Louise Moist

Louise Moist

This commentary discusses the ongoing debate regarding whether a functioning arteriovenous fistula should be surgically closed after a patient receives a successful kidney transplant. The authors explore the potential benefits of closing the access, such as reducing the workload on the heart, weighed against the risks of losing a proven site for dialysis should the transplant fail in the future. The article provides clinical perspectives on managing vascular access in the post-transplant period.

Louise Moist

Researchers conducted a large clinical trial in Canada and Australia to determine if daily fish-oil supplements could reduce heart-related complications in adults receiving hemodialysis. The study found that patients taking fish oil had a significantly lower rate of serious cardiovascular events, including heart attacks, strokes, and cardiac deaths, compared to those taking a placebo. These findings suggest that fish-oil supplementation is a safe and effective way to improve heart health in the hemodialysis population.

Louise Moist

Researchers interviewed patients with advanced chronic kidney disease to understand their experiences and challenges with weight management, particularly as obesity can be a barrier to receiving a kidney transplant. The study identified key themes including gaps in healthcare support, the influence of social circles, and how current health status limits weight loss efforts. These findings highlight the need for healthcare providers to offer more patient-centred support and address unmet needs regarding weight loss in the kidney disease community.

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.

Louise Moist

Researchers analyzed data from a large clinical trial to determine how the medication empagliflozin affects quality of life and healthcare costs for people with chronic kidney disease. The study found that patients taking the medication experienced a slight improvement in quality-adjusted life years and significant reductions in costs related to hospital admissions, other medications, and the management of kidney failure. These findings suggest that the treatment is highly likely to be cost-effective across a wide range of patients, including those with and without diabetes.

Louise MoistMatthew WeirKyla NaylorAmit GargPavel RoshanovPeter Blake

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.

Louise Moist

This scoping review examined seventeen studies on non-drug and non-surgical weight loss strategies for adults with advanced chronic kidney disease and obesity. Researchers found that programs combining significant calorie restriction with regular coaching led to the most weight loss, averaging seven kilograms over the short term. While these dietary and exercise interventions appeared safe, more information is needed regarding their long-term effectiveness and how patients perceive these programs.

Louise Moist

This article discusses the importance of advancing research into the interconnected health of the heart, kidneys, and metabolic system for people who have received a kidney transplant. It highlights the need for integrated care and specialized study designs to address the unique risks this population faces regarding cardiovascular and metabolic complications.

Louise Moist

This study analyzed data from over 240,000 kidney transplant recipients in the United States to determine if combining body mass index with body surface area better predicts health outcomes than using body mass index alone. Researchers found that patients classified as having obesity by both measurements had the highest risk of transplant complications, including delayed organ function and graft loss. These findings suggest that incorporating body surface area into pre-transplant evaluations could help clinicians more accurately identify high-risk patients than current standard assessments.

Louise Moist

To improve patient safety during transitions from hospital to home, researchers implemented a quality improvement initiative aimed at ensuring discharge summaries were completed within 48 hours. While the team successfully reduced the average time to complete these summaries from 53 to 38 hours, they found that meeting the strict 48-hour deadline often resulted in less editing and review by senior physicians and trainees. This suggests that while administrative targets for speed can be met, they may inadvertently reduce the time spent on clinical documentation quality and medical education.

Louise Moist

This report describes the treatment of a 33-year-old man with polycystic kidney disease who developed Hodgkin's lymphoma in the chest. Doctors prioritized treating the cancer while carefully adjusting chemotherapy doses as his kidney function declined, successfully achieving remission without the immediate need for dialysis. Three years later, as his kidney function continued to worsen, he successfully underwent a kidney transplant and removal of his original kidneys.

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.

Louise Moist

Researchers analyzed blood samples from over 5,000 patients with chronic kidney disease to identify specific age-related genetic mutations in blood cells known as clonal hematopoiesis of indeterminate potential. They found that patients with certain types of these mutations had a 36 per cent higher risk of experiencing major heart-related events, such as strokes or heart failure, regardless of their diabetes status or severity of kidney disease. The study also suggests that a specific genetic variation in the interleukin-6 receptor may help lower this increased cardiovascular risk.

Louise Moist

This review examines common causes of hemodialysis catheter dysfunction, such as blood clots and fibrin buildup, and discusses various strategies to maintain catheter health. The authors highlight that using specific lock solutions like thrombolytics or citrate, choosing symmetrical catheter tips, and implementing comprehensive care protocols can significantly reduce the risk of catheter failure. Identifying high-risk patients based on factors like sex and previous catheter issues is essential for creating personalized care plans and improving treatment outcomes.

Louise Moist

This study surveyed patients and health care providers to understand the impact of restrictions on showering for individuals using central venous catheters for hemodialysis. While many clinics advise against showering to prevent infections, the researchers found that most patients strongly desire to shower and many already do so despite medical advice. Health care providers expressed a willingness to change their recommendations if evidence from a high-quality study could demonstrate that showering does not increase the risk of serious bloodstream infections.

Louise Moist

Researchers analyzed data from a large clinical trial to determine if the kidney and heart benefits of the medication empagliflozin differed for patients with chronic kidney disease who were frail, had multiple health conditions, or took many medications. The study found that empagliflozin consistently reduced the risk of kidney disease progression and hospitalizations across all groups, regardless of their level of frailty or the number of other health issues they faced. These results suggest that the medication is safe and effective for a wide range of patients, including those with complex health needs.

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.

Louise MoistKyla Naylor

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.

Louise Moist

Interviews with patients at a Canadian kidney care centre revealed that while telemedicine was highly valued for its convenience, many found it easier to build trust and personal connections during in-person visits. Most participants expressed a preference for a hybrid care model that combines virtual and face-to-face appointments, particularly if their health condition were to worsen. Patients also indicated a preference for video consultations over telephone calls to enhance the quality of their interactions with healthcare providers.

Louise Moist

Researchers followed patients from the EMPA-KIDNEY trial for an additional two years after they stopped taking the study medication to see if the benefits of empagliflozin persisted. The study found that patients originally assigned to take empagliflozin continued to have a lower risk of kidney disease progression and cardiovascular death compared to those in the placebo group, even after the trial ended. These findings suggest that the protective effects of this medication on the heart and kidneys can last for at least a year after the treatment is discontinued.

Louise Moist

Researchers reviewed existing studies on non-surgical ways to control bleeding from hemodialysis fistulas and grafts both inside and outside of dialysis centres. They found that specialized hemostatic dressings significantly reduce the time it takes for bleeding to stop after needles are removed compared to standard dressings. While devices like tourniquets and compression tools are commonly used to manage severe bleeding outside the hospital, there is currently very little high-quality evidence to guide their use or confirm their impact on patient safety.

Louise Moist

This is a protocol for an ongoing clinical trial that is investigating whether daily fish oil supplements can reduce the rate of serious cardiovascular events in patients receiving long-term hemodialysis. Researchers in Canada and Australia are enrolling 1100 participants to receive either omega-3 fatty acid supplements or a placebo to see if this intervention lowers the occurrence of heart attacks, strokes, and cardiac deaths. The study will track all major cardiovascular events over at least three and a half years to determine if this simple nutritional supplement improves survival and heart health in this high-risk population.

Louise Moist

This protocol describes an ongoing study to test the feasibility of a simple home-based exercise program using Nordic walking poles for patients receiving hemodialysis or peritoneal dialysis. Researchers are evaluating whether physician-prescribed walking goals and exercise videos can improve patient-important outcomes such as muscle strength, fatigue, and sleep quality. The study aims to determine if patients can successfully adhere to the program before launching a larger trial to evaluate its long-term health benefits.

Louise Moist

Researchers conducted a scan of weight management programs across North America and identified forty programs available to individuals with chronic kidney disease, though only three were specifically tailored for this population. The study found that while various commercial, community, and medical programs exist, patients often face significant barriers such as high costs for nutritious food, a lack of specialized support, and exclusion due to complex dietary requirements. These findings highlight the need for more patient-centred and accessible weight loss resources that are specifically designed to meet the unique health needs of people living with kidney disease.

Louise Moist

This review examined the use of glucagon-like peptide 1 receptor agonists, a class of medications used for weight loss and blood sugar control, in patients with kidney failure or kidney transplants. The researchers found that these medications effectively lowered blood sugar levels and promoted weight loss in these populations, though the benefits were often accompanied by gastrointestinal side effects. While the results from small trials and observational studies are promising, the long-term impact and patient adherence to these therapies in advanced kidney disease require further investigation.

Louise Moist

Nearly half of Canadians with type 2 diabetes have kidney disease, yet many do not receive optimal screening or the latest evidence-based treatments. This review highlights a new standard of care that includes routine screening of both urine protein and kidney function, alongside the use of medications like sodium-glucose cotransporter 2 inhibitors and finerenone to protect the heart and kidneys. Treatment plans should be tailored to individual patient needs, focusing on blood pressure control, blood sugar targets, and early intervention to prevent disease progression.

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 Moist

This pilot study investigated whether high-dose vitamin K supplements could slow the hardening of heart arteries in patients receiving hemodialysis. While the treatment successfully improved vitamin K levels and activated proteins that inhibit calcium buildup, it did not significantly reduce the progression of coronary artery calcification over one year compared to a placebo. The researchers confirmed that conducting a larger trial of this nature is feasible based on high patient recruitment and medication compliance rates.

Louise Moist

Researchers studied over 6,600 patients with chronic kidney disease to determine if the medication empagliflozin could prevent the worsening of their condition or death from heart-related causes. The study found that patients taking empagliflozin had a significantly lower risk of kidney disease progression and fewer hospitalizations compared to those taking a placebo, regardless of whether they had diabetes. These benefits were consistent across different levels of kidney function, and the medication was found to be safe with similar rates of serious side effects in both groups.

Louise Moist

Researchers implemented a quality improvement initiative in a surgical department to ensure that at least half of patient discharge summaries were sent out within 48 hours of a hospital stay. By using strategies such as automated distribution of notes and regular performance feedback, the team increased the rate of timely summaries from 19% to 54% without increasing staff workload. These improvements were sustained over time, helping to ensure that information is shared quickly with other healthcare providers to support safe patient transitions from hospital to home.

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.

Louise Moist

In this study, researchers developed and evaluated a community engagement program in Guatemala to support research into chronic kidney disease of unknown origin. By applying five core principles of engagement, the team successfully built a collaborative relationship with sixty-two community leaders who reported high levels of satisfaction and involvement in the research process. This approach demonstrates how involving local partners can improve the sustainability and effectiveness of kidney health studies, particularly in low- and middle-income countries.

Louise Moist

Researchers followed a small group of factory workers for two years to determine if exposure to heat stress affected their kidney health. The study found that kidney function remained stable over the two-year period, though measurements taken before and after a single work shift suggested that cystatin C is a more reliable marker than creatinine for assessing kidney function in these environments. These findings indicate that while heat stress is a concern, these specific workers maintained their kidney health over the follow-up period.

Louise Moist

A 28-year-old woman with IgA nephropathy and advanced kidney failure presented to the emergency department with shortness of breath and fatigue after starting dapsone treatment. The patient was found to have methemoglobinemia, a condition where the blood cannot effectively carry oxygen, which was a complication of her medication. This case highlights the importance of monitoring for rare drug toxicities in patients with significant kidney impairment.

Louise Moist

Researchers conducted a large international trial to determine if the steroid methylprednisolone could prevent kidney failure in patients with IgA nephropathy who were at high risk of disease progression. The study found that patients receiving the steroid had a significantly lower risk of experiencing a major decline in kidney function or kidney failure compared to those receiving a placebo. While the treatment was effective at both full and reduced doses, the higher dose was associated with a significant increase in serious infections and other adverse events.

Louise Moist

A survey of patients with chronic kidney disease and their doctors in Ontario found that telephone appointments were generally well-received during the pandemic, with most patients finding them comfortable and safer than in-person visits. While participants appreciated saving time and money on travel, they noted drawbacks such as the lack of a physical examination and a reduced personal connection with their physician. Most doctors felt confident using telephone consultations but identified communication barriers and a need for better technology to support virtual clinics.

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.