Arsh Jain

Arsh Jain

This publication presents a debate on whether remote monitoring technology effectively extends the amount of time patients can remain on peritoneal dialysis. The author argues against the position that remote monitoring provides a clear benefit for technique survival, highlighting the lack of robust evidence to support its routine use for this purpose. This discussion is part of a series examining the role of digital health tools in managing home dialysis therapies.

Arsh Jain

This review examines the significant health disparities and high rates of chronic kidney disease faced by approximately 480 million Indigenous people worldwide due to the ongoing impacts of colonialism, systemic racism, and poverty. The authors describe how geographic isolation and a lack of culturally safe care create barriers to early detection and life-saving treatments like dialysis or transplantation. The publication provides policy recommendations and strategies for healthcare systems to deliver more responsive, equitable kidney care to Indigenous communities across the globe.

Arsh Jain

This protocol describes an ongoing study to determine if a virtual monitoring platform can reduce emergency department visits and hospitalizations for patients with advanced chronic kidney disease. Participants in the intervention group use wireless devices to track blood pressure, weight, and oxygen levels, while also completing weekly symptom surveys through a mobile tablet. The study aims to improve the safety and coordination of care during the high-risk period before a patient begins dialysis.

Arsh Jain

This review examines the development of sorbent peritoneal dialysis technologies, which are portable or wearable devices designed to clean and reuse dialysis fluid. Researchers evaluated five different systems, finding that several could effectively remove waste products like urea and creatinine in human or animal trials, often using less sugar to achieve fluid removal than standard dialysis. While these technologies offer the potential for increased patient mobility and more efficient treatment, their specific role as either a supplement to or a replacement for traditional peritoneal dialysis is still being determined.

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.

Arsh Jain

Researchers found that genetic factors account for approximately half of the individual variation in how effectively peritoneal dialysis removes excess fluid from the body. By analyzing the genomes of over 2,700 participants, the study identified several specific genes associated with fluid removal and used mouse models to demonstrate how one of these genes regulates the process. These findings help explain why some patients respond differently to peritoneal dialysis and identify potential biological pathways for improving treatment.

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.

Christopher McIntyreArsh Jain

Patients receiving maintenance dialysis often experience faster and more severe cognitive decline compared to those with advanced kidney disease who are not on dialysis. This review explores how both hemodialysis and peritoneal dialysis can cause structural and functional brain changes, leading to symptoms ranging from short-term confusion and brain fog to long-term loss of cognitive ability. The authors examine the underlying biological mechanisms of this decline and discuss potential medical interventions to protect brain health in this population.

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.

Arsh Jain

In an international consensus workshop involving patients, caregivers, and health professionals, researchers sought to standardise how the success of peritoneal dialysis is measured and reported. The participants recommended replacing negative terms like "technique failure" with neutral language such as "transfer to haemodialysis" to better reflect the patient experience. This report proposes a clear, consistent definition for this outcome to ensure that future clinical trials can be easily compared and remain relevant to both patients and clinicians.

Arsh Jain

This case report describes the successful management of a patient who required a colostomy while receiving peritoneal dialysis for kidney failure. Although intestinal stomas are sometimes considered a risk for dialysis complications like infection, placing the stoma and the dialysis catheter on opposite sides of the abdomen allowed the patient to continue his treatment safely. The procedure improved the patient's independence and quality of life without causing major complications during follow-up.

Susan HuangArsh Jain

In this phase 2 clinical trial, researchers tested whether ravulizumab, a medication that blocks a specific part of the immune system called the complement system, could help adults with IgA nephropathy. Patients receiving ravulizumab experienced a 30% greater reduction in protein leakage in their urine compared to those receiving a placebo after six months of treatment. The medication was well tolerated, with safety results similar to the placebo group, and showed potential in helping to stabilize kidney function.

Arsh Jain

Researchers examined data from over 800 patients in Canada and the United States to determine if previous abdominal surgeries affected the success of peritoneal dialysis catheters. The study found that a history of prior abdominal procedures did not increase the risk of catheter failure or complications, although surgeries in the upper abdomen were associated with a slightly higher risk of issues. These findings suggest that having had abdominal surgery in the past should not prevent patients from being considered for peritoneal dialysis.

Arsh Jain

Researchers tracked over 700 patients undergoing laparoscopic peritoneal dialysis catheter insertion and found that those with existing internal scarring, known as adhesions, were at a higher risk for complications like flow restriction or abdominal pain. While patients with adhesions were more likely to require follow-up procedures to fix catheter issues, the majority of patients in both groups were still able to successfully continue their dialysis therapy. The study identified that previous abdominal surgery, female sex, and higher body mass index were factors associated with a higher likelihood of having these adhesions.

Arsh Jain

Researchers analyzed registry data from Australia and New Zealand and found that the use of incremental peritoneal dialysis, which involves a lower initial dose of dialysis fluid, increased significantly between 2007 and 2017. The study found that starting with a lower dose was not associated with an increased risk of death and was linked to a lower rate of early transfer to hemodialysis. These findings suggest that incremental peritoneal dialysis is a safe approach that may reduce treatment burden for patients who still have some remaining kidney function.

Arsh JainPeter Blake

Researchers evaluated a modified, low-dose regimen of the antiviral medication nirmatrelvir/ritonavir in 134 dialysis patients with COVID-19 in Ontario, Canada. The study found that the treatment was safe and well-tolerated, with 96% of patients completing the full course and no COVID-19-related deaths occurring within 30 days. While many patients required adjustments to their other medications due to drug interactions, this modified dosing provides a potential treatment option for a high-risk group originally excluded from clinical trials.

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.

Louise MoistArsh Jain

Clinical domain: The study focuses on the recognition and management of obesity within a chronic kidney disease population. - What investigators did: The researchers performed a retrospective chart review (observational) and an online survey of nephrologists (observational/survey) to assess clinical documentation and physician perceptions. - Methodological features: The study relies on survey research and the analysis of clinical records to identify gaps in care delivery.