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 evaluated the impact of changing the eligibility rules for multidisciplinary kidney care in Ontario, Canada, which shifted from a simple kidney function threshold to a risk-based model. While the change led to fewer patients receiving specialized clinic care and a slight increase in late referrals before starting dialysis, there were no significant negative effects on long-term clinical outcomes like dialysis initiation methods or mortality. These findings suggest that using risk-based criteria can help focus resources on high-risk patients without compromising overall patient safety.
This study examined whether receiving team-based care from various healthcare providers within community health centres in Ontario, Canada was associated with fewer emergency department visits. Analyzing data from over 138,000 patients, researchers found that while nearly half of the patients received team-based care, there was no association between visits to individual team-based provider types and a reduction in emergency department visits. In fact, an increased number of visits to any provider type was generally associated with more frequent emergency department visits.
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 evaluated whether inpatient rehabilitation within the first six months of starting dialysis could improve physical function and reduce hospitalization and mortality rates in older adults. Researchers found that patients who underwent rehabilitation showed significant improvements in their physical independence scores by the time of discharge. However, compared to a matched group who did not receive rehabilitation, those undergoing rehabilitation had similar one-year mortality and long-term care admission rates, along with slightly higher rates of subsequent hospitalisation.
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
A population-based study in Ontario, Canada, tracked children who survived cancer to evaluate their long-term risk of developing kidney complications. Researchers found that childhood cancer survivors had a significantly higher risk of developing chronic kidney disease or hypertension compared to both hospitalized children and the general pediatric population. These findings highlight the importance of early monitoring and treatment for kidney issues in survivors to prevent serious long-term health 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 large study of hospitalized children in Ontario, Canada, who survived acute kidney injury without needing acute dialysis, found that eighteen percent experienced major adverse kidney events over a ten-year follow-up period. Compared to similar hospitalized children without acute kidney injury, survivors had a fourfold higher risk of developing chronic kidney disease, requiring long-term dialysis, or experiencing hypertension. These findings suggest that children surviving acute kidney injury require closer long-term monitoring to detect and manage kidney complications early.
A population-based study in Ontario, Canada, examined the use of mental health and addiction services among nearly six million adults with varying levels of kidney function. Researchers found that while mental health and addiction service use was common overall, individuals with advanced chronic kidney disease and those receiving maintenance dialysis were less likely to access these services compared to individuals with normal kidney function. This lower rate of service use was primarily driven by a lower utilization of outpatient mental health and addiction care.
Researchers conducted six focus groups to explore how the public and individuals with chronic kidney disease feel about being contacted directly by mail if provincial health databases identify them as being at high risk for kidney failure. While almost all participants would want to be notified about a treatable, life-threatening illness, most strongly preferred that this sensitive health information come from their own primary care provider rather than an unfamiliar research organization. The findings highlight a need for clearer privacy laws and a shift in how health systems communicate risk to patients.
A retrospective study in Ontario, Canada, found that fifty-nine percent of patients did not receive recommended multidisciplinary kidney care before starting maintenance dialysis. While some patients experienced an unpreventable, rapid decline in kidney function, others missed opportunities for early chronic kidney disease screening, timely referral to a kidney specialist, or referral to multidisciplinary care clinics. These findings highlight specific gaps in the healthcare system that could be targeted to improve pre-dialysis care.
This population-based cohort study in Ontario, Canada, examined breast cancer screening, incidence, and mortality among women receiving maintenance dialysis. The researchers evaluated how these cancer outcomes compare to the general population, given that individuals with kidney failure generally experience higher rates of cancer and cancer-related death. The findings help clarify the specific risks and screening patterns for breast cancer in this vulnerable patient group.
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.
This study explored the perspectives of primary care providers and staff at Ontario Community Health Centres regarding the potential use of artificial intelligence in patient care. While participants had limited prior knowledge of artificial intelligence, they felt it could improve patient care and help prevent staff burnout, provided the tools are easy to use, accurate, and secure. However, they also raised concerns regarding privacy, liability, and the potential negative impact of these technologies on the patient-provider relationship.
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.
A study of children in Ontario, Canada, who survived an episode of acute kidney injury requiring dialysis during hospitalization found they had significantly higher rates of rehospitalization, emergency department visits, and overall healthcare costs compared to matched hospitalized controls. Despite these higher healthcare needs, only about eighteen percent of these children received follow-up care with a kidney specialist within one year of leaving the hospital. These findings highlight a critical gap in outpatient care and suggest that better follow-up strategies are needed for pediatric survivors of severe acute kidney injury.
This report describes how an alliance of community-governed primary care organizations in Ontario, Canada transitioned toward a learning health system to improve care for disadvantaged populations. By leveraging an integrated data platform and restructuring organizational roles, the alliance enhanced data support, clinician engagement, and collaborative planning for quality improvement. These changes led to the creation of a new Practice-Based Learning Network to better utilize health data for ongoing research and evaluation.
Researchers interviewed staff at Community Health Centres in Ontario, Canada, to identify what makes a primary care network function successfully as a learning health system. The study found that shared organizational goals, high-quality data, and adequate resources are essential, but success ultimately relies on staff engagement driven by a desire to improve patient care. Key areas for improvement included the need for real-time data access, protected time for healthcare providers to work on quality improvement, and dedicated data analysis staff.
