Canadian Journal of Kidney Health and Disease最新文献

Background: Declines in skeletal muscle function and widespread vitamin D deficiency are common in individuals receiving hemodialysis (HD), yet the relationships among serum 25-hydroxyvitamin D (25(OH)D) concentrations, vitamin D supplementation, and muscle strength remain incompletely characterized in this population.

Objective: To evaluate the associations between serum 25(OH)D concentrations, dietary vitamin D intake, supplementation status, and muscle strength in a multiethnic cohort of patients undergoing HD.

Design: Cross-sectional study.

Setting: Two satellite HD centers in Toronto, Canada.

Participants: Eighty-one adults receiving HD (mean age 58 years; 64% male) were enrolled following screening based on clinical and demographic inclusion and exclusion criteria.

Measurements: Handgrip strength, measured via digital dynamometry, was the primary outcome and marker of muscle function. Serum 25(OH)D was quantified to assess biochemical vitamin D status. Three-day food and supplement logs were used to estimate dietary vitamin D intake and supplementation. Associations were assessed using multivariable linear and logistic regression, adjusting for age, sex, and dry weight.

Results: Forty-seven percent of participants exhibited sex-specific weak handgrip strength, and 25% were vitamin D deficient (<27.5 nmol/L). Serum 25(OH)D concentrations were positively associated with handgrip strength (r = 0.298, P = .023), and vitamin D supplementation was similarly associated (r = 0.285, P = .025). Deficient serum 25(OH)D levels were associated with over five-fold increased odds of weak grip strength (odds ratio (OR) 5.33; 95% confidence interval (CI): 1.59-20.67; P = .009). Although dietary vitamin D intake was inadequate in 97% of participants, it was not independently associated with muscle strength. Participants who reported supplement use had significantly higher mean serum 25(OH)D concentrations than those who did not supplement.

Limitations: This study's cross-sectional design and single geographic setting limit causal inference and broader generalizability. Self-reported dietary intake may be subject to recall error.

Conclusions: Biochemically defined vitamin D deficiency and absence of vitamin D supplementation were associated with reduced muscle strength in patients receiving HD. These findings suggest that higher serum 25(OH)D concentrations may support better musculoskeletal function, in addition to other known benefits of higher serum vitamin D levels, in populations undergoing HD treatment.

Background: Current guidelines recommend that living kidney donors should avoid non-steroidal anti-inflammatory drugs due to their potential nephrotoxic effects. It is unclear if physicians are adhering to this recommendation.

Objective: Our aim was to determine the proportion of living kidney donors that filled a non-steroidal anti-inflammatory drug prescription post-donation and the proportion with measurement of kidney function post-prescription.

Design: We conducted a population-based, retrospective cohort study.

Setting: We identified kidney donors in Alberta, Canada that had accessed the healthcare system in the outpatient, emergency department, or inpatient setting.

Patients: Adult living kidney donors in Alberta, Canada who donated between 2002 and 2019.

Measurements: We measured the number of non-steroidal anti-inflammatory drug prescriptions, type of prescribing physician, and evidence of post-prescription measurement of creatinine and potassium.

Methods: We identified the proportion of donors who filled a non-steroidal anti-inflammatory drug prescription at least 1 year post-donation. We also assessed how many donors underwent laboratory testing for kidney function and potassium within 14 days following the first prescription.

Results: Of the 759 living kidney donors included in our study, 273 (36%) had at least one non-steroidal anti-inflammatory drug prescription over a median follow-up of 7.2 years (interquartile range 3.5-11.5). The proportion of donors with at least one prescription in follow-up remained stable over time (~10% per year). Family physicians accounted for 66% of all non-steroidal anti-inflammatory drug prescriptions. Approximately, 10% of donors had measurements of serum creatinine or potassium post-prescription.

Limitations: This study was limited by the inability to capture over-the-counter non-steroidal anti-inflammatory drug use, indication for the prescriptions, and indication for bloodwork being completed in the post-prescription period.

Conclusions: Over one-third of living kidney donors are prescribed non-steroidal anti-inflammatory drugs despite current guideline recommendations, with only a minority undergoing post-prescription laboratory testing. Further research assessing outcomes following non-steroidal anti-inflammatory drug use is recommended to better inform optimal pain-management strategies for living kidney donors.

Recent clinical trials suggest benefit of anti-hyperglycemic drugs on kidney outcomes. However, there is a paucity of information available on the real-world impact.We aimed to study the real-world impact of anti-hyperglycemic drugs (metformin, sodium-glucose cotransporter-2 (SGLT-2) inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors, and glucagon-like peptide-1receptor (GLP-1R) agonists) using a cohort of patients with incident diabetes derived from the Alberta Tomorrow Project (ATP) database. A retrospective cohort was created from the ATP database using administrative data from October 1, 2000, to March 31, 2021. We examined the effect of anti-hyperglycemic medications including metformin (as a control), SGLT-2 inhibitors, DPP-4 inhibitors, and GLP-1R agonists on a composite kidney outcome including chronic kidney disease, kidney failure, dialysis, kidney transplant, and kidney-related death using a Cox-regression analysis. The study included 3001 patients with an incident diagnosis of diabetes. The average follow-up was 6.7 ± 4.6 years after diagnosis, and 628 (20.9%) patients reached the composite outcome with a mean of 5.6 ± 4.2 years to the first event. A total of 1749 (58.8%) patients were on metformin, 360 (12.0%) on SGLT-2 inhibitors, 313 (10.4%) on DPP-4 inhibitors, and 188 (6.3%) on GLP-1R agonists. Only the patients prescribed SGLT-2 inhibitors had a significant reduction in the composite outcome (hazard ratio (HR) 0.23, 95% CI 0.09-0.62, P-value = .003), and a dose-related effect was observed. Our study has shown that SGLT-2 inhibitors result in significant reduction of composite kidney outcomes, including chronic kidney disease, suggesting a renally protective effect over long term.

Purpose of program: The Kidney Research Scientist Core Education and National Training Program (KRESCENT) was launched in 2005 to enhance kidney research capacity in Canada and foster knowledge translation across the 4 pillars of health research. This program report describes the pan-Canadian KRESCENT 2.0 Health Research Training Platform (HRTP) application process that was awarded a 5-year grant through the pilot Canadian Institutes of Health Research (CIHR) HRTP program, ensuring continuation of this capacity-building program in Canada.

Sources of information: Grant application documents including meeting minutes, break out group summaries and recommendations, and Gantt timeline charts. Other resources included websites and journal articles.

Methods: All application-related documents were reviewed. Clarification of process and timelines was provided through interviews with the Nominated Principal Applicant (NPA) Dr R. Todd Alexander, Principal Applicants (PAs) Drs Adeera Levin and Sunny Hartwig, Project Manager (PM) Dr Jenn Klein, members of the Patient Community Advisory Network (PCAN), and the Kidney Foundation of Canada Program (KFoC) Manager Ms. Julie Wysocki via in-person and virtual meetings as well as email correspondence.

Key findings: The KRESCENT 2.0 HRTP application represents a 6-month pan-Canadian effort spearheaded by the NPA and a pan-Canadian team of PAs spanning multiple jurisdictions, disciplines, and sectors. Early engagement of stakeholders in the Canadian kidney research community, outstanding PM administrative support from the onset of the application process were identified as pivotal for the success of the application. Other essential factors for success included graphic design assistance to effectively communicate key and complex concepts, appointment of an EDI champion, engagement with a diverse group of collaborators, and strategic collaboration with other HRTP grant applicants to navigate the ambiguities of the pilot HRTP call. Indispensable, scrupulous final review of the complete application package was generously provided by Dr Robert Quinn (University of Alberta) prior to final grant submission to CIHR.

Limitations: Unlike other funded HRTP applicants, KRESCENT is an established kidney training platform for a small cohort of trainees. Our results may not generalize well to HRTPs with large group cohorts or newly established HRTPs.

Implications: This program report may provide valuable guidance for other groups seeking to successfully navigate the CIHR HRTP application process.

Background: There is growing interest in the nephrology community for environmentally sustainable kidney care (ESKC) to alleviate the environmental impact of kidney care services.

Objective: This study aimed to assess the knowledge of Canadian kidney care providers regarding their program's ESKC strategies.

Design setting participants measurements and methods: An electronic survey, created by the Canadian Society of Nephrology-Sustainable Nephrology Action Planning committee, was distributed to Canadian kidney care providers.

Results: A total of 421 Canadian kidney care providers responded to the survey. Various degrees of implementation of ESKC practices across the country were reported, with higher proportions of respondents reporting the use of strategies related to medication stewardship, clinical care consumables, virtual care options, office consumables, office equipment, and general waste management. It also highlighted the lack of knowledge of kidney care providers about many areas related to ESKC practices, such as energy sourcing, reverse osmosis reject water savings, procurement and product sourcing, as well as policies within the kidney program and contact with environmentally sustainable officers. Knowledge of respondents about certain strategies was also dependent on their role within the unit (eg, nephrologist vs nurse vs management), with nephrologists being relatively more aware of strategies that directly involve them, such as medication stewardship. Finally, variation across provinces was noted in terms of the incorporation of climate change adaptation or preparedness and environmental planning strategies.

Limitations: The overrepresentation of people working in academic centers, as well as those from Quebec and British Columbia, may affect the generalizability of results. As respondents may be affiliated with the same units, results reflect knowledge of the individuals regarding the strategies, rather than the presence or implementation of such strategies across units.

Conclusions: The ESKC practices from various domains are incorporated at different levels across the country, and there are important gaps in providers' awareness of such strategies, depending on their role within the unit.

Background: Traditional markers modestly predict chronic kidney disease progression in Aboriginal and Torres Strait Islander people. Therefore, we assessed associations of cardiometabolic and inflammatory clinical biomarkers with kidney disease progression among Aboriginal and Torres Strait Islander people with and without diabetes.

Objectives: To identify cardiometabolic and inflammatory clinical biomarkers that predict kidney disease progression in Aboriginal and Torres Strait Islander people.

Design: Prospective observational cohort study.

Setting: Northern Territory, Australia.

Participants: Aboriginal and Torres Strait Islander participants of the estimated glomerular filtration rate (eGFR) study with (n = 218) and without diabetes (n = 278).

Measurements: Baseline biomarkers (expressed as 1 standard deviation increase in logarithmic scale), plasma kidney injury molecule-1 (pKIM-1) (pg/ml), high-sensitivity troponin-T (hs-TnT) (ng/L), troponin-I (hs-TnI) (ng/L), and soluble tumor necrosis factor receptor-1 (sTNFR-1) (pg/ml) were assessed in 496 adults. Annual change in eGFR (ml/min/1.73 m²) and a composite kidney outcome (first of ≥30% eGFR decline with follow-up eGFR <60 ml/min/1.73 m², initiation of kidney replacement therapy or kidney disease-related death) over a median of 3 years.

Methods: Linear regression estimated annual change in eGFR (ml/min/1.73 m²). Cox proportional hazards regression estimated hazard ratio (HR) and 95% CI for developing a combined kidney health outcome.

Results: In individuals with diabetes, but not those without diabetes, higher baseline hs-TnT (-2.1 [-4.1 to -0.2], P = .033) and sTNFR-1 (-1.8 [-3.5 to -0.1], P = .039) predicted mean (95% CI) eGFR change, after adjusting for age, gender, baseline eGFR, and urinary albumin-to-creatinine ratio. Baseline variables explained 11% of eGFR decline variance; increasing to 27% (P < .001) with biomarkers. In diabetes, hs-TnT and hs-TnI were significantly associated with increased risk of kidney health outcomes.

Limitations: Limitations included potential chronic kidney disease misclassification from single creatinine and albumin measurements, limited adjustment for covariates due to a small sample size, and short follow-up restricting long-term outcome assessment.

Conclusions: Cardiovascular, kidney, and inflammatory biomarkers are likely associated with kidney function loss in diabetes, with particularly prominent associations for cardiac injury markers.

This program report describes the development and implementation of the Hemodialysis Emergency Support Team (HEST) in British Columbia, an initiative led by BC Renal in partnership with the province's 5 health authorities. The HEST was created in response to the growing risk of climate-related emergencies such as wildfires, floods, and water shortages, with the goal of ensuring continuity of care for patients receiving maintenance dialysis during service disruptions. The report outlines the provincial strategy behind HEST, including capacity building during non-emergency periods, strengthening of routine operations, and insights gained through simulation-based evaluations. Key outcomes include the achievement of provincial consensus, development of standardized staffing models, integration with existing emergency response frameworks, and the creation of rapid mobilization protocols. Beyond emergency response, HEST nurses also serve as mentors and clinical resources during non-emergency times, supporting local teams, sharing best practices, and helping build capacity within the hemodialysis unit. This dual role contributes to both emergency preparedness and long-term workforce sustainability.