Acute kidney injury: an acceptable risk of treatment with renin-angiotensin system blockade in primary care?
Abstract Background Use of renin-angiotensin system (RAS) blockade has become increasingly widespread driven by evidence-based guidance. There is concern about the role of these agents in the genesis of avoidable acute kidney injury (AKI). Objectives To investigate the association between AKI and use of RAS blockade. Design Multilevel hierarchical analysis of a large cohort of patients registered with UK general practitioners. Setting Primary care practices in ...
Source: Canadian Journal of Kidney Health and Disease - April 9, 2015 Category: Urology & Nephrology Source Type: research

Benefits and harms of citrate locking solutions for hemodialysis catheters: a systematic review and meta-analysis
Abstract Background Citrate has theoretical advantages over heparin for locking hemodialysis central venous catheters (CVCs), but the comparative effectiveness of these agents is not clear. Objectives 1) To compare the benefits and harms of citrate versus heparin locking solutions among patients undergoing hemodialysis through CVCs; 2) to appraise methodological quality of the supporting evidence. Data sources CENTRAL, MEDLINE, EMBASE, CINAHL, ISI Web of Science, and nephrology conference abstracts. ...
Source: Canadian Journal of Kidney Health and Disease - April 2, 2015 Category: Urology & Nephrology Source Type: research

Should nephrologists take a larger role in interventional nephrology, and should central line insertion remain a requirement of nephrology residency training? A debate
Abstract The Canadian Society of Nephrology must soon provide input concerning the future of procedural training in nephrology. While at one time, the ability to insert a central venous catheter (CVC) was an essential skill required by all nephrologists, in 2014, nephrology training and practice has changed in fundamental ways such that it would be both unreasonable, and impractical, to maintain this requirement. Indeed, survey evidence suggests that many current trainees are not achieving this competency. Amongst the reasons that this requirement should be withdrawn include: 1) Not all trainees have the procedur...
Source: Canadian Journal of Kidney Health and Disease - April 2, 2015 Category: Urology & Nephrology Source Type: research

Mass screening for chronic kidney disease in rural and remote Canadian first nations people: methodology and demographic characteristics
Conclusions Point of care mass screening, real time risk prediction and counselling of First Nations people at high risk of Kidney Failure is feasible in rural and remote communities. Further analysis of this cohort will describe theepidemiology of CKD in these communities, and test the cost effectiveness of this strategy. (Source: Canadian Journal of Kidney Health and Disease)
Source: Canadian Journal of Kidney Health and Disease - March 19, 2015 Category: Urology & Nephrology Source Type: research

Percutaneous native renal biopsy adequacy: a successful interdepartmental quality improvement activity
Abstract Background An adequate renal biopsy is essential for diagnosis and treatment of medical renal disease. Objective We evaluated two initiatives to improve adequacy of renal biopsy samples at our centre. Design Retrospective determination of renal biopsy adequacy. Setting Queen Elizabeth II Health Sciences Centre. Patients Patients undergoing medical renal biopsies. Measurements ...
Source: Canadian Journal of Kidney Health and Disease - March 13, 2015 Category: Urology & Nephrology Source Type: research

Should temporary hemodialysis catheter insertion remain a requirement of nephrology residency training?
Abstract Purpose of review Recently, there has been much debate about the practicality and utility of training nephrology fellows in temporary hemodialysis catheter insertion. Sources of information Literature review along with the authors’ opinion. Findings This skill can be taught easily, in a controlled fashion to maximize success and minimize complications. In order to achieve this training centres should be required to teach using simulation based mastery learning and ultrasound guidance. Empl...
Source: Canadian Journal of Kidney Health and Disease - March 5, 2015 Category: Urology & Nephrology Source Type: research

A population-based study of prevalence and risk factors of chronic kidney disease in León, Nicaragua
Conclusions Our findings are comparable to those found in regional studies and further support the hypothesis of a Mesoamerican Nephropathy. (Source: Canadian Journal of Kidney Health and Disease)
Source: Canadian Journal of Kidney Health and Disease - February 24, 2015 Category: Urology & Nephrology Source Type: research

Development of a hemodialysis safety checklist using a structured panel process
Conclusions A novel 17-item Hemodialysis Safety Checklist (Hemo Pause) for use by nurses and patients has been developed to standardize the hemodialysis procedure. Further quality improvement efforts are underway to explore the feasibility of using this checklist to reduce adverse events and strengthen the safety culture in the hemodialysis unit. (Source: Canadian Journal of Kidney Health and Disease)
Source: Canadian Journal of Kidney Health and Disease - February 12, 2015 Category: Urology & Nephrology Source Type: research

Reviewer acknowledgement 2014
Contributing reviewers The Editors of Canadian Journal of Kidney Health and Disease would like to thank all our reviewers who have contributed to the journal in Volume 1 (2014). (Source: Canadian Journal of Kidney Health and Disease)
Source: Canadian Journal of Kidney Health and Disease - February 10, 2015 Category: Urology & Nephrology Source Type: research

The use of tissue plasminogen activator as continuous infusion into an arteriovenous hemodialysis access in the hemodialysis unit: a case series
Conclusions To our knowledge this small case series is the first to describe the procedure whereby low dose tissue plasminogen activator is directly infused into the fistula by the vascular access nurse in the dialysis unit during dialysis and not in the interventional suite. This provides additional information to the existing literature that there is an alternative option for dialysis units to diminish clot burden until a more permanent solution is established through angioplasty. (Source: Canadian Journal of Kidney Health and Disease)
Source: Canadian Journal of Kidney Health and Disease - January 30, 2015 Category: Urology & Nephrology Source Type: research

Validating a scoring tool to predict acute kidney injury (AKI) following cardiac surgery
Abstract Background Acute kidney injury (AKI) after cardiac surgery is associated with an increased risk of mortality. Preoperative risk scores can identify patients at risk for AKI and facilitate preventive strategies. Currently, validated risk scores are used to predict AKI requiring dialysis (AKI-D); less is known about whether these tools predict less severe forms of AKI. Objective To evaluate the Cleveland Clinic scoring tool in predicting both AKI-D and less severe stages of AKI in patients after cardiac surgery in a Canadian tertiary care c...
Source: Canadian Journal of Kidney Health and Disease - January 30, 2015 Category: Urology & Nephrology Source Type: research

Urinary monocyte chemoattractant protein-1 levels and interstitial changes in the renal cortex and their relationship with loss of renal function in renal transplant patients with delayed graft function
Abstract Background Inflammatory cell infiltration and residual areas of fibrosis in kidneys after renal transplantation can lead to functional abnormalities with long-term implications. Objectives The aim of this study was to determine urinary monocyte chemoattractant protein-1 (uMCP-1) levels, relative cortical interstitial area (RCIA), and cortical tubulointerstitial macrophage infiltration in renal transplant patients with delayed graft function (DGF) and their possible correlation with graft outcome. Design ...
Source: Canadian Journal of Kidney Health and Disease - January 30, 2015 Category: Urology & Nephrology Source Type: research

Efficacy and safety data of subsequent entry biologics pertinent to nephrology practice: a systematic review
Conclusions Little clinical difference was found between epoetin SEBs and the reference product. Although not deemed clinically important, the financial implication of a possible dose difference between epoetin zeta and reference product should be considered in pharmacoeconomic studies. Ongoing trials are expected to address the risk of pure-red-cell aplasia with HX 575. (Source: Canadian Journal of Kidney Health and Disease)
Source: Canadian Journal of Kidney Health and Disease - December 23, 2014 Category: Urology & Nephrology Source Type: research

Potential impact of subsequent entry biologics in nephrology practice in Canada
This report provides an executive summary of the information required to guide decisions to use or implement subsequent entry biologics by comparing Canadian regulations to other developed nations, discussing their clinical issues and predicting their impact on the Canadian market and nephrology practice. We hope that this review will assist clinicians and policy makers to navigate this complex subject and to make informed decisions in the best interest of their patients. Sources of information Sources of information include published literature and reports available in the publi...
Source: Canadian Journal of Kidney Health and Disease - December 19, 2014 Category: Urology & Nephrology Source Type: research

Kidney function, albuminuria and life expectancy
Conclusion The presence and degree of albuminuria was associated with lower estimated life expectancy for both gender and was especially notable in those with eGFR ≥30 mL/min/1.73 m2. Life expectancy associated with a given level of eGFR differs substantially based on the presence and severity of albuminuria. (Source: Canadian Journal of Kidney Health and Disease)
Source: Canadian Journal of Kidney Health and Disease - December 19, 2014 Category: Urology & Nephrology Source Type: research

Organ donation and transplantation in Canada: insights from the Canadian Organ Replacement Register
Abstract Purpose of review To provide an overview of the transplant component of the Canadian Organ Replacement Register (CORR). Findings CORR is the national registry of organ failure in Canada. It has existed in some form since 1972 and currently houses data on patients with end-stage renal disease and solid organ transplants (kidney and/or non-kidney). The transplant component of CORR receives data on a voluntary basis from individual transplant centres and organ procurement organizations across the country. Coverage for transplant procedures i...
Source: Canadian Journal of Kidney Health and Disease - December 9, 2014 Category: Urology & Nephrology Source Type: research

The Steroids In the Maintenance of remission of Proliferative Lupus nephritis (SIMPL) pilot trial
Conclusions The high proportion of eligible patients recruited, and success of protocol adherence suggest a large trial of prednisone maintenance therapy compared to withdrawal is feasible. Trial registration Current Controlled Trials ISRCTN31327267. (Source: Canadian Journal of Kidney Health and Disease)
Source: Canadian Journal of Kidney Health and Disease - November 28, 2014 Category: Urology & Nephrology Source Type: research

Canadian chronic kidney disease clinics: a national survey of structure, function and models of care
Conclusions The variability in clinic structure and function offers an opportunity to explore the relationship of these elements to patient outcomes, and to determine optimal models of care. This list of contacts generated through this study, serves as a basis for establishing a CKD clinic network. This network is anticipated to facilitate the conduct of clinical trials to test novel interventions or strategies within the context of well characterized models of care. (Source: Canadian Journal of Kidney Health and Disease)
Source: Canadian Journal of Kidney Health and Disease - November 18, 2014 Category: Urology & Nephrology Source Type: research

A budget impact analysis of the introduction of erythropoiesis stimulating agent subsequent entry biologics for the treatment of anemia of chronic kidney disease in Canada
Conclusion The advent of SEBs represents an opportunity to relieve financial pressure in our healthcare system. Under the assumption that the efficacy and safety of epoetin SEBs are non-inferior to originator products, we have shown that the adoption of epoetin SEBs can lead to cost savings for the Canadian payer. (Source: Canadian Journal of Kidney Health and Disease)
Source: Canadian Journal of Kidney Health and Disease - November 11, 2014 Category: Urology & Nephrology Source Type: research

Health care prioritization: a clinician’s duty
Abstract Purpose of review Publicly funded health care systems are increasingly confronted with fiscal and demographic challenges and face pressure to constrain resource use without impacting clinical outcomes. Findings Clinicians routinely make decisions in the care of their patients that use finite health care resources. Aligning the goal of caring for their patients with ensuring that effective interventions are available for patients who are most likely to benefit is critical to sustaining the publicly funded health care system. ...
Source: Canadian Journal of Kidney Health and Disease - October 28, 2014 Category: Urology & Nephrology Source Type: research

Patient engagement and patient-centred care in the management of advanced chronic kidney disease and chronic kidney failure
Abstract Purpose The purpose of this article is to review the current status of patient-centred care (PCC) and patient engagement (PE) in the management of patients with advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD), to identify some of the barriers that exist to the achievement of PCC and PE, and to describe how these barriers can be overcome. Sources of information The review is based on the professional experience of one of the authors (RB) as a Nephrologist and health care consultant, on the MBA thesis of one of the ...
Source: Canadian Journal of Kidney Health and Disease - October 21, 2014 Category: Urology & Nephrology Source Type: research

Use of a national continuing medical education meeting to provide simulation-based training in temporary hemodialysis catheter insertion skills: a pre-test post-test study
Abstract Background Simulation-based-mastery-learning (SBML) is an effective method to train nephrology fellows to competently insert temporary, non-tunneled hemodialysis catheters (NTHCs). Previous studies of SBML for NTHC-insertion have been conducted at a local level. Objectives Determine if SBML for NTHC-insertion can be effective when provided at a national continuing medical education (CME) meeting. Describe the correlation of demographic factors, prior experience with NTHC-insertion and procedural self-confidence with simulated performance ...
Source: Canadian Journal of Kidney Health and Disease - October 14, 2014 Category: Urology & Nephrology Source Type: research

Canadian Organ Replacement Register (CORR): reflecting the past and embracing the future
Abstract Introduction The Canadian Organ Replacement Register (CORR) is the only Canadian information system on kidney and extra-kidney organ failure and transplantation in Canada. CORR’s mandate is to record and analyze the level of activity and outcomes of vital organ transplantation and treatment of end stage kidney disease using dialysis, either hemodialysis or peritoneal dialysis, activities across Canada. The Canadian Organ Replacement Register was officially launched in 1987, and it included transplantation of extra-renal vital organs (liver, heart, lung, pancreas, bowel), in a...
Source: Canadian Journal of Kidney Health and Disease - October 11, 2014 Category: Urology & Nephrology Source Type: research

Is it ethical to prescribe generic immunosuppressive drugs to renal transplant patients?
Abstract Purpose of the review This review was conducted to determine the ethical acceptability of prescribing generic immunosuppressive drugs to renal transplant patients. Sources of information The literature search was conducted using Pubmed and Google Scholar. Findings The use of generic immunosuppressive drugs (ISDs) in transplantation is a controversial topic. There is a consensus among transplant societies that clinical data is lacking and that caution should be exercised. The reluctance to use ge...
Source: Canadian Journal of Kidney Health and Disease - September 9, 2014 Category: Urology & Nephrology Source Type: research

Fluid balance, change in serum creatinine and urine output as markers of acute kidney injury post cardiac surgery: an observational study
Conclusions Oliguria and positive fluid balance is associated with a trend towards longer LOS as compared to oliguria alone. Fluid balance may therefore be a useful marker of AKI, in addition to urine output and serum creatinine. (Source: Canadian Journal of Kidney Health and Disease)
Source: Canadian Journal of Kidney Health and Disease - September 2, 2014 Category: Urology & Nephrology Source Type: research

The three-year incidence of major hemorrhage among older adults initiating chronic dialysis
Conclusions Many older patients who initiate chronic dialysis will be hospitalized with hemorrhage and receive related procedures over the subsequent three years. Despite greater age and co-morbidity over the last decade this incidence has not changed. (Source: Canadian Journal of Kidney Health and Disease)
Source: Canadian Journal of Kidney Health and Disease - September 2, 2014 Category: Urology & Nephrology Source Type: research

Bridging the gap: a Canadian perspective on translational kidney research
We present the following examples of kidney research: (1) research aimed at identifying the causative genes for inherited kidney diseases; (2) recent discoveries in cell-based therapies for kidney disease; (3) an examination of the impact of acute kidney injury in renal transplant patients; and (4) the development of a kidney failure risk equation to improve prognosis accuracy. Limitations This review focuses on research conducted by the authors. Implications The process of research translation is prolonged and challenging and therefore...
Source: Canadian Journal of Kidney Health and Disease - August 29, 2014 Category: Urology & Nephrology Source Type: research

Improving prevention, early recognition and management of acute kidney injury after major surgery: results of a planning meeting with multidisciplinary stakeholders
Abstract Purpose of review Acute kidney injury (AKI) is common after major surgery, and is associated with morbidity, mortality, increased length of hospital stay, and high health care costs. Although recent guidelines for AKI provide recommendations for identification of patients at risk, monitoring, diagnosis, and management of AKI, there is lack of understanding to guide successful implementation of these recommendations into clinical practice. Sources of information We held a planning meeting with multidisciplinary stakeholders to identify bar...
Source: Canadian Journal of Kidney Health and Disease - August 26, 2014 Category: Urology & Nephrology Source Type: research

Brief communication: patient satisfaction with the use of tablet computers: a pilot study in two outpatient home dialysis clinics
Abstract Background Electronic capture of patients’ reports of their health is significant in clinical nephrology research because health-related quality of life (HRQOL) for patients with end-stage renal disease is compromised and assessment by patients of their HRQOL in practice is relatively uncommon. Objective The purpose of this study was to evaluate patient satisfaction with and time involved in administering HRQOL and symptom assessment measures using tablet computers in two outpatient home dialysis clinics. ...
Source: Canadian Journal of Kidney Health and Disease - August 26, 2014 Category: Urology & Nephrology Source Type: research

Cost analysis of in-centre nocturnal compared with conventional hemodialysis
Conclusions Compared to CvHD, provision of ICNHD is more expensive, largely driven by increased staffing costs as patients dialyze longer. Alternate staffing models, including self-care ICNHD with minimal staff, may lead to net cost savings. The incremental cost of treatment should be considered in the context of impact on patient health outcomes, staffing model, and pragmatic factors, such as current capacity for daytime CvHD and the capital costs of new dialysis stations. (Source: Canadian Journal of Kidney Health and Disease)
Source: Canadian Journal of Kidney Health and Disease - July 2, 2014 Category: Urology & Nephrology Source Type: research

Assessment of potential biomarkers of subclinical vitamin K deficiency in patients with end-stage kidney disease
Conclusions A significant proportion of HD patients met criteria for subclinical vitamin K deficiency. Of the biomarkers measured, PIVKA-II may be superior given its independence of renal function or dyslipidemia, both of which may confound the other vitamin K biomarkers. Studies in patients with ESKD linking biomarkers of vitamin K status to important patient outcomes, including cardiovascular disease, nutritional status and mortality, are required in order to determine the optimal biomarker for evaluating vitamin K status in this particular population. (Source: Canadian Journal of Kidney Health and Disease)
Source: Canadian Journal of Kidney Health and Disease - June 24, 2014 Category: Urology & Nephrology Source Type: research

Estimation of total glomerular number using an integrated disector method in embryonic and postnatal kidneys
Abstract Congenital Anomalies of the Kidney and Urinary Tract (CAKUT) are a polymorphic group of clinical disorders comprising the major cause of renal failure in children. Included within CAKUT is a wide spectrum of developmental malformations ranging from renal agenesis, renal hypoplasia and renal dysplasia (maldifferentiation of renal tissue), each characterized by varying deficits in nephron number. First presented in the Brenner Hypothesis, low congenital nephron endowment is becoming recognized as an antecedent cause of adult-onset hypertension, a leading cause of coronary heart disease, stroke, and renal f...
Source: Canadian Journal of Kidney Health and Disease - June 17, 2014 Category: Urology & Nephrology Source Type: research

Programmatic variation in home hemodialysis in Canada: results from a nationwide survey of practice patterns
Conclusions There is wide variation between programs in all domains of HHD delivery in Canada. We plan further study of the extent to which differences in approach are related to outcomes. (Source: Canadian Journal of Kidney Health and Disease)
Source: Canadian Journal of Kidney Health and Disease - June 10, 2014 Category: Urology & Nephrology Source Type: research

Mortality risk for women on chronic hemodialysis differs by age
Conclusions Women’s survival on chronic hemodialysis varies by age compared to men with a significantly higher mortality in women younger than 45 years old and lower mortality in woman older than 75 years of age. (Source: Canadian Journal of Kidney Health and Disease)
Source: Canadian Journal of Kidney Health and Disease - June 3, 2014 Category: Urology & Nephrology Source Type: research

Incentives and organ donation: what’s (really) legal in Canada?
Abstract Purpose of review To date, there has been little analysis of the degree to which emerging incentive initiatives are permissible under Canadian law. The purpose of this review is to examine the relevant law – including legislation and case law – in order to clarify the legality of existing proposed incentive schemes. Sources of information Legislation and case law. Findings Organ donation is governed by provincial legislation that, in general, bans the exchange of any “benefit&r...
Source: Canadian Journal of Kidney Health and Disease - May 29, 2014 Category: Urology & Nephrology Source Type: research

Is the Canadian legal framework too restrictive and based on false premises?
(Source: Canadian Journal of Kidney Health and Disease)
Source: Canadian Journal of Kidney Health and Disease - May 29, 2014 Category: Urology & Nephrology Source Type: research

Evaluating the implementation strategy for estimated glomerular filtration rate reporting in Manitoba: the effect on referral numbers, wait times, and appropriateness of consults
Conclusion Despite our educational intervention, the inappropriate referrals remained high, and wait times increased. Other systemic interventions should be considered to attenuate the potential negative effects of eGFR reporting and ensure timely access for patients needing specialist consultation. (Source: Canadian Journal of Kidney Health and Disease)
Source: Canadian Journal of Kidney Health and Disease - May 22, 2014 Category: Urology & Nephrology Source Type: research

Foundations and principles of the Canadian living donor paired exchange program
Abstract Purpose of review Kidney paired donation (KPD) remains an important strategy to facilitate transplantation in patients who have a healthy and willing donor, but are unable to proceed with directed donation due to either ABO incompatibility or a positive cross-match against their intended donor. Sources of information Personal knowledge, The Canadian Blood Services Database for Living Donor Exchange, published reports and personal communications. Findings The national Living Donor Paired Exchange...
Source: Canadian Journal of Kidney Health and Disease - May 20, 2014 Category: Urology & Nephrology Source Type: research

The Canadian Society of Nephrology methods in developing and adapting clinical practice guidelines: a review
Conclusion The CSN follows a comprehensive process in identifying priority areas to be addressed in CPGs. In 2010, the CSN adopted GRADE, which enhanced the rigor and transparency of guideline development. This process focuses on systematically identifying best available evidence and carefully assessing its quality, balancing benefits and harms, considering patients’ and societies’ values and preferences, and when possible considering resource implications. Recent partnership allows wider dissemination and implementation among end users and evaluation of the effects of CPG and commentaries on the hea...
Source: Canadian Journal of Kidney Health and Disease - May 12, 2014 Category: Urology & Nephrology Source Type: research

Views of Canadian patients on or nearing dialysis and their caregivers: a thematic analysis
Conclusions Patients on or nearing dialysis and their caregivers identified four major themes, gaining knowledge, maintaining quality of life, sustaining psychosocial wellbeing and ensuring appropriate care, several of which could be addressed by the health care system without requiring significant resources. These include the development of patient materials and resources, or sharing of existing resources across Canadian renal programs, along with adopting better communication strategies. Other concerns, such as the need for increased psychosocial and financial support, require consideration by health care fund...
Source: Canadian Journal of Kidney Health and Disease - April 7, 2014 Category: Urology & Nephrology Source Type: research

Establishing a national knowledge translation and generation network in kidney disease: the CAnadian KidNey KNowledge TraNslation and GEneration NeTwork
Abstract Patients with chronic kidney disease (CKD) do not always receive care consistent with guidelines, in part due to complexities in CKD management, lack of randomized trial data to inform care, and a failure to disseminate best practice. At a 2007 conference of key Canadian stakeholders in kidney disease, attendees noted that the impact of Canadian Society of Nephrology (CSN) guidelines was attenuated given limited formal linkages between the CSN Clinical Practice Guidelines Group, kidney researchers, decision makers and knowledge users, and that further knowledge was required to guide care in patients with...
Source: Canadian Journal of Kidney Health and Disease - April 7, 2014 Category: Urology & Nephrology Source Type: research

An assessment of dialysis provider’s attitudes towards timing of dialysis initiation in Canada
Conclusions Although the majority of nephrologists in Canada who responded followed evidence-based practice regarding the timing of dialysis initiation, knowledge gaps and areas of clinical uncertainty exist. The implementation and evaluation of formal policies and knowledge translation activities may limit potentially unnecessary early dialysis initiation. (Source: Canadian Journal of Kidney Health and Disease)
Source: Canadian Journal of Kidney Health and Disease - April 7, 2014 Category: Urology & Nephrology Source Type: research

Canadian Journal of Kidney Health and Disease: a unique launch of a unique journal
Abstract Usually inaugural editorials are written by the Editor-in-Chief to describe the scope and vision for the journal to potential authors and readers. This editorial is written by the Editor-in-Chief, the Deputy Editors and the Associate Editors collaboratively as a clear signal that this is a unique and different journal. We will build this journal on a set of principles which are fundamental to improving the outcomes of patients with kidney disease. To that end, we aim to be supportive, to collaborate, to integrate multiple perspectives and to be open to possibilities. (Source: Canadian Journal of Kidney Health and Disease)
Source: Canadian Journal of Kidney Health and Disease - April 7, 2014 Category: Urology & Nephrology Source Type: research