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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 30 mL/min/1.73 m2 ), and dialysis-dependent patients is outdated and may limit access to clinically necessary contrast-enhanced magnetic resonance imaging (MRI) examinations...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
David M Kepecs, Lauren Glick, Samuel A Silver, Darren A Yuen
Purpose of Review: One of the principal mechanisms by which illness can affect driving safety is by impairing cognition. Nevertheless, despite the substantial evidence demonstrating cognitive impairment in chronic kidney disease (CKD), little is known about the effects of CKD on driving safety. Objective: Investigate the current national medical guidelines and research literature with respect to CKD and driving safety. Sources of Information: Medline, CINAHL, PEDro, Scopus as of August 2017...
2018: Canadian Journal of Kidney Health and Disease
Amber O Molnar, Louise Moist, Scott Klarenbach, Jean-Philippe Lafrance, S Joseph Kim, Karthik Tennankore, Jeffrey Perl, Joanne Kappel, Michael Terner, Jagbir Gill, Manish M Sood
Background: Hospitalizations of chronic dialysis patients have not been previously studied at a national level in Canada. Understanding the scope and variables associated with hospitalizations will inform measures for improvement. Objective: To describe the risk of all-cause and infection-related hospitalizations in patients on dialysis. Design: Retrospective cohort study using health care administrative databases. Setting: Provinces and territories across Canada (excluding Manitoba and Quebec)...
2018: Canadian Journal of Kidney Health and Disease
Aminu K Bello, Christine M Ribic, Serge H Cournoyer, Mercedeh Kiaii, Martine LeBlanc, Melanie Poulin-Costello, David N Churchill, Norman Muirhead
Background: Several studies have demonstrated harm associated with using erythropoiesis-stimulating agents (ESA) to achieve higher hemoglobin (Hb) levels. Subsequently, more conservative use of ESAs has changed anemia therapy in patients with chronic renal failure. Objective: The objectives were to identify transfusion rates in hemodialysis (HD) patients during the first year of therapy, to identify factors associated with the probability of transfusion, describe reasons for the transfusions, and identify the Hb values associated with each transfusion...
2018: Canadian Journal of Kidney Health and Disease
Tahrin Mahmood, Robert Puckrin, Linda Sugar, David Naimark
Rationale: Staphylococcus-associated glomerulonephritis (SAGN) is a rare immune complex-mediated glomerulonephritis associated with active Staphylococcus infection. We report a case illustrating the importance of clinical history and kidney biopsy findings in establishing the correct diagnosis. Presenting concerns of the patient: We report the case of a 64-year-old man with alcohol-associated cirrhosis, type 2 diabetes mellitus, and hypertension who presented to hospital with lower back and abdominal pain, rectal bleeding, a purpuric lower extremity rash, and oliguric acute kidney injury with microscopic hematuria and nephrotic-range proteinuria...
2018: Canadian Journal of Kidney Health and Disease
Michael Bonert, Bradley A Saville
Kt/V is a nondimensional number and a scaling parameter that has, with arbitrary definitions, been recast as a measure of dialysis by Gotch and Lysaght. This editorial discusses the concept of nondimensional numbers within the context of dialysis measurement, modeling, and medical evidence. It concludes that Gotch's Kt/V, Lysaght's Kt/V, and standardized Kt/V are not well suited to measure dialysis. An ideal dialysis measure would be proportional to toxins cleared by the kidney, portable with regard to dialysis modality, practical (largely devoid of calculations) and reflective of the pathology/physiology...
2018: Canadian Journal of Kidney Health and Disease
Kevin Yau, Janine F Farragher, S Joseph Kim, Olusegun Famure, Sarbjit V Jassal
Background: Functional disability is defined as the need for assistance with self-care tasks. Objective: To document changes in functional status over time among older prevalent renal transplant recipients. Design: Single center, prospective, follow-up study. Setting: Single center, tertiary care transplant center. Patients: Patients, with a functioning kidney transplant, aged 65 years or older who underwent assessment of functional status approximately 12 months previously...
2018: Canadian Journal of Kidney Health and Disease
Maoliosa Donald, Sarah Gil, Bhavneet Kahlon, Heather Beanlands, Sharon Straus, Gwen Herrington, Braden Manns, Brenda R Hemmelgarn
Background: Chronic kidney disease (CKD) clinics across Canada provide tailored care for patients with CKD with an aim to slow progression and prevent complications. These clinics provide CKD self-management resources; however, there is limited information about what resources are being used by clinics. We undertook a survey of CKD clinics across Canada to identify self-management resources for adults aged 18 years and over with CKD categories 1 to 5 and not requiring dialysis or transplant...
2018: Canadian Journal of Kidney Health and Disease
Félix Rinfret, France Lambert, Joseph Tchetagni Youmbissi, Jean-François Arcand, Richard Turcot, Maral Alimardani Bessette, Solange Bourque, Vincent Moreau, Karine Tousignant, Diane Deschênes, Lyne Cloutier
Background: The implementation of advanced chronic kidney disease (CKD) multidisciplinary clinics has now demonstrated their effectiveness in delaying and even avoiding dialysis for patients with CKD. However, very little has been documented on the management and achievement of targets for a number of parameters in this context. Objective: Our goal was to assess our multidisciplinary clinic therapy performance in relation to the targets for hypertension, anemia, and calcium phosphate assessment...
2018: Canadian Journal of Kidney Health and Disease
Jason An, Branko Braam
Rationale: We hope to increase awareness that hypokalemic paralysis may be the first presentation of Sjögren syndrome, for which potassium-sparing diuretics can be an effective adjunct to potassium replenishment. Presenting concerns: A 73-year-old female presented to a peripheral hospital with quadriparesis and a critically low serum potassium of 1.6 mmol/L with U waves on the electrocardiogram (ECG). The initial arterial blood gas showed a pH of 7.19, bicarbonate of 13 mEq/L, and a CO2 of 35 mm Hg...
2018: Canadian Journal of Kidney Health and Disease
Ngan N Lam, Krista L Lentine, Scott Klarenbach, Manish M Sood, Paul J Kuwornu, Kyla L Naylor, Gregory A Knoll, S Joseph Kim, Ann Young, Amit X Garg
Background: Use of administrative data for outcomes assessment in living kidney donors is increasing given the rarity of complications and challenges with loss to follow-up. Objective: To assess the validity of living donor nephrectomy in health care administrative databases compared with the reference standard of manual chart review. Design: Retrospective cohort study. Setting: 5 major transplant centers in Ontario, Canada...
2018: Canadian Journal of Kidney Health and Disease
Michelle D Smekal, Helen Tam-Tham, Juli Finlay, Maoliosa Donald, Eleanor Benterud, Chandra Thomas, Robert R Quinn, Kin Tam, Braden J Manns, Marcello Tonelli, Aminu Bello, Navdeep Tangri, Brenda R Hemmelgarn
Background: The kidney failure risk equation (KFRE) provides an estimate of risk of progression to kidney failure, and may guide clinical care. Objective: We aimed to describe patient, family, and health care provider's perspectives of the perceived benefits and challenges of using a risk-based approach to guide care delivery for patients with advanced chronic kidney disease (CKD), and refine implementation based on their input. Methods: We used qualitative methodology to explore perceived benefits and challenges of implementing a risk-based approach (using the KFRE) to determine eligibility for multidisciplinary CKD care in Southern Alberta...
2018: Canadian Journal of Kidney Health and Disease
Erin Ready, Kseniya Chernushkin, Nilufar Partovi, Trana Hussaini, Cindy Luo, Olwyn Johnston, R Jean Shapiro
Background: Posttransplant lymphoproliferative disorder (PTLD) is a major complication following kidney transplantation. Objective: We undertook this study to characterize PTLD in kidney transplant patients in British Columbia with regard to incidence, patient and graft survival, histological subtypes, treatment modalities, and management of immunosuppression. Design: Retrospective cohort analysis. Setting: British Columbia...
2018: Canadian Journal of Kidney Health and Disease
Frank L Ward, Sheldon W Tobe, David M J Naimark
Background: The role of desmopressin (DDAVP) to prevent or treat rapid serum sodium concentration ([Na]s) correction during hyponatremia management remains unclear. Objective: To assess DDAVP use during the first 48 hours of severe, hypovolemic hyponatremia management. The primary study hypothesis was that the use of DDAVP would slow the rate of [Na]s correction compared with those not receiving DDAVP. Design: A retrospective, observational, comparison study...
2018: Canadian Journal of Kidney Health and Disease
Caren Rose, Yvonne Sun, Ed Ferre, John Gill, David Landsberg, Jagbir Gill
Background: The Kidney Donor Risk Index (KDRI) is a continuous measure of deceased donor kidney transplant failure risk that was derived in US patients based on 10 donor characteristics. In the United States, the KDRI is utilized to guide organ allocation and to inform clinical decisions regarding organ acceptance. Objective: To examine the application of the US-derived KDRI in a large Canadian province. Patients: All deceased donor kidney-only transplant recipients in British Columbia (BC) between 2005 and 2014...
2018: Canadian Journal of Kidney Health and Disease
Sean Barbour, Clifford Lo, Gabriela Espino-Hernandez, Jagbir Gill, Adeera Levin
Glomerulonephritis (GN) is a common cause of end-stage renal disease in Canada and worldwide, and results in significant health care resource utilization and patient morbidity. However, GN has not been a traditional priority of provincial renal health care organizations, despite the known benefits to health services delivery and patient outcomes from integrated provincial care in other types of chronic kidney disease. To address this deficiency, the British Columbia (BC) Provincial Renal Agency created the BC GN Network in 2013 to coordinate provincial GN health services delivery informed by robust population-level data capture on all GN patients in the province via the BC GN Registry...
2018: Canadian Journal of Kidney Health and Disease
Marisa Battistella, Racquel Jandoc, Jeremy Y Ng, Eric McArthur, Amit X Garg
Background: Hemodialysis patients are at an increased risk of polypharmacy as they have the highest pill burden of all chronically ill patient populations, with an estimated average of 12 medications per day. Objectives: The aim of this study was to evaluate prescribing patterns of outpatient medications in patients receiving in-center hemodialysis. This was done to identify potential candidate medications for future quality improvement initiations to optimize prescribing...
2018: Canadian Journal of Kidney Health and Disease
Giorgina B Piccoli, Mona Alrukhaimi, Zhi-Hong Liu, Elena Zakharova, Adeera Levin
Background: Chronic kidney disease affects approximately 10% of the world's adult population: It is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus giving an occasion to reflect on open questions on the importance of kidney health in women for the present and the future generations. Objectives: In this review, we summarize some aspects that are unique to women's kidney health, offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community, and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly...
2018: Canadian Journal of Kidney Health and Disease
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