Canadian Journal of Kidney Health and Disease最新文献

Purpose of program: The best treatment option for most patients with kidney failure is a transplant from a living kidney donor, yet multiple barriers prevent most patients from receiving one. The Living Donor Kidney Transplantation project within the Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD) Network aims to improve access to living donor kidney transplantation across Ontario and beyond by enhancing our understanding of the living kidney donor and kidney transplant processes and by implementing and evaluating patient-informed, evidence-based solutions.

Sources of information: To achieve our goal of improving access to living donor kidney transplantation, our research draws on multiple sources, including (1) insights from patients, health care professionals, provincial and national kidney agencies, and researchers; (2) Ontario's administrative health care databases; (3) clinical trials; and (4) qualitative methodology (surveys, interviews, consensus meetings, Delphi process).

Methods: Our research activities in Phase 2 (2022-2026) focus on four key projects:(1) High-quality living kidney donor evaluation: A national consensus conference to define a high-quality living kidney donor evaluation and associated metrics.(2) One-day donor assessment clinic: A streamlined donor evaluation clinic to improve the efficiency of the living kidney donor evaluation.(3) Transplant Ambassador Program: A peer-support program led by patient volunteers to support patients with kidney failure and living kidney donors.(4) Collaboration and equitable access to transplant: Collaboration with patients, health care professionals, and health system leaders to develop, implement, and evaluate solutions with a focus on equity.

Key findings: Engaging with patients and knowledge users at every stage of our research has enabled the creation of high-quality research, resulting in actionable change. Our work has established 35 national consensus standards for a high-quality living kidney donor evaluation, demonstrated the scalability of a one-day living kidney donor evaluation clinic, expanded a peer-support program, and developed strong system partnerships.

Limitations: Our work has primarily focused on improving access to living donor kidney transplantation in the province of Ontario. Equitable access to living donor kidney transplants remains a challenge, which we plan to continue focusing on in future iterations of our work.

Implications: Our work highlights the vital role of patient-oriented research and the importance of involving patient volunteers in enhancing access to living kidney donation. Together, we remain committed to creating a Canadian system where everyone who needs a living donor kidney transplant can receive one fairly and without delay.

Introduction: People with hemodialysis-dependent kidney failure experience significantly higher cardiovascular (CV) morbidity, mortality, symptom burden, and cognitive impairment compared to the general population. Hemodialysis-induced ischemia contributes to myocardial stunning, which worsens CV outcomes. Intradialytic cycling has the potential to mitigate cardiac stunning, but its effects have not been assessed in randomized controlled trials (RCTs).

Methods: This multicenter RCT evaluates the impact of 12 weeks of intradialytic cycling on hemodialysis-induced myocardial stunning. The study will recruit 160 adults (80 intervention and 80 control) receiving maintenance hemodialysis at five Canadian centers and one Australian center. Outcome assessments are conducted at baseline, 12 weeks, and 16 weeks. An intervention implementation process evaluation is part of this study.

Outcomes: The primary outcome is change in number of regional wall motion abnormalities (RWMAs) at peak hemodialysis stress from baseline to 12 weeks. Secondary outcomes include changes in cognitive function, hemodialysis recovery time, and symptom burden.

Statistical analysis: Change in number of RWMAs at peak hemodialysis stress from baseline to 12 weeks are compared between study groups using an independent 2-tailed t test and using a Poisson generalized linear mixed model with study group as a fixed effect, and time and mean ultrafiltration rate as random effects.

Conclusion: Compared with standard care, we anticipate that intradialytic cycling will decrease myocardial stunning, resulting in improved symptom burden, and functional and cognitive status. This trial provides critical evidence regarding the benefits and feasibility of exercise during hemodialysis, potentially informing clinical practice, and guidelines for hemodialysis care.Trial registration number: NCT04877041.

Background: Kidney transplantation, a life-saving therapy for children with kidney disease, remains challenging to navigate for patients and families.

Objective: To elucidate the experiences and educational needs of patients who have received a kidney transplant and their caregivers.

Design: Qualitative descriptive study.

Setting: One province in Canada (Saskatchewan).

Patients: Patients who received a pediatric kidney transplant, transplant recipients and caregivers.

Methods: Semi-structured interviews were conducted via video or by phone and recorded and transcribed verbatim in this qualitative descriptive study. Qualitative content analysis was used to analyze the data. Decontextualization involved an inductive approach, whereby the text was coded and organized into categories and subcategories. Dedoose^® software was used to facilitate this process.

Results: Twenty-three individuals participated, including 13 caregivers (aging in range from 20's to 60's) and 10 patients who had previously received a transplant (aging in range from adolescents to 40's). Three categories emerged from their experiences: (1) the impact of the transplant on the individual (subcategories social, mental health, physical, lifestyle, returning to normal and new life perspective); (2) transplant expectations (transplant as a cure, unexpected experiences); and (3) the need for support throughout the transplant process (practical support, mental health support, healthcare support, support through shared-lived experiences, and challenges related to finding a community). Regarding education, participants identified the need for personalized, age-appropriate education delivered in digestible formats, with clear expectations, timely reinforcement, and emotional support tailored to both patients and caregivers.

Limitations: Participants were recruited from a single small center in Canada. Patient participants had received their transplant at least 5 years prior to participation in the study and were reflecting on their past experiences.

Conclusion: Feeling prepared for the transplant journey impacts the transplant experience and kidney transplant education can facilitate care and clarify expectations. The insights gathered from the study will help inform the development of educational resources for patients and caregivers.

Background: In 2022, we implemented an incremental hemodialysis (iHD) protocol to initiate twice-weekly treatment for eligible patients. This patient-centered approach aims to ease the transition to dialysis and enhance quality of life. However, limited data exists on how iHD is experienced by patients and health care providers (HCPs).

Objective: The aim of the study was to explore the benefits and challenges of iHD from patients' and HCPs' perspectives, and to generate practical considerations for its implementation.

Study design: We conducted an exploratory descriptive qualitative study, guided by an interpretivist-constructivist paradigm, using semi-structured interviews (March-May 2024).

Setting: The study was conducted in a tertiary care center.

Participants: Participants included patients who were actively or had previously received iHD and HCPs caring for iHD patients.

Methods: Interview data was analyzed thematically using inductive thematic analysis.

Results: Ten patients and five HCPs were interviewed. Six major themes were identified: (1) better quality of life than conventional hemodialysis, (2) travel and financial benefits, (3) psychosocial and emotional impact similar to conventional hemodialysis, (4) coordination of care and logistics, (5) knowledge and training challenges, and (6) challenges when switching modality. Patients preferred iHD because it afforded them more time for participation in daily life activities. However, the start of a dialysis treatment remained "traumatic" for some patients. While HCPs recognized the greater quality of life for iHD patients, HCPs expressed a need for increased monitoring to ensure adequate care. Patients noticed an inconsistency in care coordination and reduced opportunities to see nephrologists. Some HCPs reported a lack of guidance on iHD. Finally, HCPs observed patients negotiating to stay on iHD even when it became unsafe.

Limitations: The small sample size and single-center setting may limit the findings' transferability.

Conclusions: IHD was shown to offer quality of life advantages. However, the transition to iHD remained emotionally challenging for patients. Patients often exhibited resistance when moving from twice-weekly to a thrice-weekly schedule. Logistical issues for HCPs and educational barriers must be addressed to optimize delivery of iHD.

We report a case of biopsy-proven renal cortical necrosis in a 42-year-old man after bioprosthetic aortic valve replacement despite prophylactic anticoagulation. He had antiphospholipid syndrome with chronic thrombotic microangiopathy and triple-positive antibodies, leading to renal cortical necrosis manifested as severe non-reversible dialysis-dependent acute kidney injury. We identified 13 previously published reports of renal cortical necrosis due to antiphospholipid syndrome: 3 occurred postpartum, 2 after kidney transplantation, and 1 following salpingectomy for ectopic pregnancy.

Purpose of program: In 2021, the Canadian Society of Nephrology (CSN) sent a needs assessment survey to nephrology residents, fellows, and program directors that identified a significant gap in Quality Improvement (QI) training. In response, the CSN's Quality Improvement and Implementation Science (CSN-QUIS) committee launched a national nephrology fellow QI curriculum in 2022.

Methods: The program integrates online learning with interactive virtual didactic sessions, including participation in a longitudinal QI project that is presented at the CSN Annual General Meeting (CSN AGM).

Key findings: Since inception, the program has expanded to 13 nephrology training programs, including both adult and pediatric sites. Forty-one fellows have completed the full curriculum, with 76 trainees having completed at least one year and presented work at the CSN AGM. Feedback from participants has been overwhelmingly positive, particularly regarding the interactive format, real-world applicability, and national networking opportunities. Continuous fine-tuning of the curriculum itself has occurred in parallel with refinements made to session content, project scheduling, and presentation format based on learner input.

Limitations: Barriers such as limited local QI mentorship have been mitigated through virtual faculty pairing, and resources such as software access and publication support have been provided to encourage project success.

Implications: Herein, we report the development and initial experience of this national initiative, demonstrating that a structured, collaborative, and distributed QI curriculum is feasible, effective, and scalable across Canada.