Dr. Peter Blake is a Professor of Medicine at the University of Western Ontario and a renowned expert in peritoneal dialysis, having published over 100 papers and served as Editor-in-Chief of Peritoneal Dialysis International. In addition to his academic and editorial contributions, he has held significant leadership roles, including Provincial Medical Director of the Ontario Renal Network and Chair of the Canadian Society of Nephrology Work Group on Peritoneal Dialysis. His career is distinguished by extensive international speaking engagements and active service on the boards of several major nephrology journals.
Dial-Mag Investigator Writing Committee*, Killin L, Bohm C, Harris C, MacRae JM, Shah N, Thompson S, Tonelli M, Luo B, Sontrop JM, Acedillo RR, Al-Jaishi AA, Anderson S, Antonsen J, Bagga A, Beaubien E, Berry D, Blake PG, Brown PA, Bueti J, Chan CT, Cote B, Cowan AC, Cuerden MS, Day NE, Dev V, Dhruve M, Djurdjev O, Gregor L, Hiremath S, Joseph G, Kammila S, Kiaii M, Kumar Kolusu E, Lacson E Jr, Mazurat A, Molnar AO, Nathoo B, Nistico A, Oliver MJ, Pandeya S, Parmar MS, Perkins D, Quinn K, Romann A, Sasal J, Shulman T, Silver SA, Singh A, Louis IS, Steele A, Tangri N, Ting RH, Vorster H, Wadehra DB, Wald R, Walters J, Whitlock RH, Yao S, Zacharias J, Garg AX
This protocol describes an ongoing study across 137 Canadian hemodialysis centres to determine if using a higher concentration of magnesium in dialysis fluid reduces the risk of death, heart disease, and muscle cramps. Researchers are comparing a centre-wide policy of high magnesium dialysis fluid against a lower concentration over a four-year period. The study uses provincial health databases and patient questionnaires to track long-term cardiovascular outcomes and patient comfort.
In 2018, Ontario established a new multidisciplinary care model to provide standardized and timely treatment for patients with glomerulonephritis across the province. A review of nearly 7,000 patients treated under this model found that IgA nephropathy was the most common diagnosis and that six percent of participants eventually required dialysis or a kidney transplant. This new approach to specialized kidney care is becoming well established and will help inform future healthcare planning in Ontario.
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.
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.
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.
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.
Researchers analyzed health records from three large groups of patients in Ontario to estimate how many people with kidney failure die without starting dialysis or receiving a transplant. The study found that approximately one in six individuals with kidney failure dies without these treatments, highlighting a significant group that likely receives conservative medical management. These findings are important for health care planning and ensuring that resources are available for patients who choose not to pursue intensive kidney replacement therapies.
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.
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.
Researchers examined whether tailoring the bicarbonate levels in dialysis fluid to individual patients or using a standard concentration for everyone affected blood bicarbonate levels before treatment. The study found no significant difference in blood bicarbonate levels between these two approaches, with most patients maintaining levels within the normal range regardless of the strategy used. While very high concentrations in the dialysis fluid slightly increased blood levels, the overall impact on patient blood chemistry was minimal.
Researchers in Ontario compared a new race-free equation for estimating kidney function with the standard 2009 version to see how it affects patient eligibility for specialist care. The study found that using the 2021 equation significantly reduced the number of people meeting the criteria for nephrologist consultations, specialty clinic care, and kidney transplant evaluations. These findings suggest that adopting the newer equation could lead to fewer patients being referred for specialized kidney services in regions where a small percentage of the population is Black.
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.
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, Canada, found that those with chronic kidney disease who started low-dose methotrexate had double the risk of serious adverse events, such as sepsis or lung and liver toxicity, compared to those starting hydroxychloroquine. This risk was even higher for individuals with more advanced kidney impairment, particularly those with an estimated glomerular filtration rate below 45. These findings suggest that the potential for severe complications should be carefully weighed against the benefits when prescribing methotrexate to patients with reduced kidney function.
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.
This article reviews the systemic barriers that limit the use of home dialysis in the United States, such as insufficient infrastructure and gaps in staff training. The authors examine current policy initiatives and quality measurement strategies intended to increase the adoption of home therapies and compare these efforts to international models. The discussion highlights how advocacy and legislative changes can be used to better support patients who prioritize the flexibility of dialysing at home.
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.
Yau K, Enilama O, Levin A, Romney MG, Singer J, Blake P, Perl J, Leis JA, Kozak R, Tsui H, Bolotin S, Tran V, Chan CT, Tam P, Dhruve M, Kandel C, Estrada-Codecido J, Brown T, Siwakoti A, Abe KT, Hu Q, Colwill K, Gingras AC, Oliver MJ, Hladunewich MA
This protocol describes an ongoing study to track the long-term immune response to COVID-19 vaccines in up to 2500 Canadians with chronic kidney disease, including those on dialysis and kidney transplant recipients. Researchers will measure antibody levels and cellular immunity at multiple timepoints over a year to determine how well and how long these patients remain protected. The findings will help develop specific vaccination guidelines and public health recommendations for people living with kidney disease.
A study of over 20,000 patients with advanced chronic kidney disease in Ontario found that those who contracted COVID-19 during the first 21 months of the pandemic faced high rates of hospitalization and a 19 per cent death rate. Researchers identified that being fully vaccinated significantly reduced the risk of death, while factors such as lower kidney function, lower income, and living in long-term care were associated with a higher risk of infection. Although outcomes were severe, the death rate for these patients declined as the pandemic progressed and vaccination became available.
Perl J, Brown EA, Chan CT, Couchoud C, Davies SJ, Kazancioğlu R, Klarenbach S, Liew A, Weiner DE, Cheung M, Jadoul M, Winkelmayer WC, Wilkie ME, for Conference Participants
This report summarizes the conclusions from an international conference on expanding the use of home-based dialysis treatments, such as peritoneal dialysis and home hemodialysis. Experts identified that while home therapies offer greater patient autonomy and satisfaction, their use remains low due to complex barriers including healthcare policy, funding models, and a lack of provider and patient education. The group emphasized that because clinical outcomes are similar across different dialysis types, the choice of treatment should be based on shared decision-making that prioritizes the patient's lifestyle, goals, and support 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.
Hiremath S, Blake PG, Yeung A, McGuinty M, Thomas D, Ip J, Brown PA, Pandes M, Burke A, Sohail QZ, To K, Blackwell L, Oliver M, Jain AK, Chagla Z, Cooper R
Researchers evaluated a modified, low-dose regimen of the antiviral medication nirmatrelvir/ritonavir in 134 dialysis patients with COVID-19 in Ontario, Canada. The study found that the treatment was safe and well-tolerated, with 96% of patients completing the full course and no COVID-19-related deaths occurring within 30 days. While many patients required adjustments to their other medications due to drug interactions, this modified dosing provides a potential treatment option for a high-risk group originally excluded from clinical trials.
Researchers tracked the implementation of infection control measures across nearly 100 hemodialysis centres in Ontario, Canada, during the first wave of the COVID-19 pandemic. Most facilities quickly adopted safety protocols, such as symptom screening, physical distancing, and universal masking for staff and patients, within the first two months of the health emergency. These proactive measures and the sharing of best practices through provincial networks likely helped limit virus outbreaks among patients who were unable to isolate due to their need for regular life-sustaining treatment.
This multicentre study in Brazil compared patients who started peritoneal dialysis urgently within 72 hours of catheter insertion to those who started after a longer waiting period. Researchers found no significant difference in the rates of death or treatment failure during the first 90 days across the different timing groups. These findings suggest that starting peritoneal dialysis immediately is a safe and feasible alternative to hemodialysis for patients who require unplanned, urgent initiation of kidney replacement therapy.
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.
This publication is a response from the authors to commentaries regarding the Advancing American Kidney Health Initiative. It addresses perspectives on the challenges of changing the current status quo in kidney care and the goals for improving patient outcomes.
This publication provides clinical guidance on the use of nirmatrelvir/ritonavir, an antiviral treatment for COVID-19, in patients with advanced chronic kidney disease. The authors outline considerations for dose adjustments and the management of potential drug interactions to ensure the medication is used safely in this high-risk population. This guidance is intended to help clinicians navigate the complexities of prescribing this therapy when kidney function is significantly reduced.
This commentary discusses the clinical importance and effectiveness of COVID-19 vaccination for patients receiving hemodialysis. It highlights how vaccination strategies and immune responses in this vulnerable population impact their overall health outcomes during the pandemic.
A study of older adults with chronic kidney disease in Ontario found that starting allopurinol at a dose higher than 100 milligrams per day more than doubled the risk of being hospitalized for a severe skin reaction compared to starting at a lower dose. These results support the practice of using lower initial doses of this medication in patients with reduced kidney function to minimize the risk of dangerous side effects. While higher starting doses were also linked to an increase in overall hospitalizations, there was no significant difference in the risk of death between the two groups.
The Advancing American Kidney Health Initiative set ambitious goals to increase the use of home dialysis and kidney transplantation while reducing the incidence of kidney failure. This commentary discusses the complexities of measuring the success of these policy changes, noting that current metrics may not fully capture improvements in patient care or health equity. The authors highlight the need for refined data collection and evaluation strategies to ensure the initiative effectively meets its objectives for the kidney disease community.
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.
Yau K, Chan CT, Abe KT, Jiang Y, Atiquzzaman M, Mullin SI, Shadowitz E, Liu L, Kostadinovic E, Sukovic T, Gonzalez A, McGrath-Chong ME, Oliver MJ, Perl J, Leis JA, Bolotin S, Tran V, Levin A, Blake PG, Colwill K, Gingras AC, Hladunewich MA
Researchers compared the immune response of two different mRNA vaccines in patients undergoing maintenance hemodialysis at two Canadian academic centres. The study found that patients who received the Moderna vaccine had significantly higher antibody levels and a more sustained immune response compared to those who received the Pfizer-BioNTech vaccine. These findings support the recommendation for additional vaccine doses in this vulnerable population to maintain protection against the virus.
