Amit Garg

Amit Garg

This clinical trial investigated whether a low dose of the blood thinner rivaroxaban could reduce cardiovascular events in patients with advanced chronic kidney disease or kidney failure. The study was stopped early because rivaroxaban did not lower the risk of cardiovascular death, heart attack, stroke, or peripheral artery disease events compared to a placebo. Furthermore, patients taking rivaroxaban experienced significantly higher rates of major bleeding, suggesting the medication is not beneficial and may be harmful for this population.

Matthew WeirKyla NaylorAmit Garg

A population-based study of nearly 18,000 patients with kidney failure in Ontario, Canada, examined potential sex-based disparities across the pathway to kidney transplantation. The researchers found that female patients were significantly less likely to be referred to a transplant centre for assessment compared to male patients, a disadvantage that became more pronounced with older age. However, once referred, there were no significant differences between sexes in subsequent steps, including living donor contact, waitlisting, or receiving a transplant.

Amit Garg

This article introduces the CRT-Estimands Framework, a consensus-based extension of international clinical trial guidelines specifically designed for cluster randomized trials, where groups of individuals rather than single patients are randomized. The framework provides a structured set of attributes to help researchers precisely define the treatment effect they aim to estimate, addressing unique challenges such as how to handle individuals who join a cluster after randomization. Adopting this framework aims to improve the clarity of research questions in cluster trials, ultimately helping clinicians, patients, and policy makers make better-informed decisions.

Amit Garg

This study evaluated how well standard clinical risk scores predict stroke and bleeding in older adults with atrial fibrillation across different levels of kidney function. Using data from two large patient groups in California and Ontario, researchers found that these commonly used risk scores became significantly less accurate as kidney function declined. The findings suggest that tools designed for the general population are less reliable for patients with advanced kidney disease, highlighting a need for kidney-specific prediction models to guide treatment decisions.

Matthew WeirAmit GargBrad UrquhartPeter Blake

A study of dialysis patients in Ontario, Canada, found that those starting low-dose methotrexate had a more than threefold higher risk of death or serious hospitalization compared to those starting hydroxychloroquine. Nearly 30 percent of patients taking methotrexate experienced severe complications such as sepsis, lung toxicity, or bone marrow suppression within 90 days. These findings suggest that methotrexate should be avoided in the dialysis population in favour of safer alternative medications.

Matthew WeirKyla NaylorAmit Garg

Researchers updated and validated a risk calculator in Ontario, Canada, designed to help patients on dialysis compare their predicted three-year survival with dialysis versus a kidney transplant. The updated tool, which removed race as a variable to avoid clinical bias, demonstrated moderate accuracy in predicting mortality for both treatment groups. This tool can support patients and healthcare providers in making more informed decisions about pursuing kidney transplantation.

Amit Garg

A population-based study in Ontario, Canada, evaluated the risk of acute kidney injury in over 16,000 patients with advanced cancer receiving immune checkpoint inhibitors compared to other systemic therapies. Researchers found that patients treated with immune checkpoint inhibitors actually had a lower risk of developing acute kidney injury than those on other cancer therapies, with severe kidney injury occurring in only seven percent of patients. While restarting immune checkpoint inhibitor therapy after an episode of kidney injury was uncommon and carried a high risk of recurrence, it was associated with improved overall survival in select patients.

Dervla ConnaughtonMatthew WeirAndrew HouseLakshman GunaratnamAmit GargPavel Roshanov

Researchers used genetic testing to identify the underlying cause of kidney failure in nearly one-quarter of transplant recipients, often leading to a reclassification of their original diagnosis. The study also found that while only four percent of healthy prospective living donors carried high-risk genetic variants, nearly twenty percent of donors who later developed kidney complications carried these variants. These findings suggest that targeted genetic testing could improve the safety of living kidney donation by better identifying high-risk donors.

Arsh JainDanielle NashAmit GargPeter Blake

Researchers evaluated the impact of changing the eligibility rules for multidisciplinary kidney care in Ontario, Canada, which shifted from a simple kidney function threshold to a risk-based model. While the change led to fewer patients receiving specialized clinic care and a slight increase in late referrals before starting dialysis, there were no significant negative effects on long-term clinical outcomes like dialysis initiation methods or mortality. These findings suggest that using risk-based criteria can help focus resources on high-risk patients without compromising overall patient safety.

Susan HuangAmit Garg

A long-term study in Ontario, Canada, found that adults who survived an episode of thrombotic microangiopathy and achieved remission after plasma exchange had a twofold higher risk of major coronary artery disease events compared to the general population. Over a median follow-up of 16 years, these survivors also experienced significantly higher rates of heart failure, stroke, and overall mortality. These findings suggest that patients who recover from this condition require ongoing monitoring and careful management of cardiovascular risk factors.

Amit Garg

This study evaluated whether administering intravenous sodium bicarbonate to adults with severe metabolic acidosis and moderate to severe acute kidney injury would reduce mortality. The researchers found that the treatment did not significantly reduce the risk of death at 90 days compared to standard care. These findings suggest that routine use of intravenous sodium bicarbonate may not improve survival outcomes in this critically ill patient population.

Amit GargPavel Roshanov

This guide for clinical researchers compares different statistical methods for analyzing patient-reported data collected through Likert scales, such as those measuring physical discomfort. Using data from a large hemodialysis trial, researchers found that treating these scales as ordinal data rather than simplifying them into two categories provides greater statistical power and a more accurate understanding of patient experiences. The study demonstrates that these advanced statistical approaches can better capture nuances in patient discomfort, such as the increased feeling of coldness reported by patients using personalized cooler dialysis fluid.

Amit Garg

Researchers conducted an online consensus workshop with patients, caregivers, clinicians, and policymakers from across Canada to determine user preferences for a kidney failure mortality risk prediction tool. Participants prioritized using the tool during clinic visits, personalizing the prediction timeframes, and incorporating health conditions and frailty into the calculations. The findings suggest that involving end-users in the design of future risk prediction tools may improve their usability and adoption in clinical practice.

Amit Garg

This protocol describes the design and baseline characteristics of an ongoing clinical trial evaluating the safety and efficacy of low-dose rivaroxaban in patients with advanced chronic kidney disease or dialysis-dependent kidney failure who have a high risk of cardiovascular events. Participants are randomized to receive either low-dose rivaroxaban or a matching placebo to determine if the treatment reduces major cardiovascular events, such as heart attack or stroke, without causing unacceptable rates of major bleeding. The trial has randomized over 1,400 participants across multiple centres and is expected to complete enrollment in 2025.

Kyla NaylorAmit Garg

The Living Donor Kidney Transplantation project in Canada is implementing and evaluating several evidence-based strategies to improve access to kidney transplants from living donors. These initiatives include a national consensus on donor evaluation standards, a streamlined one-day assessment clinic, and a peer-support program led by patient volunteers. This program report describes how collaborating with patients and health system leaders has helped establish national standards and scalable solutions to make the transplantation process more efficient and equitable.

Amit GargAndrea CowanPeter Blake

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.

Amit GargPeter Blake

In 2018, Ontario established a new multidisciplinary care model to provide standardized and timely treatment for individuals with glomerulonephritis. An analysis of provincial administrative databases showed that nearly 7,000 patients accessed this care model over a four-year period, with IgA nephropathy being the most common diagnosis and six percent of patients eventually requiring dialysis or a kidney transplant. This new model of care is becoming well established in the province and will help guide future healthcare planning.

Amit Garg

This study compared the cardiovascular outcomes of patients with chronic kidney disease in Ontario, Canada, who initiated either glucagon-like peptide-1 receptor agonists or dipeptidyl peptidase-4 inhibitors. Researchers found that patients starting glucagon-like peptide-1 receptor agonists had a lower rate of major adverse cardiovascular events, driven primarily by a reduction in cardiovascular-related deaths. This benefit was consistent across all stages of kidney disease, levels of protein in the urine, and regardless of whether patients were also taking sodium-glucose cotransporter-2 inhibitors.

Dervla ConnaughtonMatthew WeirKyla NaylorAmit Garg

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.

Matthew WeirAmit Garg

This study evaluated the accuracy of international health database codes for identifying lithium toxicity in older adults admitted to hospitals in Ontario, Canada. Researchers compared diagnostic codes against actual laboratory measurements of blood lithium levels and found that the coding algorithm had moderate sensitivity and high specificity for identifying toxic lithium levels. The presence of these diagnostic codes successfully distinguished patients with high lithium levels and significant increases from baseline from those with normal levels.

Amit Garg

This large-scale study compared how well two common urine tests, the urinary albumin-creatinine ratio and the urinary protein-creatinine ratio, predict future kidney failure and cardiovascular events. Analyzing data from nearly 150,000 participants, researchers found that both tests are strongly linked to these health risks, but the urinary albumin-creatinine ratio showed a slightly stronger association with kidney failure. These findings support prioritizing the urinary albumin-creatinine ratio for diagnosing and risk-stratifying patients with chronic kidney disease.

Matthew WeirAmit Garg

This protocol describes the design of an ongoing study that aims to identify harmful drug-drug interactions in older adults by analyzing Ontario's administrative healthcare data. Using high-throughput computing, researchers will run thousands of population-based cohort studies to compare health outcomes in patients taking specific drug combinations against those taking only one of the medications. The goal of this project is to generate real-world evidence that can improve prescribing safety and inform regulatory decisions.

Amit Garg

This systematic review and meta-analysis compared the incidence of anterior vitrectomy, a complication involving the gel-like fluid in the eye, during cataract surgeries performed by ophthalmology residents versus experienced surgeons. Analyzing data from five studies representing nearly five thousand surgeries, researchers found a significant incidence of this complication among residents, whereas the incidence for experienced surgeons was not statistically significant. These findings highlight the potential benefits of structured surgical training, simulation, and mentorship to help residents minimize complications and improve patient outcomes.

Amit Garg

This study examined racial and ethnic disparities among nearly 100,000 patients in the United States who were placed on the kidney transplant waiting list before starting dialysis. While rates of preemptive deceased donor transplants improved for Black and Hispanic patients to match those of White patients, racial and ethnic minorities were still significantly more likely to start dialysis and less likely to receive a preemptive living donor transplant. These findings highlight ongoing inequities in access to living donor kidney transplantation despite some progress in deceased donor allocation.

Matthew WeirKyla NaylorAmit GargAndrea Cowan

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.

Amit Garg

A large population-based study compared patients with chronic kidney disease who started taking glucagon-like peptide 1 receptor agonists to those who started dipeptidyl peptidase 4 inhibitors. Researchers found that initiating glucagon-like peptide 1 receptor agonists was associated with a ten percent lower risk of emergency department visits and all-cause hospitalizations. This benefit was consistent across different statistical models and the entire spectrum of kidney disease.

Amit GargAndrea Cowan

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.

Louise MoistArsh JainDanielle NashAmit Garg

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.

Louise MoistMatthew WeirKyla NaylorAmit GargPavel RoshanovPeter Blake

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.

Amit Garg

This study evaluated the incidence and impact of heart muscle injury, known as myocardial injury after noncardiac surgery, in patients undergoing major head and neck surgery. Researchers found that nearly twelve percent of these patients experienced this type of heart injury, with the rate rising to nearly twenty-four percent in patients aged seventy-five and older. The majority of these injuries would have gone undetected without routine troponin monitoring, and experiencing this injury was linked to a more than fivefold increase in thirty-day mortality and a longer hospital stay.

Danielle NashAmit Garg

This study evaluated whether inpatient rehabilitation within the first six months of starting dialysis could improve physical function and reduce hospitalization and mortality rates in older adults. Researchers found that patients who underwent rehabilitation showed significant improvements in their physical independence scores by the time of discharge. However, compared to a matched group who did not receive rehabilitation, those undergoing rehabilitation had similar one-year mortality and long-term care admission rates, along with slightly higher rates of subsequent hospitalisation.

Amit Garg

This secondary analysis of the MyTEMP trial used advanced Bayesian statistical methods to re-evaluate the impact of using personalized cooler dialysis fluid versus standard temperature fluid on cardiovascular outcomes. Regardless of whether the statistical models assumed optimistic or skeptical prior expectations about the treatment's success, the analysis consistently showed that a center-wide policy of cooler dialysate is unlikely to reduce cardiovascular-related deaths or hospitalizations. These findings reinforce the original trial results using a different statistical framework, confirming that cooler dialysate does not provide the expected cardiovascular benefits.

Matthew WeirKyla NaylorAmit Garg

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.

Amit Garg

This study evaluated whether measuring nine vascular biomarkers in the blood three months after hospital discharge could help predict the risk of future heart failure in patients with and without acute kidney injury. Researchers identified three distinct patient groups based on these biomarkers, with the group showing a vascular injury pattern having more than double the risk of heart failure compared to those with a vascular repair pattern. Adding these biomarkers to standard clinical risk factors significantly improved the accuracy of predicting heart failure or death within three years.

Danielle NashAmit Garg

A population-based study in Ontario, Canada, tracked children who survived cancer to evaluate their long-term risk of developing kidney complications. Researchers found that childhood cancer survivors had a significantly higher risk of developing chronic kidney disease or hypertension compared to both hospitalized children and the general pediatric population. These findings highlight the importance of early monitoring and treatment for kidney issues in survivors to prevent serious long-term health complications.

Amit Garg

This study analyzed data from a large clinical trial to determine if closing the left atrial appendage of the heart during cardiac surgery benefits patients with chronic kidney disease who also have atrial fibrillation. Researchers found that the procedure successfully reduced the risk of stroke without increasing the risk of death, major bleeding, or other serious adverse events, regardless of the patient's level of kidney function. These findings suggest that surgical occlusion of the left atrial appendage is a safe and effective strategy for stroke prevention in this high-risk patient population.

Amit Garg

This study evaluated the difference between two methods of estimating kidney function, using cystatin C versus creatinine, in over 1,500 adults three months after hospital discharge. Researchers found that having a cystatin C-based estimate that was at least 30 percent lower than the creatinine-based estimate was linked to a significantly higher risk of heart failure hospitalizations, kidney failure, and death over nearly five years of follow-up. This discrepancy in kidney function estimates may serve as a valuable tool for identifying patients at high risk for poor health outcomes after a hospital stay.

Amit Garg

A large study of over 38,000 adults with atrial fibrillation across Australia and Canada compared the safety and effectiveness of the blood thinners apixaban and warfarin. Researchers found that apixaban was associated with a lower or similar risk of stroke, death, and major bleeding compared to warfarin across all levels of kidney function, including in patients with severely reduced kidney function who were not on dialysis. These findings suggest that apixaban is a safe and effective alternative to warfarin for patients with atrial fibrillation regardless of their kidney health.

Louise MoistDervla ConnaughtonMatthew WeirSusan HuangAndrew HouseLakshman GunaratnamArsh JainAmit GargAndrea CowanPavel RoshanovPeter Blake

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.

Dervla ConnaughtonAmit Garg

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.

Matthew WeirKyla NaylorAmit GargPeter Blake

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.

Kyla NaylorAmit Garg

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.

Amit Garg

This study investigated whether combining genetic risk scores with a standard clinical risk index could improve the prediction of myocardial injury after noncardiac surgery. Researchers analyzed genetic data from 506 patients of European ancestry and found that polygenic risk scores for type 2 diabetes and hemoglobin A1c were significantly associated with an increased risk of postoperative heart injury. These findings suggest that genetic factors related to blood sugar regulation may play a role in the development of heart complications after surgery.

Kyla NaylorAmit Garg

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.

Kyla NaylorAmit GargPeter Blake

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.

Amit GargAndrea CowanPeter Blake

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.

Amit Garg

This protocol describes the design of an ongoing population-based study in Ontario and Alberta, Canada, evaluating how pre-pregnancy kidney function affects the risk of progressive kidney disease after pregnancy. Researchers will compare long-term kidney outcomes between pregnant and non-pregnant women across different levels of baseline kidney function using health databases. The study aims to clarify whether pregnancy accelerates kidney decline in women with pre-existing kidney impairment.

Amit GargPavel RoshanovPeter Blake

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.

Amit GargPavel Roshanov

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.

Amit GargPavel Roshanov

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.

Amit GargPavel Roshanov

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.

Matthew WeirAmit Garg

A population-based study of older adults with chronic kidney disease in Ontario, Canada, evaluated the safety of higher versus lower doses of oral antiviral medications for herpes infections. While higher doses did not increase the overall risk of hospital visits for encephalopathy or kidney injury when using standard hospital coding, they were associated with a nearly fourfold higher risk of acute kidney injury when evaluated using actual laboratory test values. Although the absolute risk of this complication remained low at less than one percent, the findings suggest that careful dosing of these antiviral medications is important in patients with reduced kidney function.

Amit GargPavel Roshanov

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.

Kyla NaylorAmit GargPavel Roshanov

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.

Amit Garg

This study evaluated the ASSIST-CKD trial, which tested whether sending graphical kidney function reports to primary care physicians in the United Kingdom could reduce late referrals to kidney specialists. Although the trial showed no overall difference in referral timing, the data provided valuable insights into the challenges of implementing complex interventions in busy healthcare environments. These findings can help guide the design of future programs aimed at identifying and treating progressive kidney disease earlier.

Amit Garg

This study compared long-term health outcomes between living kidney donors and healthy non-donors across Canada and Australia. Over a median follow-up of seven years, researchers found no significant differences in the risk of developing high blood pressure or protein in the urine between the two groups. Although donors experienced an expected initial drop in kidney function after surgery, their subsequent rate of kidney function decline was actually slower than that of non-donors.

Danielle NashAmit Garg

A large study of hospitalized children in Ontario, Canada, who survived acute kidney injury without needing acute dialysis, found that eighteen percent experienced major adverse kidney events over a ten-year follow-up period. Compared to similar hospitalized children without acute kidney injury, survivors had a fourfold higher risk of developing chronic kidney disease, requiring long-term dialysis, or experiencing hypertension. These findings suggest that children surviving acute kidney injury require closer long-term monitoring to detect and manage kidney complications early.

Amit Garg

This article discusses strategies for integrating specialist and primary care to improve the management of chronic diseases. It highlights the importance of coordinated care models in enhancing patient outcomes and streamlining healthcare delivery.

Danielle NashAmit GargPeter Blake

A population-based study in Ontario, Canada, examined the use of mental health and addiction services among nearly six million adults with varying levels of kidney function. Researchers found that while mental health and addiction service use was common overall, individuals with advanced chronic kidney disease and those receiving maintenance dialysis were less likely to access these services compared to individuals with normal kidney function. This lower rate of service use was primarily driven by a lower utilization of outpatient mental health and addiction care.

Kyla NaylorAmit Garg

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.

Matthew WeirAmit GargBrad Urquhart

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.

Amit Garg

A study of over 41,000 physicians in Ontario, Canada, found that COVID-19 vaccine uptake was exceptionally high, with nearly 95 percent receiving at least two doses and nearly 87 percent receiving three doses within 14 months of vaccine availability. This rate of three-dose uptake was nearly double that of the general Ontario population during the same period. The high vaccination rates were consistent across different age groups, family physicians, and specialists, suggesting strong confidence among doctors in the safety and efficacy of the vaccines.

Amit Garg

This study analyzed data from a large clinical trial of patients undergoing major abdominal surgery to identify modifiable risk factors for postoperative acute kidney injury. Researchers found that receiving nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors during surgery, as well as taking blood pressure medications like angiotensin-converting enzyme inhibitors or angiotensin receptor blockers on the day of surgery, were associated with a higher risk of developing more severe acute kidney injury. These findings suggest that avoiding these specific medications around the time of surgery could be a practical strategy to protect kidney function.

Amit GargPeter Blake

This study examined whether tailoring the bicarbonate levels in dialysis fluid to individual patients or using a standard concentration affected their pre-dialysis blood bicarbonate levels. Analyzing data from over 5,000 hemodialysis patients in Ontario, Canada, researchers found no significant difference in blood bicarbonate levels between the individualized and standardized approaches. However, using very high standard bicarbonate concentrations in the dialysis fluid did slightly increase patients' blood bicarbonate levels compared to lower standard concentrations.

Amit Garg

This implementation guidance document provides research teams and ethics committees with practical advice on applying the Ottawa Statement's ethical recommendations to cluster randomized trials in hemodialysis centres. Co-developed with content experts and patient partners, the guidance addresses the unique challenges of conducting research within the hemodialysis setting and population. The project demonstrates how patients, caregivers, and other stakeholders can be actively involved in shaping research ethics standards.

Amit GargPeter Blake

This study evaluated how adopting the newer, race-free 2021 equation for estimating kidney function would affect eligibility for specialized kidney care in Ontario, Canada, compared to the older 2009 equation. Researchers found that using the 2021 equation substantially reduced the number of individuals meeting the criteria for nephrologist consultations, multidisciplinary specialty clinic care, and kidney transplant evaluations. These findings suggest that in regions with a small Black population, transitioning to the newer equation could significantly decrease the number of patients eligible for specialized kidney services.

Kyla NaylorAmit GargPeter Blake

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.

Danielle NashAmit Garg

Researchers conducted six focus groups to explore how the public and individuals with chronic kidney disease feel about being contacted directly by mail if provincial health databases identify them as being at high risk for kidney failure. While almost all participants would want to be notified about a treatable, life-threatening illness, most strongly preferred that this sensitive health information come from their own primary care provider rather than an unfamiliar research organization. The findings highlight a need for clearer privacy laws and a shift in how health systems communicate risk to patients.

Kyla NaylorAmit Garg

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.

Kyla NaylorAmit Garg

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.

Christopher McIntyreAmit Garg

This systematic review and meta-analysis evaluated the impact of exercise during hemodialysis sessions on cardiovascular health in adults with kidney failure. Analyzing data from thirty-two studies, researchers found that intradialytic exercise, primarily aerobic, significantly reduced arterial stiffness and improved diastolic blood pressure, heart pumping function, and heart rate variability compared to standard care. These findings suggest that incorporating exercise programs during dialysis treatments can meaningfully improve several physiological measures of cardiovascular health.

Matthew WeirAmit Garg

This protocol describes an ongoing study designed to use high-throughput computing and automation to conduct over 700 drug-safety cohort studies in older adults with chronic kidney disease in Ontario, Canada. By comparing short-term health outcomes between new users of outpatient medications and similar nonusers across different levels of kidney function, the researchers aim to identify credible drug-safety signals more efficiently. This automated approach using administrative health databases has the potential to improve medication safety and prevent adverse drug reactions in this vulnerable population.

Amit GargPavel Roshanov

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.

Amit Garg

A study of 590 living kidney donors in Alberta, Canada, followed for nearly nine years, found that approximately eight percent developed reduced kidney function or increased protein in their urine. Donors with lower kidney function or high blood pressure prior to donation, as well as those who developed diabetes after donation, were at a higher risk for these kidney issues. These findings provide important insights to help healthcare providers better support the long-term kidney health of living donors.

Kyla NaylorAmit GargPeter Blake

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.

Danielle NashAmit GargPeter Blake

A retrospective study in Ontario, Canada, found that fifty-nine percent of patients did not receive recommended multidisciplinary kidney care before starting maintenance dialysis. While some patients experienced an unpreventable, rapid decline in kidney function, others missed opportunities for early chronic kidney disease screening, timely referral to a kidney specialist, or referral to multidisciplinary care clinics. These findings highlight specific gaps in the healthcare system that could be targeted to improve pre-dialysis care.

Matthew WeirAmit GargBrad UrquhartPeter Blake

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.

Danielle NashAmit Garg

This population-based cohort study in Ontario, Canada, examined breast cancer screening, incidence, and mortality among women receiving maintenance dialysis. The researchers evaluated how these cancer outcomes compare to the general population, given that individuals with kidney failure generally experience higher rates of cancer and cancer-related death. The findings help clarify the specific risks and screening patterns for breast cancer in this vulnerable patient group.

Amit Garg

An analysis of data from over 27 million individuals across 114 global cohorts showed that lower estimated kidney function and higher levels of protein in the urine are both strongly linked to an increased risk of ten adverse health outcomes. These risks, which include kidney failure, cardiovascular events, and hospitalizations, were present even in individuals with very mild stages of chronic kidney disease. The findings highlight the importance of monitoring both kidney function and urine protein levels to identify patients at risk for complications.

Matthew WeirAmit GargBrad Urquhart

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.

Amit Garg

A study of over 74,000 adults with atrial fibrillation across Australia and Canada compared the effectiveness and safety of direct oral anticoagulants to warfarin. Researchers found that direct oral anticoagulants were associated with a similar or lower risk of death, stroke, and major bleeding compared to warfarin. Importantly, these benefits and safety profiles remained consistent across all levels of kidney function, including in individuals with severely reduced kidney function.

Amit Garg

Researchers analyzing data from hospitalized patients found that higher levels of a substance called epidermal growth factor in urine, particularly measured three months after leaving the hospital, were linked to a lower risk of long-term kidney problems like chronic kidney disease or kidney failure. This suggests the urinary epidermal growth factor level could be a useful indicator of kidney health and recovery following hospitalization, and aligns with findings in mice showing the substance is associated with kidney repair.

Amit GargPavel Roshanov

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.

Amit Garg

A population-based study in Ontario, Canada, investigated the safety of prescribing the antibiotic clarithromycin to patients already taking the antipsychotic medication quetiapine. Because clarithromycin blocks the enzyme that breaks down quetiapine, researchers compared it to azithromycin, an antibiotic that does not block this enzyme. The study found that patients prescribed clarithromycin alongside quetiapine had a small but significantly higher risk of experiencing a hospital encounter for a fall, fracture, or confusion within 30 days, driven primarily by an increase in fragility fractures.

Kyla NaylorAmit GargPeter Blake

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.

Amit Garg

Researchers conducted a genome-wide association study to identify genetic factors that might influence the risk of acute kidney injury in hospitalized patients. While no genetic variants reached strict genome-wide significance, two variants in the region of the DISP1 and TLR5 genes showed a strong association with increased risk. Analysis of kidney biopsy tissue confirmed that these genes are regulated differently in patients with acute kidney injury compared to healthy donors, suggesting this genetic region may play a role in susceptibility to kidney injury.

Matthew WeirAmit Garg

A study of older adults in Ontario, centreing on those aged 66 and older, 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 particularly pronounced in individuals with pre-existing reduced kidney function. The medication was also linked to higher rates of acute kidney injury and overall hospital admission within two weeks of starting treatment.

Amit Garg

A study of older adults in Ontario, Canada, newly diagnosed with atrial fibrillation found that prescribing the newer oral anticoagulants apixaban or rivaroxaban instead of warfarin led to significant health system cost savings over one year. Although the newer medications had higher drug costs, these were outweighed by substantial savings from fewer hospitalizations, emergency department visits, and physician visits. The findings suggest that healthcare reimbursement policies should prioritize apixaban or rivaroxaban as first-line treatments over warfarin.

Amit Garg

This study compared the safety and effectiveness of the blood thinner rivaroxaban versus warfarin in over 55,000 adults with atrial fibrillation across Australia and Canada. Researchers found that rivaroxaban was associated with a lower or similar risk of death, stroke, or transient ischemic attack compared to warfarin, while carrying a similar risk of major bleeding. These findings were consistent across all levels of kidney function, supporting rivaroxaban as a safe alternative to warfarin even for patients with severely reduced kidney function.

Amit Garg

This study evaluated whether measuring preoperative blood levels of a protein called growth differentiation factor-15 could help predict heart complications in patients undergoing major noncardiac surgery. Researchers found that higher levels of this protein were strongly linked to an increased risk of heart injury or vascular death within 30 days of surgery. Adding this biomarker to standard clinical risk assessments significantly improved the accuracy of predicting postoperative cardiovascular events.

Amit Garg

This study evaluated the use of a high-sensitivity troponin I blood test to predict major heart complications, such as death, heart attack, or heart failure, within 30 days after non-cardiac surgery. Researchers found that patients with peak postoperative troponin I levels at or above 75 nanograms per litre had a more than fivefold increase in the risk of these major cardiovascular events compared to those with lower levels. These findings suggest that this specific troponin threshold can help clinicians identify and diagnose postoperative heart injury in surgical patients.

Amit GargPavel Roshanov

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.

Matthew WeirAndrew HouseAmit GargBrad Urquhart

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.

Amit Garg

Researchers developed and validated a predictive tool called the Recovery and Death in Outpatients (ReDO) model to estimate the likelihood of kidney recovery or death within one year for patients who start dialysis in the hospital and continue as outpatients. Using health data from over 9,000 patients in Ontario and Alberta, the models successfully categorized patients into distinct risk groups based on factors such as age, hospital stay length, and pre-admission kidney function. The resulting online calculator can help clinicians and patients make more informed decisions about outpatient care and planning.

Amit Garg

This population-based study in Ontario, Canada, compared mental health and addiction health service use between physicians and non-physicians before and during the first 18 months of the COVID-19 pandemic. Researchers found that while outpatient mental health visits increased for both groups during the pandemic, the increase was significantly larger among physicians than non-physicians, particularly for virtual care. These findings suggest that physicians experienced greater mental health challenges during the pandemic, highlighting a need for targeted wellness support and system-level changes.

Amit Garg

This study analyzed health administrative data from Ontario, Canada, to evaluate the outcomes and healthcare resource use of hemodialysis patients hospitalized for major cardiovascular events. Researchers found that hospital admissions for myocardial infarction, congestive heart failure, and ischemic stroke were associated with prolonged hospital stays and high 30-day mortality rates. These findings confirm that cardiovascular events recorded in administrative databases represent clinically significant events with a high burden on patients and healthcare systems.

Amit Garg

By analyzing blood and urine biomarkers alongside clinical data from hospitalized patients, researchers identified two distinct subtypes of acute kidney injury. Patients with the second subtype, which was characterized by higher levels of inflammation and cell injury markers, had a significantly higher risk of long-term kidney disease progression and requiring dialysis. These findings suggest that biomarker profiles can better predict long-term kidney outcomes than standard measures like serum creatinine.

Matthew WeirDanielle NashAmit GargAndrea Cowan

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.

Amit Garg

This population-based cohort study of over 14,000 patients starting maintenance hemodialysis in Ontario, Canada, compared patient outcomes between two different physician staffing models. Researchers found no difference in mortality, kidney transplantation, home dialysis initiation, hospitalizations, or emergency department visits whether patients were cared for by a single primary nephrologist or a rotating group of nephrologists. These findings suggest that both care models are acceptable options for hemodialysis programs.

Amit Garg

This large-scale study evaluated how major cardiovascular events, such as heart failure, coronary heart disease, stroke, and atrial fibrillation, affect the future risk of kidney failure requiring replacement therapy. Researchers found that both pre-existing and newly developed cardiovascular diseases were strongly linked to a higher risk of kidney failure, with the risk being highest in the first three months following the cardiovascular event. Heart failure hospitalizations showed the strongest association, highlighting the need for targeted strategies to protect kidney function after major heart events.

Amit Garg

By analyzing a combination of clinical data and urine and blood biomarkers, researchers identified four distinct subphenotypes of acute kidney injury in hospitalized patients. These subphenotypes, which represent different patterns of inflammation, injury, and repair, were associated with significantly different long-term risks of chronic kidney disease, cardiovascular events, and death. This approach highlights the biological diversity of acute kidney injury and could help identify patients at the highest risk for poor outcomes.

Amit Garg

A retrospective study of living kidney donors in Alberta, Canada, evaluated whether receiving guideline-concordant follow-up care in the first two years after donation influenced long-term health monitoring and outcomes. Researchers found that donors who received early guideline-concordant care were significantly more likely to continue annual follow-up visits at five and ten years post-donation. However, early follow-up care did not appear to substantially influence long-term kidney function or overall hospitalization rates.

Amit GargAndrea Cowan

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.

Amit Garg

This study evaluated the long-term impact of self-reported cannabis use on kidney health using data from a cohort of hospitalized adults in the United States. Researchers found that cannabis consumption did not adversely affect kidney function or increase the risk of developing kidney disease in participants with normal baseline kidney function. However, among individuals who already had chronic kidney disease, cannabis use was associated with a faster annual decline in kidney function.

Amit Garg

This publication describes the protocol and design of an ongoing international clinical trial evaluating whether the anti-inflammatory medication colchicine can prevent heart complications after major noncardiac thoracic surgery. Researchers are randomly assigning patients aged 55 and older to receive either colchicine or a placebo starting just before surgery and continuing for ten days. The study is tracking the occurrence of perioperative atrial fibrillation and myocardial injury after noncardiac surgery, alongside safety outcomes like infection and diarrhea.

Amit GargPavel Roshanov

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.

Kyla NaylorAmit GargPeter Blake

This study compared three different research designs to estimate the effectiveness of mRNA COVID-19 vaccines in patients with stage 5 chronic kidney disease in Ontario, Canada. While all three methods showed that two vaccine doses were effective at preventing infection and severe outcomes like hospitalization or death, the 'pseudo-test-negative' design was identified as a practical and reliable approach for this specific population. This finding is important because it suggests that researchers can accurately measure vaccine effectiveness in kidney disease patients using administrative data even when specific symptom records are missing.

Amit Garg

A large population-based study in Ontario, Canada, evaluated over 500,000 pregnancies to understand how a woman's pre-pregnancy kidney function affects pregnancy outcomes. Researchers found that lower pre-pregnancy kidney function, especially when the estimated glomerular filtration rate fell below 60, was linked to a steadily increasing risk of major maternal complications, preterm delivery, and low birthweight. The presence of protein in the urine further elevated these risks, though maternal and newborn deaths remained extremely rare across all levels of kidney function.

Amit Garg

Researchers developed and validated ten patient education tools, including bulletins and videos, to help patients on hemodialysis understand and participate in deprescribing to reduce unnecessary medications. Through multiple rounds of feedback from clinicians and over one hundred patients across three Canadian cities, the tools achieved high ratings for accuracy, clarity, and relevance. These validated resources will be used in an upcoming nationwide program to support shared decision-making regarding medication management.

Amit Garg

This study evaluated the use of a high-sensitivity cardiac troponin I blood test to identify heart injury in patients undergoing noncardiac surgery. Researchers found that patients with elevated troponin levels within three days after surgery had a significantly higher risk of experiencing major cardiac events or dying within 30 days. Specifically, a postoperative troponin level of 60 ng/L or higher was associated with a greater than sevenfold increase in these serious complications.

Louise MoistArsh JainAmit Garg

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.

Amit Garg

This study evaluated whether measuring three specific blood proteins before cardiac surgery could predict long-term health outcomes. Researchers found that higher pre-operative levels of these biomarkers were independently associated with an increased risk of death, cardiovascular events, and the development or progression of chronic kidney disease over a follow-up of nearly seven years. Although these biomarkers were linked to poorer outcomes, adding them to standard clinical risk models did not significantly improve the overall ability to predict which individual patients would experience these events.

Amit Garg

A study of patients in Ontario, Canada, who survived hospitalisation with acute kidney injury found that attending a specialised follow-up clinic was not associated with a lower risk of major adverse kidney events compared to standard care. However, attendance at the clinic was associated with a lower risk of death and a higher likelihood of being prescribed certain cardioprotective medications, such as beta-blockers and statins. These findings suggest that specialised post-discharge care may improve survival and medication management for survivors of acute kidney injury.

Danielle NashKyla NaylorAmit Garg

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.

Kyla NaylorAmit GargPeter Blake

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.

Amit Garg

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 dialysis. 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.

Amit Garg

This population-based study examined whether older patients with a history of heart attacks were less likely to receive key heart medications after surviving a hospital stay complicated by acute kidney injury. Researchers found that patients who experienced acute kidney injury were significantly less likely to be prescribed angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, statins, or beta-blockers within one year of leaving the hospital. This reduction in cardiovascular drug dispensing was most pronounced in patients who had more severe stages of kidney injury.

Amit Garg

This protocol describes an ongoing prospective cohort study designed to evaluate the long-term health effects of living kidney donation by comparing donors to healthy non-donors. Researchers will track and compare changes in blood pressure, kidney function, and health-related quality of life over a follow-up period of up to fifteen years. The findings aim to clarify the specific risk of developing hypertension and other health complications that can be directly attributed to donating a kidney.

Amit Garg

Researchers developed machine learning algorithms to better identify reports of cluster randomized trials by analyzing information found in article citations, such as titles and abstracts. The best performing approach, an ensemble of multiple machine learning models, accurately identified these trials in both initial testing and a separate validation set. This tool could improve the efficiency of finding specific study designs for use in medical reviews and meta-analyses.

Amit Garg

This study evaluated whether blood levels of two inflammatory markers, soluble tumor necrosis factor receptor 1 and 2, measured three months after hospital discharge could predict future health complications. Researchers found that higher concentrations of both markers were strongly associated with an increased risk of kidney disease progression, heart failure, and death, regardless of whether patients experienced acute kidney injury during their hospital stay. These findings suggest these markers could help identify patients at higher risk for complications after leaving the hospital.

Danielle NashAmit Garg

A study of children in Ontario, Canada, who survived an episode of acute kidney injury requiring dialysis during hospitalization found they had significantly higher rates of rehospitalization, emergency department visits, and overall healthcare costs compared to matched hospitalized controls. Despite these higher healthcare needs, only about eighteen percent of these children received follow-up care with a kidney specialist within one year of leaving the hospital. These findings highlight a critical gap in outpatient care and suggest that better follow-up strategies are needed for pediatric survivors of severe acute kidney injury.

Matthew WeirAmit Garg

A study of older adults with advanced chronic kidney disease in Ontario, Canada, evaluated the safety of fluoroquinolone antibiotics prescribed at higher versus lower doses. Researchers found that patients prescribed a higher-than-recommended dose had a significantly higher risk of experiencing a hospital visit for serious adverse events, including nervous system or psychiatric disorders, low blood sugar, or collagen-associated events. Although the absolute risk of these events remained low at less than two percent, the findings highlight the importance of careful dose adjustment in patients with reduced kidney function.

Kyla NaylorAmit Garg

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.

Amit Garg

A study of over 41,000 physicians and medical trainees in Ontario, Canada, during the first year of the COVID-19 pandemic found that nearly half were tested for SARS-CoV-2, with less than one percent testing positive. Although nearly six percent of those who tested positive required hospital admission, no deaths were reported within 30 days of a positive test. Testing rates and positive cases varied by specialty, with postgraduate trainees, emergency physicians, and family doctors being tested most frequently.

Amit Garg

A systematic review and meta-analysis compared the outcomes of patients on dialysis who received either mechanical or bioprosthetic heart valves. The researchers found that mechanical valves were associated with lower short-term and long-term mortality, but carried a higher risk of bleeding and stroke. Because the overall certainty of the evidence was very low, the choice of valve should be personalized based on individual patient factors like bleeding risk and valve durability.

Matthew WeirAmit GargPeter Blake

A study of older adults with chronic kidney disease in Ontario, Canada, found that starting the gout medication allopurinol at a dose higher than 100 milligrams per day was associated with a more than twofold increased risk of hospitalisation for severe skin reactions compared to starting at a lower dose. This higher starting dose was also linked to an increased risk of overall hospitalisation, though not to a higher risk of death. These findings support the practice of initiating allopurinol at lower doses in patients with reduced kidney function to prevent serious adverse events.

Matthew WeirKyla NaylorAmit GargAndrea Cowan

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.

Amit Garg

A population-based study in Ontario, Canada, compared pregnancy outcomes between female physicians and nonphysicians of similar socioeconomic status. While physicians initially appeared to have a higher rate of severe maternal complications, this difference was explained by their older age at childbirth. Interestingly, infants born to physicians had lower rates of severe complications, and no significant differences in maternal or newborn outcomes were found when comparing different medical specialties.

Amit Garg

A large population-based study in Ontario, Canada, evaluated cancer risk and mortality across different stages of kidney disease, including patients on dialysis and transplant recipients. The study found that while overall cancer risk was highest in patients with mild to moderate chronic kidney disease and those with a kidney transplant, patients across the spectrum of kidney disease experienced higher rates of cancer-specific mortality. Additionally, patients with kidney disease were more likely to be diagnosed with advanced stage 4 cancers, with particularly high risks and mortality observed for bladder and kidney cancers and multiple myeloma.

Amit GargPavel Roshanov

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.

Kyla NaylorAmit Garg

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.

Amit Garg

This study evaluated whether a multifaceted intervention, which included provider and patient education, audit and feedback, and academic detailing, could increase the uptake of home dialysis therapies. Researchers conducted a cluster randomized trial across 55 chronic kidney disease clinics in Canada and found no significant difference in the proportion of patients using home dialysis at 180 days between the intervention and control clinics. The findings suggest that this specific combination of educational and administrative strategies was not effective in increasing home dialysis use.

Kyla NaylorAmit GargPeter Blake

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.

Kyla NaylorAmit GargPeter Blake

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.

Kyla NaylorAmit Garg

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.

Christopher McIntyreAmit Garg

This study explored the barriers and enablers to delivering exercise programs during dialysis treatments by interviewing healthcare providers and patients across twelve hospitals in Ontario, Canada. The researchers identified key challenges, including a lack of staff training, concerns about workload, and uncertainty regarding patient eligibility and safety. To address these issues, they developed a list of practical solutions and a forty-seven-item feasibility checklist to help clinics successfully implement exercise programs in dialysis units.

Amit GargPavel Roshanov

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.

Amit Garg

This study evaluated whether blood levels of angiopoietins, which are markers of blood vessel stability, could predict long-term health outcomes in patients after hospital discharge. Researchers found that a higher ratio of angiopoietin-1 to angiopoietin-2, indicating more stable blood vessels, was strongly associated with a lower risk of chronic kidney disease progression, heart failure hospitalizations, and death, particularly in patients who had experienced acute kidney injury. These findings suggest that monitoring blood vessel stability markers after hospitalisation could help identify patients at higher risk for future kidney and heart complications.

Amit GargPavel Roshanov

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.

Kyla NaylorAmit Garg

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.

Amit Garg

A population-based study of over 34,000 physicians in Ontario, Canada, found that outpatient health care visits for mental health and substance use increased by 27 per cent during the first year of the COVID-19 pandemic compared to pre-pandemic levels. The increase was particularly pronounced among physicians with no prior history of mental health or substance use concerns. These findings suggest that pandemic-related stressors significantly impacted physician well-being, highlighting a need for improved access to mental health services and systemic support.