Dr. Kyla Naylor is an Assistant Professor in Western University’s Departments of Medicine and Epidemiology & Biostatistics. She is also a Scientist with the Ontario Renal Network, Trillium Gift of Life 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 2017, she completed a CIHR-funded postdoctoral research fellowship focused on skeletal fractures among kidney transplant recipients. She earned an MSc in Environment and Sustainability and a PhD in Epidemiology & Biostatistics from Western University.
Dr. Naylor’s research focuses on kidney transplantation and health systems, to advance high-quality, evidence-informed care.
Researchers compared records from a major pediatric transplant centre in Ontario to provincial health databases to determine if administrative data can accurately identify children who received organ transplants. They found that using specific hospital procedure codes correctly identified over 90 percent of kidney, liver, heart, and lung transplants performed between 1991 and 2011. These results confirm that administrative health data is a reliable tool for conducting large-scale research on health outcomes in pediatric transplant recipients.
Researchers in Ontario, Canada, found that men who donated a kidney through laparoscopic surgery had a significantly higher risk of requiring scrotal surgery later in life compared to men who did not donate. Over a 20-year period, nearly 14 percent of donors underwent surgery to treat fluid collection in the scrotum, most commonly a procedure called a hydrocelectomy. These findings highlight a specific long-term surgical risk for male living kidney donors that may occur several years after the initial donation.
Clemens KK, Cowan A, Dixon S, Naylor K, Weir MA, Thain J, Khan T, Silver S, Molnar AO, Sultan N, Holden RM, Hiremath S, Wald R, Kitchlu A, Arnold J, Field B, Garg AX
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.
This study followed patients receiving maintenance dialysis in Ontario, Canada, to determine if surviving COVID-19 led to worse health outcomes over the following two years. Researchers found that those who survived the first 90 days after infection did not have a higher risk of death, hospitalization, or heart disease compared to similar patients who were never infected. However, experiencing a second COVID-19 infection later on was linked to an increased risk of death.
Wang C, Kang Y, Dixon SN, Jeyakumar N, Scott Brimble K, Garg AX, Blake PG, Stukel TA, Oliver MJ, Al-Jaishi A, Clemens KK, Fu L, Ip J, McKenzie S, Moist L, Molnar AO, Muanda-Tsobo F, Reich M, Roshanov P, Silver SA, Wald R, Weir MA, Yau K, Young A, Naylor KL
Researchers in Ontario, Canada, found that deaths among people with advanced chronic kidney disease increased by eight per cent during the first 21 months of the COVID-19 pandemic. Despite this increase in mortality, hospital admissions and emergency room visits for these patients actually decreased, suggesting a significant disruption in how they accessed medical care. Interestingly, visits to kidney specialists remained stable throughout the pandemic, and there was no significant change in the number of patients needing to start urgent dialysis.
Researchers examined the steps required to receive a kidney transplant across different regional renal programs in Ontario, Canada, and found significant geographic disparities in access. Patients in Northern Ontario were much less likely to be referred for transplant evaluation, find potential living donors, or be placed on the deceased donor waitlist compared to those in Toronto. These findings highlight that even within a publicly funded health care system, a patient's location can greatly influence their ability to receive a kidney transplant.
Naylor KL, Jeyakumar N, Kang Y, Dixon SN, Garg AX, Al-Jaishi A, Blake PG, Chanchlani R, Fu L, Harel Z, Ip J, Kitchlu A, Kwong JC, Nesrallah G, Oliver MJ, Stukel TA, Wald R, Weir M, Yau K
Researchers in Ontario, Canada, compared the health outcomes of over 31,000 dialysis patients before and during the first three years of the COVID-19 pandemic. While death rates were significantly higher during specific months of the pandemic, the overall mortality rate over the entire 36-month period was not substantially higher than expected. Interestingly, hospitalizations and emergency room visits decreased during the pandemic, yet there was no corresponding increase in deaths unrelated to COVID-19.
Garg AX, Feldman LS, Sontrop JM, Cuerden MS, Arnold JB, Boudville N, Karpinski M, Klarenbach S, Knoll G, Lok CE, McArthur E, Miller M, Monroy-Cuadros M, Naylor KL, Prasad GVR, Storsley L, Nguan C
A study of over 1,000 participants in Canada and Australia found that nearly 18 percent of men who donated a kidney experienced new testicular pain after surgery, compared to only two percent of healthy non-donors. The pain was almost always on the same side as the kidney removal and occurred more frequently following laparoscopic procedures than open surgeries. These findings suggest that unilateral testicular pain is a specific potential complication of living kidney donation that should be discussed during the donor consent process.
Researchers used health databases in Ontario to evaluate different ways of measuring how often patients with advanced kidney disease are referred for transplant evaluations. The study found that referral rates varied significantly depending on how patient eligibility and health status were defined, with referral occurring in as few as 16% or as many as 40% of patients across different groups. Establishing a standardized way to track these referrals is an essential step toward improving equal access to kidney transplants and identifying gaps in patient care.
Researchers conducted a process evaluation using surveys and interviews with healthcare providers to understand why a recent program failed to increase patient access to kidney transplantation in Ontario. They found that while many parts of the program were successfully integrated into daily routines, staff felt the intervention was too complex and lacked sufficient resources and frontline buy-in. These insights into implementation challenges will help guide the design of future strategies to improve transplant rates.
This study of nearly 200,000 adults in Ontario, Canada, found that obesity is highly prevalent among people with kidney disease and is associated with more health complications and socioeconomic disparities. Patients with a high body mass index and advanced kidney disease were less likely to receive a kidney transplant, although those who did undergo transplantation experienced fewer post-surgical complications. Interestingly, a higher body mass index appeared to be associated with a lower risk of death in the final stages of kidney disease, a phenomenon known as the obesity paradox.
This protocol describes an ongoing study in three Canadian provinces to evaluate pregnancy outcomes in women who have previously donated a kidney. Researchers will use administrative health records to compare the risk of high blood pressure, pre-eclampsia, and infant complications between living donors and a matched group of healthy nondonors. The findings will help transplant centres provide better counselling and follow-up care for female kidney donors of childbearing age.
This study followed nearly 800 patients on maintenance dialysis in Ontario who survived the first 30 days of a COVID-19 infection to understand their long-term health outcomes. Researchers found that these survivors faced high rates of death, reinfection, and hospitalizations for heart-related issues for more than a year following their initial illness. Patients who required intensive care during their first infection or who later became reinfected were at a significantly higher risk of death.
A study of over 15,000 transplant recipients in Ontario, Canada, found that these patients had a six times higher risk of hospitalization or death from COVID-19 compared to the general population. While the rates of severe illness declined as the pandemic progressed into the Omicron era, transplant recipients who became severely ill were generally younger and had more underlying health conditions than those in the general public. These findings highlight the ongoing vulnerability of transplant patients to severe viral outcomes despite changes in dominant virus strains.
A study in Ontario, Canada, found that patients receiving in-centre hemodialysis visit the emergency department five times more often and are hospitalized seven times more frequently than the general population. These patients also face significantly higher healthcare costs, with annual hospitalization expenses being approximately eleven times higher than those of matched individuals without kidney failure. These findings highlight the substantial burden of illness in the dialysis population and the importance of health system planning to manage these high acute care needs.
Yohanna S, Naylor KL, Sontrop JM, Ribic CM, Clase CM, Miller MC, Madan S, Hae R, Ho J, Roushani J, Parfeniuk S, Jansen M, Shavel S, Richter M, Young K, Cowell B, Lambe S, Margetts P, Piercey K, Tandon V, Boylan C, Wang C, McKenzie S, Longo B, Garg AX
To improve the efficiency of living kidney donation, researchers in Hamilton, Ontario, developed a one-day assessment clinic that condenses numerous tests and specialist consultations into a single visit. This quality improvement initiative has evaluated over 150 candidates since 2019, with nearly all participants reporting high satisfaction due to reduced travel and minimal disruption to their daily lives. By shortening the evaluation process from the provincial median of nearly one year, this model aims to increase the rates of living donation and improve outcomes for transplant recipients.
Researchers in Ontario used health records to evaluate different ways of measuring how often patients receive a kidney transplant from a living donor before they ever need to start dialysis. They found that the calculated success rate of these transplants changed significantly depending on which patient groups were included, such as whether people with other serious health conditions were filtered out. This work provides a new framework for health systems to track and improve access to early kidney transplantation.
In this study of over 6,000 solid organ transplant recipients in Ontario, Canada, researchers found that receiving a fourth dose of a COVID-19 mRNA vaccine significantly improved protection compared to receiving only three doses. A fourth dose was 70% effective at preventing severe outcomes like hospitalization or death and 39% effective at preventing infection during the period when the Omicron variant was dominant. These findings suggest that additional booster doses provide meaningful clinical benefits for transplant patients who may have a reduced immune response to standard vaccination schedules.
Researchers tested a new program across 26 kidney care centres in Ontario to see if providing extra administrative support, education, and peer storytelling could help more patients receive a kidney transplant. Although the program was successfully put into practice, it did not significantly increase the rate at which patients completed the necessary steps toward transplantation compared to those receiving standard care. These findings highlight the ongoing challenge of overcoming barriers to kidney transplantation and the need for different strategies to improve patient access.
Researchers examined kidney transplant referral rates across 27 regional chronic kidney disease programs in Ontario and found significant geographic disparities. Even after accounting for patient characteristics, the likelihood of being referred for a transplant within one year varied widely between programs, with patients in Northern regions facing substantially lower referral rates. These findings highlight inconsistent access to the first step of transplantation within a single-payer health care system.
Wing S, Thomas D, Balamchi S, Ip J, Naylor K, Dixon SN, McArthur E, Kwong JC, Perl J, Atiquzzaman M, Yeung A, Yau K, Hladunewich MA, Leis JA, Levin A, Blake PG, Oliver MJ
Researchers in Ontario, Canada, studied the effectiveness of a third dose of mRNA COVID-19 vaccines compared to two doses in over 8,000 patients receiving maintenance hemodialysis during the Omicron wave. The study found that a third dose significantly reduced the risk of both infection and severe outcomes, such as hospitalization or death, compared to receiving only two doses. Additionally, patients who had a previous COVID-19 infection were found to have a lower risk of being reinfected regardless of their vaccination status.
This protocol describes the statistical analysis plan for an ongoing study evaluating a program designed to help patients with advanced kidney disease access transplantation and living donation. Researchers are using health registry data from Ontario, Canada, to compare whether patients in kidney programs receiving extra education and administrative support complete more steps toward transplantation than those receiving standard care. The study tracks progress through four key stages, including specialist referral, donor evaluation, waitlist addition, and the successful receipt of a kidney transplant.
Researchers developed a method to identify patients with kidney failure who are likely eligible for a transplant by analyzing health records for specific conditions that usually prevent surgery, such as advanced age, dementia, or certain cancers. By applying these criteria to a large group of patients in Ontario, they were able to more accurately estimate who could potentially receive a transplant, which helps health systems better measure and improve access to care. This approach provides a way to evaluate transplant eligibility using existing administrative data when detailed clinical records are not available.
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.
This study analyzed health records from over 12,000 organ transplant recipients in Ontario, Canada, to determine how well COVID-19 vaccines protected them against infection and serious illness. Researchers found that while transplant recipients have lower protection compared to the general public, receiving a third dose significantly increased vaccine effectiveness against both infection and hospitalization or death. These findings highlight the importance of additional vaccine doses for improving immune protection in this vulnerable population.
This paper describes a collaborative effort between researchers and patients to develop programs that improve access to kidney transplantation and living kidney donation. The partnership led to the creation of the Transplant Ambassador Program, a patient-led initiative that connects individuals with kidney failure to successful transplant recipients and donors. The authors also outline the specific challenges and successes encountered when involving patients as active partners in the research and development process.
This protocol describes an ongoing study to evaluate how a quality improvement program is being delivered across kidney care centres in Ontario to increase access to transplantation. Researchers will use surveys and interviews with healthcare providers to determine if the program components, such as patient education and performance monitoring, are being implemented as intended. The findings will help explain the results of the main clinical trial and provide guidance for improving transplant access in the future.
Oliver MJ, Thomas D, Balamchi S, Ip J, Naylor K, Dixon SN, McArthur E, Kwong J, Perl J, Atiquzzaman M, Singer J, Yeung A, Hladunewich M, Yau K, Garg AX, Leis JA, Levin A, Krajden M, Blake PG
A study of over 13,000 dialysis patients in Ontario, Canada, found that COVID-19 vaccines were highly effective at preventing infection and severe outcomes like hospitalization or death. While a single dose provided significant protection, receiving two doses further reduced the risk of severe illness by 83 per cent compared to being unvaccinated. These protective benefits were consistent across different age groups, dialysis types, and vaccine brands, despite earlier concerns about weaker immune responses in this population.
Researchers tested whether placing tablets in family physician waiting rooms to encourage patients to register for organ and tissue donation would increase registration rates. The study found that inviting patients to register while they waited for their appointments did not significantly change the number of people who signed up compared to standard care. Interviews with clinic staff revealed that factors such as the tablet's location, staff motivation, and competing office priorities influenced how the program was delivered.
Researchers studied over 4,400 kidney transplant recipients in Ontario, Canada, to determine how the length of time spent on dialysis before surgery affected their health outcomes. The study found that patients who received a transplant before needing dialysis had the lowest risk of transplant failure, while those who spent longer on dialysis faced higher risks of death and hospitalization for infections. These findings suggest that shorter dialysis wait times are associated with better long-term health and survival after a kidney transplant.
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.
