Amit Garg

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 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.

Amit Garg

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.

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

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.

Amit Garg

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.

Matthew WeirAmit Garg

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.

Amit Garg

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.

Amit Garg

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.

Amit Garg

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.

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 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.

Amit Garg

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.

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.

Danielle NashAmit Garg

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.

Amit Garg

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.

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

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.

Amit Garg

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.

Danielle NashAmit Garg

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.

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.

Amit Garg

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.

Amit Garg

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.

Amit Garg

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.

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

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.

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 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.

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.

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.

Matthew WeirAmit Garg

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.

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 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.

Danielle NashAmit Garg

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.

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

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.

Amit GargPeter Blake

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.

Amit Garg

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.

Amit Garg

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.

Amit GargPeter Blake

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.

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 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.

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.

Amit Garg

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.

Christopher McIntyreAmit Garg

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.

Matthew WeirAmit Garg

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.

Danielle NashAmit GargPeter Blake

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.

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

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.

Danielle NashAmit GargPeter Blake

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.

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.

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.

Amit Garg

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.

Amit Garg

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.

Amit Garg

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.

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.

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

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.

Amit Garg

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.

Amit Garg

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.

Amit Garg

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.

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 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.

Amit Garg

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.

Amit Garg

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.

Amit Garg

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.

Amit Garg

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.

Amit Garg

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.

Amit Garg

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.

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

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.

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 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 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.

Amit Garg

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.

Amit Garg

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.

Amit Garg

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.

Amit Garg

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.

Amit Garg

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.

Amit Garg

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.

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.

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

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.

Matthew WeirAmit Garg

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.

Amit Garg

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.

Amit Garg

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.

Amit Garg

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.

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 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.

Amit Garg

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.

Amit Garg

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.

Amit Garg

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.

Danielle NashAmit Garg

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.

Matthew WeirAmit Garg

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.

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

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.

Amit Garg

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.

Matthew WeirAmit GargPeter Blake

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.

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

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.

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

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.

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 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.

Amit Garg

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.

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.

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 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.

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.

Amit Garg

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.

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.

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.

Christopher McIntyreAmit Garg

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.