Pavel Roshanov

Pavel Roshanov

Researchers reviewed nineteen studies to determine if a blood marker called soluble urokinase plasminogen activator receptor can predict complications following surgery. The analysis found that higher levels of this marker are likely associated with a greater risk of developing acute kidney injury and other postoperative issues. While the marker shows promise for identifying high-risk patients, the current evidence is limited by small study sizes and inconsistent reporting across the existing research.

Pavel Roshanov

Researchers tested a new oral medication called iptacopan in adults with C3 glomerulopathy, a rare and serious kidney disease caused by an overactive immune system. The study found that patients taking iptacopan experienced a 35 per cent reduction in urine protein levels after six months compared to those taking a placebo. The treatment was generally well tolerated with no serious safety concerns or infections related to the immune-targeting mechanism.

Pavel Roshanov

This publication provides a comprehensive overview of the clinical considerations and best practices for managing patients on maintenance hemodialysis who are undergoing surgical procedures. It addresses critical perioperative factors, including the timing of dialysis sessions, fluid and electrolyte management, and the prevention of cardiovascular complications during the surgical period. The review serves as a guide for clinicians to optimize patient safety and improve surgical outcomes in this high-risk population.

Matthew WeirPavel Roshanov

Researchers conducted a large international trial to determine if the medication spironolactone could reduce the risk of heart failure or cardiovascular death in patients receiving long-term dialysis. The study was stopped early for futility after finding no significant difference in heart-related deaths or hospitalizations between patients taking spironolactone and those taking a placebo. These results suggest that daily use of this specific medication does not provide the expected cardiovascular benefits for the maintenance dialysis population.

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.

Pavel Roshanov

Researchers analyzed over 150,000 surgical procedures in patients receiving maintenance hemodialysis to see if the dialysis dose delivered just before surgery affected survival. They found that patients who received a lower dose of dialysis than their usual average in the session immediately preceding surgery had a significantly higher risk of death within 30 days. These findings suggest that maintaining or potentially increasing the dialysis dose before a surgical procedure may be important for improving patient safety.

Pavel Roshanov

Researchers developed a tool to predict which patients are most likely to experience dangerously low blood pressure after undergoing noncardiac surgery. By analyzing data from over 40,000 patients across 14 countries, they created a model that can estimate this risk before surgery using either a comprehensive list of variables or a simplified four-item version. Identifying these high-risk patients early may help clinicians intervene sooner to prevent complications like heart or kidney injury.

Pavel Roshanov

Researchers compared two strategies for managing blood pressure in high-risk patients undergoing noncardiac surgery to see if avoiding low blood pressure or avoiding high blood pressure better protected brain health. The study found no significant difference between the two approaches in the rates of postoperative delirium or cognitive decline one year after surgery. While the strategy focused on avoiding low blood pressure did successfully reduce the number of patients who required treatment for hypotension, it did not lead to better neurocognitive outcomes.

Pavel Roshanov

Researchers validated a tool designed to predict the risk of blood clots after abdominal, urologic, or gynecologic surgery by analyzing data from over 11,000 patients. The tool uses three simple factors—age, body mass index, and history of previous blood clots—to successfully categorize patients into low, medium, and high-risk groups for developing postoperative complications. This validated instrument is now available as an online resource to help clinicians make evidence-based decisions regarding the use of blood-thinning medications after surgery.

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.

Amit GargPavel RoshanovPeter Blake

This report summarizes a conference dedicated to developing six new pragmatic clinical trials designed to improve the quality of care for patients receiving hemodialysis. Researchers, health care providers, and patient partners collaborated on study designs that will test interventions such as different blood pressure targets and dialysis fluid compositions within routine clinical settings. The initiative aims to increase the number of high-quality randomized trials in nephrology to better support evidence-based treatment decisions.

Amit GargPavel Roshanov

This report highlights that high-volume hemodiafiltration reduces the risk of death from all causes and cardiovascular issues compared to standard hemodialysis in adults with kidney failure. The findings suggest that this advanced form of dialysis may offer superior long-term survival benefits for patients requiring kidney replacement therapy.

Pavel Roshanov

A study of nearly one million surgeries in Alberta, Canada, found that patients with advanced kidney disease spent significantly more time in the hospital following major surgery compared to those with normal kidney function. Patients receiving dialysis had the longest hospital stays and were nearly four times more likely to be discharged to a facility with 24-hour nursing care rather than returning home. These findings demonstrate that the severity of preoperative kidney disease is strongly linked to a loss of independence and a longer recovery period after surgical procedures.

Amit GargPavel Roshanov

In this study, researchers analyzed data from over 45,000 patients to determine how preoperative kidney function, measured by the estimated glomerular filtration rate, predicts heart-related complications after major noncardiac surgery. They found that lower kidney function was a powerful predictor of heart injury, cardiac arrest, or death within 30 days of surgery, with the risk being particularly high for younger patients compared to older patients with the same level of kidney impairment. These findings suggest that including precise kidney function measurements and considering the patient's age could significantly improve the accuracy of surgical risk calculators.

Pavel Roshanov

This study developed a method to convert scores between two common tools used to measure the severity of Crohn’s disease, the Patient-Reported Outcome 2 and the Harvey-Bradshaw Index. By analysing data from a large clinical trial, researchers found that the two measures are highly correlated and established a simple mathematical equation to estimate one score from the other. These findings help clinicians and researchers better compare results across different types of clinical trials and apply research data to real-world patient care.

Pavel Roshanov

Researchers compared blood pressure levels during and after noncardiac surgery among patients on dialysis, patients with kidney disease not requiring dialysis, and patients with normal kidney function. The study found that patients receiving dialysis experienced more frequent and severe episodes of low blood pressure both during the operation and for 48 hours following the procedure. These findings suggest that patients on dialysis face unique hemodynamic challenges during the surgical period that may contribute to their higher risk of complications.

Pavel Roshanov

This article provides an overview of the design and statistical challenges unique to cluster-randomized trials, where entire groups rather than individuals are assigned to specific treatments. It explains how these studies can protect against the mixing of treatment effects in certain settings while highlighting the specific vulnerabilities clinicians must consider when interpreting the results. This guide serves as an educational resource to help medical professionals accurately evaluate the quality and findings of research involving institutional policies or care processes.

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.

Dervla ConnaughtonPavel Roshanov

Researchers reviewed 60 studies involving over 10,000 adults with chronic kidney disease and found that genetic testing provided a clear diagnosis for 40% of patients. The likelihood of finding a genetic cause was highest in those with cystic kidney disease or a family history of kidney problems. Importantly, the genetic results led to a change in the original diagnosis for 17% of patients and influenced treatment decisions or family screening in several cases.

Andrea CowanPavel Roshanov

This is a protocol for a series of three systematic reviews designed to evaluate the frequency of bone fractures, the accuracy of risk prediction models, and the effectiveness of various treatments in adult kidney transplant recipients. Researchers will analyze existing studies to determine how often fractures occur after transplantation and which patient factors or medications, such as vitamin D or bisphosphonates, best help in preventing bone loss. This work aims to provide an updated evidence base for managing bone health in patients who are at high risk due to prior kidney disease and long-term steroid use.

Amit GargPavel Roshanov

Researchers in Ontario, Canada, demonstrated that the unique ten-digit health card numbers assigned to residents can be used as a tool for randomizing participants in large-scale clinical trials. By using specific digits from these randomly generated numbers to assign treatment groups, investigators can simplify the trial process and reduce costs. While this method is efficient for real-world pragmatic trials, it does not allow for grouping participants by specific characteristics and should be evaluated based on the needs of each individual study.

Amit GargPavel Roshanov

This pre-specified sub-study of a large international trial compared two different strategies for managing blood pressure in patients undergoing noncardiac surgery. Researchers found that a strategy focused on avoiding low blood pressure, which involved pausing certain blood pressure medications and maintaining higher targets during surgery, did not reduce the risk of acute kidney injury compared to a strategy focused on avoiding high blood pressure. These findings were consistent even among patients who had pre-existing chronic kidney disease.

Kyla NaylorAmit GargPavel Roshanov

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.

Pavel Roshanov

This study analyzed red blood cell transfusion practices in over 39,000 adults undergoing noncardiac surgery across multiple countries. Researchers found that while transfusion rates declined over six years and most patients were treated using restrictive strategies, there was significant unexplained variation in practices depending on the specific hospital and country. These findings highlight that a patient's likelihood of receiving a transfusion is influenced not only by their hemoglobin levels and health status but also by local clinical culture.

Dervla ConnaughtonMatthew WeirSusan HuangAndrew HouseLakshman GunaratnamPavel Roshanov

Researchers analyzed genetic data from patients with chronic kidney disease to investigate why many develop severe hardening of the arteries, known as vascular calcification. They identified specific mutations in the ABCC6 gene in several families, suggesting that inherited genetic factors may directly contribute to this cardiovascular complication. Identifying these genetic causes early could eventually help doctors use targeted therapies to prevent vascular damage and reduce the risk of death in kidney disease patients.

Pavel Roshanov

Researchers analyzed data from nearly 40,000 patients undergoing noncardiac surgery to determine when major bleeding complications occur within the first month after an operation. The study found that over three-quarters of all major bleeding events happened within the first week following surgery, with more than 40 percent occurring within the first 24 hours. These findings help clinicians better time the use of blood-thinning medications and improve monitoring strategies to prevent surgical complications.

Pavel Roshanov

Researchers developed and tested the Canadian Anatomic Kidney Score, a new six-point system used to grade the physical quality of donor kidneys based on their blood vessels, anatomy, and surrounding fat. The study found that higher scores, which indicate poorer physical quality, were associated with lower kidney function one year after transplantation, with the condition of the blood vessels being the most important factor. This scoring system provides surgeons with a standardized way to assess donor kidneys alongside existing tools like genetic risk profiles and biopsies.

Pavel Roshanov

This systematic review examined how patients with kidney disease are represented in clinical trials of tranexamic acid, a medication used to reduce bleeding during surgery. The researchers found that over three-quarters of these trials explicitly excluded patients with kidney disease, often using vague or overly restrictive criteria, and very few trials adjusted the medication dose based on kidney function. While the drug appears safe and effective for those with mild to moderate kidney impairment, there is insufficient evidence to determine its safety or the correct dosage for patients with severe kidney disease.

Pavel Roshanov

A review of over 60 clinical trials found that using the medication desmopressin during surgery likely reduces the total amount of blood lost and the number of blood units required for transfusion. However, the drug did not significantly lower the overall risk of needing a transfusion and was linked to a higher risk of low blood pressure requiring medical intervention. There is currently a lack of high-quality evidence regarding the safety and effectiveness of this treatment specifically for patients with advanced kidney disease.

Pavel Roshanov

This article explains how to interpret noninferiority trials, which are studies designed to show that a new treatment is not significantly worse than an existing standard. The authors highlight that the margins used to define success can sometimes be biased and suggest that clinicians should evaluate results based on patient values rather than just the limits set by researchers. Using examples from inflammatory bowel disease, the paper provides a framework for using confidence intervals to make more patient-centred treatment decisions.

Pavel Roshanov

This review examines the ethical concerns and practical challenges associated with using placebos in clinical trials for inflammatory bowel disease. The authors propose alternative study designs that aim to protect patient safety while still providing the high-quality data necessary for clinical decision-making.

Amit GargPavel Roshanov

Researchers followed nearly 39,000 patients for one year after they were discharged from noncardiac surgery to understand how complications during their hospital stay affected long-term survival. The study found that one in 18 patients died within a year of discharge and one-quarter were readmitted to the hospital, with early complications like heart injury, major bleeding, and sepsis significantly increasing the risk of death for several months. These findings highlight that the impact of surgical complications on patient health persists long after they leave the hospital centre.

Andrew HousePavel Roshanov

Researchers evaluated a shortened two-hour monitoring protocol for patients undergoing kidney biopsies at a Canadian hospital and found that all major bleeding complications were identified within that timeframe. The study also tested a risk calculator designed to predict bleeding, which showed high accuracy in identifying high-risk patients despite the low overall number of complications. These findings suggest that a brief observation period combined with routine ultrasound is sufficient for safely managing patients after a kidney biopsy.

Amit GargPavel Roshanov

This protocol describes an ongoing study to determine if the anti-inflammatory medication colchicine can reduce the risk of sudden kidney damage in older adults undergoing major thoracic surgery. Researchers are comparing patients receiving colchicine to those receiving a placebo to see if the drug prevents increases in creatinine levels, a key marker of kidney function. The study will also evaluate if the medication provides a greater benefit to patients who already have chronic kidney disease before their operation.

Pavel Roshanov

This is a protocol for an ongoing prospective study designed to determine how to accurately convert between two different heart-related blood tests used to assess risk before non-cardiac surgery. Researchers aim to validate a formula that translates B-type natriuretic peptide levels into N-terminal pro B-type natriuretic peptide values to better predict the risk of heart injury or death within 30 days of an operation. By establishing these thresholds, the study seeks to improve how doctors interpret preoperative blood work to identify high-risk surgical patients.

Amit GargPavel Roshanov

This international study compared two different strategies for managing blood pressure in patients taking long-term medications who were undergoing noncardiac surgery. One approach focused on avoiding low blood pressure by setting higher targets and withholding certain medications, while the other focused on avoiding high blood pressure by continuing all usual medications. Researchers found no significant difference between the two strategies in the rates of major complications such as heart attack, stroke, or vascular death within 30 days of surgery.

Amit GargPavel Roshanov

This article discusses whether aspirin should be prescribed to prevent initial cardiovascular events in patients with chronic kidney disease. Based on a specific analysis of the International Polycap Study 3 trial, the authors evaluate the potential benefits and practical considerations of using aspirin for primary prevention in this patient population.

Amit GargPavel Roshanov

In this large clinical trial, researchers investigated whether giving tranexamic acid to patients undergoing noncardiac surgery could reduce the risk of serious bleeding without increasing the risk of heart attacks, strokes, or blood clots. The study found that tranexamic acid significantly reduced the occurrence of life-threatening and major bleeding compared to a placebo. However, the researchers could not definitively conclude that the drug was as safe as the placebo regarding cardiovascular complications, as the risk of these events was slightly higher in the group receiving the medication.

Amit GargPavel Roshanov

This publication describes the design of an ongoing international trial involving 10,000 patients to determine if the medication tranexamic acid can safely reduce major bleeding during non-cardiac surgery. The study also evaluates whether a specific strategy to avoid low blood pressure, which involves adjusting regular blood pressure medications and setting higher targets during surgery, reduces the risk of heart-related complications. Researchers will follow participants for one year to assess the impact of these strategies on survival and long-term cardiovascular health.

Amit GargPavel Roshanov

This protocol describes an ongoing study to determine if avoiding low blood pressure during and after noncardiac surgery reduces the risk of acute kidney injury. Researchers are comparing a strategy of withholding certain blood pressure medications and maintaining higher blood pressure targets against a standard approach of continuing usual medications. The study will involve approximately 6,800 patients across 108 centres to see if these management changes prevent significant increases in creatinine levels following surgery.