Andrea Cowan

Amit GargAndrea Cowan

Researchers used linked Ontario health records to develop and internally test a tool that estimates the risk of a bone fracture within one or three years for adults receiving dialysis. Among 11,599 people, 7.2% had a fracture over three years, most often a hip fracture, and the tool used routinely collected information such as age, sex, previous fractures, transplant history, acid-reflux medication use, and blood test results. It may help clinicians identify people who should receive further bone assessment or preventive treatment without requiring a bone-density test.

Andrea Cowan

This case report describes a newborn exposed to the medication burosumab throughout pregnancy for maternal X-linked hypophosphatemia. After birth, the infant experienced temporary high calcium levels and prolonged phosphate retention, which gradually resolved by six months of age. The findings suggest the drug crossed the placenta and remained active in the baby's system, highlighting the need for careful biochemical monitoring of exposed newborns.

Amit GargAndrea CowanPeter Blake

This narrative review examines how increasing magnesium levels, either through higher concentrations in dialysis fluid or oral supplements, affects cardiovascular health in patients undergoing hemodialysis. The authors found that while low blood magnesium is linked to higher cardiovascular risks, increasing magnesium intake can improve markers of blood vessel health, such as reducing arterial stiffness and calcification. These findings provide important context for an ongoing clinical trial evaluating whether a centre-wide policy of using higher dialysate magnesium concentrations can reduce cardiovascular hospitalizations.

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.

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.

Andrea Cowan

This study examined how frequently patients with kidney disease in Ontario, Canada, receive recommended blood tests for bone health and how well their mineral levels are controlled. Researchers found significant gaps in monitoring and control across all stages of kidney disease, even among those receiving dialysis. Maintaining these laboratory values within target ranges was associated with a lower risk of bone fractures and major heart-related events.

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 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 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.

Andrea CowanPavel Roshanov

This is a protocol for a series of three systematic reviews designed to evaluate the frequency of bone fractures, the accuracy of risk prediction models, and the effectiveness of various treatments in adult kidney transplant recipients. Researchers will analyze existing studies to determine how often fractures occur after transplantation and which patient factors or medications, such as vitamin D or bisphosphonates, best help in preventing bone loss. This work aims to provide an updated evidence base for managing bone health in patients who are at high risk due to prior kidney disease and long-term steroid use.

Louise MoistDervla ConnaughtonMatthew WeirAndrew HouseLakshman GunaratnamArsh JainAndrea CowanPavel Roshanov

Researchers evaluated the impact of a specialized kidney genetics clinic in Canada by providing genetic testing to 300 patients with chronic kidney disease who met specific referral criteria. The study found that using a standardized testing process identified a genetic cause for kidney disease in one-third of the families, with results typically delivered within three months of assessment. These genetic findings frequently led to changes in clinical management, though the researchers noted a significant delay of over ten years between a patient's initial kidney disease diagnosis and their eventual genetic evaluation.

Andrea Cowan

Researchers at a Canadian hospital developed a clinical care pathway to safely administer the bone-strengthening medication denosumab to patients with advanced chronic kidney disease and those on dialysis. The pathway included optimizing vitamin D levels, providing calcium supplements, and increasing communication between specialists, which resulted in the rate of dangerously low calcium levels dropping from fifty percent to thirteen percent. This quality improvement initiative demonstrates that structured monitoring and preventative treatments can significantly reduce the side effects of this medication in high-risk patients.

Andrea Cowan

Patients receiving peritoneal dialysis often have low bone density, but standard screening tools and risk calculators may not fully capture their actual risk of bone fractures. While medications like bisphosphonates and denosumab can improve bone density, their use is complicated by concerns regarding drug buildup in the body and the risk of dangerously low calcium levels. This review highlights the challenges in identifying high-risk patients and the lack of clear evidence for the best therapies to prevent fractures in this population.

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 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.

Andrea Cowan

This publication provides an updated set of clinical guidelines from the Canadian Urological Association for the evaluation and medical treatment of kidney stones. It offers evidence-based recommendations to help clinicians manage stone disease through diagnostic testing and non-surgical medical therapies.

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.