Pub Date : 2025-05-08eCollection Date: 2025-01-01DOI: 10.1177/20543581251338402
Mathew Kunthara, Greg A Knoll, David Massicotte-Azarniouch
Anti-thymocyte globulin (ATG) is often used when delayed graft function (DGF) occurs post-transplantation. The ATG may be associated with an increased risk of infections but may also decrease rejection risk in high-immunological risk recipients. The safety of ATG for the indication of DGF in low-immunological risk recipients has not been well characterized. We conducted a retrospective cohort study of deceased donor kidney transplant recipients deemed low-immunological risk and not planned for ATG induction, from June 2019 to June 2023 (N = 139). Participants switched to ATG post-transplant due to DGF (exposure; N = 68) were compared to those who did not receive ATG for induction (controls; N = 71 basiliximab only induction). Outcomes examined included BK, cytomegalovirus (CMV), and serious infection as well as acute rejection, graft loss, and death. Participants who received ATG for DGF, compared to controls, were older (63.9 vs 59.7 years), more often had diabetes as cause of kidney failure (45.5% vs 33.8%) were more often recipients of death determination by circulatory criteria donor (70.5% vs 30.9%) and extended criteria donor kidneys (48.5% vs 32.3%). There was no significant difference in the probability of BK (22.1% vs 21.1%, P = .89), CMV (20.6% vs 9.9%, P = .08), serious infections (44.1% vs 43.6%, P = .96), acute rejection, graft loss, or death. The use of ATG for DGF following kidney transplantation did not significantly increase infection risk nor did it improve graft outcomes. Further studies are needed to clarify the risk-benefit trade-off of using ATG for DGF.
抗胸腺细胞球蛋白（ATG）常用于移植后发生延迟移植物功能（DGF）。ATG可能与感染风险增加有关，但也可能降低高免疫风险受体的排斥风险。ATG用于低免疫风险受体DGF适应症的安全性尚未得到很好的表征。从2019年6月至2023年6月，我们对被认为免疫风险低且未计划进行ATG诱导的已故供体肾移植受者进行了回顾性队列研究（N = 139）。由于DGF暴露，参与者在移植后改用ATG；N = 68)与未接受ATG诱导的患者(对照组；N = 71仅巴昔昔单抗诱导)。检查的结果包括BK、巨细胞病毒（CMV）、严重感染以及急性排斥反应、移植物丢失和死亡。与对照组相比，接受ATG治疗DGF的参与者年龄更大（63.9 vs 59.7岁），更常因糖尿病导致肾衰竭（45.5% vs 33.8%），更常接受循环标准供者（70.5% vs 30.9%）和扩展标准供者肾脏（48.5% vs 32.3%）的死亡测定。BK （22.1% vs 21.1%, P = 0.89）、CMV （20.6% vs 9.9%, P = 0.08）、严重感染（44.1% vs 43.6%, P = 0.96）、急性排斥反应、移植物丢失或死亡的概率无显著差异。肾移植后使用ATG进行DGF治疗并没有显著增加感染风险，也没有改善移植结果。需要进一步的研究来阐明使用ATG治疗DGF的风险-收益权衡。
{"title":"Infection Risks With Thymoglobulin Use for Delayed Graft Function in Deceased Donor Kidney Transplantation: Research Letter.","authors":"Mathew Kunthara, Greg A Knoll, David Massicotte-Azarniouch","doi":"10.1177/20543581251338402","DOIUrl":"https://doi.org/10.1177/20543581251338402","url":null,"abstract":"<p><p>Anti-thymocyte globulin (ATG) is often used when delayed graft function (DGF) occurs post-transplantation. The ATG may be associated with an increased risk of infections but may also decrease rejection risk in high-immunological risk recipients. The safety of ATG for the indication of DGF in low-immunological risk recipients has not been well characterized. We conducted a retrospective cohort study of deceased donor kidney transplant recipients deemed low-immunological risk and not planned for ATG induction, from June 2019 to June 2023 (N = 139). Participants switched to ATG post-transplant due to DGF (exposure; N = 68) were compared to those who did not receive ATG for induction (controls; N = 71 basiliximab only induction). Outcomes examined included BK, cytomegalovirus (CMV), and serious infection as well as acute rejection, graft loss, and death. Participants who received ATG for DGF, compared to controls, were older (63.9 vs 59.7 years), more often had diabetes as cause of kidney failure (45.5% vs 33.8%) were more often recipients of death determination by circulatory criteria donor (70.5% vs 30.9%) and extended criteria donor kidneys (48.5% vs 32.3%). There was no significant difference in the probability of BK (22.1% vs 21.1%, <i>P</i> = .89), CMV (20.6% vs 9.9%, <i>P</i> = .08), serious infections (44.1% vs 43.6%, <i>P</i> = .96), acute rejection, graft loss, or death. The use of ATG for DGF following kidney transplantation did not significantly increase infection risk nor did it improve graft outcomes. Further studies are needed to clarify the risk-benefit trade-off of using ATG for DGF.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251338402"},"PeriodicalIF":1.6,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953568","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}
Pub Date : 2025-05-06eCollection Date: 2025-01-01DOI: 10.1177/20543581251336551
Sydney Murray, Chance Dumaine, Chris Wall, Tamalina Banerjee, James Barton, Michael Moser
<p><strong>Background: </strong>Percutaneous ultrasound-guided kidney biopsy is a critical diagnostic tool with a higher rate of complications than most other biopsies. Our prior research identified technical factors that might improve outcomes.</p><p><strong>Objective: </strong>The objective was to measure the impact of these technical and institutional interventions on specimen adequacy and complication rates in kidney biopsies.</p><p><strong>Design: </strong>This is a retrospective cohort study comparing outcomes before and after intervention implementation.</p><p><strong>Setting: </strong>Two hospitals within a single health region in Saskatchewan serving a population of approximately 1 million.</p><p><strong>Patients: </strong>All adult percutaneous ultrasound-guided kidney biopsies performed on adult patients between 2012 to 2016 (n = 242, pre-implementation) and 2017 to 2021 (n = 338, post-implementation). Both native and transplant biopsies were included, while patients under 18, open biopsies, and biopsies of kidney masses were excluded.</p><p><strong>Measurements: </strong>Primary outcomes included specimen adequacy and biopsy complications (hematoma, hemoglobin drop, infection, and arteriovenous fistula formation).</p><p><strong>Methods: </strong>Technical recommendations included introducing the biopsy needle at a 60° angle, targeting a pole, and avoiding the vascular medulla. Institutional recommendations included microscopic screening for all biopsies, limiting the number of radiologists performing procedures, using a checklist, and restricting computed tomography (CT)-guided biopsies to exceptional cases. Multivariate regression analysis assessed biopsy outcomes before and after the recommendations, controlling for known confounders while at the same time refining factors associated with fewer complications and greater diagnostic yield.</p><p><strong>Results: </strong>The rate of non-diagnostic specimens decreased from 10.3% to 4.4% (<i>P</i> = .005), and complications decreased from 35.5% to 14.2% (<i>P</i> < .0001). Two or three passes yielded excellent diagnostic success, while 4 passes increased the risk of a complication. Multivariate analysis, after accounting for the collinearity of certain technical factors revealed that medulla avoidance and biopsies done after the implementation of the 2016 recommendations significantly reduced the risk of complications (odds ratio [OR] = 0.37, <i>P</i> < .001) and non-diagnostic biopsies (OR = 0.31, <i>P</i> = .002).</p><p><strong>Limitations: </strong>Retrospective design and novelty bias may be a cause of bias in this study. Because the institutional recommendations were followed for all biopsies, it was not possible to distinguish which recommendation was most associated with the improvements. Because our study was done in a single health region, it is not clear if they are generalizable to other programs.</p><p><strong>Conclusions: </strong>The technical and institutional interventio
背景：经皮超声引导下肾活检是一种重要的诊断工具，其并发症发生率高于大多数其他活检。我们之前的研究确定了可能改善结果的技术因素。目的：目的是衡量这些技术和制度干预对肾活检标本充足性和并发症发生率的影响。设计：这是一项回顾性队列研究，比较干预实施前后的结果。环境：萨斯喀彻温省单一卫生区域内的两家医院为大约100万人口提供服务。患者：2012年至2016年（242例，实施前）和2017年至2021年（338例，实施后）对成年患者进行的所有成人经皮超声引导肾活检。原生活检和移植活检均包括在内，而18岁以下患者、开放活检和肾肿块活检除外。测量：主要结果包括标本充分性和活检并发症（血肿、血红蛋白下降、感染和动静脉瘘形成）。方法：技术建议包括穿刺针以60°角穿刺，穿刺针杆，避开血管髓质。机构建议包括对所有活组织检查进行显微筛查，限制执行手术的放射科医生的数量，使用检查清单，并将计算机断层扫描（CT）引导的活组织检查限制在特殊情况下。多变量回归分析评估了推荐前后的活检结果，控制了已知的混杂因素，同时细化了与并发症减少和诊断率提高相关的因素。结果：未诊断标本率由10.3%降至4.4% (P = 0.005)，并发症由35.5%降至14.2% （P < 0.0001）。两次或三次检查获得了极好的诊断成功，而四次检查增加了并发症的风险。在考虑了某些技术因素的共线性后，多因素分析显示，在实施2016年建议后，髓质回避和活检显著降低了并发症的风险（优势比[OR] = 0.37, P < 0.001）和非诊断性活检（OR = 0.31, P = 0.002）。局限性：回顾性设计和新颖性偏倚可能是本研究偏倚的一个原因。由于所有活组织检查都遵循了机构建议，因此不可能区分哪种建议与改善最相关。因为我们的研究是在一个单一的卫生地区进行的，所以不清楚它们是否可以推广到其他项目。结论：超声引导肾活检的技术和制度干预显著提高了标本的充分性，降低了并发症的发生率。我们增加了这些建议，因为我们已经改进了活检针倾斜的要求，以方便使用，并建议尽可能将次数限制在2或3次。
{"title":"Technical and Institutional Factors Affecting Specimen Adequacy and Complications in Ultrasound-guided Kidney Biopsy: A Retrospective Cohort Study.","authors":"Sydney Murray, Chance Dumaine, Chris Wall, Tamalina Banerjee, James Barton, Michael Moser","doi":"10.1177/20543581251336551","DOIUrl":"https://doi.org/10.1177/20543581251336551","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous ultrasound-guided kidney biopsy is a critical diagnostic tool with a higher rate of complications than most other biopsies. Our prior research identified technical factors that might improve outcomes.</p><p><strong>Objective: </strong>The objective was to measure the impact of these technical and institutional interventions on specimen adequacy and complication rates in kidney biopsies.</p><p><strong>Design: </strong>This is a retrospective cohort study comparing outcomes before and after intervention implementation.</p><p><strong>Setting: </strong>Two hospitals within a single health region in Saskatchewan serving a population of approximately 1 million.</p><p><strong>Patients: </strong>All adult percutaneous ultrasound-guided kidney biopsies performed on adult patients between 2012 to 2016 (n = 242, pre-implementation) and 2017 to 2021 (n = 338, post-implementation). Both native and transplant biopsies were included, while patients under 18, open biopsies, and biopsies of kidney masses were excluded.</p><p><strong>Measurements: </strong>Primary outcomes included specimen adequacy and biopsy complications (hematoma, hemoglobin drop, infection, and arteriovenous fistula formation).</p><p><strong>Methods: </strong>Technical recommendations included introducing the biopsy needle at a 60° angle, targeting a pole, and avoiding the vascular medulla. Institutional recommendations included microscopic screening for all biopsies, limiting the number of radiologists performing procedures, using a checklist, and restricting computed tomography (CT)-guided biopsies to exceptional cases. Multivariate regression analysis assessed biopsy outcomes before and after the recommendations, controlling for known confounders while at the same time refining factors associated with fewer complications and greater diagnostic yield.</p><p><strong>Results: </strong>The rate of non-diagnostic specimens decreased from 10.3% to 4.4% (<i>P</i> = .005), and complications decreased from 35.5% to 14.2% (<i>P</i> < .0001). Two or three passes yielded excellent diagnostic success, while 4 passes increased the risk of a complication. Multivariate analysis, after accounting for the collinearity of certain technical factors revealed that medulla avoidance and biopsies done after the implementation of the 2016 recommendations significantly reduced the risk of complications (odds ratio [OR] = 0.37, <i>P</i> < .001) and non-diagnostic biopsies (OR = 0.31, <i>P</i> = .002).</p><p><strong>Limitations: </strong>Retrospective design and novelty bias may be a cause of bias in this study. Because the institutional recommendations were followed for all biopsies, it was not possible to distinguish which recommendation was most associated with the improvements. Because our study was done in a single health region, it is not clear if they are generalizable to other programs.</p><p><strong>Conclusions: </strong>The technical and institutional interventio","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251336551"},"PeriodicalIF":1.6,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967296","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}
Pub Date : 2025-04-30eCollection Date: 2025-01-01DOI: 10.1177/20543581251336548
Dilaram Acharya, Tayler D Scory, Nusrat Shommu, Maoliosa Donald, Tyrone G Harrison, Jonathan S Murray, Simon Sawhney, Edward D Siew, Neesh Pannu, Matthew T James
<p><strong>Background: </strong>Patients hospitalized with acute kidney injury (AKI) have variable risks for chronic kidney disease (CKD); however, there is limited knowledge about how this risk influences outpatient follow-up with nephrologists.</p><p><strong>Objective: </strong>This survey study examined the likelihood that nephrologists would recommend outpatient follow-up of patients with varying risk profiles for CKD after hospitalization with AKI and the effect of reporting the predicted risk of severe CKD on their decision-making.</p><p><strong>Design: </strong>A randomized survey study examining the impact of providing predicted risks of severe CKD on nephrologists' follow-up recommendations for patients with AKI.</p><p><strong>Setting: </strong>The study included nephrologists from the United States, the United Kingdom, and Canada between September and December 2023.</p><p><strong>Patients: </strong>Participants reviewed clinical vignettes of patients with AKI and varying risks of severe CKD (G4 or G5), using an externally validated prediction model.</p><p><strong>Measurements: </strong>The primary outcome was the likelihood of recommending nephrologist specialist follow-up for each case, scored on a 7-point Likert scale (1 = "definitely not" and 7 = "definitely would").</p><p><strong>Methods: </strong>Participants were randomized to receive a version of the survey either with or without the predicted risk of severe CKD included for each vignette. Responses were compared across categories of predicted risk (<10%, 10%-49%, and ≥50%) using generalized estimating equations.</p><p><strong>Results: </strong>Of the 203 nephrologists who participated, 73 (36%) were from the United Kingdom, 71 (35%) from Canada, and 45 (22%) from the United States. Mean (95% confidence interval [CI]) Likert scores increased from 4.01 (3.68, 4.34) for patients with a <10% predicted risk to 6.06 (5.76, 6.37) for those with a ≥ 50% predicted risk of severe CKD. Nephrologists were significantly less likely to recommend outpatient nephrology follow-up for patients with a <10% predicted risk of severe CKD when the risk was reported (mean difference = -0.71 [95% CI = -1.19, -0.23]), and significantly more likely to recommend follow-up for patients with a ≥50% predicted risk when the risk of severe CKD was reported (mean difference = 0.49 [95% CI = 0.04, 0.93]).</p><p><strong>Limitations: </strong>This study focuses on nephrologists from high-income countries and relies on hypothetical scenarios rather than real-world practices. Survey respondents may not be representative of all nephrologists, although consistent findings across diverse subgroups strengthen findings.</p><p><strong>Conclusions: </strong>When the predicted risk of severe CKD is reported, nephrologists are less likely to recommend follow-up for lower risk patients with AKI and more likely to recommend follow-up for higher risk patients, leading to better alignment of recommendations for outpatient follow-
{"title":"Nephrologist's Perceptions of Risk of Severe Chronic Kidney Disease and Outpatient Follow-up After Hospitalization With AKI: Multinational Randomized Survey Study.","authors":"Dilaram Acharya, Tayler D Scory, Nusrat Shommu, Maoliosa Donald, Tyrone G Harrison, Jonathan S Murray, Simon Sawhney, Edward D Siew, Neesh Pannu, Matthew T James","doi":"10.1177/20543581251336548","DOIUrl":"https://doi.org/10.1177/20543581251336548","url":null,"abstract":"<p><strong>Background: </strong>Patients hospitalized with acute kidney injury (AKI) have variable risks for chronic kidney disease (CKD); however, there is limited knowledge about how this risk influences outpatient follow-up with nephrologists.</p><p><strong>Objective: </strong>This survey study examined the likelihood that nephrologists would recommend outpatient follow-up of patients with varying risk profiles for CKD after hospitalization with AKI and the effect of reporting the predicted risk of severe CKD on their decision-making.</p><p><strong>Design: </strong>A randomized survey study examining the impact of providing predicted risks of severe CKD on nephrologists' follow-up recommendations for patients with AKI.</p><p><strong>Setting: </strong>The study included nephrologists from the United States, the United Kingdom, and Canada between September and December 2023.</p><p><strong>Patients: </strong>Participants reviewed clinical vignettes of patients with AKI and varying risks of severe CKD (G4 or G5), using an externally validated prediction model.</p><p><strong>Measurements: </strong>The primary outcome was the likelihood of recommending nephrologist specialist follow-up for each case, scored on a 7-point Likert scale (1 = \"definitely not\" and 7 = \"definitely would\").</p><p><strong>Methods: </strong>Participants were randomized to receive a version of the survey either with or without the predicted risk of severe CKD included for each vignette. Responses were compared across categories of predicted risk (<10%, 10%-49%, and ≥50%) using generalized estimating equations.</p><p><strong>Results: </strong>Of the 203 nephrologists who participated, 73 (36%) were from the United Kingdom, 71 (35%) from Canada, and 45 (22%) from the United States. Mean (95% confidence interval [CI]) Likert scores increased from 4.01 (3.68, 4.34) for patients with a <10% predicted risk to 6.06 (5.76, 6.37) for those with a ≥ 50% predicted risk of severe CKD. Nephrologists were significantly less likely to recommend outpatient nephrology follow-up for patients with a <10% predicted risk of severe CKD when the risk was reported (mean difference = -0.71 [95% CI = -1.19, -0.23]), and significantly more likely to recommend follow-up for patients with a ≥50% predicted risk when the risk of severe CKD was reported (mean difference = 0.49 [95% CI = 0.04, 0.93]).</p><p><strong>Limitations: </strong>This study focuses on nephrologists from high-income countries and relies on hypothetical scenarios rather than real-world practices. Survey respondents may not be representative of all nephrologists, although consistent findings across diverse subgroups strengthen findings.</p><p><strong>Conclusions: </strong>When the predicted risk of severe CKD is reported, nephrologists are less likely to recommend follow-up for lower risk patients with AKI and more likely to recommend follow-up for higher risk patients, leading to better alignment of recommendations for outpatient follow-","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251336548"},"PeriodicalIF":1.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12046161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972669","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}
Pub Date : 2025-04-10eCollection Date: 2025-01-01DOI: 10.1177/20543581251331076
Jagbir Gill, Reetinder Kaur
{"title":"Life on the Line: Prioritizing Equity in Kidney Transplantation for Populations Marginalized by Race and Ethnicity.","authors":"Jagbir Gill, Reetinder Kaur","doi":"10.1177/20543581251331076","DOIUrl":"https://doi.org/10.1177/20543581251331076","url":null,"abstract":"","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251331076"},"PeriodicalIF":1.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12032458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978699","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}
Pub Date : 2025-04-09eCollection Date: 2025-01-01DOI: 10.1177/20543581251333206
Cathy Woods, Maoliosa Donald, Selina Allu, Michelle Hampson, Cynthia MacDonald, Heather Harris, Malcolm King, James Scholey, Adeera Levin, Matthew T James
{"title":"The Problems We Can-SOLVE: How Can-SOLVE CKD Network Implementation and Knowledge Mobilization Projects Are Reshaping Kidney Care in Canada.","authors":"Cathy Woods, Maoliosa Donald, Selina Allu, Michelle Hampson, Cynthia MacDonald, Heather Harris, Malcolm King, James Scholey, Adeera Levin, Matthew T James","doi":"10.1177/20543581251333206","DOIUrl":"https://doi.org/10.1177/20543581251333206","url":null,"abstract":"","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251333206"},"PeriodicalIF":1.6,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12032431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963719","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}
Background: Compared with the general population, kidney transplant recipients (KTRs) frequently visit the emergency department (ED), but much less is known about the characteristics of ED presentations requiring ambulance transport and the impact on subsequent outcomes for KTRs.
Objectives: To identify predictors of ambulance transport to the ED (ambulance-ED) and outcomes (graft failure and mortality) for those who experienced an ambulance-ED event in a cohort of KTRs.
Design: Retrospective cohort study of incident, adult KTRs receiving a transplant from 2008 to 2020.
Setting: Nova Scotia, Canada.
Patients: Adult (≥18 years), Nova Scotian KTRs affiliated with the Atlantic Canada Multi-Organ Transplant Program.
Measurements: Ambulance-ED events were captured for all transplant recipients (following the day of discharge from their initial transplant admission) using electronic records (provided by Emergency Health Services, the sole provider of emergency medical services for Nova Scotia). Ambulance-ED was defined as ambulance transport to the ED following a 911 call; interfacility transfers were excluded. Predictors of ambulance-ED included recipient, donor, immunological, and perioperative characteristics (pertaining to the initial admission for kidney transplantation). Outcomes included graft failure and mortality.
Methods: Predictors of ambulance-ED were analyzed using a multivariable negative binomial regression model and reported using incidence rate ratios (IRRs) and 95% confidence intervals (CIs). The risk of death/graft failure for those with an ambulance-ED within 30 days of hospital discharge following transplantation was analyzed using an adjusted Cox survival analysis and reported using hazard ratios (HRs) and 95% CIs.
Results: A total of 418 patients received a transplant during the study period. A total of 179 (42.8%) experienced one or more ambulance-ED events. Female sex (IRR = 1.60; 95% CI = 1.12-2.29), kidney failure secondary to diabetes (IRR = 2.52; 95% CI = 1.19-5.31), and donor age ≥45 (IRR = 1.50; 95% CI = 1.04-2.15) were all associated with ambulance-ED. There was no significant increase in the risk of death/graft failure for those that experienced ambulance-ED within 30 days of hospital discharge following transplantation (HR = 1.31; 95% CI = 0.44-3.94).
Limitations: A limitation of this study was that ambulance-ED is not a perfect surrogate marker of acute care needs in a population. Important determinants of health such as living situation and socioeconomic status were not available in this data set.
Conclusions: This study highlights the burden of ambulance use for KTRs and provides insight into the need for more optimal follow-up in certain patient subgroups who are at particularly high risk.
背景：与一般人群相比，肾移植受者（KTRs）经常访问急诊科（ED），但对需要救护车运送的ED表现特征及其对肾移植受者后续结局的影响知之甚少。目的：确定在ktr队列中经历救护车-ED事件的患者的救护车转运到急诊室（救护车-ED）和结果（移植物衰竭和死亡率）的预测因素。设计：回顾性队列研究，对2008年至2020年接受移植的成年ktr患者进行研究。环境：加拿大新斯科舍省。患者：成人（≥18岁），隶属于加拿大大西洋多器官移植计划的新斯科舍省KTRs。测量：使用电子记录（由新斯科舍省唯一的紧急医疗服务提供者紧急卫生服务部门提供）记录了所有移植受者（从初次移植入院出院当天起）的救护车- ed事件。ambulance -ED被定义为在接到911报警电话后由救护车送往急诊室；设施间转移不包括在内。救护车- ed的预测因素包括受体、供体、免疫学和围手术期特征（与肾移植初次入院有关）。结果包括移植物衰竭和死亡。方法：采用多变量负二项回归模型对急诊急诊的预测因素进行分析，并采用发病率比（IRRs）和95%置信区间（ci）进行报告。采用校正Cox生存分析分析移植术后出院30天内急诊患者的死亡/移植失败风险，并采用危险比（hr）和95% ci进行报告。结果：在研究期间，共有418例患者接受了移植。共有179人（42.8%）经历过一次或多次急诊事件。女性(IRR = 1.60；95% CI = 1.12-2.29)，继发于糖尿病的肾衰竭(IRR = 2.52；95% CI = 1.19-5.31)，供体年龄≥45岁(IRR = 1.50；95% CI = 1.04-2.15)均与急诊相关。移植术后出院后30天内急诊患者死亡/移植失败的风险无显著增加(HR = 1.31；95% ci = 0.44-3.94)。局限性：本研究的一个局限性是救护车-急诊科并不是一个人群急性护理需求的完美替代标记。这组数据中没有生活状况和社会经济地位等重要的健康决定因素。结论：本研究强调了KTRs使用救护车的负担，并提供了对某些高危患者亚组进行更优化随访的需求。
{"title":"Ambulance Service Utilization by Kidney Transplant Recipients.","authors":"Kaveh Masoumi-Ravandi, Amanda Vinson, Aran Thanamayooran, Judah Goldstein, Thomas Skinner, Karthik Tennankore","doi":"10.1177/20543581251324587","DOIUrl":"10.1177/20543581251324587","url":null,"abstract":"<p><strong>Background: </strong>Compared with the general population, kidney transplant recipients (KTRs) frequently visit the emergency department (ED), but much less is known about the characteristics of ED presentations requiring ambulance transport and the impact on subsequent outcomes for KTRs.</p><p><strong>Objectives: </strong>To identify predictors of ambulance transport to the ED (ambulance-ED) and outcomes (graft failure and mortality) for those who experienced an ambulance-ED event in a cohort of KTRs.</p><p><strong>Design: </strong>Retrospective cohort study of incident, adult KTRs receiving a transplant from 2008 to 2020.</p><p><strong>Setting: </strong>Nova Scotia, Canada.</p><p><strong>Patients: </strong>Adult (≥18 years), Nova Scotian KTRs affiliated with the Atlantic Canada Multi-Organ Transplant Program.</p><p><strong>Measurements: </strong>Ambulance-ED events were captured for all transplant recipients (following the day of discharge from their initial transplant admission) using electronic records (provided by Emergency Health Services, the sole provider of emergency medical services for Nova Scotia). Ambulance-ED was defined as ambulance transport to the ED following a 911 call; interfacility transfers were excluded. Predictors of ambulance-ED included recipient, donor, immunological, and perioperative characteristics (pertaining to the initial admission for kidney transplantation). Outcomes included graft failure and mortality.</p><p><strong>Methods: </strong>Predictors of ambulance-ED were analyzed using a multivariable negative binomial regression model and reported using incidence rate ratios (IRRs) and 95% confidence intervals (CIs). The risk of death/graft failure for those with an ambulance-ED within 30 days of hospital discharge following transplantation was analyzed using an adjusted Cox survival analysis and reported using hazard ratios (HRs) and 95% CIs.</p><p><strong>Results: </strong>A total of 418 patients received a transplant during the study period. A total of 179 (42.8%) experienced one or more ambulance-ED events. Female sex (IRR = 1.60; 95% CI = 1.12-2.29), kidney failure secondary to diabetes (IRR = 2.52; 95% CI = 1.19-5.31), and donor age ≥45 (IRR = 1.50; 95% CI = 1.04-2.15) were all associated with ambulance-ED. There was no significant increase in the risk of death/graft failure for those that experienced ambulance-ED within 30 days of hospital discharge following transplantation (HR = 1.31; 95% CI = 0.44-3.94).</p><p><strong>Limitations: </strong>A limitation of this study was that ambulance-ED is not a perfect surrogate marker of acute care needs in a population. Important determinants of health such as living situation and socioeconomic status were not available in this data set.</p><p><strong>Conclusions: </strong>This study highlights the burden of ambulance use for KTRs and provides insight into the need for more optimal follow-up in certain patient subgroups who are at particularly high risk.</p","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251324587"},"PeriodicalIF":1.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794697","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}
Background: Transplanting less-than-ideal (LTI) kidneys could help optimize organ utilization, but little is known about how patients and caregivers perceive the allocation process, waitlist, or LTI kidneys.
Objective: To explore the perspectives of patients and caregivers on the Canadian kidney transplant allocation process, waitlist, and LTI kidneys.
Design: Electronic survey.
Setting: Canada.
Patients: Transplant recipients, candidates, and caregivers.
Methods: A bilingual electronic national survey was administered from January to March 2024. The questionnaire contained sections on demographics, perceptions of organ allocation and acceptance, LTI kidneys, and educational preferences. Descriptive analysis was performed.
Results: Two hundred fifty-one responses were analyzed, including patients (63%, n = 159), and caregivers (37%, n = 92), from 11 provinces and territories. Three-quarters (74%, n = 186) understood how patients are placed on the waiting list, and 65% (n = 162) understood how donor kidneys are allocated, but 72% (n = 181) and 68% (n = 171) wanted more information about the waitlist and donor kidney allocation criteria, respectively. Approximately 20% felt that the waitlist and allocation processes were not transparent. Awareness about the option to refuse a deceased donor kidney offer was high (69%, n = 174), yet nearly half of respondents (46%, n = 115) expressed concern about being disadvantaged if an offer for a deceased donor kidney was refused. One-third of participants (33%, n = 83) were open to accepting an LTI kidney.
Limitations: Compared to the general population, more study participants were white, and the majority were educated and financially at ease. This limits the generalizability of the results.
Conclusion: Enhanced communication is required to improve transparency and information about the allocation system and waitlist in Canada.
{"title":"Patient and Caregiver Perceptions on the Allocation Process and Waitlist, and Accepting a Less-Than-Ideal Kidney: A Canadian Survey.","authors":"Marie-Chantal Fortin, Fabian Ballesteros Gallego, Héloise Cardinal, Manpreet Kaur, Rahul Mainra, Sylvain Patoine, Nicola Rosaasen, Holly Mansell","doi":"10.1177/20543581251324608","DOIUrl":"10.1177/20543581251324608","url":null,"abstract":"<p><strong>Background: </strong>Transplanting less-than-ideal (LTI) kidneys could help optimize organ utilization, but little is known about how patients and caregivers perceive the allocation process, waitlist, or LTI kidneys.</p><p><strong>Objective: </strong>To explore the perspectives of patients and caregivers on the Canadian kidney transplant allocation process, waitlist, and LTI kidneys.</p><p><strong>Design: </strong>Electronic survey.</p><p><strong>Setting: </strong>Canada.</p><p><strong>Patients: </strong>Transplant recipients, candidates, and caregivers.</p><p><strong>Methods: </strong>A bilingual electronic national survey was administered from January to March 2024. The questionnaire contained sections on demographics, perceptions of organ allocation and acceptance, LTI kidneys, and educational preferences. Descriptive analysis was performed.</p><p><strong>Results: </strong>Two hundred fifty-one responses were analyzed, including patients (63%, n = 159), and caregivers (37%, n = 92), from 11 provinces and territories. Three-quarters (74%, n = 186) understood how patients are placed on the waiting list, and 65% (n = 162) understood how donor kidneys are allocated, but 72% (n = 181) and 68% (n = 171) wanted more information about the waitlist and donor kidney allocation criteria, respectively. Approximately 20% felt that the waitlist and allocation processes were not transparent. Awareness about the option to refuse a deceased donor kidney offer was high (69%, n = 174), yet nearly half of respondents (46%, n = 115) expressed concern about being disadvantaged if an offer for a deceased donor kidney was refused. One-third of participants (33%, n = 83) were open to accepting an LTI kidney.</p><p><strong>Limitations: </strong>Compared to the general population, more study participants were white, and the majority were educated and financially at ease. This limits the generalizability of the results.</p><p><strong>Conclusion: </strong>Enhanced communication is required to improve transparency and information about the allocation system and waitlist in Canada.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251324608"},"PeriodicalIF":1.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11967212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779221","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}
Pub Date : 2025-03-31eCollection Date: 2025-01-01DOI: 10.1177/20543581251323964
Steven Habbous, Beth Montesi, Christy Masse, Corinne Weernink, Sisira Sarma, Mehmet A Begen, Ngan N Lam, Christine Dipchand, Seychelle Yohanna, Dervla M Connaughton, Lianne Barnieh, Amit X Garg
Introduction: Tracking the evaluation process of living kidney donor candidates facilitates benchmarking and can inform process redesign to improve experiences with the evaluation and enable more living donor kidney transplantation.
Methods: We reviewed the medical records for all living donor candidates who were actively undergoing evaluation at any time between January 1, 2013, and December 31, 2016, at the London Health Sciences Centre in London, Ontario, Canada. We abstracted information on demographic factors, the evaluation process, reasons for a delayed evaluation, reasons for an evaluation termination (eg, donation, decline, withdrawal, loss to follow-up), frequency and timing of evaluation testing, and recipient dialysis status.
Results: Over time, the number of living donor kidney transplants increased from 22 in 2013 to 32 in 2016 (18% and 34% of which were pre-emptive, respectively). The median number of candidates coming forward doubled from 167 in 2013 (2 candidates per recipient) to 348 in 2016 (4 candidates per recipient). Median time from first contact until donation decreased from 12.8 months in 2013 to 7.1 months in 2016 (a 45% reduction). The time from computed tomography (CT) angiography until donation (n = 74) was a median of 75 (interquartile range [IQR] = 36, 180) days, the longest single step in the evaluation. Common reasons for delay included waiting for the referral of their intended recipient for transplant evaluation (11% of candidates) and a need for the donor candidate to lose weight (8% of candidates). Donors completed the main evaluation tests on a median of 5 different dates. Thirty-six recipients started dialysis after their living donor candidates' evaluation had been underway for at least 3 months.
Conclusion: Tracking the steps and reasons for an inefficient living kidney donor evaluation process can be used for quality improvement, and efficiency improvements are expected to translate into improved outcomes and experiences.
{"title":"The Flow of Living Kidney Donor Candidates Through the Evaluation Process: A Single-Center Experience in Ontario, Canada.","authors":"Steven Habbous, Beth Montesi, Christy Masse, Corinne Weernink, Sisira Sarma, Mehmet A Begen, Ngan N Lam, Christine Dipchand, Seychelle Yohanna, Dervla M Connaughton, Lianne Barnieh, Amit X Garg","doi":"10.1177/20543581251323964","DOIUrl":"10.1177/20543581251323964","url":null,"abstract":"<p><strong>Introduction: </strong>Tracking the evaluation process of living kidney donor candidates facilitates benchmarking and can inform process redesign to improve experiences with the evaluation and enable more living donor kidney transplantation.</p><p><strong>Methods: </strong>We reviewed the medical records for all living donor candidates who were actively undergoing evaluation at any time between January 1, 2013, and December 31, 2016, at the London Health Sciences Centre in London, Ontario, Canada. We abstracted information on demographic factors, the evaluation process, reasons for a delayed evaluation, reasons for an evaluation termination (eg, donation, decline, withdrawal, loss to follow-up), frequency and timing of evaluation testing, and recipient dialysis status.</p><p><strong>Results: </strong>Over time, the number of living donor kidney transplants increased from 22 in 2013 to 32 in 2016 (18% and 34% of which were pre-emptive, respectively). The median number of candidates coming forward doubled from 167 in 2013 (2 candidates per recipient) to 348 in 2016 (4 candidates per recipient). Median time from first contact until donation decreased from 12.8 months in 2013 to 7.1 months in 2016 (a 45% reduction). The time from computed tomography (CT) angiography until donation (n = 74) was a median of 75 (interquartile range [IQR] = 36, 180) days, the longest single step in the evaluation. Common reasons for delay included waiting for the referral of their intended recipient for transplant evaluation (11% of candidates) and a need for the donor candidate to lose weight (8% of candidates). Donors completed the main evaluation tests on a median of 5 different dates. Thirty-six recipients started dialysis after their living donor candidates' evaluation had been underway for at least 3 months.</p><p><strong>Conclusion: </strong>Tracking the steps and reasons for an inefficient living kidney donor evaluation process can be used for quality improvement, and efficiency improvements are expected to translate into improved outcomes and experiences.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251323964"},"PeriodicalIF":1.6,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11960183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763055","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}
Pub Date : 2025-03-29eCollection Date: 2025-01-01DOI: 10.1177/20543581251324610
Amit X Garg, Liane S Feldman, Jessica M Sontrop, Meaghan S Cuerden, Jennifer B Arnold, Neil Boudville, Martin Karpinski, Scott Klarenbach, Greg Knoll, Charmaine E Lok, Eric McArthur, Matthew Miller, Mauricio Monroy-Cuadros, Kyla L Naylor, G V Ramesh Prasad, Leroy Storsley, Christopher Nguan
Background: Some men who donate a kidney have reported testicular pain after donation; however, attribution to donation is not clear as no prior studies included a comparison group of nondonors.
Objective: To examine the proportion of male donors who reported testicular pain in the years after nephrectomy compared to male nondonors with similar baseline health characteristics.
Design participants and setting: We enrolled 1042 living kidney donors (351 male) before nephrectomy from 17 transplant centers (12 in Canada and 5 in Australia) from 2004 to 2014. A concurrent sample of 396 nondonors (126 male) was enrolled. Follow-up occurred until November 2021.
Measurements: Donors and nondonors completed the same schedule of measurements at baseline (before nephrectomy) and follow-up. During follow-up, participants completed a questionnaire asking whether they had experienced new pain in their eyes, hands, or testicles; those who experienced pain were asked to indicate on which side of the body the pain occurred (left or right). The pain questionnaire was completed by 290 of 351 male donors (83%) and 97 of 126 male nondonors (77%) a median of 3 years after baseline (interquartile range = 2-6).
Methods: Inverse probability of treatment weighting on a propensity score was used to balance donors and nondonors on baseline characteristics. After weighting, the nondonor sample increased to a pseudo sample of 295, and most baseline characteristics were similar between donors and nondonors.
Results: At baseline, donors (n = 290) were a mean age of 49 years; 83% were employed, and 80% were married; 246 (84.8%) underwent laparoscopic surgery and 44 (15.2%) open surgery; 253 (87.2%) had a left-sided nephrectomy and 37 (12.8%) a right-sided nephrectomy. In the weighted analysis, the risk of testicular pain was significantly greater among donors than nondonors: 51/290 (17.6%) vs 7/295 (2.3%); weighted risk ratio, 7.8 (95% confidence interval [CI] = 2.7 to 22.8). Donors and nondonors did not differ statistically in terms of self-reported eye pain or hand pain. Among donors, the occurrence of testicular pain was most often unilateral (92.2%) and on the same side as the nephrectomy (90.2%). Testicular pain occurred more often in donors who had laparoscopic vs open surgery: 48/246 (19.5%) vs 3/44 (6.8%) but was similar in those who had a left-sided vs right-sided nephrectomy: 44/253 (17.4%) vs 7/37 (18.9%).
Limitations: Participants recalled their symptoms several years after baseline, and we did not assess the timing, severity, or duration of pain or any treatments received for the pain.
Conclusion: Unilateral testicular pain on the same side of a nephrectomy is a potential complication of living kidney donation that warrants further investigation.
{"title":"Testicular Pain After Living Kidney Donation: Results From a Multicenter Cohort Study.","authors":"Amit X Garg, Liane S Feldman, Jessica M Sontrop, Meaghan S Cuerden, Jennifer B Arnold, Neil Boudville, Martin Karpinski, Scott Klarenbach, Greg Knoll, Charmaine E Lok, Eric McArthur, Matthew Miller, Mauricio Monroy-Cuadros, Kyla L Naylor, G V Ramesh Prasad, Leroy Storsley, Christopher Nguan","doi":"10.1177/20543581251324610","DOIUrl":"10.1177/20543581251324610","url":null,"abstract":"<p><strong>Background: </strong>Some men who donate a kidney have reported testicular pain after donation; however, attribution to donation is not clear as no prior studies included a comparison group of nondonors.</p><p><strong>Objective: </strong>To examine the proportion of male donors who reported testicular pain in the years after nephrectomy compared to male nondonors with similar baseline health characteristics.</p><p><strong>Design participants and setting: </strong>We enrolled 1042 living kidney donors (351 male) before nephrectomy from 17 transplant centers (12 in Canada and 5 in Australia) from 2004 to 2014. A concurrent sample of 396 nondonors (126 male) was enrolled. Follow-up occurred until November 2021.</p><p><strong>Measurements: </strong>Donors and nondonors completed the same schedule of measurements at baseline (before nephrectomy) and follow-up. During follow-up, participants completed a questionnaire asking whether they had experienced new pain in their eyes, hands, or testicles; those who experienced pain were asked to indicate on which side of the body the pain occurred (left or right). The pain questionnaire was completed by 290 of 351 male donors (83%) and 97 of 126 male nondonors (77%) a median of 3 years after baseline (interquartile range = 2-6).</p><p><strong>Methods: </strong>Inverse probability of treatment weighting on a propensity score was used to balance donors and nondonors on baseline characteristics. After weighting, the nondonor sample increased to a pseudo sample of 295, and most baseline characteristics were similar between donors and nondonors.</p><p><strong>Results: </strong>At baseline, donors (n = 290) were a mean age of 49 years; 83% were employed, and 80% were married; 246 (84.8%) underwent laparoscopic surgery and 44 (15.2%) open surgery; 253 (87.2%) had a left-sided nephrectomy and 37 (12.8%) a right-sided nephrectomy. In the weighted analysis, the risk of testicular pain was significantly greater among donors than nondonors: 51/290 (17.6%) vs 7/295 (2.3%); weighted risk ratio, 7.8 (95% confidence interval [CI] = 2.7 to 22.8). Donors and nondonors did not differ statistically in terms of self-reported eye pain or hand pain. Among donors, the occurrence of testicular pain was most often unilateral (92.2%) and on the same side as the nephrectomy (90.2%). Testicular pain occurred more often in donors who had laparoscopic vs open surgery: 48/246 (19.5%) vs 3/44 (6.8%) but was similar in those who had a left-sided vs right-sided nephrectomy: 44/253 (17.4%) vs 7/37 (18.9%).</p><p><strong>Limitations: </strong>Participants recalled their symptoms several years after baseline, and we did not assess the timing, severity, or duration of pain or any treatments received for the pain.</p><p><strong>Conclusion: </strong>Unilateral testicular pain on the same side of a nephrectomy is a potential complication of living kidney donation that warrants further investigation.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251324610"},"PeriodicalIF":1.6,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751256","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}
Pub Date : 2025-03-29eCollection Date: 2025-01-01DOI: 10.1177/20543581251328077
Kyla L Naylor, Nivethika Jeyakumar, Yuguang Kang, Stephanie N Dixon, Amit X Garg, Ahmed Al-Jaishi, Peter G Blake, Rahul Chanchlani, Longdi Fu, Ziv Harel, Jane Ip, Ahbijat Kitchlu, Jeffrey C Kwong, Gihad Nesrallah, Matthew J Oliver, Therese A Stukel, Ron Wald, Matthew Weir, Kevin Yau
<p><strong>Background: </strong>The impact of the COVID-19 pandemic on clinical outcomes and healthcare utilization in patients receiving maintenance dialysis is unclear.</p><p><strong>Objective: </strong>To compare the rates of clinical outcomes and healthcare utilization in patients receiving maintenance dialysis (in-center and home modalities) before and during the COVID-19 pandemic.</p><p><strong>Design: </strong>Population-based, repeated cross-sectional study.</p><p><strong>Setting: </strong>Linked administrative healthcare databases from Ontario, Canada.</p><p><strong>Patients: </strong>Adults receiving maintenance dialysis from March 15, 2017, to March 14, 2020 (pre-COVID-19 pandemic period) and from March 15, 2020, to March 14, 2023 (COVID-19 pandemic period).</p><p><strong>Measurements: </strong>Our primary outcome was all-cause mortality. Our secondary outcomes included non-COVID-19-related mortality, all-cause hospitalizations (excluding elective surgeries), emergency room visits, intensive care unit admissions, and hospital admissions with mechanical ventilation. We also examined cardiovascular-related hospitalizations, kidney-related outcomes, and ambulatory visits.</p><p><strong>Methods: </strong>We used Poisson generalized estimating equations to model pre-COVID outcome trends and used these to predict post-COVID outcomes and to estimate the relative change (i.e., the ratio of the observed to the expected rate).</p><p><strong>Results: </strong>In 31 900 individuals receiving maintenance dialysis during the study period, the crude incidence rate (per 1000 person-years) of all-cause mortality was 165.0 in the pre-COVID-19 period, compared to 173.2 during the first year of the pandemic and 171.7 during the first 36 months of the pandemic. After adjustment, there was a statistically significant increase in all-cause mortality in 14 out of the 36 months of the COVID-19 period compared to the pre-COVID-19 period, with 494 recorded COVID-19-related deaths. However, when examining the overall all-cause mortality across the months, the adjusted relative rate (aRR) comparing the observed to expected all-cause mortality rate was not statistically significant in the first year of the pandemic (1.08, 95% CI: 1.00, 1.16) and the first 36 months of the pandemic (1.08, 95% CI: 0.99, 1.18) compared to the pre-pandemic period. The crude incidence rate of non-COVID-19-related mortality was 165.0 in the pre-COVID-19 period, compared to 163.3 during the first year of the pandemic and 157.7 during the first 36 months. After adjustment, there was no substantial change in the rate of non-COVID-19-related deaths in the first year of the pandemic (aRR 1.01, 95% CI: 0.94, 1.09), but there was a substantial decrease in all-cause hospitalization, with an aRR of 0.92 (95% CI: 0.88, 0.97), and a substantial decrease in emergency room visits and intensive care unit admissions; findings were consistent 36 months into the pandemic.</p><p><strong>Limitations: </str
{"title":"Clinical Outcomes and Healthcare Utilization in Patients Receiving Maintenance Dialysis After the Onset of the COVID-19 Pandemic in Ontario, Canada.","authors":"Kyla L Naylor, Nivethika Jeyakumar, Yuguang Kang, Stephanie N Dixon, Amit X Garg, Ahmed Al-Jaishi, Peter G Blake, Rahul Chanchlani, Longdi Fu, Ziv Harel, Jane Ip, Ahbijat Kitchlu, Jeffrey C Kwong, Gihad Nesrallah, Matthew J Oliver, Therese A Stukel, Ron Wald, Matthew Weir, Kevin Yau","doi":"10.1177/20543581251328077","DOIUrl":"10.1177/20543581251328077","url":null,"abstract":"<p><strong>Background: </strong>The impact of the COVID-19 pandemic on clinical outcomes and healthcare utilization in patients receiving maintenance dialysis is unclear.</p><p><strong>Objective: </strong>To compare the rates of clinical outcomes and healthcare utilization in patients receiving maintenance dialysis (in-center and home modalities) before and during the COVID-19 pandemic.</p><p><strong>Design: </strong>Population-based, repeated cross-sectional study.</p><p><strong>Setting: </strong>Linked administrative healthcare databases from Ontario, Canada.</p><p><strong>Patients: </strong>Adults receiving maintenance dialysis from March 15, 2017, to March 14, 2020 (pre-COVID-19 pandemic period) and from March 15, 2020, to March 14, 2023 (COVID-19 pandemic period).</p><p><strong>Measurements: </strong>Our primary outcome was all-cause mortality. Our secondary outcomes included non-COVID-19-related mortality, all-cause hospitalizations (excluding elective surgeries), emergency room visits, intensive care unit admissions, and hospital admissions with mechanical ventilation. We also examined cardiovascular-related hospitalizations, kidney-related outcomes, and ambulatory visits.</p><p><strong>Methods: </strong>We used Poisson generalized estimating equations to model pre-COVID outcome trends and used these to predict post-COVID outcomes and to estimate the relative change (i.e., the ratio of the observed to the expected rate).</p><p><strong>Results: </strong>In 31 900 individuals receiving maintenance dialysis during the study period, the crude incidence rate (per 1000 person-years) of all-cause mortality was 165.0 in the pre-COVID-19 period, compared to 173.2 during the first year of the pandemic and 171.7 during the first 36 months of the pandemic. After adjustment, there was a statistically significant increase in all-cause mortality in 14 out of the 36 months of the COVID-19 period compared to the pre-COVID-19 period, with 494 recorded COVID-19-related deaths. However, when examining the overall all-cause mortality across the months, the adjusted relative rate (aRR) comparing the observed to expected all-cause mortality rate was not statistically significant in the first year of the pandemic (1.08, 95% CI: 1.00, 1.16) and the first 36 months of the pandemic (1.08, 95% CI: 0.99, 1.18) compared to the pre-pandemic period. The crude incidence rate of non-COVID-19-related mortality was 165.0 in the pre-COVID-19 period, compared to 163.3 during the first year of the pandemic and 157.7 during the first 36 months. After adjustment, there was no substantial change in the rate of non-COVID-19-related deaths in the first year of the pandemic (aRR 1.01, 95% CI: 0.94, 1.09), but there was a substantial decrease in all-cause hospitalization, with an aRR of 0.92 (95% CI: 0.88, 0.97), and a substantial decrease in emergency room visits and intensive care unit admissions; findings were consistent 36 months into the pandemic.</p><p><strong>Limitations: </str","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"12 ","pages":"20543581251328077"},"PeriodicalIF":1.6,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751255","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}
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