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Canadian Journal of Kidney Health and Disease

James Kiberd, Usman Khan, Cynthia Stockman, Arun Radhakrishnan, Matthew Phillips, Bryce A Kiberd, Kenneth A West, Steven Soroka, Christopher Chan, Karthik K Tennankore
Background: Improving a patient's experience with their care through an online interface for communication (an eHealth patient portal) has been shown to be beneficial in some studies of chronic disease populations. However, little is known about the effectiveness of an eHealth portal for delivery of care to home dialysis patients. Objectives: Primary: To determine whether an eHealth portal is effective at improving a patient's experience with their home dialysis care...
2018: Canadian Journal of Kidney Health and Disease
Sonali de Chickera, Ayub Akbari, Adeera Levin, Mila Tang, Pierre Brown, Ognjenka Djurdev, Mohan Biyani, Edward G Clark, Manish M Sood
Background: Polycystic kidney disease (PKD) leads to progressive chronic kidney disease (CKD) with a subsequent risk of adverse events such as cardiac disease, infections, end-stage kidney disease (ESKD), and mortality. Objectives: To determine the risks of CKD-related adverse outcomes in patients with PKD compared with patients without PKD. Setting: Canadian study of prediction of death, dialysis and interim cardiovascular events (CanPREDDICT) was a prospective pan-Canadian cohort study from 2008-2013 involving 28 facilities with adjudicated outcomes...
2018: Canadian Journal of Kidney Health and Disease
Judith Klassen, Gail Wilson
Rationale: With marijuana legalization, clinicians need to be aware of Cannabinoid Hyperemesis Syndrome (CHS), which may masquerade as other disease states such as uremia. Presenting concerns of the patient: A 37-year-old man with bipolar affective disease treated with lithium had progressive renal insufficiency presumably on the basis of interstitial fibrosis. He developed persistent and severe nausea and vomiting which was assumed to be on the basis of uremia...
2018: Canadian Journal of Kidney Health and Disease
Sidharth Kumar Sethi, Vinod Krishnappa, Nisha Nangethu, Paul Nemer, Lawrence A Frazee, Rupesh Raina
Purpose of review: Sustained low-efficiency dialysis (SLED) is increasingly used as a renal replacement modality in critically ill patients with acute kidney injury (AKI) and hemodynamic instability. There is, therefore, a greater need for the understanding of the antibiotic dosage and pharmacokinetics in these patients, to provide them with optimal therapy. Sources of information: PubMed/Medline, Embase, and Google Scholar. Methods: PubMed/Medline, Embase, and Google Scholar databases were searched using a combination of key words: dialysis, end stage renal disease, renal failure, sustained low efficiency dialysis, extended daily dialysis, prolonged intermittent renal replacement therapy (PIRRT), and antibiotic dosing...
2018: Canadian Journal of Kidney Health and Disease
Hind H Lazrak, Emilie René, Naoual Elftouh, Jean-Philippe Lafrance
Background: Low-molecular-weight heparins (LMWH) replaced unfractionated heparin (UFH) in multiple indications. Although LMWH efficacy in hemodialysis was demonstrated through multiple studies, their safety remains controversial. The potential bioaccumulation in patients undergoing chronic hemodialysis raised the question of bleeding risk among this population. Objective: The aim of this study was to evaluate bleeding risk among patients with chronic hemodialysis receiving LMWH or UFH for the extracorporeal circuit anticoagulation...
2018: Canadian Journal of Kidney Health and Disease
Raymond K Hsu, Jonathon D Truwit, Michael A Matthay, Joseph E Levitt, Boyd Taylor Thompson, Kathleen D Liu
Background: Acute kidney injury (AKI) commonly occurs in patients with sepsis and acute respiratory distress syndrome (ARDS). Objective: To investigate whether statin treatment is protective against AKI in sepsis-associated ARDS. Design: Secondary analysis of data from Statins for Acutely Injured Lungs in Sepsis (SAILS), a randomized controlled trial that tested the impact of rosuvastatin therapy on mortality in patients with sepsis-associated ARDS...
2018: Canadian Journal of Kidney Health and Disease
Meherzad Kutky, Sarah Aloudat
Rationale: Late-onset systemic lupus erythematosus (SLE) represents a specific subgroup of SLE, and although there is no strict age cut-off, 50 years is commonly used as the minimum age for disease onset. In this report, we present a case of a 74-year-old male with late-onset SLE and biopsy-proven lupus nephritis (LN). Presenting concerns of the patient: A 74-year-old male was referred to the nephrology clinic with a rapidly rising creatinine from a baseline of 60 µmol/L to 176 µmol/L...
2018: Canadian Journal of Kidney Health and Disease
Hamid Mohamadlou, Anna Lynn-Palevsky, Christopher Barton, Uli Chettipally, Lisa Shieh, Jacob Calvert, Nicholas R Saber, Ritankar Das
Background: A major problem in treating acute kidney injury (AKI) is that clinical criteria for recognition are markers of established kidney damage or impaired function; treatment before such damage manifests is desirable. Clinicians could intervene during what may be a crucial stage for preventing permanent kidney injury if patients with incipient AKI and those at high risk of developing AKI could be identified. Objective: In this study, we evaluate a machine learning algorithm for early detection and prediction of AKI...
2018: Canadian Journal of Kidney Health and Disease
Ann Young, Greg A Knoll, Eric McArthur, Stephanie N Dixon, Amit X Garg, Charmaine E Lok, Ngan N Lam, S Joseph Kim
Background: Deceased donor kidney allocation in the United States is guided by the Kidney Donor Risk Index (KDRI). The generalizability of the KDRI beyond the United States has not been widely studied. Objective: To assess the generalizability of the KDRI in a cohort of non-US (Canadian) deceased donor kidney transplant recipients. Design: Population-based retrospective cohort study. Setting: Ontario, Canada. Patients: Recipients of deceased donor kidneys from January 1, 2005, to March 31, 2011...
2018: Canadian Journal of Kidney Health and Disease
Ngan N Lam, Krista L Lentine, Brenda Hemmelgarn, Scott Klarenbach, Robert R Quinn, Anita Lloyd, Sita Gourishankar, Amit X Garg
Background: Previous guidelines recommend that living kidney donors receive lifelong annual follow-up care to assess renal health. Objective: To determine whether these best practice recommendations are currently being followed. Design: Retrospective cohort study using linked health care databases. Setting: Alberta, Canada (2002-2014). Patients: Living kidney donors. Measurements: We determined the proportion of donors who had annual outpatient physician visits and laboratory measurements for serum creatinine and albuminuria...
2018: Canadian Journal of Kidney Health and Disease
Gihad E Nesrallah, Stephanie N Dixon, Marnie MacKinnon, Sarbjit Vanita Jassal, Sarah E Bota, Jade S Dirk, Erin Arthurs, Peter G Blake, Manish M Sood, Amit X Garg, Sara N Davison
Background: Many patients who receive chronic hemodialysis have a limited life expectancy comparable to that of patients with metastatic cancer. However, patterns of home palliative care use among patients receiving hemodialysis are unknown. Objectives: We aimed to undertake a current-state analysis to inform measurement and quality improvement in palliative service use in Ontario. Methods: We conducted a descriptive study of outcomes and home palliative care use by Ontario residents maintained on chronic dialysis using multiple provincial healthcare datasets...
2018: Canadian Journal of Kidney Health and Disease
Istvan Mucsi, Marta Novak, Deanna Toews, Amy Waterman
Purpose: In this article, we describe a province-wide collaborative project in which we adapted the Explore Transplant (ET) education program for use in Ontario, Canada, to develop Explore Transplant Ontario (ETO). Kidney transplantation (KT), especially living donor kidney transplantation (LDKT), is the best treatment for many patients with end-stage kidney disease (ESKD), with the best patient survival and quality of life and also reduced health care costs. Yet KT and LDKT are underutilized both internationally and in Canada...
2018: Canadian Journal of Kidney Health and Disease
Vinusha Kalatharan, Mathieu Lemaire, Matthew B Lanktree
Purpose of review: Genetic testing can improve diagnostic precision in some patients with end-stage renal disease (ESRD) providing the potential for targeted therapy and improved patient outcomes. We sought to describe the genetic architecture of ESRD and Canadian data sources available for further genetic investigation into ESRD. Sources of information: We performed PubMed searches of English, peer-reviewed articles using keywords "chronic kidney disease," "ESRD," "genetics," "sequencing," and "administrative databases," and searched for nephrology-related Mendelian diseases on the Online Mendelian Inheritance in Man database...
2018: Canadian Journal of Kidney Health and Disease
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2018: Canadian Journal of Kidney Health and Disease
R Todd Alexander, Eric McArthur, Racquel Jandoc, Blayne Welk, Daniel G Fuster, Amit X Garg, Robert R Quinn
Background: Thiazide diuretics are commonly prescribed to prevent kidney stones. However, it is unclear whether higher doses confer greater benefit. Objective: To determine whether lower doses of thiazide diuretics confer a similar protective effect against kidney stone events as higher doses. Design: Population-based cohort study. Setting: Linked health administrative databases in Ontario, Canada. Patients: Older adults newly prescribed a thiazide diuretic between 2003 and 2014 were separated into 2 groups based on daily dose: low dose (⩽12...
2018: Canadian Journal of Kidney Health and Disease
Maury Pinsk, Jolanta Karpinski, Euan Carlisle
Purpose of the review: The Royal College of Physicians and Surgeons of Canada, with its Competence by Design initiative, is adopting the principles of competency-based medical education for residency training and continuing professional development. This initiative is being undertaken to meet the new standards of medical education in Canada, which include social accountability to meet performance-based outcomes of training. Nephrology is poised to implement Competence by Design into residency training in July 2018 and initiate a continuous quality improvement cycle to periodically renew and update the training requirements to be socially accountable and relevant in the modern age of medicine...
2018: Canadian Journal of Kidney Health and Disease
Anne Tsampalieros, Greg A Knoll, Stephanie Dixon, Shane English, Douglas Manuel, Carl Van Walraven, Monica Taljaard, Dean Fergusson
Background: Significant variation in both patient case mix and the structure of care in kidney transplantation has been previously described in the United States. Objective: The objective of our study was to characterize patient case mix, patterns of care, and inpatient outcomes across 5 kidney transplant centers in the province of Ontario, Canada. Design: This was a retrospective population-based cohort study using health care administrative databases...
2018: Canadian Journal of Kidney Health and Disease
Tharshika Thangarasa, Rameez Imtiaz, Swapnil Hiremath, Deborah Zimmerman
Background: Exercise has been shown to be of benefit in the general population and in patients with chronic diseases. Despite a lack of compelling evidence, patients with end-stage kidney disease (ESKD) treated with peritoneal dialysis (PD) are often discouraged from participating in exercise programs that include weight lifting due to concerns about the development of hernias and leaks. The actual effects of physical activity with or without structured exercise programs for patients on PD remain unclear...
2018: Canadian Journal of Kidney Health and Disease
Nicola Schieda, Jason I Blaichman, Andreu F Costa, Rafael Glikstein, Casey Hurrell, Matthew James, Pejman Jabehdar Maralani, Wael Shabana, An Tang, Anne Tsampalieros, Christian B van der Pol, Swapnil Hiremath
Purpose of review: Use of gadolinium-based contrast agents (GBCA) in renal impairment is controversial, with physician and patient apprehension in acute kidney injury (AKI), chronic kidney disease (CKD), and dialysis because of concerns regarding nephrogenic systemic fibrosis (NSF). The position that GBCA are absolutely contraindicated in AKI, category G4 and G5 CKD (estimated glomerular filtration rate [eGFR] < 30 mL/min/1.73 m2 ), and dialysis-dependent patients is outdated and may limit access to clinically necessary contrast-enhanced magnetic resonance imaging (MRI) examinations...
2018: Canadian Journal of Kidney Health and Disease
Brandon Budhram, Ayub Akbari, Pierre Brown, Mohan Biyani, Gregory Knoll, Deborah Zimmerman, Cedric Edwards, Brendan McCormick, Ann Bugeja, Manish M Sood
Background: Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease, with afflicted patients often progressing to end-stage kidney disease (ESKD) requiring renal replacement therapy (RRT). As the timelines to ESKD are predictable over decades, it follows that ADPKD patients should be optimized regarding kidney transplantation, home dialysis therapies, and vascular access. Objectives: To examine the association of kidney transplantation, dialysis modalities, and vascular access in ADPKD patients compared with a matched, non-ADPKD cohort...
2018: Canadian Journal of Kidney Health and Disease
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