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Home Sweet Home: A Program Report on Promoting the Uptake of Home Dialysis. 甜蜜之家:促进家庭透析吸收的计划报告。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2025-01-10 eCollection Date: 2025-01-01 DOI: 10.1177/20543581241312625
Lucas James Churchill, Frances Reintjes, Robert Pauly, Nikhil Shah, Stephanie Thompson
<p><strong>Purpose of program: </strong>Canada's growing prevalence of people with kidney failure receiving kidney replacement therapy has necessitated the expansion of dialysis programs. Although facility-based hemodialysis is the predominant dialysis modality in Canada, it is substantially costlier than home dialysis (peritoneal or home hemodialysis). Initiatives to increase the uptake of home dialysis typically consist of didactic and experiential education. We describe a novel local initiative, Home Sweet Home (HSH), where individuals with lived experience of home dialysis and kidney health professionals share their experience and knowledge with participants in a clinic setting that has been set up to represent a metaphorical home. The aim of this report is to describe our HSH program and to evaluate its acceptability and reach for future scale and spread. We also explored home dialysis uptake among program participants.</p><p><strong>Sources of information: </strong>We collected feedback from attendees following each HSH event with anonymized surveys. We obtained clinical and demographic data and modality at follow-up from 2 linked databases, the Canadian Organ Replacement Register (CORR) and a regional clinical database, the Nephrology Information System (NIS).</p><p><strong>Methods: </strong>Reach was evaluated according to modality (i.e., the proportion of participants who were non-dialysis dependent vs the proportion receiving facility-based maintenance hemodialysis) and the proportion living remotely (defined as greater than 200 km from the event). We examined acceptability as the proportion who were interested in a home therapy (either peritoneal dialysis, home hemodialysis, or both) after attending the event. Demographic data and survey data were summarized with counts and percentages. Free text from surveys was collated and summarized. Participants were followed from the time of program attendance until June 21, 2022 or death.</p><p><strong>Key findings: </strong>A total of 291 participants attended HSH between 2015 and 2019. At the time of program attendance, 70% of participants had chronic kidney disease (CKD) not requiring dialysis (CKD G4-5ND) and 30% had CKD G5D on facility-based maintenance hemodialysis. Participants were primarily urban dwelling (ie, in Edmonton). After the event, 92% of participants indicated they were interested in a home dialysis modality. From the survey free text, participants commonly expressed that they valued the "first-hand information" and a "real life perspective" from HSH facilitators and the simulation helped to ease anxiety about home dialysis. Participants expressed a desire for longer HSH events with more opportunities to ask questions. At a median follow-up of 858 days (interquartile range = 353-1347), 18% of the cohort remained dialysis independent and 25% died. Of the remaining 167 participants, N = 41 (25%) were receiving a home dialysis modality (either peritoneal dialysis or home hemodial
项目目的:加拿大越来越多的肾衰竭患者接受肾脏替代疗法,这使得扩大透析项目成为必要。虽然以设施为基础的血液透析是加拿大主要的透析方式,但它比家庭透析(腹膜或家庭血液透析)昂贵得多。提高家庭透析使用率的举措通常包括教学和体验式教育。我们描述了一个新颖的地方倡议,家庭甜蜜之家(HSH),在这里,有家庭透析生活经验的个人和肾脏健康专业人员与诊所设置的参与者分享他们的经验和知识,这个诊所设置代表了一个隐喻的家。本报告的目的是描述我们的HSH计划,并评估其可接受性和达到未来的规模和传播。我们还探讨了项目参与者的家庭透析吸收情况。信息来源:我们在每次HSH活动后通过匿名调查收集与会者的反馈。我们从加拿大器官替代登记(CORR)和区域临床数据库肾脏病信息系统(NIS)两个相关数据库中获得临床和人口统计数据和随访模式。方法:根据模式(即非透析依赖者的比例与接受基于设施的维持性血液透析的比例)和居住在偏远地区的比例(定义为距离事件超过200公里)来评估Reach。我们检查了参加活动后对家庭治疗(腹膜透析、家庭血液透析或两者)感兴趣的比例的可接受性。人口统计数据和调查数据以计数和百分比汇总。来自调查的免费文本被整理和总结。参与者从参加节目开始一直跟踪到2022年6月21日或死亡。主要发现:2015年至2019年期间,共有291名参与者参加了HSH。在参加项目时,70%的参与者患有不需要透析的慢性肾病(CKD) (CKD G4-5ND), 30%的参与者患有基于设施的维持性血液透析的CKD G5D。参与者主要居住在城市(即埃德蒙顿)。活动结束后,92%的参与者表示他们对家庭透析方式感兴趣。从调查的免费文本中,参与者普遍表示他们重视HSH调解员的“第一手信息”和“真实生活视角”,模拟有助于缓解对家庭透析的焦虑。与会者表示希望举办更长时间的HSH活动,并有更多机会提问。在中位随访858天(四分位数范围= 353-1347)时,18%的队列患者保持独立透析,25%的患者死亡。在其余167名参与者中,N = 41(25%)接受了家庭透析方式(腹膜透析或家庭血液透析),N = 40(24%)接受了肾移植,N = 86(51%)接受了基于设施的血液透析。局限性:通过访谈和焦点小组可以更深入地了解HSH计划如何影响家庭透析的决策。对于家庭治疗和HSH出勤率没有因果关系。我们没有关于在最后一次记录的随访方式之前谁接受了家庭治疗的数据,这可能低估了家庭治疗的使用。启示:HSH项目是高度可接受的,92%的参与者报告他们对家庭方式感兴趣。通过从血透机构和农村及偏远地区招募更多的人,HSH的覆盖范围可以得到改善。
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引用次数: 0
Definitions of Hemodynamic Instability Related to Renal Replacement Therapy in Critically Ill Patients: A Systematic Review Protocol. 危重患者肾替代治疗相关血流动力学不稳定的定义:一项系统评价方案。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2025-01-07 eCollection Date: 2025-01-01 DOI: 10.1177/20543581241312631
Jean Zhuo Wang, Lindsey Sikora, Peter Farrell, Swapnil Hiremath, Edward G Clark
<p><strong>Background: </strong>Hemodynamic instability related to renal replacement therapy (HIRRT) is a common complication affecting critically ill patients that require renal replacement therapy (RRT). There is currently no consensus regarding the definition of HIRRT in critically ill patients. In this context, the impacts of HIRRT on clinical outcomes such as mortality or renal recovery in critically ill patients are unclear.</p><p><strong>Objective: </strong>The primary objective of this proposed systematic review is to evaluate the association between HIRRT and clinical outcomes, as reported within randomized control trials in the literature. The secondary objective of this systematic review is to compare rates of HIRRT, according to various definitions used by randomized controlled trials, across different RRT modalities used to treat critically ill patients, with the goal of paving the way toward a common definition of HIRRT for future research.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Measurements: </strong>The rates of HIRRT, mortality, and renal recovery will be reported according to each definition of HIRRT.</p><p><strong>Patients: </strong>Critically-ill adults with acute kidney injury admitted to intensive care units.</p><p><strong>Methods: </strong>The search strategy will be developed to identify articles in Medline, MEDLINE In-Process, EMBASE, and Cochrane CENTRAL Registry. We will include randomized control trials examining renal replacement therapy in critically ill patients. This will include intermittent hemodialysis (iHD), all forms of prolonged intermittent RRT (PIRRT), and continuous renal replacement therapy (CRRT). Only articles that report a definition of HIRRT and the rates of HIRRT will be included in our analysis. Two reviewers will independently screen all articles for inclusion and exclusion. Data extraction and quality assessment will be also performed in duplicate. All disagreements will be resolved through discussion or a third reviewer.</p><p><strong>Limitations: </strong>The heterogeneity in the definitions of HIRRT and outcome reporting may limit the ability to perform meta-analysis and perform comparisons in the rates of HIRRT between RRT modalities.</p><p><strong>Conclusions: </strong>This systematic review aims to assess the association between HIRRT and important clinical outcomes. In doing so, we will identify definitions of HIRRT within the current literature and the rates of HIRRT associated with these definitions. HIRRT can result in early discontinuation of dialysis, organ injury from hypoperfusion, and may negatively impact mortality and renal recovery in critically ill patients. This systematic review will synthesize the impact and frequency of HIRRT reported in the literature and, in doing so, may help determine the extent to which common definitions of HIRRT might be recommended for standardized use in future research related to HIRRT.</p><p><strong>Syste
背景:肾替代治疗(hrrt)相关血流动力学不稳定是影响需要肾替代治疗(RRT)的危重患者的常见并发症。目前对于危重患者hrt的定义尚无共识。在这种情况下,hrt对危重患者的临床结果,如死亡率或肾脏恢复的影响尚不清楚。目的:本系统综述的主要目的是评估文献中随机对照试验中报道的hrrt与临床结果之间的关系。本系统综述的次要目的是根据随机对照试验中使用的各种定义,比较用于治疗危重患者的不同RRT模式下的hirt率,目的是为未来研究中hirt的共同定义铺平道路。设计:系统回顾和荟萃分析。测量方法:将根据hrt的每个定义报告hrt的比率、死亡率和肾脏恢复。患者:重症监护病房的急性肾损伤危重成人。方法:将制定搜索策略来识别Medline、Medline in - process、EMBASE和Cochrane CENTRAL Registry中的文章。我们将纳入随机对照试验,检查危重患者的肾脏替代疗法。这将包括间歇性血液透析(iHD),所有形式的延长间歇性RRT (PIRRT)和持续肾脏替代治疗(CRRT)。只有报告了hrt定义和hrt发生率的文章才会被纳入我们的分析。两名审稿人将独立筛选所有文章的纳入和排除。数据提取和质量评估也将一式两份进行。所有分歧将通过讨论或第三方审稿人解决。局限性:hrt定义和结果报告的异质性可能会限制进行荟萃分析和在不同RRT方式之间进行hrt率比较的能力。结论:本系统综述旨在评估hrrt与重要临床结果之间的关系。在此过程中,我们将确定当前文献中hirt的定义以及与这些定义相关的hirt发生率。hrt可导致早期停止透析,低灌注造成器官损伤,并可能对危重患者的死亡率和肾脏恢复产生负面影响。这一系统综述将综合文献中报道的hrt的影响和频率,这样做可能有助于确定在何种程度上推荐hrt的共同定义,以便在未来与hrt相关的研究中标准化使用。系统评价注册:PROSPERO注册号:CRD42023396550。
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引用次数: 0
Patient, Caregiver, and Provider Perspectives on Improving Provider-Patient Interactions in Hemodialysis: A Qualitative Study. 改善血液透析中医患互动的患者、护理者和提供者观点:一项定性研究。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2025-01-03 eCollection Date: 2025-01-01 DOI: 10.1177/20543581241309986
Melanie D Talson, Priscila Ferreira da Silva, Juli Finlay, Krista Rossum, Kaytlynn V Soroka, Michael McCormick, Arlene Desjarlais, Hans Vorster, Rachelle Sass, Matthew James, Manish M Sood, Allison Jaure, Neesh Pannu, Karthik Tennankore, Stephanie Thompson, Marcello Tonelli, Clara Bohm

Background: Improving interactions between people receiving hemodialysis and health care providers of facility-based hemodialysis care is a top priority for patients, caregivers, and health care providers.

Objective: To identify challenges for high-quality clinical interactions in facility-based hemodialysis care as well as potential solutions.

Design: Multicentre qualitative study using focus groups and semi-structured interviews to elicit the perspectives of patients, caregivers, and health care providers.

Setting: Five Canadian facility-based hemodialysis centers.

Participants: English-speaking adults receiving facility-based hemodialysis for longer than 6 months, their caregivers, and hemodialysis health care providers.

Methods: Between May 2017 and August 2018, focus groups and interviews with patients and their caregivers subsequently informed semi-structured interviews with providers. Data were analyzed using inductive thematic analysis with application of a grounded theory approach.

Results: A total of 8 focus groups and 44 interviews were completed. Participants included 64 people receiving hemodialysis, 18 caregivers, and 31 health care providers. Communication between health care providers and patients was often characterized as intersections of care (unidirectional) rather than interactions (bidirectional). Challenges were grouped into 4 main themes as follows: (1) culture of care provision; (2) mistrust between patients and health care providers; (3) time constraints for clinical interactions, and (4) lack of collaboration and care coordination among health care team. Potential solutions were identified for each challenge.

Limitations: Findings were limited to Canadian context, English-speaking adults, and individuals receiving facility-based hemodialysis in urban centers.

Conclusions: Interactions between health care providers and people receiving dialysis are often unidirectional, where the patient is a passive recipient of ideas and information from the health care provider. To promote improved bidirectional interactions, team-based care that includes better tools to improve information transfer, better information regarding roles, and identity of health care team members and opportunities for all members of the health care team, including the people receiving dialysis, to provide input on care plans is required.

Trial registration: Not applicable.

背景:改善接受血液透析的人与以设施为基础的血液透析护理的卫生保健提供者之间的互动是患者、护理人员和卫生保健提供者的首要任务。目的:确定在以设施为基础的血液透析护理中高质量临床互动的挑战以及潜在的解决方案。设计:采用焦点小组和半结构化访谈的多中心定性研究,以引出患者、护理人员和卫生保健提供者的观点。环境:五个加拿大血透中心。参与者:接受血透治疗超过6个月的英语成年人、他们的护理人员和血透保健提供者。方法:在2017年5月至2018年8月期间,对患者及其护理人员进行焦点小组和访谈,随后对提供者进行半结构化访谈。数据分析采用归纳主题分析与扎根理论的应用方法。结果:共完成8个焦点小组和44个访谈。参与者包括64名接受血液透析的人,18名护理人员和31名卫生保健提供者。卫生保健提供者和患者之间的沟通通常被描述为护理的交叉点(单向),而不是相互作用(双向)。挑战分为以下4个主题:(1)护理文化;(2)患者与医护人员之间的不信任;(3)临床互动的时间限制;(4)卫生保健团队之间缺乏协作和护理协调。针对每个挑战确定了可能的解决方案。局限性:研究结果仅限于加拿大背景、讲英语的成年人和在城市中心接受基于设施的血液透析的个人。结论:卫生保健提供者和接受透析的人之间的互动往往是单向的,病人是一个被动的接受者,从卫生保健提供者的想法和信息。为了促进改进的双向互动,需要以团队为基础的护理,包括更好的工具来改进信息传递,更好地了解保健团队成员的角色和身份,并为保健团队的所有成员(包括接受透析的人)提供机会,为护理计划提供投入。试验注册:不适用。
{"title":"Patient, Caregiver, and Provider Perspectives on Improving Provider-Patient Interactions in Hemodialysis: A Qualitative Study.","authors":"Melanie D Talson, Priscila Ferreira da Silva, Juli Finlay, Krista Rossum, Kaytlynn V Soroka, Michael McCormick, Arlene Desjarlais, Hans Vorster, Rachelle Sass, Matthew James, Manish M Sood, Allison Jaure, Neesh Pannu, Karthik Tennankore, Stephanie Thompson, Marcello Tonelli, Clara Bohm","doi":"10.1177/20543581241309986","DOIUrl":"https://doi.org/10.1177/20543581241309986","url":null,"abstract":"<p><strong>Background: </strong>Improving interactions between people receiving hemodialysis and health care providers of facility-based hemodialysis care is a top priority for patients, caregivers, and health care providers.</p><p><strong>Objective: </strong>To identify challenges for high-quality clinical interactions in facility-based hemodialysis care as well as potential solutions.</p><p><strong>Design: </strong>Multicentre qualitative study using focus groups and semi-structured interviews to elicit the perspectives of patients, caregivers, and health care providers.</p><p><strong>Setting: </strong>Five Canadian facility-based hemodialysis centers.</p><p><strong>Participants: </strong>English-speaking adults receiving facility-based hemodialysis for longer than 6 months, their caregivers, and hemodialysis health care providers.</p><p><strong>Methods: </strong>Between May 2017 and August 2018, focus groups and interviews with patients and their caregivers subsequently informed semi-structured interviews with providers. Data were analyzed using inductive thematic analysis with application of a grounded theory approach.</p><p><strong>Results: </strong>A total of 8 focus groups and 44 interviews were completed. Participants included 64 people receiving hemodialysis, 18 caregivers, and 31 health care providers. Communication between health care providers and patients was often characterized as <i>intersections</i> of care (unidirectional) rather than <i>interactions</i> (bidirectional). Challenges were grouped into 4 main themes as follows: (1) culture of care provision; (2) mistrust between patients and health care providers; (3) time constraints for clinical interactions, and (4) lack of collaboration and care coordination among health care team. Potential solutions were identified for each challenge.</p><p><strong>Limitations: </strong>Findings were limited to Canadian context, English-speaking adults, and individuals receiving facility-based hemodialysis in urban centers.</p><p><strong>Conclusions: </strong>Interactions between health care providers and people receiving dialysis are often unidirectional, where the patient is a passive recipient of ideas and information from the health care provider. To promote improved bidirectional interactions, team-based care that includes better tools to improve information transfer, better information regarding roles, and identity of health care team members and opportunities for all members of the health care team, including the people receiving dialysis, to provide input on care plans is required.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581241309986"},"PeriodicalIF":1.6,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11696963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Case Series of Infection-Related Glomerulonephritis in Quebec Indigenous Peoples. 魁北克原住民感染相关肾小球肾炎病例系列。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-12-25 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241309977
Thomas Nodzynski, Zahra Sohani, Ajay Rajaram, Pierre Olivier Fiset, Chantal Bernard, Murray Vasilevsky, Catherine Weber

Rationale: Infection-related glomerulonephritis (IRGN) is an immune-mediated glomerulonephritis caused by extra-renal infectious diseases. There has been an important shift in epidemiology in recent years, with a significant proportion of adults affected. The incidence of IRGN is higher amongst Indigenous populations and especially in those with multiple comorbidities. Beginning in 2019, we observed several IRGN cases amongst adult Indigenous peoples referred to the McGill University Health Center (MUHC). The aim of this article is to describe the demographic, clinical, and outcome data of these individuals and highlight the heterogeneity of IRGN in this population through 2 illustrative cases.

Presenting concerns of the patient: In total, 8 cases of IRGN were identified between 2019 and 2022. All patients presented with features of acute glomerulonephritis.

Diagnoses: All patients had documented evidence of an infection that preceded their diagnosis of IRGN. IRGN was not the initial clinical diagnosis in all cases.

Interventions: Half the patients received immunosuppression while the others received supportive care only.

Outcomes: Four patients required initiation of hemodialysis at time of presentation and at 2 years of follow-up, 3 of the 4 remained hemodialysis-dependent.

Teaching points: Our case series emphasizes the heterogenous clinical, laboratory, and pathological presentations that make the diagnosis of IRGN quite challenging. A high index of suspicion should be present when a patient presents with acute kidney injury, features of a glomerulonephritis, and an infection, especially those with multiple comorbidities and a preceding history of chronic kidney disease.

理由:感染相关性肾小球肾炎(IRGN)是由肾外感染性疾病引起的免疫介导的肾小球肾炎。近年来,该病的流行病学发生了重大变化,相当一部分成年人也受到了影响。IRGN在土著人群中发病率较高,尤其是在患有多种并发症的人群中。从2019年开始,我们在转诊至麦吉尔大学健康中心(MUHC)的成年原住民中发现了几例IRGN病例。本文旨在描述这些人的人口统计学、临床和结果数据,并通过 2 个说明性病例强调 IRGN 在该人群中的异质性:在2019年至2022年期间,共发现了8例IRGN病例。所有患者均表现为急性肾小球肾炎:所有患者在确诊 IRGN 之前都有感染的记录证据。IRGN并非所有病例的最初临床诊断:干预措施:半数患者接受免疫抑制治疗,其他患者仅接受支持治疗:四名患者在发病时需要进行血液透析,随访两年后,四名患者中有三人仍需依赖血液透析:我们的系列病例强调了不同的临床、实验室和病理表现,这使得IRGN的诊断颇具挑战性。当患者出现急性肾损伤、肾小球肾炎特征和感染时,尤其是合并多种疾病和既往有慢性肾脏病史的患者,应高度怀疑IRGN。
{"title":"Case Series of Infection-Related Glomerulonephritis in Quebec Indigenous Peoples.","authors":"Thomas Nodzynski, Zahra Sohani, Ajay Rajaram, Pierre Olivier Fiset, Chantal Bernard, Murray Vasilevsky, Catherine Weber","doi":"10.1177/20543581241309977","DOIUrl":"10.1177/20543581241309977","url":null,"abstract":"<p><strong>Rationale: </strong>Infection-related glomerulonephritis (IRGN) is an immune-mediated glomerulonephritis caused by extra-renal infectious diseases. There has been an important shift in epidemiology in recent years, with a significant proportion of adults affected. The incidence of IRGN is higher amongst Indigenous populations and especially in those with multiple comorbidities. Beginning in 2019, we observed several IRGN cases amongst adult Indigenous peoples referred to the McGill University Health Center (MUHC). The aim of this article is to describe the demographic, clinical, and outcome data of these individuals and highlight the heterogeneity of IRGN in this population through 2 illustrative cases.</p><p><strong>Presenting concerns of the patient: </strong>In total, 8 cases of IRGN were identified between 2019 and 2022. All patients presented with features of acute glomerulonephritis.</p><p><strong>Diagnoses: </strong>All patients had documented evidence of an infection that preceded their diagnosis of IRGN. IRGN was not the initial clinical diagnosis in all cases.</p><p><strong>Interventions: </strong>Half the patients received immunosuppression while the others received supportive care only.</p><p><strong>Outcomes: </strong>Four patients required initiation of hemodialysis at time of presentation and at 2 years of follow-up, 3 of the 4 remained hemodialysis-dependent.</p><p><strong>Teaching points: </strong>Our case series emphasizes the heterogenous clinical, laboratory, and pathological presentations that make the diagnosis of IRGN quite challenging. A high index of suspicion should be present when a patient presents with acute kidney injury, features of a glomerulonephritis, and an infection, especially those with multiple comorbidities and a preceding history of chronic kidney disease.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241309977"},"PeriodicalIF":1.6,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Outcomes Using a Standardized Provincial Childhood Nephrotic Syndrome Clinical Pathway. 使用标准化省级儿童肾病综合征临床路径的结果。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-12-25 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241304505
Laura H Kim, Marisa Catapang, Nonnie Polderman, Robert Humphreys, Cherry Mammen, Eleonora Jugnauth, Douglas G Matsell

Background: In 2013, the British Columbia (BC) Childhood Nephrotic Syndrome Clinical Pathway (CNSCP) was developed to standardize the care of children with nephrotic syndrome (NS). In BC, children access nephrology care at BC Children's Hospital (BCCH) and multiple regional clinics.

Objective: The primary objective was to compare induction therapy and clinical outcomes between BCCH and regional clinics since implementation of the CNSCP.

Design setting and patients: This was a retrospective cohort study of children with NS in BC.

Measurements and methods: We conducted a retrospective cohort study of children 1 to 17 years old with new-onset NS from 2013 to 2019 inclusive with minimum 12 months of follow-up. Children with non-minimal change disease, steroid resistance, incomplete induction therapy, or less than 6 months of pathway treatment within their first year post-diagnosis were excluded. Clinics were categorized as BCCH or regional (Surrey, Prince George, or Kelowna).

Results: Sixty-nine patients were included, with 52 (75%) at BCCH and 17 (25%) at regional clinics. There were no significant between-group differences in age, sex, or clinical characteristics at time of diagnosis. Comparing BCCH and regional clinics, there was no difference in induction prednisone exposure (median 3400, interquartile range [IQR] 3331-3585 mg/m2 vs 3492, IQR 3397-3644 mg/m2, P = .167), annualized relapse rate (median 3.3, IQR 1.1-5.3 vs 2.3, IQR 0.5-4.2, P = .575), or development of frequently relapsing courses (50% vs 62%, P = .475). There was a similar number of first-year clinic visits (4.2 ± 1.2 vs 4.0 ± 1.8, P = .655) and dietitian-reviewed food records (67% vs 47%, P = .135, BCCH vs regional). More children at BCCH had a recommended ophthalmology surveillance visit (87% vs 59%, P = .01, BCCH vs regional).

Limitations: Study limitations include small sample size and exclusion of children with complicated NS (ie, relapse during induction, steroid resistance).

Conclusion: Since we implemented the CNSCP, children with NS received comparable care and had similar outcomes at BCCH and regional clinics without significant practice variation.

背景:2013年,不列颠哥伦比亚省(BC)制定了儿童肾病综合征临床路径(CNSCP),以规范儿童肾病综合征(NS)的护理。在不列颠哥伦比亚省,儿童可以在不列颠哥伦比亚省儿童医院(BCCH)和多个地区诊所接受肾脏病治疗。目的:主要目的是比较自CNSCP实施以来,BCCH和区域诊所的诱导治疗和临床结果。设计环境和患者:这是一项针对不列颠哥伦比亚省NS患儿的回顾性队列研究。测量和方法:我们对2013年至2019年1至17岁新发NS患儿进行了回顾性队列研究,随访时间至少为12个月。排除非最小变化疾病、类固醇抵抗、不完全诱导治疗或诊断后一年内途径治疗少于6个月的儿童。诊所被分类为BCCH或区域(萨里、乔治王子或基洛纳)。结果:纳入69例患者,其中52例(75%)在BCCH就诊,17例(25%)在区域诊所就诊。在年龄、性别或诊断时的临床特征方面,组间无显著差异。比较BCCH和区域诊所,诱导强尼松暴露(中位数3400,四分位数范围[IQR] 3331-3585 mg/m2 vs 3492, IQR 3397-3644 mg/m2, P = 0.167),年复发率(中位数3.3,IQR 1.1-5.3 vs 2.3, IQR 0.5-4.2, P = 0.575),或频繁复发病程的发展(50% vs 62%, P = 0.475)无差异。第一年的就诊次数(4.2±1.2 vs 4.0±1.8,P = 0.655)和营养师评价的饮食记录(67% vs 47%, P = 0.135, BCCH vs地区)相似。更多的儿童在BCCH接受推荐的眼科监测访问(87% vs 59%, P = 0.01, BCCH vs地区)。局限性:研究的局限性包括样本量小,排除了患有复杂NS的儿童(即诱导期间复发,类固醇抵抗)。结论:自我们实施CNSCP以来,患有NS的儿童在BCCH和区域诊所获得了相当的护理和相似的结果,没有明显的实践差异。
{"title":"Outcomes Using a Standardized Provincial Childhood Nephrotic Syndrome Clinical Pathway.","authors":"Laura H Kim, Marisa Catapang, Nonnie Polderman, Robert Humphreys, Cherry Mammen, Eleonora Jugnauth, Douglas G Matsell","doi":"10.1177/20543581241304505","DOIUrl":"10.1177/20543581241304505","url":null,"abstract":"<p><strong>Background: </strong>In 2013, the British Columbia (BC) Childhood Nephrotic Syndrome Clinical Pathway (CNSCP) was developed to standardize the care of children with nephrotic syndrome (NS). In BC, children access nephrology care at BC Children's Hospital (BCCH) and multiple regional clinics.</p><p><strong>Objective: </strong>The primary objective was to compare induction therapy and clinical outcomes between BCCH and regional clinics since implementation of the CNSCP.</p><p><strong>Design setting and patients: </strong>This was a retrospective cohort study of children with NS in BC.</p><p><strong>Measurements and methods: </strong>We conducted a retrospective cohort study of children 1 to 17 years old with new-onset NS from 2013 to 2019 inclusive with minimum 12 months of follow-up. Children with non-minimal change disease, steroid resistance, incomplete induction therapy, or less than 6 months of pathway treatment within their first year post-diagnosis were excluded. Clinics were categorized as BCCH or regional (Surrey, Prince George, or Kelowna).</p><p><strong>Results: </strong>Sixty-nine patients were included, with 52 (75%) at BCCH and 17 (25%) at regional clinics. There were no significant between-group differences in age, sex, or clinical characteristics at time of diagnosis. Comparing BCCH and regional clinics, there was no difference in induction prednisone exposure (median 3400, interquartile range [IQR] 3331-3585 mg/m<sup>2</sup> vs 3492, IQR 3397-3644 mg/m<sup>2</sup>, <i>P</i> = .167), annualized relapse rate (median 3.3, IQR 1.1-5.3 vs 2.3, IQR 0.5-4.2, <i>P</i> = .575), or development of frequently relapsing courses (50% vs 62%, <i>P</i> = .475). There was a similar number of first-year clinic visits (4.2 ± 1.2 vs 4.0 ± 1.8, <i>P</i> = .655) and dietitian-reviewed food records (67% vs 47%, <i>P</i> = .135, BCCH vs regional). More children at BCCH had a recommended ophthalmology surveillance visit (87% vs 59%, <i>P</i> = .01, BCCH vs regional).</p><p><strong>Limitations: </strong>Study limitations include small sample size and exclusion of children with complicated NS (ie, relapse during induction, steroid resistance).</p><p><strong>Conclusion: </strong>Since we implemented the CNSCP, children with NS received comparable care and had similar outcomes at BCCH and regional clinics without significant practice variation.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241304505"},"PeriodicalIF":1.6,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Canadian Highly Sensitized Patient Program Report: A 1000 Kidney Transplants Story. 加拿大高度敏感患者项目报告:1000例肾移植的故事。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-12-24 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241306811
M Khaled Shamseddin, Steven Paraskevas, Rahul Mainra, Kyle Maru, Bailey Piggott, Darlene Jagusic, Kathy Yetzer, Lakshman Gunaratnam, Christine Ribic, Joseph Kim, Sunita Singh, Stephanie Hoar, G V Ramesh Prasad, Melanie Masse, Isabelle Houde, Myriam Khalili, Kenneth West, Rob Liwski, Sean Martin, Nessa Gogan, Martin Karpinski, Mauricio Monroy-Cuadros, Sita Gourishankar, Olwyn Johnston, James Lan, Christopher Nguen, John Gill, Michel Pâquet
<p><strong>Purpose: </strong>Highly sensitized patients (HSPs) with kidney failure have limited access to kidney transplantation and poorer post-transplant outcomes. Prioritizing HSPs in kidney allocation systems and expanding the pool of deceased donors available to them has helped to reduce their wait times for transplant and enhanced post-transplant outcomes. The Canadian HSP Program was established by Canadian Blood Services in collaboration with provincial organ donation and transplantation programs throughout the country to increase transplant opportunities for transplant candidates needing very specific matches from deceased kidney donors. Highly sensitized patients in the Canadian Program are defined by a calculated panel-reactive antibody (cPRA) ≥95%. In this report, we describe the evolution and trajectory of the Canadian HSP Program and evaluate the national impact on the first 1000 kidney transplant cases.</p><p><strong>Source of information: </strong>To allocate deceased donor kidney organs nationally to HSPs and report on the Canadian HSP Program's performance, Canadian Blood Services developed a national database registry known as the Canadian Transplant Registry (CTR) and an online reporting tool known as the Canadian HSP Program Data Dashboard.</p><p><strong>Methods: </strong>The CTR, which collects HSPs' data for the purpose of matching potential donors to HSPs and as part of required national quality, safety, and efficiency performance measurements, was retrospectively reviewed. Due to the nature of using deidentified aggregate registry data, a patient consent form was not required. A Research Ethical Board (REB) application was also waived.</p><p><strong>Key findings: </strong>In this article, we describe the historical development, initial deployment, and evolution of the Canadian HSP Program with a primary aim to increase the rate of deceased donor kidney transplantation. A secondary aim was to evaluate the national impact of the Canadian HSP Program on the first 1000 kidney transplant cases. Transplant candidates who have participated in the Canadian HSP Program and recipients who received transplants were predominantly females (average age 50 years, female 62%) with blood group O (47% of candidates, 42% of transplants). Seventy percent of all active transplant candidates enrolled in the HSP Program were in the hardest to match group (cPRA ≥99%), and only 22% of the transplant candidates with cPRA of 100% have received a transplant to date through the Program. The average times from first participation in the Canadian HSP Program to transplantation for cPRA ≥99% transplant recipients were significantly longer than for cPRA 95% to 98% recipients averaging 22 months versus 6 months, respectively. By the end of June 2024, the Canadian HSP Program had facilitated 1000 transplants, 613 of which were from interprovincial matches. The average (SD) cold ischemic time (CIT) was 14.5 (5.9) hours, with interprovincial transplants exhi
目的:高度敏感的肾功能衰竭患者(HSPs)接受肾移植的机会有限,移植后预后较差。在肾脏分配系统中优先考虑高热量人群,并扩大他们可获得的已故供体池,有助于减少他们等待移植的时间,提高移植后的结果。加拿大HSP计划是由加拿大血液服务中心与全国各省器官捐赠和移植项目合作建立的,目的是增加需要与已故肾脏捐赠者进行特定匹配的移植候选人的移植机会。在加拿大项目中,高度敏感患者的定义是计算出的整体反应性抗体(cPRA)≥95%。在本报告中,我们描述了加拿大HSP计划的演变和轨迹,并评估了国家对前1000例肾移植病例的影响。信息来源:为了在全国范围内将已故捐赠者的肾脏器官分配给HSP,并报告加拿大HSP计划的表现,加拿大血液服务中心开发了一个国家数据库注册表,即加拿大移植注册表(CTR)和一个在线报告工具,即加拿大HSP计划数据仪表板。方法:CTR收集HSPs的数据,目的是匹配潜在的HSPs供体,并作为必要的国家质量、安全和效率绩效测量的一部分。由于使用未识别的汇总登记数据的性质,不需要患者同意表格。研究伦理委员会(REB)的申请也被豁免。主要发现:在这篇文章中,我们描述了加拿大HSP计划的历史发展,最初的部署和演变,主要目的是提高已故供体肾移植的比率。第二个目的是评估加拿大HSP计划对前1000例肾移植病例的全国影响。参加加拿大HSP计划的移植候选人和接受移植的接受者主要是女性(平均年龄50岁,女性62%),O型血(47%的候选人,42%的移植)。参加HSP计划的所有活跃移植候选人中有70%属于最难匹配组(cPRA≥99%),只有22%的cPRA为100%的移植候选人通过该计划接受了移植。从首次参加加拿大HSP计划到移植,cPRA≥99%的移植受者的平均时间明显长于cPRA 95%至98%的受者,分别为22个月和6个月。到2024年6月底,加拿大HSP计划已经促成了1000例移植,其中613例来自省际匹配。平均(SD)冷缺血时间(CIT)为14.5(5.9)小时,与省内移植相比,跨省移植的CIT明显更长,平均多4.7小时。局限性:我们的研究局限性包括:首先,这是一项回顾性登记数据分析,没有可用的短期和长期临床结果数据(患者和移植物存活)。其次,鉴于注册数据的性质,并非所有相关数据都已被捕获,报告也可能不完整。含义:CTR注册数据的检查显示,加拿大HSP计划在使1000名HSP获得移植机会方面产生了有意义的影响,否则他们可能无法获得移植机会。
{"title":"Canadian Highly Sensitized Patient Program Report: A 1000 Kidney Transplants Story.","authors":"M Khaled Shamseddin, Steven Paraskevas, Rahul Mainra, Kyle Maru, Bailey Piggott, Darlene Jagusic, Kathy Yetzer, Lakshman Gunaratnam, Christine Ribic, Joseph Kim, Sunita Singh, Stephanie Hoar, G V Ramesh Prasad, Melanie Masse, Isabelle Houde, Myriam Khalili, Kenneth West, Rob Liwski, Sean Martin, Nessa Gogan, Martin Karpinski, Mauricio Monroy-Cuadros, Sita Gourishankar, Olwyn Johnston, James Lan, Christopher Nguen, John Gill, Michel Pâquet","doi":"10.1177/20543581241306811","DOIUrl":"10.1177/20543581241306811","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Highly sensitized patients (HSPs) with kidney failure have limited access to kidney transplantation and poorer post-transplant outcomes. Prioritizing HSPs in kidney allocation systems and expanding the pool of deceased donors available to them has helped to reduce their wait times for transplant and enhanced post-transplant outcomes. The Canadian HSP Program was established by Canadian Blood Services in collaboration with provincial organ donation and transplantation programs throughout the country to increase transplant opportunities for transplant candidates needing very specific matches from deceased kidney donors. Highly sensitized patients in the Canadian Program are defined by a calculated panel-reactive antibody (cPRA) ≥95%. In this report, we describe the evolution and trajectory of the Canadian HSP Program and evaluate the national impact on the first 1000 kidney transplant cases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Source of information: &lt;/strong&gt;To allocate deceased donor kidney organs nationally to HSPs and report on the Canadian HSP Program's performance, Canadian Blood Services developed a national database registry known as the Canadian Transplant Registry (CTR) and an online reporting tool known as the Canadian HSP Program Data Dashboard.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The CTR, which collects HSPs' data for the purpose of matching potential donors to HSPs and as part of required national quality, safety, and efficiency performance measurements, was retrospectively reviewed. Due to the nature of using deidentified aggregate registry data, a patient consent form was not required. A Research Ethical Board (REB) application was also waived.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key findings: &lt;/strong&gt;In this article, we describe the historical development, initial deployment, and evolution of the Canadian HSP Program with a primary aim to increase the rate of deceased donor kidney transplantation. A secondary aim was to evaluate the national impact of the Canadian HSP Program on the first 1000 kidney transplant cases. Transplant candidates who have participated in the Canadian HSP Program and recipients who received transplants were predominantly females (average age 50 years, female 62%) with blood group O (47% of candidates, 42% of transplants). Seventy percent of all active transplant candidates enrolled in the HSP Program were in the hardest to match group (cPRA ≥99%), and only 22% of the transplant candidates with cPRA of 100% have received a transplant to date through the Program. The average times from first participation in the Canadian HSP Program to transplantation for cPRA ≥99% transplant recipients were significantly longer than for cPRA 95% to 98% recipients averaging 22 months versus 6 months, respectively. By the end of June 2024, the Canadian HSP Program had facilitated 1000 transplants, 613 of which were from interprovincial matches. The average (SD) cold ischemic time (CIT) was 14.5 (5.9) hours, with interprovincial transplants exhi","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241306811"},"PeriodicalIF":1.6,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11672600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142902577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Incidence, Prediction, and Prevention of Fractures After Kidney Transplantation: A Systematic Review Protocol. 肾移植术后骨折的发生率、预测和预防:一项系统回顾方案。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-12-23 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241306799
Andrea C Cowan, Karla Solo, Victoria Lebedeva, Yasaman Mohammadi Kamalabadi, Maha El-Shimy, Aayushi Joshi, Edith Ginika Olalike, Misa Tanaka, Adam G R Klotz, Hatoun Wahid Elazhary, Antonia Zhu, Adam Forster, Shafaz Veettil, Sachin G Nair, Maria Fernanda Servin Martinez, Dweeti Nayak, V Nikhila Priya, Catherine Wellan, Diana Maria Cespedes Arcani, Pavel S Roshanov
<p><strong>Background: </strong>Kidney transplant recipients are uniquely exposed to the disordered bone metabolism associated with chronic kidney disease beginning before transplantation followed by chronic corticosteroid use after transplantation. Previous efforts to synthesize the rapidly accruing evidence regarding estimation and management of fracture risk in kidney transplant recipients are outdated and incomplete.</p><p><strong>Objective: </strong>To synthesize the evidence informing the overall incidence, patient-specific risk prediction, and methods of prevention of fractures in patient living with a kidney transplant.</p><p><strong>Design: </strong>Three systematic reviews will address the following questions: What is the overall incidence of skeletal fracture after kidney transplantation (review 1)? Which prediction models and individual prognostic factors predict fracture in kidney transplant recipients (review 2)? and How effective are different antifracture interventions at preventing fracture or improving surrogate markers of bone health in kidney transplant recipients (review 3)?</p><p><strong>Setting: </strong>Cohort studies (reviews 1 and 2) and randomized trials (review 2) with a mean/median follow-up ≥12 months beginning after transplant. Review 3: randomized trials or new-user cohort studies with concurrent controls evaluating the effect of antifracture interventions including bisphosphonates, calcium supplementation, cinacalcet, denosumab, parathyroid hormone analogues, parathyroidectomy, raloxifene, romosozumab, steroid withdrawal or minimization protocols after kidney transplant, vitamin D (both active and nutritional), other antifracture interventions.</p><p><strong>Patients: </strong>Adult kidney transplant recipients in studies published after the year 2000.</p><p><strong>Measurements: </strong>Review 1: incidence rate or cumulative risk of fracture. Review 2: For prediction models, measures of discrimination (eg, c-statistic), calibration (calibration curves, observed:expected ratios), and net benefit (ie, from decision curve analysis); for individual prognostic factors, relative measures of association with fractures. Review 3: measures of treatment effect on fractures and on surrogate markers of bone health (eg, bone mineral density, trabecular bone score).</p><p><strong>Methods: </strong>We searched MEDLINE, Embase, and the Cochrane Library using subject headings and keywords related to kidney transplant and fractures. Pairs of reviewers will screen records independently in duplicate to identify studies relevant to one or more of the 3 reviews and categorize each study accordingly. Single reviewers will extract data and evaluate risk of bias for each included study using one of the following tools as appropriate: the Quality of Prognostic Studies tool, the Prediction model Risk Of Bias ASsessment tool, the Risk Of Bias In Non-randomised Studies-of Interventions tool, and the Cochrane Risk of Bias 2.0 tool. A second
背景:肾移植受者在移植前就患有慢性肾脏病,移植后又长期使用皮质类固醇,因此骨代谢紊乱。以往对肾移植受者骨折风险评估和管理方面快速积累的证据进行综合的工作既过时又不完整:综合有关肾移植患者骨折的总体发生率、患者特异性风险预测和预防方法的证据:设计:三篇系统综述将探讨以下问题:肾移植后骨骼骨折的总体发生率是多少(综述 1)?哪些预测模型和个体预后因素可预测肾移植受者的骨折(综述 2)?不同的抗骨折干预措施在预防肾移植受者骨折或改善骨骼健康代用指标方面的效果如何(综述 3)?队列研究(综述 1 和 2)和随机试验(综述 2),平均/中位随访时间≥12 个月。综述3:评估抗骨折干预措施效果的随机试验或新用户队列研究,同时进行对照,包括双膦酸盐、钙补充剂、西那卡西特、地诺索单抗、甲状旁腺激素类似物、甲状旁腺切除术、雷洛昔芬、罗莫索单抗、肾移植后类固醇停用或最小化方案、维生素D(活性和营养)、其他抗骨折干预措施:患者:2000 年后发表的研究中的成年肾移植受者:回顾 1:骨折发生率或累积风险。综述 2:对于预测模型,判别度(如 c 统计量)、校准(校准曲线、观察到的与预期的比率)和净效益(即决策曲线分析);对于单个预后因素,与骨折相关性的相对测量。综述 3:治疗对骨折和骨骼健康代用指标(如骨矿物质密度、骨小梁评分)的影响测量:我们使用与肾移植和骨折相关的主题词和关键词检索了 MEDLINE、Embase 和 Cochrane 图书馆。一对审稿人将独立筛选记录,一式两份,以确定与 3 篇综述中的一篇或多篇相关的研究,并对每篇研究进行相应分类。单个审稿人将酌情使用以下工具之一提取数据并评估每项纳入研究的偏倚风险:预后研究质量工具、预测模型偏倚风险评估工具、非随机干预研究中的偏倚风险工具以及 Cochrane 偏倚风险 2.0 工具。第二位审稿人将进行独立核实。在综述 1 中,我们将通过随机效应荟萃分析来综合研究水平的汇总估计值;在综述 2 中,我们将通过计票和随机效应荟萃分析来综合研究水平的汇总估计值;在综述 3 中,我们将通过随机效应配对分析和网络荟萃分析(如果可行)来综合研究水平的汇总估计值:局限性:依赖已发表的研究容易出现发表偏差,尤其是预测研究(综述 2)和治疗效果研究(综述 3):本综述将提供与患者、临床医生、指南制定者和研究人员相关的 3 个主题的最新证据。
{"title":"Incidence, Prediction, and Prevention of Fractures After Kidney Transplantation: A Systematic Review Protocol.","authors":"Andrea C Cowan, Karla Solo, Victoria Lebedeva, Yasaman Mohammadi Kamalabadi, Maha El-Shimy, Aayushi Joshi, Edith Ginika Olalike, Misa Tanaka, Adam G R Klotz, Hatoun Wahid Elazhary, Antonia Zhu, Adam Forster, Shafaz Veettil, Sachin G Nair, Maria Fernanda Servin Martinez, Dweeti Nayak, V Nikhila Priya, Catherine Wellan, Diana Maria Cespedes Arcani, Pavel S Roshanov","doi":"10.1177/20543581241306799","DOIUrl":"10.1177/20543581241306799","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Kidney transplant recipients are uniquely exposed to the disordered bone metabolism associated with chronic kidney disease beginning before transplantation followed by chronic corticosteroid use after transplantation. Previous efforts to synthesize the rapidly accruing evidence regarding estimation and management of fracture risk in kidney transplant recipients are outdated and incomplete.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To synthesize the evidence informing the overall incidence, patient-specific risk prediction, and methods of prevention of fractures in patient living with a kidney transplant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Three systematic reviews will address the following questions: What is the overall incidence of skeletal fracture after kidney transplantation (review 1)? Which prediction models and individual prognostic factors predict fracture in kidney transplant recipients (review 2)? and How effective are different antifracture interventions at preventing fracture or improving surrogate markers of bone health in kidney transplant recipients (review 3)?&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Cohort studies (reviews 1 and 2) and randomized trials (review 2) with a mean/median follow-up ≥12 months beginning after transplant. Review 3: randomized trials or new-user cohort studies with concurrent controls evaluating the effect of antifracture interventions including bisphosphonates, calcium supplementation, cinacalcet, denosumab, parathyroid hormone analogues, parathyroidectomy, raloxifene, romosozumab, steroid withdrawal or minimization protocols after kidney transplant, vitamin D (both active and nutritional), other antifracture interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Adult kidney transplant recipients in studies published after the year 2000.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;Review 1: incidence rate or cumulative risk of fracture. Review 2: For prediction models, measures of discrimination (eg, c-statistic), calibration (calibration curves, observed:expected ratios), and net benefit (ie, from decision curve analysis); for individual prognostic factors, relative measures of association with fractures. Review 3: measures of treatment effect on fractures and on surrogate markers of bone health (eg, bone mineral density, trabecular bone score).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We searched MEDLINE, Embase, and the Cochrane Library using subject headings and keywords related to kidney transplant and fractures. Pairs of reviewers will screen records independently in duplicate to identify studies relevant to one or more of the 3 reviews and categorize each study accordingly. Single reviewers will extract data and evaluate risk of bias for each included study using one of the following tools as appropriate: the Quality of Prognostic Studies tool, the Prediction model Risk Of Bias ASsessment tool, the Risk Of Bias In Non-randomised Studies-of Interventions tool, and the Cochrane Risk of Bias 2.0 tool. A second ","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241306799"},"PeriodicalIF":1.6,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11672528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142902578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prediction of Acute Kidney Injury After Cardiac Surgery With Combined Arterial and Venous Intrarenal Doppler. 动脉、静脉联合肾内多普勒预测心脏手术后急性肾损伤。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-12-23 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241309976
Cameron Giles, Karel Huard, André Denault, William Beaubien-Souligny
<p><strong>Background: </strong>Acute kidney injury (AKI) occurs in up to 50% of cardiac surgical patients and is often hemodynamically mediated. Point-of-care ultrasound is a non-invasive tool that has the potential to characterize intrarenal hemodynamics and predict the risk of AKI.</p><p><strong>Objectives: </strong>We aimed to determine the predictive characteristics of intrarenal arterial and venous Doppler markers for postoperative AKI in cardiac surgical patients.</p><p><strong>Design: </strong>This study is the secondary analysis of a prospective cohort study.</p><p><strong>Setting: </strong>This study is carried out in a care academic cardiac surgical center in Montreal, Quebec, Canada.</p><p><strong>Patients: </strong>Adult patients undergoing cardiac surgery with the use of cardiopulmonary bypass.</p><p><strong>Measurements: </strong>Point-of-care ultrasound assessments were performed preoperatively and at intensive care unit admission. Arterial measurements included the renal resistive index (RRI) and intrarenal artery velocity-time integral normalized to peak systolic velocity (VTI/PSV). Venous measurements included intrarenal venous flow (IRVF) pattern and renal venous stasis index (RVSI).</p><p><strong>Methods: </strong>We used area under the receiving operating characteristic curves (AUCs) with net reclassification index (NRI) and multivariable logistic regression to determine predictive characteristics for postoperative AKI. Furthermore, we used hierarchical clustering to identify potential groups with similar Doppler parameters and performed comparisons of patients' characteristics and outcomes between groups.</p><p><strong>Results: </strong>We included 136 patients with 47 (34.6%) developing postoperative AKI. At intensive care unit admission, arterial indices showed similar discrimination for the prediction of AKI (RRI: AUC = 0.64; 95% confidence interval (CI) = 0.55 to 0.74; and VTI/PSV: AUC = 0.67; 95% CI = 0.57 to 0.77). Venous Doppler indices including IRVF patterns (AUC = 0.64; 95% CI = 0.53 to 0.74) and RVSI (AUC = 0.60; 95% CI = 0.50 to 0.71) also showed similar performance. The combined model of RRI and IRVF pattern (AUC = 0.69; 95% CI = 0.59 to 0.78) improved the prediction of AKI compared to either RRI (NRI = 0.50; 95% CI = 0.17 to 0.84) or IRVF pattern (NRI = 0.38; 95% CI = 0.04 to 0.70) alone. Through hierarchical clustering, we identified 3 groups (1: low RRI, 2: high RRI/low RVSI, and 3: high RRI/high RVSI) with different patient characteristics and outcomes. The patient in group 3 had a higher risk of AKI and worse clinical outcomes compared with other groups.</p><p><strong>Limitations: </strong>Single-center design in cardiac surgical patients limits generalizability.</p><p><strong>Conclusions: </strong>Although more complex indices of intrarenal Doppler indices including the VTI/PSV and RVSI did not improve prediction of postoperative AKI, combining RRI and IRVF pattern improved risk prediction for AKI. Intrar
背景:多达50%的心脏手术患者会出现急性肾损伤(AKI),通常是由血流动力学介导的。护理点超声是一种无创工具,有可能描述肾内血流动力学特征并预测 AKI 风险:我们旨在确定肾内动脉和静脉多普勒标记物对心脏手术患者术后 AKI 的预测特性:本研究是一项前瞻性队列研究的二次分析:本研究在加拿大魁北克省蒙特利尔市的一家心脏外科护理学术中心进行:使用心肺旁路进行心脏手术的成人患者:术前和入重症监护室时进行护理点超声评估。动脉测量包括肾脏阻力指数(RRI)和肾内动脉速度-时间积分归一于收缩峰值速度(VTI/PSV)。静脉测量包括肾内静脉流量(IRVF)模式和肾静脉淤血指数(RVSI):我们使用接受操作特征曲线下面积(AUC)和净再分类指数(NRI)以及多变量逻辑回归来确定术后 AKI 的预测特征。此外,我们还采用分层聚类法确定了具有相似多普勒参数的潜在组别,并对各组患者的特征和预后进行了比较:我们共纳入了 136 例患者,其中 47 例(34.6%)发生了术后 AKI。在重症监护室入院时,动脉指数对 AKI 的预测显示出相似的区分度(RRI:AUC = 0.64;95% 置信区间 (CI) = 0.55 至 0.74;VTI/PSV:AUC = 0.67;95% CI = 0.57 至 0.77)。包括 IRVF 模式(AUC = 0.64;95% CI = 0.53 至 0.74)和 RVSI(AUC = 0.60;95% CI = 0.50 至 0.71)在内的静脉多普勒指数也显示出相似的性能。与单独使用 RRI(NRI = 0.50;95% CI = 0.17 至 0.84)或 IRVF 模式(NRI = 0.38;95% CI = 0.04 至 0.70)相比,RRI 和 IRVF 模式的组合模型(AUC = 0.69;95% CI = 0.59 至 0.78)提高了对 AKI 的预测能力。通过分层聚类,我们确定了三组(1:低 RRI;2:高 RRI/低 RVSI;3:高 RRI/高 RVSI),这三组患者的特征和预后各不相同。与其他组别相比,第 3 组患者发生 AKI 的风险更高,临床预后更差:局限性:心脏手术患者的单中心设计限制了推广性:尽管包括 VTI/PSV 和 RVSI 在内的更复杂的肾内多普勒指数并不能改善术后 AKI 的预测,但结合 RRI 和 IRVF 模式可改善 AKI 的风险预测。肾内动静脉多普勒亚型确定了术后 AKI 的高风险患者群体。
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引用次数: 0
Unused Hemodialysis Acid Concentrate is Dollars and Dialysate Down the Drain: An Opinion Piece. 未使用的血液透析酸浓缩物是美元和透析液的流失:一篇观点文章。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-12-20 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241308631
Anukul Ghimire, Karthik K Tennankore, George Vitale
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引用次数: 0
Physical Frailty and Functional Status in Kidney Transplantation: A Systematic Review. 肾移植中的身体虚弱和功能状态:系统综述。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-12-16 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241300777
Priscilla Karnabi, David Massicotte-Azarniouch, Shawn Marshall, Greg A Knoll

Background: Frailty and functional decline are being recognized as important conditions in kidney transplant candidates. However, the ideal measures of functional status and frailty remain unknown as there is not a complete understanding of the relationship between these conditions and important post-transplant outcomes.

Objective: The objective was to examine the association between different measures of frailty and functional status evaluated before or at the time of transplant with adverse clinical outcomes post-transplantation.

Design: This study is a systematic review.

Setting: Observational studies including cohort, case-control, or cross-sectional studies examining the effect of frailty and functional status on clinical outcomes. There were no restrictions on type of setting or country of origin.

Patients: Adults who were waitlisted for kidney transplant or had received a kidney transplant.

Measurements: Data including demographic information (eg, sample size, age, country), assessments of frailty or functional status and their domains, and outcomes including mortality, transplantation, graft loss, delayed graft function and hospital readmission were extracted.

Methods: A search was performed in Medline, Embase, and Cochrane Central Register for Controlled Trials. Studies were included from inception to February 7, 2023. The eligibility of studies was screened by 2 independent reviewers. Data were presented by frailty/functional status instrument and clinical outcome. Point estimates and 95% confidence intervals from fully adjusted statistical models were reported or calculated from the raw data.

Results: A total of 50 studies were identified, among which 36 unique instruments were found. Measurements of these instruments occurred mostly at time of kidney transplant, transplant evaluation, and waitlisting. The median sample size of studies was 457 patients (interquartile range = 183-1760). Frailty and lower functional status were associated with an increased risk for mortality. Similar trends were observed among other clinical outcomes such as graft loss and rehospitalization.

Limitations: The heterogeneity in measurement instruments, study designs, and outcome definitions prevents pooling of the data. Selection bias and the validity of data collection could not be ascertained for some studies.

Conclusion: Frailty and functional status measures are important predictors of post-kidney transplant outcomes. Further studies are needed to evaluate the best instruments to assess frailty and functional status, and importantly, interventional studies are needed to determine whether prehabilitation strategies can improve post-transplant outcomes.

Registration prospero: CRD42016045251.

背景:虚弱和功能下降被认为是肾移植候选人的重要条件。然而,功能状态和虚弱的理想测量仍然未知,因为这些条件与重要的移植后结果之间的关系尚未完全了解。目的:目的是检查移植前或移植时评估的不同虚弱程度和功能状态与移植后不良临床结果之间的关系。设计:本研究为系统综述。背景:观察性研究,包括队列、病例对照或横断面研究,检查虚弱和功能状态对临床结果的影响。对环境类型或原产国没有限制。患者:正在等待肾移植或已经接受肾移植的成年人。测量方法:提取的数据包括人口统计信息(如样本量、年龄、国家)、衰弱或功能状态及其域的评估,以及包括死亡率、移植、移植物损失、移植物功能延迟和再入院在内的结果。方法:在Medline、Embase和Cochrane中央对照试验登记处进行检索。研究包括从开始到2023年2月7日。研究的合格性由2名独立审稿人进行筛选。数据由衰弱/功能状态仪和临床结果提供。从完全调整的统计模型中报告或从原始数据中计算点估计和95%置信区间。结果:共鉴定了50个研究,其中发现了36个独特的仪器。这些仪器的测量大多发生在肾移植、移植评估和等待名单的时候。研究的中位样本量为457例患者(四分位数间距= 183-1760)。虚弱和较低的功能状态与死亡风险增加有关。在其他临床结果如移植物丢失和再住院中也观察到类似的趋势。局限性:测量工具、研究设计和结果定义的异质性阻碍了数据的汇集。一些研究无法确定选择偏差和数据收集的有效性。结论:虚弱和功能状态指标是肾移植后预后的重要预测指标。需要进一步的研究来评估评估虚弱和功能状态的最佳工具,重要的是,需要进行介入性研究来确定康复策略是否可以改善移植后的预后。注册地址:CRD42016045251。
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引用次数: 0
期刊
Canadian Journal of Kidney Health and Disease
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