Christopher McIntyre

Christopher McIntyre

This commentary highlights the need for caution when applying findings from sodium-glucose cotransporter-2 inhibitor trials to children with congenital anomalies of the kidney and urinary tract. It emphasizes that safety considerations must be tailored to specific patient phenotypes in this population. The authors call for careful evaluation of how these medications might affect children with unique structural kidney issues differently than adults.

Christopher McIntyre

This protocol describes an ongoing randomized controlled trial investigating whether 12 weeks of cycling during hemodialysis sessions can reduce heart muscle stress and injury, known as myocardial stunning. Researchers will use ultrasound to monitor heart wall motion and assess whether this exercise improves cognitive function, recovery time, and overall symptoms for patients. The study aims to provide evidence on the benefits and feasibility of intradialytic exercise to help inform future clinical care guidelines.

Christopher McIntyre

Researchers used advanced imaging to study how hemodialysis affects blood flow to the heart muscle in thirteen patients with and without coronary artery disease. They found that dialysis caused a significant reduction in heart muscle perfusion and led to temporary wall motion abnormalities, even in patients without existing artery blockages. In patients with coronary artery disease, these heart stresses were more severe and persisted longer after the dialysis session ended.

Christopher McIntyre

Researchers in Ontario, Canada, studied whether a newer type of dialysis called expanded hemodialysis could improve the quality of life and symptom burden for patients compared to standard treatment. Using a specialized digital tool to track patient experiences, the study found that expanded hemodialysis significantly improved energy levels, sleep quality, and physical pain, though these benefits decreased when patients returned to standard treatment. The findings suggest that this specialized dialysis filter provides durable relief for common symptoms and more consistent well-being for those on long-term dialysis.

Christopher McIntyre

This review examines the technical challenges of using bioimpedance to estimate fluid levels in patients receiving hemodialysis, focusing on how different electrode setups and body shapes can lead to measurement errors. The authors demonstrate that standard wrist-to-ankle measurements often underestimate fluid volume in individuals with higher body fat, whereas measuring the limbs and trunk separately provides more accurate results. They suggest that using 3D body scans to account for individual body shape could significantly improve the accuracy of these fluid assessments in clinical practice.

Christopher McIntyre

This study used an animal model to investigate how different sodium levels in dialysis fluid affect the protective lining of blood vessels and blood flow in small vessels. Researchers found that hemodialysis itself causes injury to this vessel lining and reduces blood flow, but these harmful effects were significantly worse when a high-sodium dialysis fluid was used. These findings suggest that high sodium concentrations during treatment may lead to more severe and lasting damage to the circulatory system.

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.

Christopher McIntyre

Researchers developed a new concentrated solution containing icodextrin and dextrose for use in the abdominal cavity to improve the removal of excess salt and water. Testing in animals and a small group of humans showed that this solution removed significantly more sodium and fluid than standard peritoneal dialysis fluids without causing serious side effects or tissue damage. This approach may eventually offer a new way to manage fluid overload in patients with kidney or heart failure.

Christopher McIntyre

This review examines advanced magnetic resonance imaging techniques that allow for the non-invasive assessment of kidney function, blood flow, and tissue oxygenation without the need for radiation or contrast dyes. These innovative methods, including specialized sodium and phosphorus imaging, can detect early signs of kidney scarring and metabolic changes that traditional blood and urine tests might miss. These tools are particularly promising for children with kidney disease or transplants, as they enable safe and repeated monitoring of the entire organ over time.

Christopher McIntyre

This pilot study explored the use of specialized sodium magnetic resonance imaging to assess remaining kidney function in people receiving hemodialysis by measuring sodium levels in different parts of the kidney. Researchers found that healthy individuals have a distinct sodium gradient between the inner and outer layers of the kidney that is significantly reduced or absent in dialysis patients, reflecting a loss of the kidney's ability to concentrate urine. This imaging technique provides a new way to evaluate the health of kidney tubules that cannot be captured by traditional urine volume measurements alone.

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.

Christopher McIntyre

Standard hemodialysis can cause repeated circulatory stress, leading to reduced blood flow and damage to vital organs such as the heart, brain, and liver. This review explores how these frequent episodes of vascular injury contribute to the high rates of cardiovascular disease and premature death seen in patients receiving dialysis. The authors also discuss various treatment strategies aimed at protecting these organs and improving long-term health outcomes.

Christopher McIntyre

Researchers used a new testing panel to measure twenty-one different proteins in the blood and urine of healthy individuals and patients with acute or chronic kidney disease. They identified specific protein signatures, such as osteoactivin and beta-2-microglobulin, that could accurately distinguish between healthy participants and those with kidney injury. These findings suggest that these protein profiles could serve as important tools for diagnosing and monitoring different stages of kidney dysfunction.

Christopher McIntyre

Clinical domain: The paper focuses on the management of patients receiving maintenance hemodialysis, specifically the use of cooled dialysate to prevent cardiovascular complications. - What investigators did: The authors synthesized existing evidence, including observational data and the results of the MyTEMP trial, to provide a broad overview and perspective on the current role of dialysate cooling. - Methodological features: This is a non-systematic review of the literature and clinical trial results.

Christopher McIntyre

Researchers used a non-invasive skin sensor called photoplethysmography to monitor blood flow in patients during hemodialysis and compared the results to direct heart imaging. They found that a decrease in skin blood flow was closely linked to reduced heart muscle perfusion and the development of temporary heart injury known as myocardial stunning. This technology may offer a simple way to monitor and manage circulatory stress and heart damage during dialysis treatments.

Christopher McIntyre

This review explores the use of specialized sodium magnetic resonance imaging to track how sodium builds up in the skin, heart, and kidneys of people with chronic kidney disease. Researchers found that excess sodium accumulation in these tissues is linked to worsening kidney function, higher levels of inflammation, and heart problems. This imaging technology is becoming an important tool in clinical trials to better understand how sodium imbalance contributes to the progression of kidney disease and its complications.

Christopher McIntyreAndrew House

Midodrine is an effective therapy for managing low blood pressure during hemodialysis treatments when other standard interventions have failed. This publication argues in favour of its use, highlighting its role in improving patient stability and ensuring the completion of necessary dialysis sessions.

Christopher McIntyre

Researchers used specialized magnetic resonance imaging and spectroscopy to observe the brains of patients during a hemodialysis session. They found evidence of brain swelling and chemical changes consistent with reduced blood flow and oxygen deprivation occurring during the treatment. These findings suggest that a single session of dialysis can cause acute brain injury, which may contribute to the long-term cognitive decline often seen in these patients.

Christopher McIntyreAndrew House

This study evaluated the safety and feasibility of a new blood-filtering treatment called leucocyte modulation, which aims to reduce the harmful immune system overactivity seen in severe COVID-19 infections. Researchers found that the treatment was safe for critically ill patients on mechanical ventilation and was associated with a significant reduction in the dose of blood-pressure-supporting medications required. While the results are promising, the study was a small preliminary evaluation intended to support the design of larger trials to determine the best way to use this therapy.

Christopher McIntyre

This review examines how hemodialysis affects the microcirculation, the smallest blood vessels in the body, which are often damaged in patients with chronic kidney disease. While current monitoring focuses on large-scale measures like blood pressure, new non-invasive technologies can detect small-vessel stress and potential organ damage during treatment. Adopting these tools into clinical practice could allow for more personalized dialysis care and help prevent tissue injury before it occurs.

Christopher McIntyre

Researchers used specialized magnetic resonance imaging to measure the concentration of sodium stored in the skin of patients receiving hemodialysis and peritoneal dialysis. They found that higher levels of skin sodium were associated with a significantly increased risk of death and major heart-related events, independent of traditional risk factors like age or blood sodium levels. In patients on hemodialysis, skin sodium levels were specifically linked to the sodium concentration in the dialysis fluid, heart failure, and protein levels in the blood.

Christopher McIntyre

Researchers describe the successful treatment of a 12-year-old boy with a rare inherited kidney disorder called hereditary hypophosphatemic rickets with hypercalciuria. By adding growth hormone and fluconazole to standard phosphate supplements, the clinical team was able to improve the patient's bone pain, growth, and high urine calcium levels. Advanced magnetic resonance imaging of the skin and muscle also provided a rationale for using a low-sodium diet to help manage the condition.

Christopher McIntyre

This pilot study used specialized magnetic resonance imaging to measure sodium levels in the skin and muscle tissues of children with chronic kidney disease compared to healthy peers and adults. Researchers found that while overall sodium levels did not differ between healthy children and those with kidney disease, specific causes of kidney disease led to different patterns, with glomerular diseases showing higher sodium and tubular disorders showing lower sodium. These tissue sodium levels were closely linked to the presence of protein in the urine and low blood protein levels, suggesting that the underlying cause of kidney disease influences how the body stores sodium.

Christopher McIntyreAndrew House

Researchers in Ontario used a participatory photography method called Photovoice to explore resilience and quality of life among adults receiving long-term hemodialysis. Participants used various camera technologies to document their daily lives and led focus groups to determine how their images and personal stories should be shared with the public. This collaborative approach aims to empower patients as community informants and develop new ways to raise awareness about living with chronic kidney disease.

Christopher McIntyre

In this cross-sectional study, researchers assessed cognitive function in patients who had recently started maintenance hemodialysis, specifically those who had been on treatment for less than one year. They found that a high proportion of these patients experienced cognitive impairment, particularly in the areas of verbal processing and reasoning, with average scores consistently lower than those of healthy individuals of the same age and sex. These findings suggest that significant changes in brain function occur early in the course of dialysis treatment, which may impact a patient's quality of life and ability to make healthcare decisions.

Christopher McIntyreAndrew House

Researchers used a specialized type of imaging called sodium magnetic resonance imaging to measure the salt gradient between the inner and outer parts of the kidney in healthy volunteers and patients with chronic kidney disease. The study found that this imaging technique accurately tracked changes in kidney salt levels following a water load and matched results from traditional urine tests. This technology provides a non-invasive way to assess kidney concentration ability and could be a feasible tool for monitoring patients with reduced kidney function.

Christopher McIntyre

Researchers developed a new animal model to observe how hemodialysis affects blood flow in small blood vessels in real-time. They found that even in healthy rats, the dialysis procedure caused significant disturbances in blood circulation and reduced blood flow to muscle tissues. These findings suggest that the hemodialysis process itself may contribute to organ injury by restricting blood flow through the microvasculature.

Louise MoistChristopher McIntyre

Researchers followed eight patients undergoing hemodialysis through the creation of an upper-arm arteriovenous fistula and tracked changes in their heart structure using magnetic resonance imaging. They found that all patients experienced an increase in the muscle mass of the heart's main pumping chamber, and most experienced a decrease in the chamber’s ability to pump blood effectively within the first year. These changes in heart structure are concerning because increased heart muscle mass is linked to a higher risk of health problems and death in people with kidney disease.

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.