher risk of hospitalization or death from COVID-19 compared to the general population. While the rates of severe illness declined as the pandemic progressed into the Omicron era, transplant recipients who became severely ill were generally younger and had more underlying health conditions than those in the general public. These findings highlight the ongoing vulnerability of transplant patients to severe viral outcomes despite changes in dominant virus strains.
Researchers analyzed genetic data from patients with chronic kidney disease to investigate why many develop severe hardening of the arteries, known as vascular calcification. They identified specific mutations in the ABCC6 gene in several families, suggesting that inherited genetic factors may directly contribute to this cardiovascular complication. Identifying these genetic causes early could eventually help doctors use targeted therapies to prevent vascular damage and reduce the risk of death in kidney disease patients.
In older adults taking digoxin, starting a course of the antibiotic trimethoprim-sulfamethoxazole was associated with a nearly sixfold higher risk of hospitalization for digoxin toxicity compared to starting amoxicillin. While the absolute risk of this complication remained low at less than one percent, the interaction is clinically significant because digoxin has a narrow safety range. Physicians should consider using alternative antibiotics or reducing the digoxin dose when these medications must be used together.
This study examined the rates of COVID-19 vaccination among over 41,000 physicians in Ontario, Canada, using provincial health databases. Researchers found that nearly 95% of physicians received at least two doses and approximately 87% received three doses within 14 months of the vaccines becoming available. These vaccination rates were significantly higher than those seen in the general population during the same period, suggesting high levels of professional confidence in vaccine safety and effectiveness.
Researchers examined whether tailoring the bicarbonate levels in dialysis fluid to individual patients or using a standard concentration for everyone affected blood bicarbonate levels before treatment. The study found no significant difference in blood bicarbonate levels between these two approaches, with most patients maintaining levels within the normal range regardless of the strategy used. While very high concentrations in the dialysis fluid slightly increased blood levels, the overall impact on patient blood chemistry was minimal.
Garg AX, Arnold JB, Cuerden MS, Dipchand C, Feldman LS, Gill JS, Karpinski M, Klarenbach S, Knoll G, Lok CE, Miller M, Monroy-Cuadros M, Nguan C, Prasad GVR, Sontrop JM, Storsley L, Boudville N
Researchers followed over 900 living kidney donors and a similar group of healthy nondonors for several years to compare their long-term health outcomes. The study found that kidney donors did not have a higher risk of developing high blood pressure or significant protein in their urine compared to those who did not donate. While donors had lower overall kidney function due to the removal of one kidney, their remaining kidney function declined more slowly over time than the function of nondonors.
Researchers in Ontario, Canada, found that people living with HIV who were on dialysis had a significantly lower chance of receiving a kidney transplant compared to those without HIV when accounting for the risk of death. Despite this disparity in access, the study found that long-term transplant success and survival rates were similar between patients with and without HIV. These findings highlight a potential inequity in access to transplantation for individuals living with HIV despite comparable clinical outcomes after the procedure.
Researchers reviewed existing studies on non-surgical ways to control bleeding from hemodialysis fistulas and grafts both inside and outside of dialysis centres. They found that specialized hemostatic dressings significantly reduce the time it takes for bleeding to stop after needles are removed compared to standard dressings. While devices like tourniquets and compression tools are commonly used to manage severe bleeding outside the hospital, there is currently very little high-quality evidence to guide their use or confirm their impact on patient safety.
This pilot study explored the use of specialized sodium magnetic resonance imaging to assess remaining kidney function in people receiving hemodialysis by measuring sodium levels in different parts of the kidney. Researchers found that healthy individuals have a distinct sodium gradient between the inner and outer layers of the kidney that is significantly reduced or absent in dialysis patients, reflecting a loss of the kidney's ability to concentrate urine. This imaging technique provides a new way to evaluate the health of kidney tubules that cannot be captured by traditional urine volume measurements alone.
Researchers discovered that a family of proteins called calmodulin-dependent protein kinases interacts with key cell death regulators to cause heart transplant injury and rejection in mice. By blocking these proteins, the investigators were able to maintain healthy cell function and significantly extend the survival of the transplanted hearts. These findings suggest that targeting these specific pathways could eventually help prevent organ rejection in transplant recipients.
Goldstein CE, Taljaard M, Nicholls SG, Beaucage M, Brehaut J, Cook CL, Cote BB, Craig JC, Dixon SN, Du Toit J, Du Val CCS, Garg AX, Grimshaw JM, Kalatharan S, Kim SYH, Kinsella A, Luyckx V, Weijer C
This document provides specific guidance for applying ethical standards to the design and conduct of cluster randomized trials within hemodialysis centres. Developed by experts and patient partners, the guidance addresses unique challenges in the dialysis setting, such as how to obtain informed consent and protect vulnerable participants when entire clinics are assigned to a study intervention. This framework aims to ensure that large-scale research in dialysis units is conducted ethically while incorporating the perspectives of patients and caregivers.
A woman who donated a kidney was later found to have a genetic mutation for Alport Syndrome that had initially been classified as a finding of uncertain significance. Five years after her donation, a re-evaluation of her genetic data and family history led to the discovery that the mutation was likely disease-causing, explaining her unexpected decline in kidney function. This case highlights the importance of periodically re-examining genetic test results, especially for potential living kidney donors, as scientific understanding of specific mutations evolves over time.
Researchers analyzed data from nearly 40,000 patients undergoing noncardiac surgery to determine when major bleeding complications occur within the first month after an operation. The study found that over three-quarters of all major bleeding events happened within the first week following surgery, with more than 40 percent occurring within the first 24 hours. These findings help clinicians better time the use of blood-thinning medications and improve monitoring strategies to prevent surgical complications.
Researchers in Ontario compared a new race-free equation for estimating kidney function with the standard 2009 version to see how it affects patient eligibility for specialist care. The study found that using the 2021 equation significantly reduced the number of people meeting the criteria for nephrologist consultations, specialty clinic care, and kidney transplant evaluations. These findings suggest that adopting the newer equation could lead to fewer patients being referred for specialized kidney services in regions where a small percentage of the population is Black.
Researchers developed and tested the Canadian Anatomic Kidney Score, a new six-point system used to grade the physical quality of donor kidneys based on their blood vessels, anatomy, and surrounding fat. The study found that higher scores, which indicate poorer physical quality, were associated with lower kidney function one year after transplantation, with the condition of the blood vessels being the most important factor. This scoring system provides surgeons with a standardized way to assess donor kidneys alongside existing tools like genetic risk profiles and biopsies.
A study in Ontario, Canada, found that patients receiving in-centre hemodialysis visit the emergency department five times more often and are hospitalized seven times more frequently than the general population. These patients also face significantly higher healthcare costs, with annual hospitalization expenses being approximately eleven times higher than those of matched individuals without kidney failure. These findings highlight the substantial burden of illness in the dialysis population and the importance of health system planning to manage these high acute care needs.
Researchers examined data from over 800 patients in Canada and the United States to determine if previous abdominal surgeries affected the success of peritoneal dialysis catheters. The study found that a history of prior abdominal procedures did not increase the risk of catheter failure or complications, although surgeries in the upper abdomen were associated with a slightly higher risk of issues. These findings suggest that having had abdominal surgery in the past should not prevent patients from being considered for peritoneal dialysis.
Researchers conducted focus groups with members of the public and people living with chronic kidney disease to explore the ethics of using provincial health databases to contact individuals at high risk for future kidney failure. While participants generally supported the idea of being notified about serious health risks, they strongly preferred that such information come from their own primary care provider rather than an unfamiliar organization. The study highlights a need for clearer privacy laws and better communication strategies to balance the social responsibility of early disease detection with patient privacy and trust.
Yohanna S, Naylor KL, Sontrop JM, Ribic CM, Clase CM, Miller MC, Madan S, Hae R, Ho J, Roushani J, Parfeniuk S, Jansen M, Shavel S, Richter M, Young K, Cowell B, Lambe S, Margetts P, Piercey K, Tandon V, Boylan C, Wang C, McKenzie S, Longo B, Garg AX
To improve the efficiency of living kidney donation, researchers in Hamilton, Ontario, developed a one-day assessment clinic that condenses numerous tests and specialist consultations into a single visit. This quality improvement initiative has evaluated over 150 candidates since 2019, with nearly all participants reporting high satisfaction due to reduced travel and minimal disruption to their daily lives. By shortening the evaluation process from the provincial median of nearly one year, this model aims to increase the rates of living donation and improve outcomes for transplant recipients.
Researchers in Ontario used health records to evaluate different ways of measuring how often patients receive a kidney transplant from a living donor before they ever need to start dialysis. They found that the calculated success rate of these transplants changed significantly depending on which patient groups were included, such as whether people with other serious health conditions were filtered out. This work provides a new framework for health systems to track and improve access to early kidney transplantation.
This systematic review examined how patients with kidney disease are represented in clinical trials of tranexamic acid, a medication used to reduce bleeding during surgery. The researchers found that over three-quarters of these trials explicitly excluded patients with kidney disease, often using vague or overly restrictive criteria, and very few trials adjusted the medication dose based on kidney function. While the drug appears safe and effective for those with mild to moderate kidney impairment, there is insufficient evidence to determine its safety or the correct dosage for patients with severe kidney disease.
This study analyzed data from over 2,400 patients who underwent major abdominal surgery to identify factors that could be modified to prevent postoperative acute kidney injury. Researchers found that receiving nonsteroidal anti-inflammatory drugs during surgery or taking blood pressure medications, such as angiotensin-converting enzyme inhibitors, on the morning of surgery was linked to a higher risk of more severe kidney injury. These findings suggest that avoiding these specific medications around the time of surgery may be a practical strategy to protect kidney function in surgical patients.
Vaara ST, Serpa Neto A, Bellomo R, Adhikari NKJ, Dreyfuss D, Gallagher M, Gaudry S, Hoste E, Joannidis M, Pettilä V, Wang AY, Kashani K, Wald R, Bagshaw SM, Ostermann M, STandard vs. Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) Investigators
Researchers analyzed data from a large international trial to compare how doctors in different regions manage severe acute kidney injury in intensive care units. They found significant differences in fluid management and the timing and type of dialysis used, with patients in Australia and New Zealand showing higher survival rates at 90 days compared to those in North America and Europe. These findings highlight how regional variations in clinical practice may influence recovery and survival for critically ill patients.
Kidney injury molecule-1 is a well-known indicator of kidney damage, but it also plays a vital role in how the body identifies and clears away dying cells. This protein is found on the surface of injured kidney cells and various immune cells, where it helps regulate inflammation and immune responses by binding to specific markers on apoptotic or necrotic cells. Understanding the biological functions and genetic variations of this molecule may lead to its use as both a diagnostic tool and a target for new treatments in inflammatory and kidney diseases.
This systematic review and meta-analysis evaluated the impact of performing exercise during hemodialysis sessions on heart and blood vessel health. The researchers found that intradialytic exercise significantly reduced arterial stiffness and improved several measures of heart function, including diastolic blood pressure and the heart's pumping capacity. These findings suggest that incorporating aerobic exercise into regular dialysis care may help improve cardiovascular health for individuals with kidney failure.
Standard hemodialysis can cause repeated circulatory stress, leading to reduced blood flow and damage to vital organs such as the heart, brain, and liver. This review explores how these frequent episodes of vascular injury contribute to the high rates of cardiovascular disease and premature death seen in patients receiving dialysis. The authors also discuss various treatment strategies aimed at protecting these organs and improving long-term health outcomes.
Researchers used advanced computer algorithms to group kidney transplant candidates into three distinct categories based on shared health and frailty characteristics. By analyzing data from multiple transplant centres, the study identified specific patterns of health deficits that define different types of frailty in this population. This clustering approach provides a more detailed way to understand the diverse health profiles of patients waiting for a kidney transplant.
Researchers tested the movement and breakdown of a new anti-inflammatory drug called SY-005 in patients hospitalized with severe COVID-19 and normal kidney function. The study found that the drug was cleared from the bloodstream within six hours of administration without building up in the body or affecting the blood's ability to clot. These findings help determine the appropriate dosing schedule for future clinical trials of this medication.
A review of over 60 clinical trials found that using the medication desmopressin during surgery likely reduces the total amount of blood lost and the number of blood units required for transfusion. However, the drug did not significantly lower the overall risk of needing a transfusion and was linked to a higher risk of low blood pressure requiring medical intervention. There is currently a lack of high-quality evidence regarding the safety and effectiveness of this treatment specifically for patients with advanced kidney disease.
This review explores the field of pharmacometabolomics, which involves analyzing small molecules in blood or urine to predict how an individual will respond to specific medications. By identifying these metabolic markers, researchers can better understand drug metabolism and transport, potentially allowing for more precise dosing to improve treatment effectiveness and reduce harmful side effects. The authors highlight examples of this approach in treating major depressive disorder and managing cancer chemotherapy, while also discussing the current challenges in moving these techniques into routine clinical practice.
Researchers compared the success of kidney transplants from older or higher-risk donors based on whether the organ was donated after circulatory death or brain death. They found that kidneys donated after circulatory death had significantly higher rates of initial function delay and a higher risk of graft failure within the first three years. Despite these differences in organ survival, there was no significant difference in overall patient survival between the two groups.
This is a protocol for an ongoing clinical trial that is investigating whether daily fish oil supplements can reduce the rate of serious cardiovascular events in patients receiving long-term hemodialysis. Researchers in Canada and Australia are enrolling 1100 participants to receive either omega-3 fatty acid supplements or a placebo to see if this intervention lowers the occurrence of heart attacks, strokes, and cardiac deaths. The study will track all major cardiovascular events over at least three and a half years to determine if this simple nutritional supplement improves survival and heart health in this high-risk population.
Researchers tracked over 700 patients undergoing laparoscopic peritoneal dialysis catheter insertion and found that those with existing internal scarring, known as adhesions, were at a higher risk for complications like flow restriction or abdominal pain. While patients with adhesions were more likely to require follow-up procedures to fix catheter issues, the majority of patients in both groups were still able to successfully continue their dialysis therapy. The study identified that previous abdominal surgery, female sex, and higher body mass index were factors associated with a higher likelihood of having these adhesions.
This is a protocol for an ongoing study that describes a new approach to identifying drug safety signals in older adults with chronic kidney disease using high-throughput computing and automation. Researchers will use administrative health databases in Ontario to conduct over 700 automated cohort studies, comparing the risk of 74 different acute health outcomes between new users of various medications and non-users. By analyzing these risks across different levels of kidney function, the study aims to more efficiently detect adverse drug reactions in this vulnerable population.
This article explains how to interpret noninferiority trials, which are studies designed to show that a new treatment is not significantly worse than an existing standard. The authors highlight that the margins used to define success can sometimes be biased and suggest that clinicians should evaluate results based on patient values rather than just the limits set by researchers. Using examples from inflammatory bowel disease, the paper provides a framework for using confidence intervals to make more patient-centred treatment decisions.
Researchers in Ontario, Canada, examined how often people with different stages of kidney disease used mental health and addiction services over a nine-year period. They found that while mental health concerns are common, individuals with advanced chronic kidney disease or those on dialysis were actually less likely to use these services compared to people with healthy kidney function. This lower rate of use was primarily due to fewer visits to outpatient mental health providers among those with more severe kidney disease.
This review examines the ethical concerns and practical challenges associated with using placebos in clinical trials for inflammatory bowel disease. The authors propose alternative study designs that aim to protect patient safety while still providing the high-quality data necessary for clinical decision-making.
Bouzemane A, Vignot E, Derain Dubourg L, De Mul A, Molin A, Chapurlat R, Fontanges E, Delsart D, Akbari A, Huang SHS, McIntyre CW, Bacchetta J, Lemoine S
Researchers studied whether adults with X-linked hypophosphatemia, a rare genetic condition causing high levels of a hormone called fibroblast growth factor 23, have an increased risk of heart disease or high blood pressure. In a group of twenty-two patients, the study found that most had normal heart structure and blood pressure, with no signs of stiffening in the arteries. These findings suggest that the elevated hormone levels associated with this specific genetic condition may not carry the same cardiovascular risks as seen in patients with chronic kidney disease.
Researchers followed nearly 39,000 patients for one year after they were discharged from noncardiac surgery to understand how complications during their hospital stay affected long-term survival. The study found that one in 18 patients died within a year of discharge and one-quarter were readmitted to the hospital, with early complications like heart injury, major bleeding, and sepsis significantly increasing the risk of death for several months. These findings highlight that the impact of surgical complications on patient health persists long after they leave the hospital centre.
Researchers followed 590 living kidney donors in Alberta for nearly nine years to identify risk factors for developing reduced kidney function or protein in the urine after donation. The study found that eight percent of donors developed these signs of kidney disease, with the risk being significantly higher for those who had lower kidney function or high blood pressure before donation, or who developed diabetes afterward. These findings help doctors and donors better understand long-term health risks and the importance of monitoring after a kidney donation.
In this study of over 6,000 solid organ transplant recipients in Ontario, Canada, researchers found that receiving a fourth dose of a COVID-19 mRNA vaccine significantly improved protection compared to receiving only three doses. A fourth dose was 70% effective at preventing severe outcomes like hospitalization or death and 39% effective at preventing infection during the period when the Omicron variant was dominant. These findings suggest that additional booster doses provide meaningful clinical benefits for transplant patients who may have a reduced immune response to standard vaccination schedules.
Researchers used a new testing panel to measure twenty-one different proteins in the blood and urine of healthy individuals and patients with acute or chronic kidney disease. They identified specific protein signatures, such as osteoactivin and beta-2-microglobulin, that could accurately distinguish between healthy participants and those with kidney injury. These findings suggest that these protein profiles could serve as important tools for diagnosing and monitoring different stages of kidney dysfunction.
A study of over 9,000 adults in Ontario found that nearly 60 percent of patients did not receive recommended multidisciplinary care in the year before starting dialysis. While some patients experienced an unavoidable rapid decline in kidney function, others faced preventable gaps such as missed screening for kidney disease or late referrals to specialists. These findings highlight specific opportunities for health systems to improve the coordination of care for patients with advancing kidney disease.
A study of older adults in Ontario, Canada, found that those with chronic kidney disease who started low-dose methotrexate had double the risk of serious adverse events, such as sepsis or lung and liver toxicity, compared to those starting hydroxychloroquine. This risk was even higher for individuals with more advanced kidney impairment, particularly those with an estimated glomerular filtration rate below 45. These findings suggest that the potential for severe complications should be carefully weighed against the benefits when prescribing methotrexate to patients with reduced kidney function.
Researchers at a Canadian hospital developed a clinical care pathway to safely administer the bone-strengthening medication denosumab to patients with advanced chronic kidney disease and those on dialysis. The pathway included optimizing vitamin D levels, providing calcium supplements, and increasing communication between specialists, which resulted in the rate of dangerously low calcium levels dropping from fifty percent to thirteen percent. This quality improvement initiative demonstrates that structured monitoring and preventative treatments can significantly reduce the side effects of this medication in high-risk patients.
Researchers tested a new program across 26 kidney care centres in Ontario to see if providing extra administrative support, education, and peer storytelling could help more patients receive a kidney transplant. Although the program was successfully put into practice, it did not significantly increase the rate at which patients completed the necessary steps toward transplantation compared to those receiving standard care. These findings highlight the ongoing challenge of overcoming barriers to kidney transplantation and the need for different strategies to improve patient access.
Researchers evaluated a shortened two-hour monitoring protocol for patients undergoing kidney biopsies at a Canadian hospital and found that all major bleeding complications were identified within that timeframe. The study also tested a risk calculator designed to predict bleeding, which showed high accuracy in identifying high-risk patients despite the low overall number of complications. These findings suggest that a brief observation period combined with routine ultrasound is sufficient for safely managing patients after a kidney biopsy.
This protocol describes an ongoing study to test the feasibility of a simple home-based exercise program using Nordic walking poles for patients receiving hemodialysis or peritoneal dialysis. Researchers are evaluating whether physician-prescribed walking goals and exercise videos can improve patient-important outcomes such as muscle strength, fatigue, and sleep quality. The study aims to determine if patients can successfully adhere to the program before launching a larger trial to evaluate its long-term health benefits.
Researchers analyzed data from a large clinical trial to compare whether starting treatment with continuous dialysis or intermittent dialysis led to better outcomes for critically ill patients with severe acute kidney injury. After adjusting for differences between the two groups, they found that patients who began with continuous therapy had a lower risk of being dead or still requiring dialysis 90 days later. This benefit was primarily due to a significant reduction in the number of patients who remained dependent on dialysis treatments.
Writing Group for the CKD Prognosis Consortium, Grams ME, Coresh J, Matsushita K, Ballew SH, Sang Y, Surapaneni A, Alencar de Pinho N, Anderson A, Appel LJ, Ärnlöv J, Azizi F, Bansal N, Bell S, Bilo HJG, Brunskill NJ, Carrero JJ, Chadban S, Chalmers J, Chen J, Ciemins E, Cirillo M, Ebert N, Evans M, Ferreiro A, Fu EL, Fukagawa M, Green JA, Gutierrez OM, Herrington WG, Hwang SJ, Inker LA, Iseki K, Jafar T, Jassal SK, Jha V, Kadota A, Katz R, Köttgen A, Konta T, Kronenberg F, Lee BJ, Lees J, Levin A, Looker HC, Major R, Melzer Cohen C, Mieno M, Miyazaki M, Moranne O, Muraki I, Naimark D, Nitsch D, Oh W, Pena M, Purnell TS, Sabanayagam C, Satoh M, Sawhney S, Schaeffner E, Schöttker B, Shen JI, Shlipak MG, Sinha S, Stengel B, Sumida K, Tonelli M, Valdivielso JM, van Zuilen AD, Visseren FLJ, Wang AY, Wen CP, Wheeler DC, Yatsuya H, Yamagata K, Yang JW, Young A, Zhang H, Zhang L, Levey AS, Gansevoort RT
A large global study of over 27 million people found that lower kidney function and higher levels of protein in the urine are both strongly linked to an increased risk of ten major health problems, including heart disease, stroke, and kidney failure. These risks were evident even in individuals with only mild kidney impairment, regardless of whether kidney function was measured using standard blood tests or more specialized markers. The findings highlight that even early stages of kidney disease are significant predictors of future hospitalizations and cardiovascular events.
Clinical domain: The paper focuses on the management of patients receiving maintenance hemodialysis, specifically the use of cooled dialysate to prevent cardiovascular complications. - What investigators did: The authors synthesized existing evidence, including observational data and the results of the MyTEMP trial, to provide a broad overview and perspective on the current role of dialysate cooling. - Methodological features: This is a non-systematic review of the literature and clinical trial results.
This article reviews the systemic barriers that limit the use of home dialysis in the United States, such as insufficient infrastructure and gaps in staff training. The authors examine current policy initiatives and quality measurement strategies intended to increase the adoption of home therapies and compare these efforts to international models. The discussion highlights how advocacy and legislative changes can be used to better support patients who prioritize the flexibility of dialysing at home.
Researchers used a non-invasive skin sensor called photoplethysmography to monitor blood flow in patients during hemodialysis and compared the results to direct heart imaging. They found that a decrease in skin blood flow was closely linked to reduced heart muscle perfusion and the development of temporary heart injury known as myocardial stunning. This technology may offer a simple way to monitor and manage circulatory stress and heart damage during dialysis treatments.
Cheetham MS, Cho Y, Krishnasamy R, Milanzi E, Chow J, Hawley C, Moodie JA, Jose MD, MacGinley R, Nguyen T, Palmer SC, Walker R, Wong J, Jain AK, Boudville N, Johnson DW, Huang LL
Researchers analyzed registry data from Australia and New Zealand and found that the use of incremental peritoneal dialysis, which involves a lower initial dose of dialysis fluid, increased significantly between 2007 and 2017. The study found that starting with a lower dose was not associated with an increased risk of death and was linked to a lower rate of early transfer to hemodialysis. These findings suggest that incremental peritoneal dialysis is a safe approach that may reduce treatment burden for patients who still have some remaining kidney function.
Researchers found that higher levels of a protein called epidermal growth factor in the urine of hospitalized patients were associated with a significantly lower risk of developing chronic kidney disease or kidney failure over the following four years. This relationship was strongest when the protein was measured three months after hospital discharge, suggesting it serves as a marker for the kidney's ability to repair itself after an injury. These clinical findings were supported by animal studies showing that the same protein is actively produced during the healthy recovery of kidney tissue.
This report describes two cases where patients with tuberous sclerosis complex experienced declining kidney function due to microscopic disease rather than the large kidney tumours typically associated with the condition. The authors provide evidence that medications known as mTOR inhibitors may help improve kidney function in these patients even when large tumours are absent. The findings suggest that doctors should regularly monitor kidney function in all patients with this genetic condition and consider a kidney biopsy if the cause of decline is unclear.
Schierbaum LM, Schneider S, Buerger F, Halawi AA, Seltzsam S, Wang C, Zheng B, Wu CW, Dai R, Connaughton DM, Salmanullah D, Nakayama M, Mann N, Shril S, Hildebrandt F
Researchers used gene expression data from human fetal kidneys to identify which genes are most active during organ development and likely to cause birth defects of the kidney and urinary tract. By comparing this developmental data with genetic sequences from affected families, they identified four promising new candidate genes that may be responsible for these conditions. This approach helps scientists prioritize which genetic variants are most likely to cause disease in children and young adults.
Ha JT, Scaria A, Andrade J, Badve SV, Birks P, Bota SE, Campain A, Djurdjev O, Garg AX, Harel Z, Hemmelgarn B, Hockham C, James MT, Jardine MJ, Lam D, Levin A, McArthur E, Ravani P, Shao S, Sood MM, Tan Z, Tangri N, Whitlock R, Gallagher M, Jun M
Researchers compared the safety and effectiveness of the blood thinner rivaroxaban against warfarin in over 55,000 adults with atrial fibrillation and varying levels of kidney function. The study found that rivaroxaban was as effective or better than warfarin at preventing stroke and death, with a similar risk of major bleeding across all stages of kidney disease. These results suggest that rivaroxaban is a safe alternative to warfarin for patients with reduced kidney function, including those with advanced chronic kidney disease.
In this study, researchers used advanced genetic sequencing to analyze 167 Canadian patients suspected of having atypical hemolytic uremic syndrome, a rare condition involving abnormal blood clotting and kidney failure. They found that only a very small percentage of patients had clearly identifiable disease-causing genetic mutations, while many others carried variants of uncertain significance that are difficult to interpret clinically. These findings highlight the complexity of using genetic testing to diagnose this condition and the need for stricter guidance when interpreting genetic results in clinical practice.
This protocol describes an ongoing study to determine if the anti-inflammatory medication colchicine can reduce the risk of sudden kidney damage in older adults undergoing major thoracic surgery. Researchers are comparing patients receiving colchicine to those receiving a placebo to see if the drug prevents increases in creatinine levels, a key marker of kidney function. The study will also evaluate if the medication provides a greater benefit to patients who already have chronic kidney disease before their operation.
This review explores the use of specialized sodium magnetic resonance imaging to track how sodium builds up in the skin, heart, and kidneys of people with chronic kidney disease. Researchers found that excess sodium accumulation in these tissues is linked to worsening kidney function, higher levels of inflammation, and heart problems. This imaging technology is becoming an important tool in clinical trials to better understand how sodium imbalance contributes to the progression of kidney disease and its complications.
Researchers conducted a scan of weight management programs across North America and identified forty programs available to individuals with chronic kidney disease, though only three were specifically tailored for this population. The study found that while various commercial, community, and medical programs exist, patients often face significant barriers such as high costs for nutritious food, a lack of specialized support, and exclusion due to complex dietary requirements. These findings highlight the need for more patient-centred and accessible weight loss resources that are specifically designed to meet the unique health needs of people living with kidney disease.
This review examines the evidence for using medical therapies to manage coronary artery disease in people with chronic kidney disease and those receiving dialysis. The authors highlight that while standard treatments like aspirin and statins are commonly used, their effectiveness may decrease as kidney function declines, and patients face a higher risk of side effects. The paper also discusses newer medications, such as sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, which show potential for reducing heart-related complications in this population.
Researchers examined kidney transplant referral rates across 27 regional chronic kidney disease programs in Ontario and found significant geographic disparities. Even after accounting for patient characteristics, the likelihood of being referred for a transplant within one year varied widely between programs, with patients in Northern regions facing substantially lower referral rates. These findings highlight inconsistent access to the first step of transplantation within a single-payer health care system.
A study of adults in Ontario, Canada, found that taking the antipsychotic medication quetiapine alongside the antibiotic clarithromycin was associated with a higher risk of hospital visits for confusion, falls, or fractures compared to taking it with azithromycin. This increased risk is likely due to clarithromycin interfering with the body's ability to break down quetiapine, leading to higher levels of the drug in the blood. The most significant finding was a nearly 75 percent increase in the relative risk of bone fractures within 30 days of starting the combined medications.
Patients receiving peritoneal dialysis often have low bone density, but standard screening tools and risk calculators may not fully capture their actual risk of bone fractures. While medications like bisphosphonates and denosumab can improve bone density, their use is complicated by concerns regarding drug buildup in the body and the risk of dangerously low calcium levels. This review highlights the challenges in identifying high-risk patients and the lack of clear evidence for the best therapies to prevent fractures in this population.
Researchers tracked over 1,100 critically ill patients across five academic centres to understand the patterns and outcomes of continuous kidney replacement therapy for acute kidney injury. The study found that while sepsis was the most common cause of kidney injury and fluid overload was a primary reason for starting treatment, there was significant variation in medical practice between different hospitals. Only about 41 percent of patients survived to hospital discharge, with older age and higher severity of illness being major factors linked to lower survival rates.
Researchers conducted a large-scale genetic study to identify variations in DNA that might make hospitalized patients more susceptible to acute kidney injury. While no single genetic marker reached the strictest threshold for significance, two specific genes involved in cell transport and immune response showed strong associations and were found to be active in injured kidney tissues. These findings suggest that specific regions of the genome may influence how the kidneys respond to stress during hospitalization.
Researchers at a Canadian transplant centre found that kidney transplant recipients who experienced delayed graft function were more likely to develop late-onset cytomegalovirus infections. These infections significantly increased the risk of transplant failure, particularly in patients whose new kidney did not function immediately after surgery. The study suggests that closer monitoring of immune responses to the virus might help improve long-term outcomes for these high-risk patients.
Researchers used exome sequencing to investigate genetic causes of neurogenic bladder, a condition where nerve signaling issues disrupt bladder function and can lead to kidney damage. They identified a rare homozygous variant in the CHRM5 gene in one patient, a gene previously linked to bladder overactivity in animal models. While the gene remains a potential candidate for this condition, initial laboratory tests did not provide enough evidence to confirm that this specific genetic change was the definitive cause.
This is a protocol for an ongoing prospective study designed to determine how to accurately convert between two different heart-related blood tests used to assess risk before non-cardiac surgery. Researchers aim to validate a formula that translates B-type natriuretic peptide levels into N-terminal pro B-type natriuretic peptide values to better predict the risk of heart injury or death within 30 days of an operation. By establishing these thresholds, the study seeks to improve how doctors interpret preoperative blood work to identify high-risk surgical patients.
In this study of older adults in Ontario, Canada, researchers compared the total healthcare costs associated with different blood-thinning medications used to treat atrial fibrillation. They found that while newer drugs like apixaban and rivaroxaban are more expensive than warfarin, they actually saved the healthcare system money by significantly reducing costs related to hospitalizations, emergency department visits, and physician consultations. These findings suggest that using newer blood thinners as a first-line treatment is more cost-effective than the traditional use of warfarin.
Researchers analyzed blood and urine samples from over 700 hospitalized patients to identify two distinct subtypes of acute kidney injury based on molecular markers of inflammation and cell damage. Patients in the second subtype had a significantly higher risk of developing long-term complications, such as the progression of chronic kidney disease and the need for dialysis. These biological subtypes provided better information about a patient's future health than the current standard clinical tests used to measure the severity of kidney injury.
Researchers developed a new laboratory test to measure a molecule called TMAP in the blood and evaluated its potential as a marker for kidney function across several patient groups. The study found that TMAP levels were significantly higher in patients with chronic kidney disease and those receiving dialysis compared to healthy individuals, with levels rising as the kidney's filtering capacity declined. Because TMAP was also found in other species and even in maple tree sap, it appears to be part of a biological process that is widely conserved across nature.
Researchers used mouse models to identify 26 specific substances in the blood, urine, and kidneys that change early on after exposure to the chemotherapy drug cisplatin. These metabolic markers, which are linked to energy production in cells and the gut microbiome, could help identify kidney injury much sooner than current standard tests. This study provides a potential panel of markers to help monitor and understand how cisplatin damages the kidneys in clinical settings.
This review examined the use of glucagon-like peptide 1 receptor agonists, a class of medications used for weight loss and blood sugar control, in patients with kidney failure or kidney transplants. The researchers found that these medications effectively lowered blood sugar levels and promoted weight loss in these populations, though the benefits were often accompanied by gastrointestinal side effects. While the results from small trials and observational studies are promising, the long-term impact and patient adherence to these therapies in advanced kidney disease require further investigation.
This international study compared two different strategies for managing blood pressure in patients taking long-term medications who were undergoing noncardiac surgery. One approach focused on avoiding low blood pressure by setting higher targets and withholding certain medications, while the other focused on avoiding high blood pressure by continuing all usual medications. Researchers found no significant difference between the two strategies in the rates of major complications such as heart attack, stroke, or vascular death within 30 days of surgery.
Researchers developed a prediction tool to estimate the likelihood of recovering kidney function or the risk of death for patients who start dialysis in the hospital and continue it after being discharged. By analyzing health data from thousands of patients in Ontario and Alberta, they identified key factors such as age, hospital stay length, and prior kidney function that influence these outcomes. The resulting model accurately categorizes patients into risk groups, providing a resource to help clinicians and patients plan for future care needs.
This study compared mental health and addiction service use between physicians and the general population in Ontario, Canada, before and during the COVID-19 pandemic. Researchers found that while both groups saw an increase in outpatient visits for mental health during the pandemic, the increase was significantly larger among physicians. These findings suggest that physicians may have experienced greater mental health challenges during this period, highlighting a need for improved wellness supports within the healthcare system.
Researchers analyzed health records from over 14,000 patients in Ontario to determine the impact of heart attacks, heart failure, and strokes on those receiving maintenance hemodialysis. The study found that these cardiovascular events were associated with high rates of hospital resource use and a significant risk of death within 30 days of admission. These findings confirm that cardiovascular events recorded in administrative databases represent clinically serious health outcomes for dialysis patients.
Researchers found that measuring blood levels of a protein called growth differentiation factor-15 before major surgery can help predict the risk of heart complications or death within 30 days. Higher concentrations of this protein were strongly linked to an increased likelihood of heart injury, and adding this measurement to standard clinical assessments significantly improved the accuracy of risk predictions. This suggests that the protein could serve as a valuable tool for identifying high-risk patients before they undergo noncardiac surgical procedures.
This study compared two different ways of providing care to patients starting hemodialysis in Ontario, Canada: being assigned to one consistent primary kidney specialist or being cared for by a rotating group of specialists. Researchers found no differences between the two models in terms of patient survival, rates of kidney transplantation, transition to home dialysis, or hospital visits. These findings suggest that both staffing models are effective and provide similar clinical outcomes for patients receiving long-term dialysis.
Midodrine is an effective therapy for managing low blood pressure during hemodialysis treatments when other standard interventions have failed. This publication argues in favour of its use, highlighting its role in improving patient stability and ensuring the completion of necessary dialysis sessions.
Researchers identified four distinct subtypes of acute kidney injury by analyzing specific markers of inflammation, injury, and repair in the blood and urine of over 700 patients. These subtypes were linked to very different long-term outcomes, with certain groups facing a significantly higher risk of death, heart disease, and the development of chronic kidney disease. This approach helps better define the complex nature of kidney injury and may improve the ability to predict which patients are at the highest risk for future health complications.
A study of older adults in Ontario found that while the overall risk of developing low blood calcium after starting the medication denosumab is low, it increases significantly for those with advanced kidney disease or those on dialysis. For patients with the lowest kidney function, nearly one in four experienced mild low calcium and about fifteen percent experienced severe cases. These findings suggest that kidney function and baseline calcium levels are critical factors for doctors to monitor when prescribing this bone-strengthening treatment.
Yau K, Enilama O, Levin A, Romney MG, Singer J, Blake P, Perl J, Leis JA, Kozak R, Tsui H, Bolotin S, Tran V, Chan CT, Tam P, Dhruve M, Kandel C, Estrada-Codecido J, Brown T, Siwakoti A, Abe KT, Hu Q, Colwill K, Gingras AC, Oliver MJ, Hladunewich MA
This protocol describes an ongoing study to track the long-term immune response to COVID-19 vaccines in up to 2500 Canadians with chronic kidney disease, including those on dialysis and kidney transplant recipients. Researchers will measure antibody levels and cellular immunity at multiple timepoints over a year to determine how well and how long these patients remain protected. The findings will help develop specific vaccination guidelines and public health recommendations for people living with kidney disease.
To understand how artificial intelligence might be integrated into primary care, researchers interviewed 27 staff members and healthcare providers at community health centres across Ontario. Participants generally lacked deep knowledge of the technology but felt it could improve patient care and reduce provider burnout if the tools were easy to use and accurate. While open to these innovations, staff expressed concerns regarding patient privacy, legal liability, and the potential for technology to negatively affect the personal relationship between patients and their providers.
Clinical domain: The study focuses on patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis who have reached kidney failure and require dialysis. - What investigators did: They performed a systematic search and pooled data from existing studies to calculate rates of death, infection, and disease relapse. - Methodological features: The study is a meta-analysis of existing observational data.
Researchers used specialized magnetic resonance imaging and spectroscopy to observe the brains of patients during a hemodialysis session. They found evidence of brain swelling and chemical changes consistent with reduced blood flow and oxygen deprivation occurring during the treatment. These findings suggest that a single session of dialysis can cause acute brain injury, which may contribute to the long-term cognitive decline often seen in these patients.
This study protocol describes an ongoing project to identify health system factors that influence the rates of living donor kidney transplantation across different Canadian provinces. Researchers are conducting interviews and focus groups with stakeholders to compare how high-performing and low-performing provincial systems manage the transplant process. The findings aim to inform policy changes and interventions that could help increase the number of living donor transplants across the country.
Researchers studied living kidney donors in Alberta to determine if receiving recommended medical follow-up during the first two years after donation influenced their long-term health and care. The study found that donors who had consistent early follow-up were significantly more likely to continue annual check-ups five and ten years later, although this early care did not appear to change long-term kidney function or hospitalization rates. These findings suggest that while early engagement helps maintain routine monitoring, further strategies may be needed to improve long-term health outcomes for donors.
This randomized trial investigated whether a highly absorbable form of curcumin could slow the progression of chronic kidney disease in adults with high levels of protein in their urine. Researchers found that taking 90 milligrams of micro-particle curcumin daily for six months did not significantly improve kidney function or reduce protein leakage compared to a placebo. These results suggest that this specific curcumin formulation does not provide measurable benefits for managing albuminuric chronic kidney disease over a short-term period.
Cowan AC, Clemens KK, Sontrop JM, Dixon SN, Killin L, Anderson S, Acedillo RR, Bagga A, Bohm C, Brown PA, Cote B, Dev V, Harris C, Hiremath S, Kiaii M, Lacson E Jr, Molnar AO, Oliver MJ, Parmar MS, McRae JM, Nathoo B, Quinn K, Shah N, Silver SA, Tascona DJ, Thompson S, Ting RH, Tonelli M, Vorster H, Wadehra DB, Wald R, Wolf M, Garg AX
This review examined how magnesium intake from diet, supplements, or dialysis fluid affects bone health and fracture risk in the general population and people with kidney disease. While higher magnesium levels were linked to better bone density in healthy individuals and lower parathyroid hormone levels in dialysis patients, the evidence for preventing fractures remains inconclusive. Findings from the general population may not directly apply to those on dialysis, where higher blood magnesium levels were specifically associated with a lower risk of hip fractures.
A study of over 20,000 patients with advanced chronic kidney disease in Ontario found that those who contracted COVID-19 during the first 21 months of the pandemic faced high rates of hospitalization and a 19 per cent death rate. Researchers identified that being fully vaccinated significantly reduced the risk of death, while factors such as lower kidney function, lower income, and living in long-term care were associated with a higher risk of infection. Although outcomes were severe, the death rate for these patients declined as the pandemic progressed and vaccination became available.
This study examined the long-term effects of cannabis use on kidney health by following hospitalized adults for over four years. Researchers found that while cannabis consumption did not impact kidney function in individuals with healthy kidneys, it was associated with a faster decline in kidney function among those who already had chronic kidney disease. However, cannabis use was not linked to a higher risk of developing new kidney disease or reaching kidney failure.
Researchers analyzed blood samples from over 4,500 patients undergoing non-cardiac surgery to determine if levels of a heart protein called high-sensitivity troponin I could predict complications. They found that patients with elevated levels of this protein in the three days following surgery had a significantly higher risk of experiencing major heart problems or death within a month. These findings help establish specific thresholds that doctors can use to identify and monitor patients who experience heart injury during the surgical recovery period.
This is a protocol for an ongoing international randomized trial investigating whether the anti-inflammatory medication colchicine can prevent heart complications after major thoracic surgery. Researchers are assigning patients to receive either colchicine or a placebo for ten days to determine if the drug reduces the incidence of new-onset atrial fibrillation and heart muscle injury. The study will also monitor for potential side effects such as infection and diarrhea in over 3,000 participants across 11 countries.
A large study of over 500,000 pregnancies in Ontario, Canada, found that lower kidney function before pregnancy is linked to a higher risk of complications for both the mother and the baby. The risk of preterm delivery and low birthweight increased as kidney function declined, particularly when kidney function was less than 60 percent of normal or when protein was present in the urine. These findings suggest that pre-pregnancy kidney health is a critical factor in predicting pregnancy success and can help doctors provide better counselling and care for women with kidney disease.
Perl J, Brown EA, Chan CT, Couchoud C, Davies SJ, Kazancioğlu R, Klarenbach S, Liew A, Weiner DE, Cheung M, Jadoul M, Winkelmayer WC, Wilkie ME, for Conference Participants
This report summarizes the conclusions from an international conference on expanding the use of home-based dialysis treatments, such as peritoneal dialysis and home hemodialysis. Experts identified that while home therapies offer greater patient autonomy and satisfaction, their use remains low due to complex barriers including healthcare policy, funding models, and a lack of provider and patient education. The group emphasized that because clinical outcomes are similar across different dialysis types, the choice of treatment should be based on shared decision-making that prioritizes the patient's lifestyle, goals, and support system.
Nearly half of Canadians with type 2 diabetes have kidney disease, yet many do not receive optimal screening or the latest evidence-based treatments. This review highlights a new standard of care that includes routine screening of both urine protein and kidney function, alongside the use of medications like sodium-glucose cotransporter 2 inhibitors and finerenone to protect the heart and kidneys. Treatment plans should be tailored to individual patient needs, focusing on blood pressure control, blood sugar targets, and early intervention to prevent disease progression.
Wing S, Thomas D, Balamchi S, Ip J, Naylor K, Dixon SN, McArthur E, Kwong JC, Perl J, Atiquzzaman M, Yeung A, Yau K, Hladunewich MA, Leis JA, Levin A, Blake PG, Oliver MJ
Researchers in Ontario, Canada, studied the effectiveness of a third dose of mRNA COVID-19 vaccines compared to two doses in over 8,000 patients receiving maintenance hemodialysis during the Omicron wave. The study found that a third dose significantly reduced the risk of both infection and severe outcomes, such as hospitalization or death, compared to receiving only two doses. Additionally, patients who had a previous COVID-19 infection were found to have a lower risk of being reinfected regardless of their vaccination status.
Hiremath S, Blake PG, Yeung A, McGuinty M, Thomas D, Ip J, Brown PA, Pandes M, Burke A, Sohail QZ, To K, Blackwell L, Oliver M, Jain AK, Chagla Z, Cooper R
Researchers evaluated a modified, low-dose regimen of the antiviral medication nirmatrelvir/ritonavir in 134 dialysis patients with COVID-19 in Ontario, Canada. The study found that the treatment was safe and well-tolerated, with 96% of patients completing the full course and no COVID-19-related deaths occurring within 30 days. While many patients required adjustments to their other medications due to drug interactions, this modified dosing provides a potential treatment option for a high-risk group originally excluded from clinical trials.
Cho TH, Ng PCK, Lefebvre MJ, Desjarlais A, McCann D, Waldvogel B, Tonelli M, Garg AX, Wilson J, Beaulieu M, Marin J, Orsulak C, Talson M, Sharma M, Feldberg J, Bohm C, Battistella M
Researchers developed and validated a set of educational bulletins and videos to help patients on hemodialysis understand the process of safely reducing or stopping unnecessary medications. Through three rounds of feedback from over 100 patients across Canada, the tools were refined to ensure they were clear, accurate, and helpful for shared decision-making. These resources will be used in a national program to address the challenges of taking multiple medications while undergoing dialysis.
Mark PB, Carrero JJ, Matsushita K, Sang Y, Ballew SH, Grams ME, Coresh J, Surapaneni A, Brunskill NJ, Chalmers J, Chan L, Chang AR, Chinnadurai R, Chodick G, Cirillo M, de Zeeuw D, Evans M, Garg AX, Gutierrez OM, Heerspink HJL, Heine GH, Herrington WG, Ishigami J, Kronenberg F, Lee JY, Levin A, Major RW, Marks A, Nadkarni GN, Naimark DMJ, Nowak C, Rahman M, Sabanayagam C, Sarnak M, Sawhney S, Schneider MP, Shalev V, Shin JI, Siddiqui MK, Stempniewicz N, Sumida K, Valdivielso JM, van den Brand J, Yee-Moon Wang A, Wheeler DC, Zhang L, Visseren FLJ, Stengel B
This study of over 25 million individuals found that experiencing a major heart-related event, such as heart failure or a stroke, significantly increases the risk of later developing kidney failure. Heart failure hospitalizations showed the strongest link, with the highest risk of kidney failure occurring in the first three months following the heart event. These findings suggest that heart and kidney health are closely linked and that patients who experience cardiovascular issues require careful monitoring for declining kidney function.
Researchers identified specific thresholds for a high-sensitivity heart protein test that can predict the risk of serious heart complications or death within 30 days of noncardiac surgery. Patients with test results above 60 nanograms per litre were found to have a significantly higher risk of experiencing major cardiac events compared to those with lower levels. These findings help doctors better identify which surgical patients are experiencing silent heart injury that requires closer monitoring.
This article discusses whether aspirin should be prescribed to prevent initial cardiovascular events in patients with chronic kidney disease. Based on a specific analysis of the International Polycap Study 3 trial, the authors evaluate the potential benefits and practical considerations of using aspirin for primary prevention in this patient population.
Researchers studied patients with head and neck cancer to identify markers in the blood and urine that could predict or detect early kidney damage caused by the chemotherapy drug cisplatin. They found that specific metabolites related to energy production and mitochondrial health were significantly different in patients who developed kidney injury compared to those who did not. These findings suggest that testing for these specific substances before or shortly after treatment could help identify patients at high risk for this serious side effect.
Researchers tracked the implementation of infection control measures across nearly 100 hemodialysis centres in Ontario, Canada, during the first wave of the COVID-19 pandemic. Most facilities quickly adopted safety protocols, such as symptom screening, physical distancing, and universal masking for staff and patients, within the first two months of the health emergency. These proactive measures and the sharing of best practices through provincial networks likely helped limit virus outbreaks among patients who were unable to isolate due to their need for regular life-sustaining treatment.
This narrative review examines the difficulties in managing high potassium levels in outpatient settings, noting that current treatment thresholds are inconsistent and often rely on individual clinical judgment. The authors highlight issues such as falsely elevated laboratory results and a lack of standardized notification systems between laboratories and healthcare providers. These inconsistencies can lead to unnecessary emergency department visits or delays in treating potentially life-threatening conditions.
Researchers found that patients with advanced knee osteoarthritis have an accumulation of dead cells in their joint lining compared to healthy individuals. This buildup occurs because specialized immune cells called macrophages, which normally clear away dead cells through a process called efferocytosis, are significantly less effective in patients with osteoarthritis. The study also demonstrated that fluid from osteoarthritic joints can directly impair this clearing function in healthy immune cells, particularly during early stages of the disease when pain and inflammation are high.
Klämbt V, Buerger F, Wang C, Naert T, Richter K, Nauth T, Weiss AC, Sieckmann T, Lai E, Connaughton DM, Seltzsam S, Mann N, Majmundar AJ, Wu CW, Onuchic-Whitford AC, Shril S, Schneider S, Schierbaum L, Dai R, Bekheirnia MR, Joosten M, Shlomovitz O, Vivante A, Banne E, Mane S, Lifton RP, Kirschner KM, Kispert A, Rosenberger G, Fischer KD, Lienkamp SS, Zegers MMP, Hildebrandt F
Researchers identified that mutations in the ARHGEF6 gene on the X chromosome are a cause of congenital anomalies of the kidneys and urinary tract in humans. By studying kidney cells and animal models, the team demonstrated that these genetic variants disrupt essential cell signaling and movement required for normal kidney development. This discovery adds to the known genetic causes of the most common form of kidney disease in children.
Jun M, Scaria A, Andrade J, Badve SV, Birks P, Bota SE, Campain A, Djurdjev O, Garg AX, Ha J, Harel Z, Hemmelgarn B, Hockham C, James MT, Jardine MJ, Levin A, McArthur E, Ravani P, Shao S, Sood MM, Tan Z, Tangri N, Whitlock R, Gallagher M
Researchers compared the effectiveness and safety of direct oral anticoagulants versus warfarin in over 74,000 adults with atrial fibrillation across different levels of kidney function. The study found that direct oral anticoagulants were as effective or more effective than warfarin at preventing stroke and death, while also carrying a similar or lower risk of major bleeding. These benefits were consistent across all stages of kidney disease, including in patients with significantly reduced kidney function.
A study of adults aged 66 and older in Ontario, Canada, found that starting the antibiotic trimethoprim-sulfamethoxazole was associated with a more than threefold increased risk of hospitalization for high potassium levels compared to starting amoxicillin. This risk was significantly higher for individuals with pre-existing reduced kidney function, and the medication was also linked to higher rates of acute kidney injury. These findings highlight the importance of monitoring kidney function and potassium levels when prescribing this common antibiotic to older patients.
This pilot study investigated whether high-dose vitamin K supplements could slow the hardening of heart arteries in patients receiving hemodialysis. While the treatment successfully improved vitamin K levels and activated proteins that inhibit calcium buildup, it did not significantly reduce the progression of coronary artery calcification over one year compared to a placebo. The researchers confirmed that conducting a larger trial of this nature is feasible based on high patient recruitment and medication compliance rates.
Researchers surveyed women from families with a rare inherited condition called autosomal dominant tubulointerstitial kidney disease to understand how it affects pregnancy. The study found that while affected women had a higher rate of premature births compared to unaffected family members, they experienced lower rates of high blood pressure during pregnancy than is typically seen in other types of chronic kidney disease. Most pregnancies resulted in good outcomes for both mother and baby, even though the majority of women were unaware of their genetic diagnosis at the time of pregnancy.
Meraz-Muñoz AY, Jeyakumar N, Luo B, Beaubien-Souligny W, Chanchlani R, Clark EG, Harel Z, Kitchlu A, Neyra JA, Zappitelli M, Chertow GM, Garg AX, Wald R, Silver SA
Researchers studied whether patients with a history of heart attack were less likely to receive essential cardiovascular medications after a hospital stay involving acute kidney injury. The study found that survivors of acute kidney injury were significantly less likely to be prescribed blood pressure medications, statins, or beta-blockers within one year of discharge compared to those without kidney injury. This trend was most noticeable in patients who experienced more severe stages of kidney damage during their hospitalization.
This report describes how a network of community health centres in Ontario, Canada, transitioned into a learning health system to improve primary care for disadvantaged populations. By restructuring their organization and leveraging an integrated data platform, the network enhanced its ability to use real-world data for research, quality improvement, and collaborative planning. The initiative focused on engaging clinicians and community members to ensure that data-driven insights lead to better health outcomes and more efficient healthcare delivery.
Researchers measured three specific blood proteins in over 1,300 adults before they underwent cardiac surgery to see if these markers could predict long-term health outcomes. Higher levels of these proteins were linked to an increased risk of death, heart-related events, and the development or worsening of chronic kidney disease over nearly seven years of follow-up. While these markers provide valuable insights into a patient's risk profile, they did not significantly improve the accuracy of existing clinical models used to predict these outcomes.
The first Molecules and Mechanisms Mediating Kidney Health and Disease meeting was held to unite Canadian researchers focused on the fundamental biology of kidney development and disease. Participants identified key barriers to scientific progress and proposed strategies for improvement, including the creation of a national research network and better integration between basic science and clinical nephrology. This report outlines the meeting outcomes and emphasizes the need for regular collaboration to accelerate the translation of laboratory findings into improved patient care.
Researchers in Ontario, Canada, evaluated whether a specialized follow-up clinic for patients who survived acute kidney injury improved long-term health outcomes. While attendance at the clinic did not significantly reduce the risk of major kidney-related events, it was associated with a lower risk of death and a higher likelihood of being prescribed heart-protective medications like beta-blockers and statins. These findings suggest that specialized post-hospitalization care may influence survival and medication management even if it does not immediately prevent the progression of kidney disease.
Researchers in Nova Scotia, Canada, studied whether measuring C-peptide levels before a kidney transplant could predict the development of diabetes after the procedure. They found that patients with high pre-transplant C-peptide levels had a nearly 20-fold higher risk of developing post-transplant diabetes within one year, even when accounting for body mass index. This suggests that testing C-peptide levels before surgery could help identify high-risk patients who might benefit from early preventative care.
This multicentre study in Brazil compared patients who started peritoneal dialysis urgently within 72 hours of catheter insertion to those who started after a longer waiting period. Researchers found no significant difference in the rates of death or treatment failure during the first 90 days across the different timing groups. These findings suggest that starting peritoneal dialysis immediately is a safe and feasible alternative to hemodialysis for patients who require unplanned, urgent initiation of kidney replacement therapy.
This protocol describes the statistical analysis plan for an ongoing study evaluating a program designed to help patients with advanced kidney disease access transplantation and living donation. Researchers are using health registry data from Ontario, Canada, to compare whether patients in kidney programs receiving extra education and administrative support complete more steps toward transplantation than those receiving standard care. The study tracks progress through four key stages, including specialist referral, donor evaluation, waitlist addition, and the successful receipt of a kidney transplant.
This study evaluated the safety and feasibility of a new blood-filtering treatment called leucocyte modulation, which aims to reduce the harmful immune system overactivity seen in severe COVID-19 infections. Researchers found that the treatment was safe for critically ill patients on mechanical ventilation and was associated with a significant reduction in the dose of blood-pressure-supporting medications required. While the results are promising, the study was a small preliminary evaluation intended to support the design of larger trials to determine the best way to use this therapy.
This study investigated whether tailoring the temperature of dialysis fluid to each patient's body temperature could reduce cardiovascular problems in people receiving long-term hemodialysis. Researchers found no significant difference in rates of cardiovascular death or hospital admission between patients receiving personalized cooler dialysis and those receiving standard temperature dialysis. The findings suggest that the widespread adoption of cooler dialysis may need to be re-evaluated, as it did not demonstrate the expected cardiovascular benefits in this large trial.
This study examined whether having pre-existing chronic kidney disease affects the outcomes of different timing strategies for starting dialysis in patients with sudden, severe kidney failure. Researchers found that for patients who already had chronic kidney disease, starting dialysis early led to a three times higher risk of remaining dependent on dialysis after 90 days compared to a more standard, watchful approach. In contrast, the timing of dialysis initiation did not affect long-term dialysis dependence or survival for patients who had healthy kidney function before their acute illness.
Researchers studied over 6,600 patients with chronic kidney disease to determine if the medication empagliflozin could prevent the worsening of their condition or death from heart-related causes. The study found that patients taking empagliflozin had a significantly lower risk of kidney disease progression and fewer hospitalizations compared to those taking a placebo, regardless of whether they had diabetes. These benefits were consistent across different levels of kidney function, and the medication was found to be safe with similar rates of serious side effects in both groups.
Garg AX, Arnold JB, Cuerden M, Dipchand C, Feldman LS, Gill JS, Karpinski M, Klarenbach S, Knoll GA, Lok C, Miller M, Monroy-Cuadros M, Nguan C, Prasad GVR, Sontrop JM, Storsley L, Boudville N
This protocol describes an ongoing prospective study designed to evaluate the long-term health effects of living kidney donation by comparing over one thousand donors to a group of healthy non-donors. Researchers are tracking changes in blood pressure, kidney function, and protein in the urine, while also assessing patient-reported quality of life and mental health over several years. The goal is to determine the specific risks of hypertension and declining kidney function that can be directly attributed to the act of donating a kidney.
Researchers implemented a quality improvement initiative in a surgical department to ensure that at least half of patient discharge summaries were sent out within 48 hours of a hospital stay. By using strategies such as automated distribution of notes and regular performance feedback, the team increased the rate of timely summaries from 19% to 54% without increasing staff workload. These improvements were sustained over time, helping to ensure that information is shared quickly with other healthcare providers to support safe patient transitions from hospital to home.
Researchers developed machine learning algorithms to better identify reports of cluster randomized trials by analyzing information found in article citations like titles and abstracts. The best performing algorithm accurately identified these trials in both initial testing and a separate validation set. This tool could improve the efficiency of finding these types of studies for use in medical reviews and evidence synthesis.
Clinical domain: The study focuses on the recognition and management of obesity within a chronic kidney disease population. - What investigators did: The researchers performed a retrospective chart review (observational) and an online survey of nephrologists (observational/survey) to assess clinical documentation and physician perceptions. - Methodological features: The study relies on survey research and the analysis of clinical records to identify gaps in care delivery.
Congenital anomalies of the kidney and urinary tract are a leading cause of kidney failure in children and can also affect adults. This review explores how specific single-gene defects disrupt embryonic development to cause these conditions, noting that approximately 10 to 20 percent of cases have a clear genetic origin. Understanding these gene pathways helps explain the wide variety of urinary tract and kidney problems seen in patients.
Wu CW, Lim TY, Wang C, Seltzsam S, Zheng B, Schierbaum L, Schneider S, Mann N, Connaughton DM, Nakayama M, van der Ven AT, Dai R, Kolvenbach CM, Kause F, Ottlewski I, Stajic N, Soliman NA, Kari JA, El Desoky S, Fathy HM, Milosevic D, Turudic D, Al Saffar M, Awad HS, Eid LA, Ramanathan A, Senguttuvan P, Mane SM, Lee RS, Bauer SB, Lu W, Hilger AC, Tasic V, Shril S, Sanna-Cherchi S, Hildebrandt F
Researchers investigated the genetic causes of congenital anomalies of the kidney and urinary tract by looking for missing or duplicated sections of DNA, known as copy number variations. By adding this analysis to standard genetic sequencing in 170 families, the team increased the rate of successful genetic diagnosis from 13% to 18%. These findings suggest that searching for these specific structural genetic changes can help more families understand the underlying cause of their child's kidney condition.
This review explores why individuals with chronic kidney disease face a significantly higher risk of heart disease and stroke, focusing on the role of toxins that accumulate when kidney function declines. These substances, including those produced by gut bacteria and systemic metabolic processes, contribute to vascular damage beyond what is explained by traditional risk factors like high blood pressure. The authors suggest that reducing these toxins through specialized diets, intensive dialysis, kidney transplantation, or specific vitamin therapies may be necessary to improve cardiovascular outcomes in this population.
This review examines how hemodialysis affects the microcirculation, the smallest blood vessels in the body, which are often damaged in patients with chronic kidney disease. While current monitoring focuses on large-scale measures like blood pressure, new non-invasive technologies can detect small-vessel stress and potential organ damage during treatment. Adopting these tools into clinical practice could allow for more personalized dialysis care and help prevent tissue injury before it occurs.
Researchers measured the levels of two inflammatory proteins in the blood of patients three months after they were discharged from the hospital. Higher concentrations of these proteins were strongly linked to an increased risk of kidney disease progression, heart failure, and death over the following four years, regardless of whether the patient had experienced an acute kidney injury during their hospital stay. These findings suggest that these specific proteins could help doctors identify and monitor patients at higher risk for serious health complications following hospitalization.
Researchers re-examined data from a large international trial to determine if starting dialysis earlier in critically ill patients with acute kidney injury provided any benefit. Using advanced statistical modeling, they found a very low probability that early dialysis improves survival and noted that patients in the early-start group actually spent fewer days alive and free from dialysis. These results support the current practice of waiting for standard clinical indications before beginning kidney-replacement therapy.
Children who survived an episode of acute kidney injury requiring dialysis were found to have significantly higher rates of hospital readmission, emergency department visits, and overall healthcare costs compared to other hospitalized children. Despite these increased risks, fewer than one in five of these children were seen by a kidney specialist within the first year after leaving the hospital. These findings highlight a substantial long-term health and economic burden following severe childhood kidney injury and suggest a need for better follow-up care.
In this study, researchers developed and evaluated a community engagement program in Guatemala to support research into chronic kidney disease of unknown origin. By applying five core principles of engagement, the team successfully built a collaborative relationship with sixty-two community leaders who reported high levels of satisfaction and involvement in the research process. This approach demonstrates how involving local partners can improve the sustainability and effectiveness of kidney health studies, particularly in low- and middle-income countries.
Researchers followed a small group of factory workers for two years to determine if exposure to heat stress affected their kidney health. The study found that kidney function remained stable over the two-year period, though measurements taken before and after a single work shift suggested that cystatin C is a more reliable marker than creatinine for assessing kidney function in these environments. These findings indicate that while heat stress is a concern, these specific workers maintained their kidney health over the follow-up period.
A 28-year-old woman with IgA nephropathy and advanced kidney failure presented to the emergency department with shortness of breath and fatigue after starting dapsone treatment. The patient was found to have methemoglobinemia, a condition where the blood cannot effectively carry oxygen, which was a complication of her medication. This case highlights the importance of monitoring for rare drug toxicities in patients with significant kidney impairment.
This publication is a response from the authors to commentaries regarding the Advancing American Kidney Health Initiative. It addresses perspectives on the challenges of changing the current status quo in kidney care and the goals for improving patient outcomes.
This study of older adults in Ontario with advanced chronic kidney disease found that those prescribed higher doses of fluoroquinolone antibiotics had a higher risk of serious side effects compared to those given lower doses. These adverse events included hospital visits for nervous system or psychiatric disorders, dangerously low blood sugar, and tendon or collagen-related issues. While the overall risk of these complications remained low at less than two percent, the findings highlight the importance of careful dose adjustment based on kidney function.
Researchers developed a method to identify patients with kidney failure who are likely eligible for a transplant by analyzing health records for specific conditions that usually prevent surgery, such as advanced age, dementia, or certain cancers. By applying these criteria to a large group of patients in Ontario, they were able to more accurately estimate who could potentially receive a transplant, which helps health systems better measure and improve access to care. This approach provides a way to evaluate transplant eligibility using existing administrative data when detailed clinical records are not available.
Researchers tracked COVID-19 testing and infection rates among more than 41,000 physicians in Ontario, Canada, during the first year of the pandemic before vaccines were available. Nearly half of the physicians were tested at least once, with less than one percent testing positive and no deaths reported within 30 days of a positive test. Testing and infection rates varied by medical specialty, with the highest testing rates seen among medical trainees and emergency doctors.
Kim KS, Belley-Côté EP, Gupta S, Pandey A, Alsagheir A, Makhdoum A, McClure G, Newsome B, Gao SW, Bossard M, Isayama T, Ikuta Y, Walsh M, Garg AX, Guyatt GH, Whitlock RP
Researchers reviewed 28 studies to compare the outcomes of mechanical versus bioprosthetic heart valves in patients receiving long-term dialysis. While mechanical valves were associated with lower mortality rates over time, they also significantly increased the risk of bleeding and stroke compared to bioprosthetic valves. Because the overall quality of evidence was low, the choice of valve should be based on individual patient factors such as bleeding risk and the expected lifespan of the valve.
This publication provides clinical guidance on the use of nirmatrelvir/ritonavir, an antiviral treatment for COVID-19, in patients with advanced chronic kidney disease. The authors outline considerations for dose adjustments and the management of potential drug interactions to ensure the medication is used safely in this high-risk population. This guidance is intended to help clinicians navigate the complexities of prescribing this therapy when kidney function is significantly reduced.
Researchers used specialized magnetic resonance imaging to measure the concentration of sodium stored in the skin of patients receiving hemodialysis and peritoneal dialysis. They found that higher levels of skin sodium were associated with a significantly increased risk of death and major heart-related events, independent of traditional risk factors like age or blood sodium levels. In patients on hemodialysis, skin sodium levels were specifically linked to the sodium concentration in the dialysis fluid, heart failure, and protein levels in the blood.
Researchers describe the successful treatment of a 12-year-old boy with a rare inherited kidney disorder called hereditary hypophosphatemic rickets with hypercalciuria. By adding growth hormone and fluconazole to standard phosphate supplements, the clinical team was able to improve the patient's bone pain, growth, and high urine calcium levels. Advanced magnetic resonance imaging of the skin and muscle also provided a rationale for using a low-sodium diet to help manage the condition.
This pilot study used specialized magnetic resonance imaging to measure sodium levels in the skin and muscle tissues of children with chronic kidney disease compared to healthy peers and adults. Researchers found that while overall sodium levels did not differ between healthy children and those with kidney disease, specific causes of kidney disease led to different patterns, with glomerular diseases showing higher sodium and tubular disorders showing lower sodium. These tissue sodium levels were closely linked to the presence of protein in the urine and low blood protein levels, suggesting that the underlying cause of kidney disease influences how the body stores sodium.
This commentary discusses the clinical importance and effectiveness of COVID-19 vaccination for patients receiving hemodialysis. It highlights how vaccination strategies and immune responses in this vulnerable population impact their overall health outcomes during the pandemic.
A study of older adults with chronic kidney disease in Ontario found that starting allopurinol at a dose higher than 100 milligrams per day more than doubled the risk of being hospitalized for a severe skin reaction compared to starting at a lower dose. These results support the practice of using lower initial doses of this medication in patients with reduced kidney function to minimize the risk of dangerous side effects. While higher starting doses were also linked to an increase in overall hospitalizations, there was no significant difference in the risk of death between the two groups.
This publication provides an updated set of clinical guidelines from the Canadian Urological Association for the evaluation and medical treatment of kidney stones. It offers evidence-based recommendations to help clinicians manage stone disease through diagnostic testing and non-surgical medical therapies.
Researchers compared the risk of bone fractures between older adults in Ontario starting sodium-glucose cotransporter-2 inhibitors and those starting dipeptidyl peptidase-4 inhibitors. The study found no significant difference in fracture risk between the two medication groups over one year, regardless of the patient's baseline kidney function. These findings suggest that this class of diabetes medication does not increase the risk of skeletal injuries in patients with chronic kidney disease.
Researchers in Ontario used a participatory photography method called Photovoice to explore resilience and quality of life among adults receiving long-term hemodialysis. Participants used various camera technologies to document their daily lives and led focus groups to determine how their images and personal stories should be shared with the public. This collaborative approach aims to empower patients as community informants and develop new ways to raise awareness about living with chronic kidney disease.
Researchers compared pregnancy outcomes between physicians and non-physicians in Ontario, Canada, to determine if occupational factors influenced health risks. While physicians initially appeared to have a higher risk of severe maternal complications, this was largely explained by their older age at the time of childbirth. Interestingly, newborns of physicians were found to have a lower risk of severe health issues compared to those of non-physicians, with no significant differences found between different medical specialties.
Researchers conducted a large international trial to determine if the steroid methylprednisolone could prevent kidney failure in patients with IgA nephropathy who were at high risk of disease progression. The study found that patients receiving the steroid had a significantly lower risk of experiencing a major decline in kidney function or kidney failure compared to those receiving a placebo. While the treatment was effective at both full and reduced doses, the higher dose was associated with a significant increase in serious infections and other adverse events.
This study analyzed health records from over 12,000 organ transplant recipients in Ontario, Canada, to determine how well COVID-19 vaccines protected them against infection and serious illness. Researchers found that while transplant recipients have lower protection compared to the general public, receiving a third dose significantly increased vaccine effectiveness against both infection and hospitalization or death. These findings highlight the importance of additional vaccine doses for improving immune protection in this vulnerable population.
This study interviewed staff at community health centres in Ontario to identify the essential components of a successful learning health system in primary care. Researchers found that shared organizational goals, high-quality data, and dedicated resources are necessary foundations, but success ultimately depends on staff engagement and protected time for improvement work. The findings highlight that while a desire to improve patient care motivates staff, many centres still face challenges with real-time data access and a lack of specialized personnel for data analysis.
This paper describes a collaborative effort between researchers and patients to develop programs that improve access to kidney transplantation and living kidney donation. The partnership led to the creation of the Transplant Ambassador Program, a patient-led initiative that connects individuals with kidney failure to successful transplant recipients and donors. The authors also outline the specific challenges and successes encountered when involving patients as active partners in the research and development process.
Researchers analyzed health records for over five million residents in Ontario, Canada, to determine how kidney health affects cancer risk and survival. The study found that while cancer risk was highest in people with mild kidney disease or kidney transplants, those with any stage of kidney disease were more likely to be diagnosed with advanced cancer and faced a higher risk of dying from the disease. Certain types of cancer, including bladder and kidney cancers and multiple myeloma, were particularly common and more lethal as kidney function declined.
In this cross-sectional study, researchers assessed cognitive function in patients who had recently started maintenance hemodialysis, specifically those who had been on treatment for less than one year. They found that a high proportion of these patients experienced cognitive impairment, particularly in the areas of verbal processing and reasoning, with average scores consistently lower than those of healthy individuals of the same age and sex. These findings suggest that significant changes in brain function occur early in the course of dialysis treatment, which may impact a patient's quality of life and ability to make healthcare decisions.
In this large clinical trial, researchers investigated whether giving tranexamic acid to patients undergoing noncardiac surgery could reduce the risk of serious bleeding without increasing the risk of heart attacks, strokes, or blood clots. The study found that tranexamic acid significantly reduced the occurrence of life-threatening and major bleeding compared to a placebo. However, the researchers could not definitively conclude that the drug was as safe as the placebo regarding cardiovascular complications, as the risk of these events was slightly higher in the group receiving the medication.
The Advancing American Kidney Health Initiative set ambitious goals to increase the use of home dialysis and kidney transplantation while reducing the incidence of kidney failure. This commentary discusses the complexities of measuring the success of these policy changes, noting that current metrics may not fully capture improvements in patient care or health equity. The authors highlight the need for refined data collection and evaluation strategies to ensure the initiative effectively meets its objectives for the kidney disease community.
Borges FK, Devereaux PJ, Cuerden M, Sontrop JM, Bhandari M, Guerra-Farfán E, Patel A, Sigamani A, Umer M, Neary J, Tiboni M, Tandon V, Ramokgopa MT, Sancheti P, Lawendy AR, Balaguer-Castro M, Jenkinson R, Ślęczka P, Nur AN, Wood GCA, Feibel RJ, McMahon JS, Biccard BM, Ortalda A, Szczeklik W, Wang CY, Tomás-Hernández J, Vincent J, Harvey V, Pettit S, Balasubramanian K, Slobogean G, Garg AX, HIP ATTACK-1 Investigators
This protocol describes an ongoing study to evaluate how a quality improvement program is being delivered across kidney care centres in Ontario to increase access to transplantation. Researchers will use surveys and interviews with healthcare providers to determine if the program components, such as patient education and performance monitoring, are being implemented as intended. The findings will help explain the results of the main clinical trial and provide guidance for improving transplant access in the future.
Knoll G, Campbell P, Chassé M, Fergusson D, Ramsay T, Karnabi P, Perl J, House AA, Kim J, Johnston O, Mainra R, Houde I, Baran D, Treleaven DJ, Senecal L, Tibbles LA, Hébert MJ, White C, Karpinski M, Gill JS
This study followed over 200 Canadian patients who returned to dialysis after a kidney transplant failed to determine how their ongoing use of anti-rejection medications affected their health. Researchers found that patients who continued taking immunosuppressants had a lower risk of death compared to those who stopped the medications or took only prednisone, without experiencing a significant increase in hospitalizations for infections. While continuing these medications did not prevent the development of antibodies that could complicate future transplants, the findings suggest that maintaining some immunosuppression after transplant failure may offer survival benefits.
Researchers tested a multi-part program including staff education, patient tools, and performance feedback to see if it would increase the number of patients choosing home-based dialysis in Canada. The study found that the intervention did not lead to a higher proportion of patients using home dialysis six months after starting treatment compared to standard care. These results suggest that educational and administrative support alone may not be enough to overcome existing barriers to home dialysis use.
Oliver MJ, Thomas D, Balamchi S, Ip J, Naylor K, Dixon SN, McArthur E, Kwong J, Perl J, Atiquzzaman M, Singer J, Yeung A, Hladunewich M, Yau K, Garg AX, Leis JA, Levin A, Krajden M, Blake PG
A study of over 13,000 dialysis patients in Ontario, Canada, found that COVID-19 vaccines were highly effective at preventing infection and severe outcomes like hospitalization or death. While a single dose provided significant protection, receiving two doses further reduced the risk of severe illness by 83 per cent compared to being unvaccinated. These protective benefits were consistent across different age groups, dialysis types, and vaccine brands, despite earlier concerns about weaker immune responses in this population.
This publication explores the ethical considerations surrounding policies that require patients on the kidney transplant waitlist to receive the SARS-CoV-2 vaccine. The authors examine the balance between individual patient autonomy and the collective responsibility of transplant centres to ensure the best possible outcomes for donated organs. The discussion highlights the complexities of mandating medical interventions in the context of life-saving organ transplantation.
Researchers tested whether placing tablets in family physician waiting rooms to encourage patients to register for organ and tissue donation would increase registration rates. The study found that inviting patients to register while they waited for their appointments did not significantly change the number of people who signed up compared to standard care. Interviews with clinic staff revealed that factors such as the tablet's location, staff motivation, and competing office priorities influenced how the program was delivered.
Researchers used a specialized type of imaging called sodium magnetic resonance imaging to measure the salt gradient between the inner and outer parts of the kidney in healthy volunteers and patients with chronic kidney disease. The study found that this imaging technique accurately tracked changes in kidney salt levels following a water load and matched results from traditional urine tests. This technology provides a non-invasive way to assess kidney concentration ability and could be a feasible tool for monitoring patients with reduced kidney function.
Yau K, Chan CT, Abe KT, Jiang Y, Atiquzzaman M, Mullin SI, Shadowitz E, Liu L, Kostadinovic E, Sukovic T, Gonzalez A, McGrath-Chong ME, Oliver MJ, Perl J, Leis JA, Bolotin S, Tran V, Levin A, Blake PG, Colwill K, Gingras AC, Hladunewich MA
Researchers compared the immune response of two different mRNA vaccines in patients undergoing maintenance hemodialysis at two Canadian academic centres. The study found that patients who received the Moderna vaccine had significantly higher antibody levels and a more sustained immune response compared to those who received the Pfizer-BioNTech vaccine. These findings support the recommendation for additional vaccine doses in this vulnerable population to maintain protection against the virus.
This publication describes the design of an ongoing international trial involving 10,000 patients to determine if the medication tranexamic acid can safely reduce major bleeding during non-cardiac surgery. The study also evaluates whether a specific strategy to avoid low blood pressure, which involves adjusting regular blood pressure medications and setting higher targets during surgery, reduces the risk of heart-related complications. Researchers will follow participants for one year to assess the impact of these strategies on survival and long-term cardiovascular health.
This study evaluated the impact of a specialized genetic kidney disease clinic in Ireland that used various genomic sequencing methods to diagnose adults with suspected inherited kidney conditions. Researchers achieved a genetic diagnosis in over half of the participants, which led to the reclassification of diagnoses for some and allowed others to avoid invasive kidney biopsies. The findings demonstrate that integrating genetic testing into clinical care can significantly improve diagnostic accuracy and guide treatment decisions for patients with kidney disease.
Myran DT, Cantor N, Rhodes E, Pugliese M, Hensel J, Taljaard M, Talarico R, Garg AX, McArthur E, Liu CW, Jeyakumar N, Simon C, McFadden T, Gerin-Lajoie C, Sood MM, Tanuseputro P
This study examined healthcare visits for mental health and substance use among over 34,000 physicians in Ontario, Canada, during the COVID-19 pandemic. Researchers found a 27% increase in the rate of these visits compared to the pre-pandemic period, with the most significant rise occurring among doctors who had no previous history of mental health or substance use concerns. These findings suggest that pandemic-related stressors significantly impacted physician well-being, highlighting a need for better access to support services for healthcare providers.
Wang C, Seltzsam S, Zheng B, Wu CW, Nicolas-Frank C, Yousef K, Au KS, Mann N, Pantel D, Schneider S, Schierbaum L, Kitzler TM, Connaughton DM, Mao Y, Dai R, Nakayama M, Kari JA, El Desoky S, Shalaby M, Eid LA, Awad HS, Tasic V, Mane SM, Lifton RP, Baum MA, Shril S, Estrada CR, Hildebrandt F
Researchers used whole exome sequencing to investigate whether specific genetic mutations contribute to spina bifida, a common congenital malformation. By analyzing the genetic data of 50 unrelated individuals and comparing them to known mouse models and human syndromes, the team identified 18 potential candidate genes that may be linked to the condition. These findings suggest that some cases of spina bifida may have a monogenic cause, where a mutation in a single gene is responsible for the defect.
This protocol describes an ongoing study to determine if avoiding low blood pressure during and after noncardiac surgery reduces the risk of acute kidney injury. Researchers are comparing a strategy of withholding certain blood pressure medications and maintaining higher blood pressure targets against a standard approach of continuing usual medications. The study will involve approximately 6,800 patients across 108 centres to see if these management changes prevent significant increases in creatinine levels following surgery.
A survey of patients with chronic kidney disease and their doctors in Ontario found that telephone appointments were generally well-received during the pandemic, with most patients finding them comfortable and safer than in-person visits. While participants appreciated saving time and money on travel, they noted drawbacks such as the lack of a physical examination and a reduced personal connection with their physician. Most doctors felt confident using telephone consultations but identified communication barriers and a need for better technology to support virtual clinics.
Researchers found that the balance of two proteins involved in blood vessel stability, measured three months after hospital discharge, can predict long-term health outcomes in patients with and without acute kidney injury. A higher ratio of angiopoietin-1 to angiopoietin-2 was linked to a significantly lower risk of developing chronic kidney disease, heart failure, and death. These findings suggest that blood vessel instability may be a key factor in how kidney injury leads to heart and kidney complications.
Researchers developed a new animal model to observe how hemodialysis affects blood flow in small blood vessels in real-time. They found that even in healthy rats, the dialysis procedure caused significant disturbances in blood circulation and reduced blood flow to muscle tissues. These findings suggest that the hemodialysis process itself may contribute to organ injury by restricting blood flow through the microvasculature.
Researchers followed eight patients undergoing hemodialysis through the creation of an upper-arm arteriovenous fistula and tracked changes in their heart structure using magnetic resonance imaging. They found that all patients experienced an increase in the muscle mass of the heart's main pumping chamber, and most experienced a decrease in the chamber’s ability to pump blood effectively within the first year. These changes in heart structure are concerning because increased heart muscle mass is linked to a higher risk of health problems and death in people with kidney disease.
Researchers used advanced gene editing and protein analysis to identify ZMYM2 as a key protein that binds to the transcription factor TBX18, which is essential for the proper development of various organs. Both of these proteins are linked to congenital anomalies of the kidney and urinary tract, and this study found they are present together during the development of the ureter in mice. These findings help explain the molecular machinery required for normal kidney and urinary tract formation during embryonic development.
Researchers studied over 4,400 kidney transplant recipients in Ontario, Canada, to determine how the length of time spent on dialysis before surgery affected their health outcomes. The study found that patients who received a transplant before needing dialysis had the lowest risk of transplant failure, while those who spent longer on dialysis faced higher risks of death and hospitalization for infections. These findings suggest that shorter dialysis wait times are associated with better long-term health and survival after a kidney transplant.
Nearly one-third of adults with chronic kidney disease in Ontario, Canada, were prescribed opioids for non-cancer pain, with codeine and hydromorphone being the most common choices. Many of these prescriptions were considered potentially inappropriate, such as the use of codeine in patients with severely reduced kidney function or the concurrent use of benzodiazepines. While overall opioid prescribing and unsafe practices declined between 2013 and 2018, the high frequency of use highlights a need for better pain management strategies in this population.
Zheng B, Seltzsam S, Wang C, Schierbaum L, Schneider S, Wu CW, Dai R, Connaughton DM, Nakayama M, Mann N, Stajic N, Mane S, Bauer SB, Tasic V, Nam HJ, Shril S, Hildebrandt F
Researchers used whole-exome sequencing to analyze the genetic data of 541 families affected by congenital anomalies of the kidneys and urinary tract. By focusing on the Forkhead box family of genes, which are known to be important for organ development, the team identified three new candidate genes—FOXL2, FOXA2, and FOXA3—linked to these conditions. This study demonstrates that focusing on gene families with similar functions can be an effective strategy for discovering the underlying genetic causes of complex kidney and urinary tract malformations.
To identify the barriers and facilitators of exercise programs during hemodialysis, researchers interviewed 43 patients and healthcare providers across 12 hospitals in Ontario. The study found that while local champions and patient success stories support these programs, significant challenges remain, including a lack of staff expertise, concerns about workload, and uncertainty regarding exercise safety. Based on these findings, the investigators developed a feasibility checklist and a list of practical solutions to help clinical teams successfully implement exercise interventions within dialysis units.
