Dr. Danielle M. Nash is an Assistant Professor in Western University’s Departments of Medicine and Epidemiology & Biostatistics. She is also a Scientist with the Ontario Renal Network, the London Health Sciences Research Institute, and the Kidney, Dialysis and Transplantation (KDT) Provincial Program at ICES.
Dr. Naylor currently holds a four-year CIHR-funded Early Career Salary Award. In 2018, she completed a 3-year CIHR-funded postdoctoral research fellowship with a focus on learning health systems in primary care. She holds an MSc in Epidemiology & Biostatistics from Western University and a PhD in Health Research Methods, Evidence, and Impact from McMaster University.
Dr. Nash’s research focuses on kidney learning health systems to advance high-quality, evidence-informed care.
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.
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.
Lebel A, Chanchlani R, Cockovski V, Dart A, Fleming AJ, Garg AX, Jeyakumar N, Kim K, Kitchlu A, McArthur E, Nash D, Nathan PC, Parekh RS, Pearl R, Pole J, Ramphal R, Reid J, Schechter-Finkelstein T, Sung L, Wald R, Wang S, Wong P, Zappitelli M
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.
Robinson CH, Jeyakumar N, Luo B, Askenazi D, Deep A, Garg AX, Goldstein S, Greenberg JH, Mammen C, Nash DM, Parekh RS, Silver SA, Thabane L, Wald R, Zappitelli M, Chanchlani R
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.
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.
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.
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.
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.
To understand how artificial intelligence might be integrated into primary care, researchers interviewed 27 staff members and healthcare providers at community health centres across Ontario. Participants generally lacked deep knowledge of the technology but felt it could improve patient care and reduce provider burnout if the tools were easy to use and accurate. While open to these innovations, staff expressed concerns regarding patient privacy, legal liability, and the potential for technology to negatively affect the personal relationship between patients and their providers.
This report describes how a network of community health centres in Ontario, Canada, transitioned into a learning health system to improve primary care for disadvantaged populations. By restructuring their organization and leveraging an integrated data platform, the network enhanced its ability to use real-world data for research, quality improvement, and collaborative planning. The initiative focused on engaging clinicians and community members to ensure that data-driven insights lead to better health outcomes and more efficient healthcare delivery.
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.
This study interviewed staff at community health centres in Ontario to identify the essential components of a successful learning health system in primary care. Researchers found that shared organizational goals, high-quality data, and dedicated resources are necessary foundations, but success ultimately depends on staff engagement and protected time for improvement work. The findings highlight that while a desire to improve patient care motivates staff, many centres still face challenges with real-time data access and a lack of specialized personnel for data analysis.
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.
