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Tutunea-Fatan E, Arumugarajah S, Suri RS, Edgar CR, Hon I, Dikeakos JD, Gunaratnam L. Sensing Dying Cells in Health and Disease: The Importance of Kidney Injury Molecule-1. J Am Soc Nephrol 2024:00001751-990000000-00259. [PMID: 38353655 DOI: 10.1681/asn.0000000000000334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Kidney injury molecule-1 (KIM-1), also known as T-cell Ig and mucin domain-1 (TIM-1), is a widely recognized biomarker for AKI, but its biological function is less appreciated. KIM-1/TIM-1 belongs to the T-cell Ig and mucin domain family of conserved transmembrane proteins, which bear the characteristic six-cysteine Ig-like variable domain. The latter enables binding of KIM-1/TIM-1 to its natural ligand, phosphatidylserine, expressed on the surface of apoptotic cells and necrotic cells. KIM-1/TIM-1 is expressed in a variety of tissues and plays fundamental roles in regulating sterile inflammation and adaptive immune responses. In the kidney, KIM-1 is upregulated on injured renal proximal tubule cells, which transforms them into phagocytes for clearance of dying cells and helps to dampen sterile inflammation. TIM-1, expressed in T cells, B cells, and natural killer T cells, is essential for cell activation and immune regulatory functions in the host. Functional polymorphisms in the gene for KIM-1/TIM-1, HAVCR1 , have been associated with susceptibility to immunoinflammatory conditions and hepatitis A virus-induced liver failure, which is thought to be due to a differential ability of KIM-1/TIM-1 variants to bind phosphatidylserine. This review will summarize the role of KIM-1/TIM-1 in health and disease and its potential clinical applications as a biomarker and therapeutic target in humans.
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Affiliation(s)
- Elena Tutunea-Fatan
- Matthew Mailing Centre for Translational Transplant Studies, Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - Shabitha Arumugarajah
- Matthew Mailing Centre for Translational Transplant Studies, Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Rita S Suri
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Nephrology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Cassandra R Edgar
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Ingrid Hon
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jimmy D Dikeakos
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Lakshman Gunaratnam
- Matthew Mailing Centre for Translational Transplant Studies, Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Division of Nephrology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Kharat A, Tallaa F, Lepage MA, Trinh E, Suri RS, Mavrakanas TA. Volume Status Assessment by Lung Ultrasound in End-Stage Kidney Disease: A Systematic Review. Can J Kidney Health Dis 2023; 10:20543581231217853. [PMID: 38148768 PMCID: PMC10750529 DOI: 10.1177/20543581231217853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/22/2023] [Indexed: 12/28/2023] Open
Abstract
Purpose of review Lung ultrasound is a noninvasive bedside technique that can accurately assess pulmonary congestion by evaluating extravascular lung water. This technique is expanding and is easily available. Our primary outcome was to compare the efficacy of volume status assessment by lung ultrasound with clinical evaluation, echocardiography, bioimpedance, or biomarkers. The secondary outcomes were all-cause mortality and cardiovascular events. Sources of information We conducted a MEDLINE literature search for observational and randomized studies with lung ultrasound in patients on maintenance dialysis. Methods From a total of 2363 articles, we included 28 studies (25 observational and 3 randomized). The correlation coefficients were pooled for each variable of interest using the generic inverse variance method with a random effects model. Among the clinical parameters, New York Heart Association Functional Classification of Heart Failure status and lung auscultation showed the highest correlation with the number of B-lines on ultrasound, with a pooled r correlation coefficient of .57 and .36, respectively. Among echocardiographic parameters, left ventricular ejection fraction and inferior vena cava index had the strongest correlation with the number of B-lines, with a pooled r coefficient of .35 and .31, respectively. Three randomized studies compared a lung ultrasound-guided approach with standard of care on hard clinical endpoints. Although patients in the lung ultrasound group achieved better decongestion and blood pressure control, there was no difference between the 2 management strategies with respect to death from any cause or major adverse cardiovascular events. Key findings Lung ultrasound may be considered for the identification of patients with subclinical volume overload. Trials did not show differences in clinically important outcomes. The number of studies was small and many were of suboptimal quality. Limitations The included studies were heterogeneous and of relatively limited quality.
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Affiliation(s)
- Aileen Kharat
- Division of Respirology, Geneva University Hospitals, Switzerland
| | - Faissal Tallaa
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Marc-Antoine Lepage
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Emilie Trinh
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Rita S. Suri
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Thomas A. Mavrakanas
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
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Suri RS, Moist L, Lok C, Clase CM, Harris J, Reid RD, Ramsay T, Zimmerman D. A Simple Exercise Program for Patients With End-Stage Kidney Disease to Improve Strength and Quality of Life: Clinical Research Protocol. Can J Kidney Health Dis 2023; 10:20543581231205160. [PMID: 37901358 PMCID: PMC10605660 DOI: 10.1177/20543581231205160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/06/2023] [Indexed: 10/31/2023] Open
Abstract
Background Most patients with end-stage kidney disease (ESKD) appreciate the importance of exercise and would like to increase their physical activity; however, they report a few key barriers, including (1) lack of physician advice to do so, (2) lack of safe and convenient programs (ie, appropriate for home or neighborhood), and (3) cost. Importantly, patients indicated in a previous survey that they would prefer an exercise program that improves muscle strength and symptoms, and are less interested in cardiovascular disease prevention. Objective To test the feasibility of a simple, prescribed exercise program using Nordic walking poles in patients with ESKD treated with dialysis. Design Randomized multicenter pilot trial of an exercise intervention that includes Nordic walking poles, personalized physician exercise prescriptions, pedometers, and access to exercise videos, compared with standard of care, in patients being treated with maintenance dialysis. Setting Multicenter tertiary care centers in Canada. Patients Ambulatory adult patients with ESKD treated with peritoneal dialysis or hemodialysis (HD) for at least 6 months at participating sites are potentially eligible. Inclusion criteria include ability to use Nordic walking poles (either de novo or in place of mobility aid) and to provide informed consent in English or in French. Exclusion criteria include (1) any absolute contraindication to exercise, (2) baseline step count >8000 steps/day, (3) planned living donor kidney transplant, and (4) participation in another interventional trial that may affect the results of this study. Methods This is a randomized multicenter pilot trial of an exercise intervention that consists of a prescription to exercise using Nordic walking poles, a pedometer to track activity, and access to exercise videos, with the comparator of standard of care (dialysis unit staff encouragement to exercise) in patients being treated with maintenance dialysis. Randomization is concealed and uses a 1:1 ratio for group assignment. Our specific aims are to determine the feasibility of patient recruitment, adherence to the exercise program (verified by step counts), and efficacy of the intervention on patient-important outcomes that were assessed as a priority by patients in a prior survey-specifically strength, fatigue, and sleep. We record days spent in hospital and loss of independent living to inform sample size calculations for a definitive trial of exercise in patient with ESKD treated with dialysis. Adverse events are closely monitored. Outcomes Primary: Our recruitment goal is 90 to 150 patients over 27 months; adherence success will be defined if >75% of randomized patients, excluding those who are transplanted or deceased, achieve >80% of their prescribed steps at 6 and 12 months. Secondary Efficacy Outcomes: (1) strength-hand grip strength and 5 times sit to stand, (2) energy-Short Form (SF)-36 vitality subscale, and (3) sleep-Pittsburg Sleep Quality Index will be assessed at baseline, 6, and 12 months. Results Trial recruitment started before the COVID-19 pandemic and the pandemic led to many interruptions and delays. Online exercise Web sites and a tailored video were added to the protocol to encourage activity when participants were unable or reluctant to walk in public places. Limitations This trial was designed to include ambulatory patients with ESKD and does not address the burden of disease in patients with very restricted mobility. Trial Registration NCT03787589.
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Affiliation(s)
- Rita S. Suri
- Department of Medicine, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Louise Moist
- Department of Medicine, London Health Science Centre, Western University, London, ON, Canada
| | - Charmaine Lok
- Department of Medicine, University Health Network, University of Toronto, ON, Canada
| | - Catherine M. Clase
- Department of Medicine, Hamilton Centre for Kidney Research, McMaster University, Hamilton, ON, Canada
| | - Jennifer Harris
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, ON, Canada
| | - Robert D. Reid
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, ON, Canada
| | - Tim Ramsay
- School of Epidemiology and Public Health, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
| | - Deborah Zimmerman
- Department of Medicine, Ottawa Hospital, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
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Cybulsky AV, Cercena L, Goodyer PR, Suri RS. Transition From Pediatric to Adult Nephrology Care: Program Report of a Single-Center Experience. Can J Kidney Health Dis 2023; 10:20543581231191836. [PMID: 37564323 PMCID: PMC10411281 DOI: 10.1177/20543581231191836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/23/2023] [Indexed: 08/12/2023] Open
Abstract
Purpose of program Adolescents and young adults with chronic disease face many personal and systemic barriers that may impede their successful transition from pediatric to adult care, putting them at risk for treatment nonadherence, loss to follow-up, and poor health outcomes. Such barriers include impaired socioemotional functioning, overreliance on adult caregivers, lack of disease-specific knowledge, and poor coordination between pediatric and adult health care services. In 2007, we established a specialized youth to adult nephrology transition clinic at a tertiary care center to address these barriers and provide adolescents and young adults with renal disease followed at the affiliated children's hospital with a seamless transition to adult care. Sources of information The attending clinic nephrologist collected data prospectively for this quality improvement report. Methods The features of this specialized clinic included (1) single point of entry and single triage adult nephrologist, (2) ongoing follow-up with a single adult nephrologist who communicated with the pediatric nephrologists, and (3) a single specialized clinic nurse who provided disease-specific education and helped to ensure ongoing patient engagement and follow-up. Importantly, the transition patients were booked into regular appointment slots in the adult nephrologist's general clinic, which facilitated regular follow-up without additional resources. The salary of the transition clinic nurse was covered by an unrestricted grant. Patient visits were in-person, except between 2020 and 2021 when visits were by telephone due to the pandemic. Key findings A total of 213 patients were referred and assessed in the transition clinic from February 2007 until October 2022. Most referrals were from pediatric nephrologists. Among the patients, 29% had a hereditary kidney disease; in 71%, the disease was acquired. The most common disease was glomerulonephritis and ~30% of the patients suffered from a "rare" disease. Of the 213 patients, 123 (58%) continue to be followed up (mean follow-up: 4.8 years), 27 (13%) were transferred to other physicians, in part to accommodate treatment closer to patients' homes, and 29 (14%) without ongoing care needs were discharged. Only 33 (15%) were lost to follow-up. There were several advantages to the clinic, including the maintenance of accurate records, a process to minimize loss to follow-up, and a "critical mass" of patients with rare diseases, which facilitated development of special expertise in rare disease pathogenesis, diagnosis, treatment, and management of complications. Patients with glomerulonephritis demonstrated a stable serum creatinine over 3 to 15 years, and morbidity (as reflected by emergency room visits and hospitalizations) was low. Limitations Due to the relatively small numbers of patients in the disease categories, it was not possible to determine conclusively whether attendance of patients in the transition clinic reduced the rate of progression of kidney disease or morbidity. Implications A dedicated referral, triage, and follow-up process post-transition with only modest financial resources and personnel can result in accurate tracking of clinic data, as well as consistent and reliable follow-up and expert patient care.
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Affiliation(s)
- Andrey V. Cybulsky
- Department of Medicine, McGill University Health Centre Research Institute, McGill University, Montreal, QC, Canada
| | - Leonor Cercena
- Department of Medicine, McGill University Health Centre Research Institute, McGill University, Montreal, QC, Canada
| | - Paul R. Goodyer
- Department of Pediatrics, McGill University Health Centre Research Institute, McGill University, Montreal, QC, Canada
| | - Rita S. Suri
- Department of Medicine, McGill University Health Centre Research Institute, McGill University, Montreal, QC, Canada
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Goupil R, Nadeau-Fredette AC, Prasad B, Hundemer GL, Suri RS, Beaubien-Souligny W, Agharazii M. CENtral blood pressure Targeting: a pragmatic RAndomized triaL in advanced Chronic Kidney Disease (CENTRAL-CKD): A Clinical Research Protocol. Can J Kidney Health Dis 2023; 10:20543581231172407. [PMID: 37168686 PMCID: PMC10164859 DOI: 10.1177/20543581231172407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/26/2023] [Indexed: 05/13/2023] Open
Abstract
Background Emerging data favor central blood pressure (BP) over brachial cuff BP to predict cardiovascular and kidney events, as central BP more closely relates to the true aortic BP. Considering that patients with advanced chronic kidney disease (CKD) are at high cardiovascular risk and can have unreliable brachial cuff BP measurements (due to high arterial stiffness), this population could benefit the most from hypertension management using central BP measurements. Objective To assess the feasibility and efficacy of targeting central BP as opposed to brachial BP in patients with CKD G4-5. Design Pragmatic multicentre double-blinded randomized controlled pilot trial. Setting Seven large academic advanced kidney care clinics across Canada. Patients A total of 116 adults with CKD G4-5 (estimated glomerular filtration rate [eGFR] < 30 mL/min) and brachial cuff systolic BP between 120 and 160 mm Hg. The key exclusion criteria are 1) ≥ 5 BP drugs, 2) recent acute kidney injury, myocardial infarction, stroke, heart failure or injurious fall, 3) previous kidney replacement therapy. Methods Double-blind randomization to a central or a brachial cuff systolic BP target (both < 130 mm Hg) as measured by a validated central BP device. The study duration is 12 months with follow-up visits every 2 to 4 months, based on local practice. All other aspects of CKD management are at the discretion of the attending nephrologist. Outcomes Primary Feasibility: Feasibility of a large-scale trial based on predefined components. Primary Efficacy: Carotid-femoral pulse wave velocity at 12 months. Others: Efficacy (eGFR decline, albuminuria, BP drugs, and quality of life); Events (major adverse cardiovascular events, CKD progression, hospitalization, mortality); Safety (low BP events and acute kidney injury). Limitations May be challenging to distinguish whether central BP is truly different from brachial BP to the point of significantly influencing treatment decisions. Therapeutic inertia may be a barrier to successfully completing a randomized trial in a population of CKD G4-5. These 2 aspects will be evaluated in the feasibility assessment of the trial. Conclusion This is the first trial to evaluate the feasibility and efficacy of using central BP to manage hypertension in advanced CKD, paving the way to a future large-scale trial. Trial registration clinicaltrials.gov (NCT05163158).
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Affiliation(s)
- Rémi Goupil
- Hopital du Sacré-Coeur de Montréal, Université de Montréal, QC, Canada
| | | | | | - Gregory L. Hundemer
- Division of Nephrology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
| | - Rita S. Suri
- McGill University Health Centre, McGill University, Montréal, QC, Canada
| | | | - Mohsen Agharazii
- Centre Hospitalier Universitaire de Québec, Université Laval, Canada
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Sannier G, Nicolas A, Dubé M, Marchitto L, Nayrac M, Tastet O, Chatterjee D, Tauzin A, Lima-Barbosa R, Laporte M, Cloutier R, Sreng Flores AM, Boutin M, Gong SY, Benlarbi M, Ding S, Bourassa C, Gendron-Lepage G, Medjahed H, Goyette G, Brassard N, Delgado GG, Niessl J, Gokool L, Morrisseau C, Arlotto P, Rios N, Tremblay C, Martel-Laferrière V, Prat A, Bélair J, Beaubien-Souligny W, Goupil R, Nadeau-Fredette AC, Lamarche C, Finzi A, Suri RS, Kaufmann DE. A third SARS-CoV-2 mRNA vaccine dose in people receiving hemodialysis overcomes B cell defects but elicits a skewed CD4 + T cell profile. Cell Rep Med 2023; 4:100955. [PMID: 36863335 PMCID: PMC9902290 DOI: 10.1016/j.xcrm.2023.100955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/27/2022] [Accepted: 02/02/2023] [Indexed: 02/10/2023]
Abstract
Cellular immune defects associated with suboptimal responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccination in people receiving hemodialysis (HD) are poorly understood. We longitudinally analyze antibody, B cell, CD4+, and CD8+ T cell vaccine responses in 27 HD patients and 26 low-risk control individuals (CIs). The first two doses elicit weaker B cell and CD8+ T cell responses in HD than in CI, while CD4+ T cell responses are quantitatively similar. In HD, a third dose robustly boosts B cell responses, leads to convergent CD8+ T cell responses, and enhances comparatively more T helper (TH) immunity. Unsupervised clustering of single-cell features reveals phenotypic and functional shifts over time and between cohorts. The third dose attenuates some features of TH cells in HD (tumor necrosis factor alpha [TNFα]/interleukin [IL]-2 skewing), while others (CCR6, CXCR6, programmed cell death protein 1 [PD-1], and HLA-DR overexpression) persist. Therefore, a third vaccine dose is critical to achieving robust multifaceted immunity in hemodialysis patients, although some distinct TH characteristics endure.
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Affiliation(s)
- Gérémy Sannier
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Alexandre Nicolas
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Mathieu Dubé
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Lorie Marchitto
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Manon Nayrac
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Olivier Tastet
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Debashree Chatterjee
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Alexandra Tauzin
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | | | - Mélanie Laporte
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Rose Cloutier
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Alina M Sreng Flores
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Marianne Boutin
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Shang Yu Gong
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Department of Microbiology and Immunology, McGill University, Montreal, QC H3A 2B4, Canada
| | - Mehdi Benlarbi
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Shilei Ding
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Catherine Bourassa
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Gabrielle Gendron-Lepage
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Halima Medjahed
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Guillaume Goyette
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Nathalie Brassard
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Gloria-Gabrielle Delgado
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Julia Niessl
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Laurie Gokool
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Chantal Morrisseau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Pascale Arlotto
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada
| | - Norka Rios
- Research Institute of the McGill University Health Centre, Montreal, QC H3H 2L9, Canada
| | - Cécile Tremblay
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Valérie Martel-Laferrière
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Alexandre Prat
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Département de Neurosciences, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Justin Bélair
- Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - William Beaubien-Souligny
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Nephrology Division, Centre Hospitalier de l'Université de Montréal, Montreal, QC H3X 3E4, Canada
| | - Rémi Goupil
- Centre de Recherche of the Hôpital du Sacré-Cœur de Montréal, Montreal, QC H4J 1C5, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Annie-Claire Nadeau-Fredette
- Nephrology Division, Centre Hospitalier de l'Université de Montréal, Montreal, QC H3X 3E4, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada; Centre de Recherche of the Hôpital Maisonneuve-Rosemont, Montreal, QC H1T 2M4, Canada
| | - Caroline Lamarche
- Nephrology Division, Centre Hospitalier de l'Université de Montréal, Montreal, QC H3X 3E4, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada; Centre de Recherche of the Hôpital Maisonneuve-Rosemont, Montreal, QC H1T 2M4, Canada
| | - Andrés Finzi
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Université de Montréal, Montreal, QC H3T 1J4, Canada; Department of Microbiology and Immunology, McGill University, Montreal, QC H3A 2B4, Canada.
| | - Rita S Suri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Research Institute of the McGill University Health Centre, Montreal, QC H3H 2L9, Canada; Division of Nephrology, Department of Medicine, McGill University, Montreal, QC H3G 2M1, Canada.
| | - Daniel E Kaufmann
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 0A9, Canada; Département de Médecine, Université de Montréal, Montréal, QC H3T 1J4, Canada; Division of Infectious Diseases, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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Solomon J, Festa MC, Chatzizisis YS, Samanta R, Suri RS, Mavrakanas TA. Sodium-glucose co-transporter 2 inhibitors in patients with chronic kidney disease. Pharmacol Ther 2023; 242:108330. [PMID: 36513134 DOI: 10.1016/j.pharmthera.2022.108330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
Diabetes drives an increasing burden of cardiovascular and renal disease worldwide, motivating the search for new hypoglycemic agents that confer cardiac and renal protective effects. Although initially developed as hypoglycemic agents, sodium-glucose co-transporter 2 (SGLT-2) inhibitors have since been studied in patients with and without diabetes for the management of heart failure and chronic kidney disease. A growing body of evidence supports the efficacy and safety of SGLT-2 inhibitors in patients with chronic kidney disease (CKD), based on complex mechanisms of action that extend far beyond glucosuria and that confer beneficial effects on cardiovascular and renal hemodynamics, fibrosis, inflammation, and end-organ protection. This review focuses on the pharmacology and pathophysiology of SGLT-2 inhibitors in patients with CKD, as well as their cardiovascular and renal effects in this population. We are focusing on the five agents that have been tested in cardiovascular outcome trials and that have been approved either in Europe or in North America: empagliflozin, dapagliflozin, canagliflozin, ertugliglozin, and sotagliflozin.
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Affiliation(s)
- Joshua Solomon
- Division of Internal Medicine, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Maria Carolina Festa
- Division of Internal Medicine, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Yiannis S Chatzizisis
- Division of Cardiovascular Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Ratna Samanta
- Division of Nephrology, Department of Medicine, McGill University Health Center, Montreal, QC, Canada
| | - Rita S Suri
- Division of Nephrology, Department of Medicine, McGill University Health Center, Montreal, QC, Canada; Research Institute of the McGill University Health Center, Montreal, QC, Canada
| | - Thomas A Mavrakanas
- Division of Nephrology, Department of Medicine, McGill University Health Center, Montreal, QC, Canada; Research Institute of the McGill University Health Center, Montreal, QC, Canada.
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8
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Affdal A, Malo MF, Blum D, Ballesteros F, Beaubien-Souligny W, Caron ML, Nadeau-Fredette AC, Vasilevsky M, Rios N, Suri RS, Fortin MC. Lived Experiences of Hemodialysis Health Care Workers during the COVID-19 Pandemic: A Qualitative Study from the Quebec Renal Network. Kidney360 2023; 4:188-197. [PMID: 36821610 PMCID: PMC10103388 DOI: 10.34067/kid.0004252022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022]
Abstract
Key Points Hemodialysis workers' well-being and work were affected by the COVID-19 pandemics. Effective communication strategies and taking into account psychological distress are ways to mitigate the challenges faced by health care workers. Background The COVID-19 pandemic has disrupted health systems and created numerous challenges in hospitals worldwide for patients and health care workers (HCWs). Hemodialysis centers are at risk of COVID-19 outbreaks given the difficulty of maintaining social distancing and the fact that hemodialysis patients are at higher risk of being infected with COVID-19. During the COVID-19 pandemic, HCWs have had to face many challenges and stressors. Our study was designed to gain HCWs' perspectives on their experiences of the impacts of the COVID-19 pandemic in hemodialysis units. Methods Semistructured interviews were conducted with 22 HCWs (nurses, nephrologists, pharmacists, social workers, patient attendants, and security agents) working in five hemodialysis centers in Montreal, between November 2020 and May 2021. The content of the interviews was analyzed using thematic analysis. Results Four themes were identified during the interviews. The first was the impact of COVID-19 on work organization, regarding which participants reported an increased workload, a need for a consistent information strategy, and positive innovations such as telemedicine. The second theme was challenges associated with communicating and caring for dialysis patients during the pandemic. The third theme was psychological distress experienced by hemodialysis staff and the psychosocial impact of COVID-19 on their personal lives. The fourth theme was recommendations made by participants for future public health emergencies, such as maintaining public health measures, ensuring an adequate supply of protective equipment, and developing a consistent communication strategy. Conclusions During the first and second waves of the COVID-19 pandemic, HCWs working in hemodialysis units faced multiple challenges that affected their well-being and their work. To minimize challenges for HCWs in hemodialysis during a future pandemic, the health care system should provide an adequate supply of protective equipment, develop effective communication strategies, and take into account the psychological distress related to HCWs' professional and personal lives.
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Affiliation(s)
- Aliya Affdal
- Bioethics Program, École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Françoise Malo
- Bioethics Program, École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada
| | - Dan Blum
- Division of nephrology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Fabian Ballesteros
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - William Beaubien-Souligny
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Faculté de médecine de l'Université de Montréal, Montreal, Quebec, Canada
- Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Line Caron
- Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Annie-Claire Nadeau-Fredette
- Faculté de médecine de l'Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | | | - Norka Rios
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Rita S. Suri
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Faculté de médecine de l'Université de Montréal, Montreal, Quebec, Canada
- Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
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9
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Molnar AO, Bota SE, Naylor K, Nash DM, Smith G, Suri RS, Sood MM, Gomes T, Garg AX. Opioid prescribing practices in chronic kidney disease: a population-based cohort study. Nephrol Dial Transplant 2022; 37:2408-2417. [PMID: 34888696 DOI: 10.1093/ndt/gfab343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Chronic pain is common, and its management is complex in patients with chronic kidney disease (CKD), but limited data are available on opioid prescribing. We examined opioid prescribing for non-cancer and non-end-of-life care in patients with CKD. METHODS This was a population-based retrospective cohort study using administrative databases in Ontario, Canada which included adults with CKD defined by an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 from 1 November 2012 to 31 December 2018 and estimated the proportion of opioid prescriptions (type, duration, dose, potentially inappropriate prescribing, etc.) within 1 year of cohort entry. Prescriptions had to precede dialysis, kidney transplant or death. RESULTS We included 680 445 adults with CKD, and 198 063 (29.1%) were prescribed opioids. Codeine (14.9%) and hydromorphone (7.2%) were the most common opioids. Among opioid users, 24.3% had repeated or long-term use, 26.1% were prescribed high doses and 56.8% were new users. Opioid users were more likely to be female, had cardiac disease or a mental health diagnosis, and had more healthcare visits. The proportions for potentially inappropriate prescribing indicators varied (e.g. 50.1% with eGFR <30 were prescribed codeine, and 20.6% of opioid users were concurrently prescribed benzodiazepines, while 7.2% with eGFR <30 mL/min/1.73 m2 were prescribed morphine, and 7.0% were received more than one opioid concurrently). Opioid prescriptions declined with time (2013 cohort: 31.1% versus 2018 cohort: 24.5%; p <0.0001), as did indicators of potentially inappropriate prescribing. CONCLUSIONS Opioid use was common in patients with CKD. While opioid prescriptions and potentially inappropriate prescribing have declined in recent years, interventions to improve pain management without the use of opioids and education on safer prescribing practices are needed.
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Affiliation(s)
- Amber O Molnar
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, ON, Canada.,ICES, ON, Canada
| | | | | | | | | | - Rita S Suri
- Research Institute of the McGill University Health Center (MUHC), and Division of Nephrology, Department of Medicine, MUHC, Montreal, QC, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Manish M Sood
- ICES, ON, Canada.,Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Tara Gomes
- ICES, ON, Canada.,Unity Health, Toronto, ON, Canada
| | - Amit X Garg
- ICES, ON, Canada.,Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
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10
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Valentini N, Marchitto L, Raymond M, Goyette G, Kaufmann DE, Finzi A, Suri RS, Lamarche C. Innate Immunity and SARS-CoV-2 Vaccine Response in Hemodialysis Patients. Kidney360 2022; 3:1763-1768. [PMID: 36514720 PMCID: PMC9717667 DOI: 10.34067/kid.0002542022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/08/2022] [Indexed: 01/12/2023]
Abstract
Patients receiving hemodialysis (HD) have more inflammatory monocytes and less plasmacytoid dendritic cells (DCs) compared with healthy controls.Patients on HD who have a poor antibody response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine had fewer monocyte-derived DCs and conventional DCs compared with good responders.The defects in antigen presentation might be possible therapeutic targets to increase vaccine efficacy in HD patients.
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Affiliation(s)
- Nicolas Valentini
- Hôpital Maisonneuve-Rosemont Research Institute, Montreal, Quebec, Canada,Department of Pharmacology and Physiology, University of Montreal, Montreal, Quebec, Canada
| | - Lorie Marchitto
- Centre Hospitalier Universitaire de Montreal (CHUM) Research Institute, Montreal, Quebec, Canada,Department of Microbiology, Infectiology and Immunology, University of Montreal, Montreal, Quebec, Canada
| | - Maxime Raymond
- Hôpital Maisonneuve-Rosemont Research Institute, Montreal, Quebec, Canada
| | - Guillaume Goyette
- Centre Hospitalier Universitaire de Montreal (CHUM) Research Institute, Montreal, Quebec, Canada
| | - Daniel E. Kaufmann
- Centre Hospitalier Universitaire de Montreal (CHUM) Research Institute, Montreal, Quebec, Canada,Departement of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Andrés Finzi
- Centre Hospitalier Universitaire de Montreal (CHUM) Research Institute, Montreal, Quebec, Canada,Department of Microbiology, Infectiology and Immunology, University of Montreal, Montreal, Quebec, Canada
| | - Rita S. Suri
- Research Institute of the McGill University Health Center, Montreal, Quebec, Canada,Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Caroline Lamarche
- Hôpital Maisonneuve-Rosemont Research Institute, Montreal, Quebec, Canada,Departement of Medicine, University of Montreal, Montreal, Quebec, Canada
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11
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Suri RS, Lee JY, Ban MR, Shrum B, Tutunea-Fatan E, Ismail OZ, Leckie S, McIntyre A, Xu Q, Lee SH, de Chickera S, Hegele RA, Gunaratnam L. Defective KIM-1 phagocytosis does not predispose to acute graft dysfunction after kidney transplantation in humans. Kidney Int 2022; 102:435-439. [DOI: 10.1016/j.kint.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/02/2022] [Accepted: 05/11/2022] [Indexed: 11/15/2022]
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12
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Malo MF, Affdal A, Blum D, Ballesteros F, Beaubien-Souligny W, Caron ML, Nadeau-Fredette AC, Vasilevsky M, Rios N, Fortin MC, Suri RS. Lived Experiences of Patients Receiving Hemodialysis during the COVID-19 Pandemic: A Qualitative Study from the Quebec Renal Network. Kidney360 2022; 3:1057-1064. [PMID: 35845331 PMCID: PMC9255873 DOI: 10.34067/kid.0000182022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/21/2022] [Indexed: 01/10/2023]
Abstract
Background Hemodialysis patients have faced unique challenges during the COVID-19 pandemic. They face high risk of death if infected and have unavoidable exposure to others when they come to hospital three times weekly for their life-saving treatments. The objective of this study was to gain a better understanding of the scope and magnitude of the effects of the pandemic on the lived experience of patients receiving in-center hemodialysis. Methods We conducted semi-structured interviews with 22 patients who were undergoing dialysis treatments in five hemodialysis centers in Montreal from November 2020 to May 2021. Interviews were transcribed and then analyzed using thematic content analysis. Results Most participants reported no negative effects of the COVID-19 pandemic on their hemodialysis care. Several patients had negative feelings related to forced changes in their dialysis schedules, and this was especially pronounced for indigenous patients in a shared living situation. Some patients were concerned about contracting COVID-19, especially during public transportation, whereas others expressed confidence that the physical distancing and screening measures implemented at the hospital would protect them and their loved ones. Some participants reported that masks negatively affected their interactions with health care workers, and for many others, the pandemic was associated with feelings of loneliness. Finally, some respondents reported some positive effects of the pandemic, including use of telemedicine and creating a sense of solidarity. Conclusions Patients undergoing hemodialysis reported no negative effects on their medical care but faced significant disruptions in their routines and social interactions due to the COVID-19 pandemic. Nevertheless, they showed great resilience in their ability to adapt to the new reality of their hemodialysis treatments. We also show that studies focused on understanding the lived experiences of indigenous patients and patients from different ethnic backgrounds are needed in order reduce inequities in care during public health emergencies.
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Affiliation(s)
- Marie-Françoise Malo
- Bioethics Program, École de santé publique de l’Université de Montréal, Montreal, Canada
| | - Aliya Affdal
- Bioethics Program, École de santé publique de l’Université de Montréal, Montreal, Canada
| | - Dan Blum
- Division of nephrology, Jewish General Hospital, Montreal, Canada
| | - Fabian Ballesteros
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Canada
| | - William Beaubien-Souligny
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Canada,Faculté de médecine de l’Université de Montréal, Montreal, Canada,Centre hospitalier de l’Université de Montréal, Montreal, Canada
| | - Marie-Line Caron
- Centre hospitalier de l’Université de Montréal, Montreal, Canada
| | - Annie-Claire Nadeau-Fredette
- Faculté de médecine de l’Université de Montréal, Montreal, Canada,Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Canada
| | | | - Norka Rios
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Canada,Faculté de médecine de l’Université de Montréal, Montreal, Canada,Centre hospitalier de l’Université de Montréal, Montreal, Canada
| | - Rita S. Suri
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, Canada,Faculty of Medicine, McGill University, Montreal, Canada,Research Institute of the McGill University Health Centre, Montreal, Canada
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13
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Rigas C, Park H, Nassim M, Su CL, Greenway K, Lipman M, McVeigh C, Novak M, Trinh E, Alam A, Suri RS, Mucsi I, Torres-Platas SG, Noble H, Sekhon H, Rej S, Lifshitz M. Long-term Effects of a Brief Mindfulness Intervention Versus a Health Enhancement Program for Treating Depression and Anxiety in Patients Undergoing Hemodialysis: A Randomized Controlled Trial. Can J Kidney Health Dis 2022; 9:20543581221074562. [PMID: 35273807 PMCID: PMC8902179 DOI: 10.1177/20543581221074562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Depression and anxiety affect approximately 50% of patients with kidney
failure receiving hemodialysis and are associated with decreased quality of
life and increased risk of hospitalization and mortality. A Brief
Mindfulness Intervention (BMI) may be promising in treating depressive and
anxiety symptoms in this population, but the long-term sustainability of the
intervention’s effects is unknown. Objective: We previously conducted a randomized controlled trial (RCT; n = 55) comparing
an 8-week BMI with an active control (Health Enhancement Program [HEP]) for
patients receiving dialysis, with depression and/or anxiety. Here, we
examine the 6-month follow-up data to determine the long-term sustainability
of BMI versus HEP in reducing (1) depressive symptoms, (2) anxiety symptoms,
and (3) the efficacy of BMI versus HEP in reducing the likelihood of
hospitalization. Design: In this study, we analyzed 6-month follow-up data from an 8-week
assessor-blinded parallel RCT, which evaluated the efficacy of a BMI against
an active control, HEP, in patients receiving hemodialysis with symptoms of
depression and/or anxiety. Setting: The study took place at hemodialysis centers in 4 tertiary-care hospitals in
Montreal, Canada. Participants: Participants included adults aged ≥18 years who were receiving in-center
hemodialysis 3 times per week and had symptoms of depression and/or anxiety
as indicated by a score ≥6 on the Patient Health Questionnaire–9 (PHQ-9)
and/or the General Anxiety Disorder–7 (GAD-7). Methods: Participants were randomized to the treatment arm (BMI) or the active control
arm (HEP) and completed assessments at baseline, 8 weeks, and 6-month
follow-up. Depression was assessed using the PHQ-9, and anxiety was assessed
by the GAD-7. Hospitalization rates were assessed using medical chart
information. Results: We observed significant decrease in depression scores over 6 months in both
BMI and HEP groups, with no significant difference between groups. Anxiety
scores significantly decreased over 6 months, but only in the BMI group.
Brief Mindfulness Intervention and Health Enhancement Program were
comparable in terms of hospitalization rates. Limitations: The limitations of our study include the modest sample size and lack of a
third arm such as a waitlist control. Conclusions: Our results suggest that the beneficial effects of BMI and HEP for improving
mood disorder symptoms in patients receiving dialysis persist at 6-month
follow-up. Both interventions showed sustained effects for depressive
symptoms, but BMI may be more useful in this population given its efficacy
in reducing anxiety symptoms as well. Trial registration: Prior to recruitment, the trial had been registered (ClinicalTrials.gov
Identifier: NCT03406845).
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Affiliation(s)
- Christina Rigas
- Geri-PARTy Research Group, Jewish General Hospital, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Haley Park
- Geri-PARTy Research Group, Jewish General Hospital, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Marouane Nassim
- Geri-PARTy Research Group, Jewish General Hospital, Montreal, QC, Canada
| | - Chien-Lin Su
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Kyle Greenway
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Mark Lipman
- Division of Nephrology, Jewish General Hospital, Montreal, QC, Canada
- Research Institute of the McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Clare McVeigh
- School of Nursing and Midwifery, Queen’s University, Belfast, UK
| | - Marta Novak
- Department of Psychiatry, University Health Network, University of Toronto, ON, Canada
| | - Emilie Trinh
- Research Institute of the McGill University Health Center, McGill University, Montreal, QC, Canada
- Division of Nephrology, McGill University Health Centre, Montreal, QC, Canada
| | - Ahsan Alam
- Research Institute of the McGill University Health Center, McGill University, Montreal, QC, Canada
- Division of Nephrology, McGill University Health Centre, Montreal, QC, Canada
| | - Rita S. Suri
- Research Institute of the McGill University Health Center, McGill University, Montreal, QC, Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, QC, Canada
| | - Istvan Mucsi
- Division of Nephrology, McGill University Health Centre, Montreal, QC, Canada
- Transplant Inpatient Unit, Division of Nephrology, University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, ON, Canada
| | | | - Helen Noble
- School of Nursing and Midwifery, Queen’s University, Belfast, UK
| | - Harmehr Sekhon
- Geri-PARTy Research Group, Jewish General Hospital, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Soham Rej
- Geri-PARTy Research Group, Jewish General Hospital, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Michael Lifshitz
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Department of Medicine, University of Toronto, ON, Canada
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14
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Beaudet M, Ravensbergen L, DeWeese J, Beaubien-Souligny W, Nadeau-Fredette AC, Rios N, Caron ML, Suri RS, El-Geneidy A. Accessing hemodialysis clinics during the COVID-19 pandemic. Transp Res Interdiscip Perspect 2022; 13:100533. [PMID: 35036907 PMCID: PMC8743465 DOI: 10.1016/j.trip.2021.100533] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/09/2021] [Accepted: 12/30/2021] [Indexed: 06/14/2023]
Abstract
Transportation is a key element of access to healthcare. The COVID-19 pandemic posed unique and unforeseen challenges to patients receiving hemodialysis who rely on three times weekly transportation to receive their life-saving treatments, but there is little data on the problems they faced. This study explores the attitudes, fears, and concerns of hemodialysis patients during the pandemic with a focus on their travel to/from dialysis treatments. A mixed methods travel survey was distributed to hemodialysis patients from three urban centers in Montréal, Canada, during the pandemic (n = 43). The survey included closed questions that were analysed through descriptive statistics as well as open-ended questions that were assessed through thematic analysis. Descriptive statistics show that hemodialysis patients are more fearful of contracting COVID-19 in transit than they are at the treatment center. Patients taking paratransit, public transportation, and taxis are more fearful of COVID-19 while traveling than those who drive, who are driven, or who walk to the clinic. In the open-ended questions, patients reported struggling with confusing COVID-19 protocols in public transport, including conflicting information on whether paratransit taxis allowed one or multiple passengers. Paratransit was the most used travel mode to access treatment (n = 30), with problems identified in the open-ended questions, such as long and unreliable pickup windows, and extended travel times. To limit COVID-19 exposure and stress for paratransit users, agencies should consider sitting one patient per paratransit taxi, clearly communicating COVID-19 protocols online and in the vehicles, and tracking vehicles for more efficient pickups.
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Affiliation(s)
| | | | | | - William Beaubien-Souligny
- Section of Nephrology, Department of Medicine, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Canada
| | | | - Norka Rios
- Research Institute of the McGill University Health Center, Canada
| | - Marie-Line Caron
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada
| | - Rita S Suri
- Division of Nephrology, Department of Medicine, Research Institute of the McGill University Health Center, McGill University, Canada
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15
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Ethier I, Nevis I, Suri RS. Quality of Life and Hemodynamic Effects of Switching From Hemodialysis to Hemodiafiltration: A Canadian Controlled Cohort Study. Can J Kidney Health Dis 2021; 8:20543581211057717. [PMID: 34804556 PMCID: PMC8600559 DOI: 10.1177/20543581211057717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/28/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Recent randomized clinical trials have demonstrated beneficial effects of
hemodiafiltration (HDF) compared with hemodialysis (HD) on mortality and
hemodynamic stability. Data on quality of life in HDF compared with HD is
limited. Objective: This study aimed to determine whether patients receiving HD experience
improvements in quality of life, hemodynamic and laboratory parameters after
switching to HDF. Design: Observational controlled cohort study. Setting & Patients: Adult patients receiving maintenance dialysis were followed for 3 months both
before and after transfer to a new unit, where they received HDF. Prior to
transfer, control patients were already treated by HDF. Methods: Quality of life at baseline and follow-up was measured using the validated
minutes to recovery (MR) question. Dialysis data were collected for 3
consecutive sessions monthly; laboratory values were collected monthly.
Wilcoxon signed rank test and repeated measures analysis of covariance were
used to evaluate pre/post transfer changes and quantile regression to
identify predictors of change in recovery time. Results: Of 227 patients, 82 died, were transplanted, were hospitalized or did not
transfer, leaving 123 subjects and 22 controls for analysis. MR did not
improve with switching to HDF, although patients with MR > 60 min before
transfer experienced a significant decrease in their MR, compared with
controls. There was no improvement in intradialytic hypotension with HDF.
There were no differences in laboratory values before vs after switch. Limitations: Nonrandomized single-center study, including only small numbers of patients
and covering a short follow-up period; hemodynamic values only evaluated
over 1 week per month; residual kidney function not recorded. Conclusions: In this Canadian experience of HDF, patients remained stable with respect to
several laboratory and dialysis related parameters. Switch to HDF was
associated with substantially reduced recovery time in patients with MR >
60 minutes at baseline.
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Affiliation(s)
- Isabelle Ethier
- Department of Medicine, Section of Nephrology, Centre Hospitalier de l'Université de Montréal, QC, Canada.,Department of Medicine, Section of Nephrology, Centre de Recherche, Centre Hospitalier de l'Université de Montréal, QC, Canada
| | - Immaculate Nevis
- Goodman School of Business, Brock University, St. Catharines, ON, Canada
| | - Rita S Suri
- Department of Medicine, Section of Nephrology, Centre de Recherche, Centre Hospitalier de l'Université de Montréal, QC, Canada.,Department of Medicine, Section of Nephrology, McGill University Health Centre, Montreal, QC, Canada
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16
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Carr EJ, Kronbichler A, Graham-Brown M, Abra G, Argyropoulos C, Harper L, Lerma EV, Suri RS, Topf J, Willicombe M, Hiremath S. Review of Early Immune Response to SARS-CoV-2 Vaccination Among Patients With CKD. Kidney Int Rep 2021; 6:2292-2304. [PMID: 34250319 PMCID: PMC8257418 DOI: 10.1016/j.ekir.2021.06.027] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/07/2021] [Accepted: 06/21/2021] [Indexed: 02/07/2023] Open
Abstract
The effects of the coronavirus disease-2019 (COVID-19) pandemic, particularly among those with chronic kidney disease (CKD), who commonly have defects in humoral and cellular immunity, and the efficacy of vaccinations against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are uncertain. To inform public health and clinical practice, we synthesized published studies and preprints evaluating surrogate measures of immunity after SARS-CoV-2 vaccination in patients with CKD, including those receiving dialysis or with a kidney transplant. We found 35 studies (28 published, 7 preprints), with sample sizes ranging from 23 to 1140 participants and follow-up ranging from 1 week to 1 month after vaccination. Seventeen of these studies enrolled a control group. In the 22 studies of patients receiving dialysis, the development of antibodies was observed in 18% to 53% after 1 dose and in 70% to 96% after 2 doses of mRNA vaccine. In the 14 studies of transplant recipients, 3% to 59% mounted detectable humoral or cellular responses after 2 doses of mRNA vaccine. After vaccination, there were a few reported cases of relapse or de novo glomerulonephritis, and acute transplant rejection, suggesting a need for ongoing surveillance. Studies are needed to better evaluate the effectiveness of SARS-CoV-2 vaccination in these populations. Rigorous surveillance is necessary for detection of long-term adverse effects in patients with autoimmune disease and transplant recipients. For transplant recipients and those with suboptimal immune responses, alternate vaccination platforms and strategies should be considered. As additional data arise, the NephJC COVID-19 page will continue to be updated (http://www.nephjc.com/news/covid-vaccine).
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Affiliation(s)
| | | | | | - Graham Abra
- Satellite Healthcare, San Jose, California, USA
- Division of Nephrology, Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Christos Argyropoulos
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Lorraine Harper
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Edgar V. Lerma
- Section of Nephrology, University of Illinois at Chicago/Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| | - Rita S. Suri
- Research Institute, University Health Center, Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Joel Topf
- Department of Medicine, Oakland University William Beaumont School of Medicine, Detroit, Michigan, USA
| | | | - Swapnil Hiremath
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Murdoch A, Tennankore KK, Bohm C, Clase CM, Levin A, Vorster H, Suri RS. Re-Envisioning the Canadian Nephrology Trials Network: A Can-SOLVE-CKD Stakeholder Meeting of Patient Partners and Researchers. Can J Kidney Health Dis 2021; 8:20543581211030396. [PMID: 34345433 PMCID: PMC8283045 DOI: 10.1177/20543581211030396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/04/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose The Canadian Nephrology Trials Network (CNTN) was formed in 2014 to support Canadian researchers in developing, designing, and conducting prospective studies in nephrology. In response to the changing landscape and needs within the Canadian nephrology research community, an interest in further growth and development of the network was identified. In the following report, we describe the process undertaken to re-envision the network through the creation of 3 new committees and how the committees are facilitating change and growth within the CNTN for future sustainability. Sources of information To understand areas for improvement and capacity building, the organization charged with overseeing the CNTN, Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD), began by conducting an environmental scan. As well, 2 informal surveys were sent to nephrology professionals (who were members of the CNTN and the Canadian Society of Nephrology) and patient partners (from Can-SOLVE CKD). Methods In September 2018, 44 CNTN members and other stakeholders from across Canada (including patient partners and representatives from research funding agencies) convened for a 2-day visioning workshop in Mississauga, Ontario. The agenda for this workshop was largely based on the results from the informal surveys. CNTN leadership participated and chose other workshop participants through informal stakeholder mapping and purposeful recruitment. Patient partners were recruited to participate in the workshop through advertisement within the Can-SOLVE-CKD patient council. The survey results and discussion questions were presented to participants at the workshop who, in turn, discussed in large- and small-group session ways in which the CNTN might be expanded. Results Surveys of patient partners indicated that they would like to see greater involvement of patients in the research process. Surveys of researchers indicated that they wanted more support and resources for coordinating prospective trials. The themes which emerged from the workshop discussions were peer review, engagement, and training. These themes were broadened and formally re-named to Scientific Operations, Communications and Engagement, and Capacity Building. A working committee, each co-led by a nephrologist with research experience and a patient partner, was created to advance each of these identified themes. An executive committee was created to provide overall strategic leadership and governance to the network. The Scientific Operations Committee conducts peer reviews; provides letters of endorsement after peer review; and holds semi-annual in-person meetings where researchers can present their proposals and obtain feedback from multiple stakeholders, including patients. The Communications and Engagement Committee publishes a quarterly newsletter, engages the community on Twitter, and reaches out to community sites and new nephrologists to engage them in research. The Capacity Building Committee conducts webinars to encourage patient partners to develop their own research questions and is developing a hub-and-spoke model to improve research collaboration. Limitations We did not conduct formal stakeholder mapping. Only attendees of the visioning workshop provided input, and not everyone's comment or opinion was included in the workshop report. Perspectives were limited to the sample of people who attended the workshop or were surveyed and may not reflect perspectives of all stakeholders in nephrology research in Canada. We did not use formal qualitative methodology to summarize the workshops. Implications Renewed areas of focus and related committees within the CNTN could lead to an increased capacity for nephrology research, increased engagement and collaboration with researchers, a higher likelihood of funding with rigorous peer review, and more clinical trials and multicenter collaborative prospective research being conducted in Canada.
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Affiliation(s)
- Alicia Murdoch
- Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD) Network, Vancouver, BC, Canada
| | - Karthik K Tennankore
- Department of Medicine, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority, Halifax, Canada
| | - Clara Bohm
- Department of Internal Medicine, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Department of Community Health Sciences, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, MB, Canada
| | - Catherine M Clase
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Department of Medicine, St. Joseph's Healthcare Hamilton, ON, Canada
| | - Adeera Levin
- Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD) Network, Vancouver, BC, Canada.,Division of Nephrology, Department of Medicine, McGill University, Montreal, QB, Canada
| | - Hans Vorster
- Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD) Network, Vancouver, BC, Canada
| | - Rita S Suri
- Division of Nephrology, Department of Medicine, McGill University, Montreal, QB, Canada.,Research Institute of the McGill University University Health Center, Montreal, QB, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, QB, Canada
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18
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Robinson BM, Guedes M, Alghonaim M, Cases A, Dasgupta I, Gan L, Jacobson SH, Kanjanabuch T, Kim YL, Kleophas W, Labriola L, Perlman RL, Reboldi G, Srivatana V, Suri RS, Tsuruya K, Torres PU, Pisoni RL, Pecoits-Filho R. Worldwide Early Impact of COVID-19 on Dialysis Patients and Staff and Lessons Learned: A DOPPS Roundtable Discussion. Kidney Med 2021; 3:619-634. [PMID: 34007963 PMCID: PMC8120787 DOI: 10.1016/j.xkme.2021.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
As the worst global pandemic of the past century, coronavirus disease 2019 (COVID-19) has had a disproportionate effect on maintenance dialysis patients and their health care providers. At a virtual roundtable on June 12, 2020, Dialysis Outcomes and Practice Patterns Study (DOPPS) investigators from 15 countries in Asia, Europe, and the Americas described and compared the effects of COVID-19 on dialysis care, with recent updates added. Most striking is the huge difference in risk to dialysis patients and staff across the world. Per-population cases and deaths among dialysis patients vary more than 100-fold across participating countries, mirroring burden in the general population. International data indicate that the case-fatality ratio remains at 10% to 30% among dialysis patients, confirming the gravity of infection, and that cases are much more common among in-center than home dialysis patients. This latter finding merits urgent study because in-center patients often have greater community exposure, and in-center transmission may be uncommon under optimal protocols. Greater telemedicine use is a welcome change here to stay, and our community needs to improve emergency planning and protect dialysis staff from the next pandemic. Finally, the pandemic's challenges have prompted widespread partnering and innovation in kidney care and research that must be sustained after this global health crisis.
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Affiliation(s)
| | - Murilo Guedes
- School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil
| | - Mohammed Alghonaim
- Saudi Center for Organ Transplantation, Riyadh, Saudi Arabia
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Aleix Cases
- University of Barcelona, IDIBAPS, Barcelona, Spain
| | | | - Liangying Gan
- Department of Nephrology, Peking University People’s Hospital, Beijing, China
| | - Stefan H. Jacobson
- Division of Nephrology, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Talerngsak Kanjanabuch
- Division of Nephrology and Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Thailand
| | - Yong-Lim Kim
- School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Werner Kleophas
- Davita Germany, Hamburg, Düsseldorf, Germany
- Nephrology Clinic, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Laura Labriola
- Department of Nephrology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | | | | | - Vesh Srivatana
- Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY
- The Rogosin Institute, New York, NY
| | - Rita S. Suri
- Division of Nephrology, McGill University, Montreal, Canada
| | - Kazuhiko Tsuruya
- Department of Nephrology, Nara Medical University, Kashihara, Nara, Japan
- Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Pablo Urena Torres
- AURA Nord Saint Ouen, Saint Ouen, France and Department of Renal Physiology. Necker Hospital, University of Paris Descartes, Paris, France
| | | | - Roberto Pecoits-Filho
- Arbor Research Collaborative for Health, Ann Arbor, MI
- School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil
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19
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Worthen G, Vinson A, Cardinal H, Doucette S, Gogan N, Gunaratnam L, Keough-Ryan T, Kiberd BA, Prasad B, Rockwood K, Sills L, Suri RS, Tangri N, Walsh M, West K, Yohanna S, Tennankore K. Prevalence of Frailty in Patients Referred to the Kidney Transplant Waitlist. Kidney360 2021; 2:1287-1295. [PMID: 35369656 PMCID: PMC8676383 DOI: 10.34067/kid.0001892021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/13/2021] [Indexed: 02/07/2023]
Abstract
Background Comparisons between frailty assessment tools for waitlist candidates are a recognized priority area for kidney transplantation. We compared the prevalence of frailty using three established tools in a cohort of waitlist candidates. Methods Waitlist candidates were prospectively enrolled from 2016 to 2020 across five centers. Frailty was measured using the Frailty Phenotype (FP), a 37-variable frailty index (FI), and the Clinical Frailty Scale (CFS). The FI and CFS were dichotomized using established cutoffs. Agreement was compared using κ coefficients. Area under the receiver operating characteristic (ROC) curves were generated to compare the FI and CFS (treated as continuous measures) with the FP. Unadjusted associations between each frailty measure and time to death or waitlist withdrawal were determined using an unadjusted Cox proportional hazards model. Results Of 542 enrolled patients, 64% were male, 80% were White, and the mean age was 54±14 years. The prevalence of frailty by the FP was 16%. The mean FI score was 0.23±0.14, and the prevalence of frailty was 38% (score of ≥0.25). The median CFS score was three (IQR, 2-3), and the prevalence was 15% (score of ≥4). The κ values comparing the FP with the FI (0.44) and CFS (0.27) showed fair to moderate agreement. The area under the ROC curves for the FP and FI/CFS were 0.86 (good) and 0.69 (poor), respectively. Frailty by the CFS (HR, 2.10; 95% CI, 1.04 to 4.24) and FI (HR, 1.79; 95% CI, 1.00 to 3.21) was associated with death or permanent withdrawal. The association between frailty by the FP and death/withdrawal was not statistically significant (HR, 1.78; 95% CI, 0.79 to 3.71). Conclusion Frailty prevalence varies by the measurement tool used, and agreement between these measurements is fair to moderate. This has implications for determining the optimal frailty screening tool for use in those being evaluated for kidney transplant.
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Affiliation(s)
- George Worthen
- Division of Nephrology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Amanda Vinson
- Division of Nephrology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Héloise Cardinal
- Division of Nephrology, Centre de Recherche du CHUM, Montreal, Quebec, Canada
| | | | - Nessa Gogan
- Division of Nephrology, Horizon Health Network, Saint John, New Brunswick, Canada
| | - Lakshman Gunaratnam
- Division of Nephrology, London Health Sciences Center, London, Ontario, Canada
| | - Tammy Keough-Ryan
- Division of Nephrology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Bryce A. Kiberd
- Division of Nephrology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Bhanu Prasad
- Division of Nephrology, Regina General Hospital, Regina, Saskatchewan, Canada
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Laura Sills
- Nova Scotia Health Authority, Halifax, Canada
| | - Rita S. Suri
- Research Institute of the McGill University Health Center and Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Navdeep Tangri
- Chronic Disease Innovation Center, Winnipeg, Manitoba, Canada
| | - Michael Walsh
- Division of Nephrology, McMaster University, Hamilton, Ontario, Canada
| | - Kenneth West
- Division of Nephrology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Seychelle Yohanna
- Division of Nephrology, McMaster University, Hamilton, Ontario, Canada
| | - Karthik Tennankore
- Division of Nephrology, Dalhousie University, Halifax, Nova Scotia, Canada
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20
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Goupil R, Benlarbi M, Beaubien-Souligny W, Nadeau-Fredette AC, Chatterjee D, Goyette G, Gunaratnam L, Lamarche C, Tom A, Finzi A, Suri RS. Short-term antibody response after 1 dose of BNT162b2 vaccine in patients receiving hemodialysis. CMAJ 2021; 193:E793-E800. [PMID: 33980499 PMCID: PMC8177936 DOI: 10.1503/cmaj.210673] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND: Patients receiving in-centre hemodialysis are at high risk of exposure to SARS-CoV-2 and death if infected. One dose of the BNT162b2 SARS-CoV-2 vaccine is efficacious in the general population, but responses in patients receiving hemodialysis are uncertain. METHODS: We obtained serial plasma from patients receiving hemodialysis and health care worker controls before and after vaccination with 1 dose of the BNT162b2 mRNA vaccine, as well as convalescent plasma from patients receiving hemodialysis who survived COVID-19. We measured anti–receptor binding domain (RBD) immunoglobulin G (IgG) levels and stratified groups by evidence of previous SARS-CoV-2 infection. RESULTS: Our study included 154 patients receiving hemodialysis (135 without and 19 with previous SARS-CoV-2 infection), 40 controls (20 without and 20 with previous SARS-CoV-2 infection) and convalescent plasma from 16 patients. Among those without previous SARS-CoV-2 infection, anti-RBD IgG was undetectable at 4 weeks in 75 of 131 (57%, 95% confidence interval [CI] 47% to 65%) patients receiving hemodialysis, compared with 1 of 20 (5%, 95% CI 1% to 23%) controls (p < 0.001). No patient with nondetectable levels at 4 weeks developed anti-RBD IgG by 8 weeks. Results were similar in non-immunosuppressed and younger individuals. Three patients receiving hemodialysis developed severe COVID-19 after vaccination. Among those with previous SARS-CoV-2 infection, median anti-RBD IgG levels at 8 weeks in patients receiving hemodialysis were similar to controls at 3 weeks (p = 0.3) and to convalescent plasma (p = 0.8). INTERPRETATION: A single dose of BNT162b2 vaccine failed to elicit a humoral immune response in most patients receiving hemodialysis without previous SARS-CoV-2 infection, even after prolonged observation. In those with previous SARS-CoV-2 infection, the antibody response was delayed. We advise that patients receiving hemodialysis be prioritized for a second BNT162b2 dose at the recommended 3-week interval.
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Affiliation(s)
- Rémi Goupil
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal (Goupil); Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM) (Benlarbi, Chatterjee, Goyette, Finzi, Suri); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Nadeau-Fredette, Lamarche), Montréal, Que.; Department of Microbiology and Immunology and Division of Nephrology, Department of Medicine (Gunaratnam), Western University, London, Ont.; Research Institute of the McGill University Health Centre (Tom, Suri); Département de microbiologie, infectiologie et immunologie (Finzi), Université de Montréal; Department of Microbiology and Immunology (Finzi), McGill University; Division of Nephrology (Suri), Department of Medicine, McGill University, Montréal, Que
| | - Mehdi Benlarbi
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal (Goupil); Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM) (Benlarbi, Chatterjee, Goyette, Finzi, Suri); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Nadeau-Fredette, Lamarche), Montréal, Que.; Department of Microbiology and Immunology and Division of Nephrology, Department of Medicine (Gunaratnam), Western University, London, Ont.; Research Institute of the McGill University Health Centre (Tom, Suri); Département de microbiologie, infectiologie et immunologie (Finzi), Université de Montréal; Department of Microbiology and Immunology (Finzi), McGill University; Division of Nephrology (Suri), Department of Medicine, McGill University, Montréal, Que
| | - William Beaubien-Souligny
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal (Goupil); Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM) (Benlarbi, Chatterjee, Goyette, Finzi, Suri); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Nadeau-Fredette, Lamarche), Montréal, Que.; Department of Microbiology and Immunology and Division of Nephrology, Department of Medicine (Gunaratnam), Western University, London, Ont.; Research Institute of the McGill University Health Centre (Tom, Suri); Département de microbiologie, infectiologie et immunologie (Finzi), Université de Montréal; Department of Microbiology and Immunology (Finzi), McGill University; Division of Nephrology (Suri), Department of Medicine, McGill University, Montréal, Que
| | - Annie-Claire Nadeau-Fredette
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal (Goupil); Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM) (Benlarbi, Chatterjee, Goyette, Finzi, Suri); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Nadeau-Fredette, Lamarche), Montréal, Que.; Department of Microbiology and Immunology and Division of Nephrology, Department of Medicine (Gunaratnam), Western University, London, Ont.; Research Institute of the McGill University Health Centre (Tom, Suri); Département de microbiologie, infectiologie et immunologie (Finzi), Université de Montréal; Department of Microbiology and Immunology (Finzi), McGill University; Division of Nephrology (Suri), Department of Medicine, McGill University, Montréal, Que
| | - Debashree Chatterjee
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal (Goupil); Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM) (Benlarbi, Chatterjee, Goyette, Finzi, Suri); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Nadeau-Fredette, Lamarche), Montréal, Que.; Department of Microbiology and Immunology and Division of Nephrology, Department of Medicine (Gunaratnam), Western University, London, Ont.; Research Institute of the McGill University Health Centre (Tom, Suri); Département de microbiologie, infectiologie et immunologie (Finzi), Université de Montréal; Department of Microbiology and Immunology (Finzi), McGill University; Division of Nephrology (Suri), Department of Medicine, McGill University, Montréal, Que
| | - Guillaume Goyette
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal (Goupil); Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM) (Benlarbi, Chatterjee, Goyette, Finzi, Suri); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Nadeau-Fredette, Lamarche), Montréal, Que.; Department of Microbiology and Immunology and Division of Nephrology, Department of Medicine (Gunaratnam), Western University, London, Ont.; Research Institute of the McGill University Health Centre (Tom, Suri); Département de microbiologie, infectiologie et immunologie (Finzi), Université de Montréal; Department of Microbiology and Immunology (Finzi), McGill University; Division of Nephrology (Suri), Department of Medicine, McGill University, Montréal, Que
| | - Lakshman Gunaratnam
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal (Goupil); Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM) (Benlarbi, Chatterjee, Goyette, Finzi, Suri); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Nadeau-Fredette, Lamarche), Montréal, Que.; Department of Microbiology and Immunology and Division of Nephrology, Department of Medicine (Gunaratnam), Western University, London, Ont.; Research Institute of the McGill University Health Centre (Tom, Suri); Département de microbiologie, infectiologie et immunologie (Finzi), Université de Montréal; Department of Microbiology and Immunology (Finzi), McGill University; Division of Nephrology (Suri), Department of Medicine, McGill University, Montréal, Que
| | - Caroline Lamarche
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal (Goupil); Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM) (Benlarbi, Chatterjee, Goyette, Finzi, Suri); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Nadeau-Fredette, Lamarche), Montréal, Que.; Department of Microbiology and Immunology and Division of Nephrology, Department of Medicine (Gunaratnam), Western University, London, Ont.; Research Institute of the McGill University Health Centre (Tom, Suri); Département de microbiologie, infectiologie et immunologie (Finzi), Université de Montréal; Department of Microbiology and Immunology (Finzi), McGill University; Division of Nephrology (Suri), Department of Medicine, McGill University, Montréal, Que
| | - Alexander Tom
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal (Goupil); Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM) (Benlarbi, Chatterjee, Goyette, Finzi, Suri); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Nadeau-Fredette, Lamarche), Montréal, Que.; Department of Microbiology and Immunology and Division of Nephrology, Department of Medicine (Gunaratnam), Western University, London, Ont.; Research Institute of the McGill University Health Centre (Tom, Suri); Département de microbiologie, infectiologie et immunologie (Finzi), Université de Montréal; Department of Microbiology and Immunology (Finzi), McGill University; Division of Nephrology (Suri), Department of Medicine, McGill University, Montréal, Que
| | - Andrés Finzi
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal (Goupil); Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM) (Benlarbi, Chatterjee, Goyette, Finzi, Suri); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Nadeau-Fredette, Lamarche), Montréal, Que.; Department of Microbiology and Immunology and Division of Nephrology, Department of Medicine (Gunaratnam), Western University, London, Ont.; Research Institute of the McGill University Health Centre (Tom, Suri); Département de microbiologie, infectiologie et immunologie (Finzi), Université de Montréal; Department of Microbiology and Immunology (Finzi), McGill University; Division of Nephrology (Suri), Department of Medicine, McGill University, Montréal, Que
| | - Rita S Suri
- Centre de recherche de l'Hôpital du Sacré-Cœur de Montréal (Goupil); Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM) (Benlarbi, Chatterjee, Goyette, Finzi, Suri); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Nadeau-Fredette, Lamarche), Montréal, Que.; Department of Microbiology and Immunology and Division of Nephrology, Department of Medicine (Gunaratnam), Western University, London, Ont.; Research Institute of the McGill University Health Centre (Tom, Suri); Département de microbiologie, infectiologie et immunologie (Finzi), Université de Montréal; Department of Microbiology and Immunology (Finzi), McGill University; Division of Nephrology (Suri), Department of Medicine, McGill University, Montréal, Que.
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21
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Lee JY, Arumugarajah S, Lian D, Maehara N, Haig AR, Suri RS, Miyazaki T, Gunaratnam L. Recombinant apoptosis inhibitor of macrophage protein reduces delayed graft function in a murine model of kidney transplantation. PLoS One 2021; 16:e0249838. [PMID: 33891625 PMCID: PMC8064555 DOI: 10.1371/journal.pone.0249838] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 03/25/2021] [Indexed: 12/03/2022] Open
Abstract
Reperfusion injury following cold and warm ischemia (IRI) is unavoidable during kidney transplantation and contributes to delayed graft function (DGF) and premature graft loss. Death of tubular epithelial cells (TECs) by necrosis during IRI releases pro-inflammatory mediators (e.g. HMGB1), propagating further inflammation (necroinflammation) and tissue damage. Kidney Injury Molecule-1 (KIM-1) is a phagocytic receptor upregulated on proximal TECs during acute kidney injury. We have previously shown that renal KIM-1 protects the graft against transplant associated IRI by enabling TECs to clear apoptotic and necrotic cells, and that recognition of necrotic cells by KIM-1 is augmented in the presence of the opsonin, apoptosis inhibitor of macrophages (AIM). Here, we tested whether recombinant AIM (rAIM) could be used to mitigate transplant associated IRI. We administered rAIM or vehicle control to nephrectomised B6 mice transplanted with a single B6 donor kidney. Compared to grafts in vehicle-treated recipients, grafts from rAIM-treated mice exhibited significantly less renal dysfunction, tubular cell death, tissue damage, tubular obstruction, as well as local and systemic inflammation. Both mouse and human rAIM enhanced the clearance of necrotic cells by murine and human TECs, respectively in vitro. These data support testing of rAIM as a potential therapeutic agent to reduce DGF following kidney transplantation.
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Affiliation(s)
- Ji Yun Lee
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
- Matthew Mailing Centre for Translational Transplant Studies, Lawson Health Research Institute, London, Ontario, Canada
| | - Shabitha Arumugarajah
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
- Matthew Mailing Centre for Translational Transplant Studies, Lawson Health Research Institute, London, Ontario, Canada
| | - Dameng Lian
- Matthew Mailing Centre for Translational Transplant Studies, Lawson Health Research Institute, London, Ontario, Canada
| | - Natsumi Maehara
- Centre for Disease Biology and Integrative Medicine, University of Tokyo, Tokyo, Japan
| | - Aaron R. Haig
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
| | - Rita S. Suri
- Faculty of Medicine, Division of Nephrology, McGill University, Montreal, Quebec, Canada
| | - Toru Miyazaki
- Centre for Disease Biology and Integrative Medicine, University of Tokyo, Tokyo, Japan
| | - Lakshman Gunaratnam
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
- Matthew Mailing Centre for Translational Transplant Studies, Lawson Health Research Institute, London, Ontario, Canada
- Division of Nephrology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- * E-mail:
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22
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Alabbas A, Harvey E, Kirpalani A, Teoh CW, Mammen C, Pederson K, Nemec R, Davis TK, Mathew A, McCormick B, Banks CA, Frenette CH, Clark DA, Zimmerman D, Qirjazi E, Mac-Way F, Vorster H, Antonsen JE, Kappel JE, MacRae JM, Hemmett J, Tennankore KK, Moist LM, Copland M, McCormick M, Suri RS, Singh RS, Davison SN, Lemaire M, Chanchlani R. Canadian Association of Paediatric Nephrologists COVID-19 Rapid Response: Home and In-Center Dialysis Guidance. Can J Kidney Health Dis 2021; 8:20543581211053458. [PMID: 34777841 PMCID: PMC8586166 DOI: 10.1177/20543581211053458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 11/15/2022] Open
Abstract
PURPOSE OF THE PROGRAM This article provides guidance on optimizing the management of pediatric patients with end-stage kidney disease (ESKD) who will be or are being treated with any form of home or in-center dialysis during the COVID-19 pandemic. The goals are to provide the best possible care for pediatric patients with ESKD during the pandemic and ensure the health care team's safety. SOURCES OF INFORMATION The core of these rapid guidelines is derived from the Canadian Society of Nephrology (CSN) consensus recommendations for adult patients recently published in the Canadian Journal of Kidney Health and Disease (CJKHD). We also consulted specific documents from other national and international agencies focused on pediatric kidney health. Additional information was obtained by formal review of the published academic literature relevant to pediatric home or in-center hemodialysis. METHODS The Leadership of the Canadian Association of Paediatric Nephrologists (CAPN), which is affiliated with the CSN, solicited a team of clinicians and researchers with expertise in pediatric home and in-center dialysis. The goal was to adapt the guidelines recently adopted for Canadian adult dialysis patients for pediatric-specific settings. These included specific COVID-19-related themes that apply to dialysis in a Canadian environment, as determined by a group of senior renal leaders. Expert clinicians and nurses with deep expertise in pediatric home and in-center dialysis reviewed the revised pediatric guidelines. KEY FINDINGS We identified 7 broad areas of home dialysis practice management that may be affected by the COVID-19 pandemic: (1) peritoneal dialysis catheter placement, (2) home dialysis training, (3) home dialysis management, (4) personal protective equipment, (5) product delivery, (6) minimizing direct health care providers and patient contact, and (7) caregivers support in the community. In addition, we identified 8 broad areas of in-center dialysis practice management that may be affected by the COVID-19 pandemic: (1) identification of patients with COVID-19, (2) hemodialysis of patients with confirmed COVID-19, (3) hemodialysis of patients not yet known to have COVID-19, (4) management of visitors to the dialysis unit, (5) handling COVID-19 testing of patients and staff, (6) safe practices during resuscitation procedures in a pandemic, (7) routine hemodialysis care, and (8) hemodialysis care under fixed dialysis resources. We make specific suggestions and recommendations for each of these areas. LIMITATIONS At the time when we started this work, we knew that evidence on the topic of pediatric dialysis and COVID-19 would be severely limited, and our resources were also limited. We did not, therefore, do formal systematic review or meta-analysis. We did not evaluate our specific suggestions in the clinical environment. Thus, this article's advice and recommendations are primarily expert opinions and subject to the biases associated with this level of evidence. To expedite the publication of this work, we created a parallel review process that may not be as robust as standard arms' length peer-review processes. IMPLICATIONS We intend these recommendations to help provide the best care possible for pediatric patients prescribed in-center or home dialysis during the COVID-19 pandemic, a time of altered priorities and reduced resources.
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Affiliation(s)
- Abdullah Alabbas
- Division of Nephrology, Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Elizabeth Harvey
- Division of Nephrology, Department of Paediatrics, University of Toronto, ON, Canada
| | - Amrit Kirpalani
- Division of Nephrology, Department of Paediatrics, Western University, London, ON, Canada
| | - Chia Wei Teoh
- Division of Nephrology, Department of Paediatrics, University of Toronto, ON, Canada
| | - Cherry Mammen
- Division of Nephrology, Department of Pediatrics, The University of British Columbia, Vancouver, Canada
| | - Kristen Pederson
- Division of Nephrology, Department of Pediatrics, University of Manitoba, Winnipeg, Canada
| | - Rose Nemec
- Division of Nephrology, Department of Paediatrics, University of Toronto, ON, Canada
| | - T. Keefe Davis
- Division of Nephrology, Department of Medicine & Pediatrics, University of Saskatchewan, Saskatoon, Canada
| | - Anna Mathew
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Cheryl A. Banks
- Prince Edward Island Provincial Renal Program, Summerside, Canada
| | - Charles H. Frenette
- Division of Infectious Diseases, Infection Prevention and Control, Department of Medicine, McGill University, Montreal, QC, Canada
| | - David A. Clark
- Division of Nephrology, Department of Medicine, Dalhousie University & Nova Scotia Health, Halifax, Canada
| | | | - Elena Qirjazi
- Division of Nephrology, Department of Medicine, Alberta Health Services, University of Calgary, Canada
| | - Fabrice Mac-Way
- Division of Nephrology, Department of Medicine, Hôtel-Dieu de Québec Hospital, CHU de Québec-Université Laval, Quebec City, Canada
| | | | - John E. Antonsen
- Hemodialysis Committee, British Columbia Renal Agency, Vancouver, Canada
| | - Joanne E. Kappel
- Division of Nephrology, Department of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Jennifer M. MacRae
- Division of Nephrology, Department of Medicine, Alberta Health Services, University of Calgary, Canada
| | - Juliya Hemmett
- Division of Nephrology, Department of Medicine, Alberta Health Services, University of Calgary, Canada
| | - Karthik K. Tennankore
- Division of Nephrology, Department of Medicine, Dalhousie University & Nova Scotia Health, Halifax, Canada
| | - Louise M. Moist
- Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
| | | | | | - Rita S. Suri
- Division of Nephrology, Department of Medicine, Research Institute, McGill University, Montreal, QC, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, QC, Canada
| | - Rajinder S. Singh
- Division of Nephrology, Department of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Sara N. Davison
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Mathieu Lemaire
- Division of Nephrology, Department of Paediatrics, University of Toronto, ON, Canada
- Mathieu Lemaire, Division of Nephrology, Department of Paediatrics, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
| | - Rahul Chanchlani
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children’s Hospital, Hamilton, ON, Canada
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Collister D, Pohl K, Herrington G, Lee SF, Rabbat C, Tennankore K, Zimmermann D, Tangri N, Wald R, Manns B, Suri RS, Nadeau-Fredette AC, Goupil R, Silver SA, Walsh M. The DIalysis Symptom COntrol-Restless Legs Syndrome (DISCO-RLS) Trial: A Protocol for a Randomized, Crossover, Placebo-Controlled Blinded Trial. Can J Kidney Health Dis 2020; 7:2054358120968959. [PMID: 33294203 PMCID: PMC7705292 DOI: 10.1177/2054358120968959] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/11/2020] [Indexed: 11/17/2022] Open
Abstract
Background Restless legs syndrome (RLS) affects approximately 30% of patients with end-stage kidney disease and is associated with impaired sleep and health-related quality of life. Medications used to treat RLS in patients receiving dialysis may have an increased risk of adverse events with dose titration, and residual RLS symptoms are common despite the use of effective treatments. Randomized controlled trials of monotherapy and combination pharmacologic therapy for RLS in hemodialysis are needed. Objective To perform a randomized, crossover, placebo-controlled blinded trial of pharmacologic therapy for RLS in hemodialysis. Design/setting The DIalysis Symptom COntrol-Restless Legs Syndrome (DISCO-RLS) trial is a randomized, crossover, placebo-controlled blinded trial of fixed low-dose pharmacologic therapy in patients receiving hemodialysis in 10 centers across Canada. It uses patient partners in its design, conduct, and reporting. Participants Adults receiving thrice-weekly hemodialysis for at least 3 months with RLS of at least mild symptoms defined International Restless Legs Syndrome Study Group Rating Scale (IRLS) of 10 or more will enter a double placebo run-in period to exclude nonadherent participants and those unable to tolerate double placebo. Seventy-two participants who completed the run-in period will be randomized to 1 of 8 treatment sequences based on modeling with 4 treatment periods. Methods Each treatment period lasts 4 weeks and consists of ropinirole 0.5 mg daily and gabapentin 100 mg daily, both together or neither with a double dummy placebo control for each treatment. The primary outcome is the difference in change scores of the IRLS between study treatments. Secondary outcomes are the differences in change scores of the Restless Legs Syndrome-6 Scale, patient global impression, 5-level EQ-5D version, and safety outcomes. Results This randomized, crossover, placebo-controlled blinded trial will evaluate the efficacy and safety of fixed low-dose combination of ropinirole and gabapentin in patients receiving hemodialysis with RLS. Limitations Patients with chronic kidney disease not on dialysis, kidney transplant recipients and those receiving peritoneal dialysis or home hemodialysis are not included. The intervention's long term safety and efficacy including the risk of augmentation is not captured. Conclusion This randomized crossover placebo controlled blinded trial will evaluate the efficacy and safety of fixed low-dose combination ropinirole and gabapentin in patients receiving hemodialysis with RLS. Trial Registration ClinicalTrials.gov (NCT03806530).
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Affiliation(s)
- David Collister
- Population Health Research Institute, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Kayla Pohl
- Population Health Research Institute, Hamilton, ON, Canada
| | - Gwen Herrington
- Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD), Vancouver, BC, Canada
| | - Shun Fu Lee
- Population Health Research Institute, Hamilton, ON, Canada
| | - Christian Rabbat
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | | | - Navdeep Tangri
- Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - Ron Wald
- Department of Medicine, University of Toronto, ON, Canada
| | - Braden Manns
- Department of Medicine and Community Health Sciences, University of Calgary, AB, Canada
| | - Rita S Suri
- Department of Medicine, McGill University, Montréal, QC, Canada.,Centre de Recherche, Université de Montréal, QC, Canada
| | | | - Remi Goupil
- Faculté de Médecine, Université de Montréal, QC, Canada
| | - Samuel A Silver
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Michael Walsh
- Population Health Research Institute, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
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Rossum K, Finlay J, McCormick M, Desjarlais A, Vorster H, Fontaine G, Talson M, Ferreira Da Silva P, Soroka KV, Sass R, James M, Tong A, Harris C, Melnyk Y, Sood MM, Pannu N, Suri RS, Tennankore K, Thompson S, Tonelli M, Bohm C. A Mixed Method Investigation to Determine Priorities for Improving Information, Interaction, and Individualization of Care Among Individuals on In-center Hemodialysis: The Triple I Study. Can J Kidney Health Dis 2020; 7:2054358120953284. [PMID: 33149921 PMCID: PMC7580147 DOI: 10.1177/2054358120953284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/29/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Current health systems do not effectively address all aspects of chronic care. For better self-management of disease, kidney patients have identified the need for improved health care information, interaction with health care providers, and individualization of care. OBJECTIVE The Triple I study examined challenges to exchange of information, interaction between patients and health care providers and individualization of care in in-center hemodialysis with the aim of identifying the top 10 challenges that individuals on in-center hemodialysis face in these 3 areas. DESIGN We employed a sequential mixed methods approach with 3 phases:1. A qualitative study with focus groups and interviews (Apr 2017 to Aug 2018);2. A cross-sectional national ranking survey (Jan 2019 to May 2019);3. A prioritization workshop using a modified James Lind Alliance process (June 2019). SETTING In-center hemodialysis units in 7 academic centers across Canada: Vancouver, Calgary, Edmonton, Winnipeg, Ottawa, Montreal, and Halifax. PARTICIPANTS Individuals receiving in-center hemodialysis, their caregivers, and health care providers working in in-center hemodialysis participated in each of the 3 phases. METHODS In Phase 1, we collected qualitative data through (1) focus groups and interviews with hemodialysis patients and their caregivers and (2) individual interviews with health care providers and decision makers. Participants identified challenges to in-center hemodialysis care and potential solutions to these challenges. In Phase 2, we administered a pan-Canadian cross-sectional ranking survey. The survey asked respondents to prioritize the challenges to in-center hemodialysis care identified in Phase 1 by ranking their top 5 topics/challenges in each of the 3 "I" categories. In Phase 3, we undertook a face-to-face priority setting workshop which followed a modified version of the James Lind Alliance priority setting workshop process. The workshop employed an iterative process incorporating small and large group sessions during which participants identified, ranked, and voted on the top challenges and innovations to hemodialysis care. Four patient partners contributed to study design, implementation, analysis, and interpretation. RESULTS Across the 5 participating centers, we conducted 8 focus groups and 44 interviews, in which 113 participants identified 45 distinct challenges to in-center hemodialysis care. Subsequently, completion of a national ranking survey (n = 323) of these challenges resulted in a short-list of the top 30 challenges. Finally, using small and large group sessions to develop consensus during the prioritizing workshop, 38 stakeholders used this short-list to identify the top 10 challenges to in-center hemodialysis care. These included individualization of dialysis-related education; improved information in specific topic areas (transplant status, dialysis modalities, dialysis-related complications, and other health risks); more flexibility in hemodialysis scheduling; better communication and continuity of care within the health care team; and increased availability of transportation, financial, and social support programs. LIMITATIONS Participants were from urban centers and were predominately English-speaking. Survey response rate of 31.5% in Phase 2 may have led to selection bias. We collected limited information on social determinants of health, which could confound our results. CONCLUSION Overall, the challenges we identified demonstrate that individualized care and information that improves interaction with health care providers is important to patients receiving in-center hemodialysis. In future stages of this project, we will aim to address these challenges by trialing innovative patient-centered solutions. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Krista Rossum
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Juli Finlay
- Faculty of Medicine, University of Calgary, AB, Canada
| | | | - Arlene Desjarlais
- Patient Council, Can-SOLVE CKD Network, Canada
- Indigenous Peoples’ Engagement and Research Council, Can-SOLVE CKD Network, Canada
| | | | - George Fontaine
- Patient Council, Can-SOLVE CKD Network, Canada
- Indigenous Peoples’ Engagement and Research Council, Can-SOLVE CKD Network, Canada
| | - Melanie Talson
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | | | - Rachelle Sass
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Matthew James
- Faculty of Medicine, University of Calgary, AB, Canada
| | - Allison Tong
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Claire Harris
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Yuriy Melnyk
- BC Provincial Renal Agency, Vancouver, BC, Canada
| | | | - Neesh Pannu
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Rita S. Suri
- Faculty of Medicine, McGill University, Montreal, QC, Canada
- Centre de Recherche de l’Université de Montréal, QC, Canada
| | - Karthik Tennankore
- Department of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, NS, Canada
| | | | | | - Clara Bohm
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Chronic Disease Innovation Centre, Winnipeg, MB, Canada
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Levin A, Sapir D, Steele A, Cherney D, Hellstrom IC, Lanktree MB, Moist L, Suri RS. Proceedings From a Canadian Nephrology Forum: Nephrology Is Back. Can J Kidney Health Dis 2020; 7:2054358120965001. [PMID: 33117551 PMCID: PMC7573708 DOI: 10.1177/2054358120965001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/31/2020] [Indexed: 01/21/2023] Open
Abstract
PURPOSE OF CONFERENCE On January 18, 2020, the Nephrology is Back learning day forum was held in Toronto, ON, Canada. The objectives of the meeting were to describe recent advances in nephrology for community and academic nephrologists and patients, and to define challenges and opportunities for integration of new data into clinical practice. The intent was to test a unique forum for continuing medical education integrating physician and patient experiences with the goal of encouraging change in practice. SOURCES OF INFORMATION Program content was based on current literature and clinical experience. Additional information was provided by patient partners who attended the meeting to provide their perspective on current issues in nephrology. METHODS A steering committee (A.L., A.S., and D.S.) developed goals and an outline for the content to be covered over the course of the meeting and led the recruitment of speakers. Speakers were asked to develop their presentations independently following direction by the committee, based on primary sources, including their own experiences. Presentations were followed by discussion including both physicians and patients, and participants had an opportunity to evaluate the conference and its outcomes. KEY FINDINGS We present a unique approach to providing continuing medical education by including both physicians and patients in the learning process. Patient perspectives accompanying presentations around data and other clinical topics provided a much different environment from other knowledge translation exercises. We believe this represents an innovative approach for knowledge translation that allows physicians to address clinical topics in a novel manner, including the integration of new findings into practice and the need to cascade this education to their peers. LIMITATIONS Because the conference was a one-time event, it has been difficult to assess the actual clinical impact of the knowledge translation exercise and whether physician behaviors have changed as a result of the activity. The conference could also have included broader representation from across Canada. IMPLICATIONS The success of this test forum among both physicians and patient partners suggests that the inclusion of patient partners in learning could have an important role in future educational initiatives.
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Affiliation(s)
- Adeera Levin
- Division of Nephrology, The University of British Columbia, Vancouver, Canada,Adeera Levin, Division of Nephrology, The University of British Columbia, 1081 Burrard Street, Room 6010A, Vancouver, BC, Canada V6Z 1Y6.
| | - Daniel Sapir
- Halton Healthcare Services, Oakville, ON, Canada
| | - Andrew Steele
- Lakeridge Health, Oshawa, ON, Canada,Queen’s University, Kingston, ON, Canada
| | - David Cherney
- University Health Network, University of Toronto, ON, Canada
| | | | - Matthew B. Lanktree
- Division of Nephrology, Department of Medicine, St. Joseph’s Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
| | - Louise Moist
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Rita S. Suri
- Division of Nephrology, McGill University, Montreal, QC, Canada
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26
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Gale J, Clark DA, Bohm C, Canney M, Davis I, LeBlanc JJ, Shorter AM, Suri RS, Vinson AJ, West KA, Tennankore KK. COVID-19 Status, Symptom Burden, and Characteristics of Dialysis Patients Residing in Areas of Community Transmission: Research Letter. Can J Kidney Health Dis 2020; 7:2054358120964178. [PMID: 33117550 PMCID: PMC7573725 DOI: 10.1177/2054358120964178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/09/2020] [Indexed: 11/15/2022] Open
Abstract
Background Routine testing of hemodialysis patients for COVID-19 (outside of those identified as "at risk" based on regional practice) is not universally recommended. However, there is variability in the clinical presentation of COVID-19; patients may experience symptoms that do not meet regional criteria for testing and some patients with active infection may be asymptomatic. To avoid missing individuals who are infected, consideration could be made for regular screening, particularly among those residing in areas with evidence of community spread. Objective To describe the clinical characteristics, symptom burden, and COVID-19 status in a cross-section of hemodialysis patients residing in areas with evidence of community spread. Design Cross-sectional study. Setting Three hemodialysis units in a large tertiary care facility in Nova Scotia, Canada. Patients In-center hemodialysis patients who resided in areas with evidence of community transmission at the time of the study. Methods All dialysis patients (irrespective of whether or not they resided in areas with community spread) completed a standard "at-risk" questionnaire for COVID-19 based on (1) 2 or more of new or worsening cough, fever greater than 38°C, sore throat, headache, runny nose/new or acute respiratory illness consistent with infection or (2) any one of close contact with a known/suspected case, travel outside of the province or residence in a facility with an outbreak prior to entry into the dialysis unit at each treatment. Patients residing in areas with evidence of community spread were swabbed for SARS-CoV-2 over a 1-week period (May 1-7, 2020) using a combined oropharyngeal/nares swab irrespective of whether or not they were identified as "at-risk." Measurements Baseline characteristics of patients were acquired using electronic records. In addition to the "at-risk" questionnaire, patients answered "yes" or "no" to any of the following symptoms at the time of the swab (sneeze, fatigue, myalgia, nausea/vomiting, diarrhea, malaise, abdominal pain, loss of taste, and loss of smell). Results Of the 334 patients receiving dialysis at the time of the study, 133 resided in areas with evidence of community transmission and 104 consented for the study. No patients met our regional criteria for being "at-risk" and no patients reported cough, sore throat or fever at the time of swab. Many other symptoms were noted, including sneezing (24%), fatigue (16%), myalgias (11%), nausea/vomiting (11%), loss of taste (4%), and loss of smell (4%). Overall, 100% of swabs performed for this study were negative for SARS-CoV-2. Limitations Single-center study, and the daily new case rate was exceedingly low (4-14) at the time of the study, emphasizing that the findings are not generalizable to areas of higher prevalence of SARS-CoV-2. Conclusions In this study of hemodialysis patients residing in areas with community spread who otherwise did not meet symptom criteria for being "at-risk," we did not identify any individual who tested positive for SARS-CoV-2. Future studies are needed to examine the utility of routine testing for COVID-19 (outside of those who are "at-risk") in areas of higher disease prevalence. Trial Registration Not applicable as this is not a clinical trial.
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Affiliation(s)
| | - David Austin Clark
- Department of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, NS, Canada
| | - Clara Bohm
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Mark Canney
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Ian Davis
- Department of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, NS, Canada
| | - Jason Joseph LeBlanc
- Dalhousie University, Halifax, NS, Canada
- Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, NS, Canada
| | | | - Rita S. Suri
- Department of Medicine, McGill University, Montreal, QC, Canada
- Centre de Recherche de l’Université de Montréal, QC, Canada
| | - Amanda Jean Vinson
- Department of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, NS, Canada
| | - Kenneth A. West
- Department of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, NS, Canada
| | - Karthik Kannan Tennankore
- Department of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, NS, Canada
- Karthik Kannan Tennankore, Division of Nephrology, Department of Medicine, Dalhousie University & Nova Scotia Health Authority, 5820 University Avenue, Halifax, NS, Canada B3H 1V8.
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Jegatheswaran J, Chan R, Hiremath S, Moorman D, Suri RS, Ramsay T, Zimmerman D. Use of the FRAIL Questionnaire in Patients With End-Stage Kidney Disease. Can J Kidney Health Dis 2020; 7:2054358120952904. [PMID: 32995037 PMCID: PMC7502991 DOI: 10.1177/2054358120952904] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/08/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Frailty is a clinical phenotype of decreased physiologic reserve that is associated with increased morbidity and mortality. The most meaningful way to assess frailty in patients with end-stage kidney disease (ESKD) is unknown. Objective: To assess the prevalence of frailty in ESKD patients using the easy-to-administer FRAIL scale and, to determine its association with mortality, transplantation, and hospitalization. Design: A cohort study was used. Setting: The Ottawa Hospital, Ottawa, Ontario, Canada, was the setting of this study. Patients: All eligible adult ESKD patients treated with dialysis from August to November 2017 at The Ottawa Hospital were invited to participate. Measurements: The FRAIL scale. Methods: Eligible patients completed an exercise survey with FRAIL questions embedded within the instrument. Number of comorbid illnesses was determined from the electronic medical record and weight loss was calculated from target weight in the patients’ dialysis prescription. Mortality, transplant status, and hospitalizations were ascertained from the electronic medical record 18 months later; differences by frailty status were evaluated using descriptive statistics. Kaplan-Meier and Cox regression models were used to examine the association between frailty and transplant. Results: Of 476 ESKD patients screened, 261 participated; 101 receiving peritoneal dialysis, 135 intermittent hemodialysis, and 25 home hemodialysis. Thirty-nine, 145, and 77 were frail, pre-frail, and not frail, respectively. Employment status, ethnicity, and comorbid illnesses differed significantly by frailty status, but mortality did not. In univariate analysis, frail patients were less likely to be listed for (P = .05) and to receive a kidney transplant (P = .02). However, after adjusting for age and modality, frailty was not statistically associated with a decreased likelihood of transplant (Hazard Ratio: 0.15; confidence interval [CI], 0.02-1.15; P = .068). The results were similar when accounting for the competing risk of death (P = .060). Frail patients were more likely to be hospitalized (P = .01) and spend more time in the hospital (P = .04). Limitations: Single-center design with a relatively short follow-up and small sample size limiting the number of variables that could be assessed in analysis. We also excluded patients who were unable to communicate in English or French and those patients with physical limitations such as amputations, potentially affecting generalizability. Conclusions: Frail ESKD patients as identified by the FRAIL scale are less likely to receive a renal transplant; this association diminished statistically after adjusting for age and modality and when accounting for the competing risk of death. Frail patients were at increased risk of hospitalization. Further study with larger patient numbers and longer follow-up is needed to determine the usefulness of the FRAIL scale in predicting adverse outcomes. Trial registration: Not required as this was an observational study.
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Affiliation(s)
- Januvi Jegatheswaran
- Department of Medicine, Ottawa Hospital, University of Ottawa, Ontario, Canada.,Division of Nephrology, Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ryan Chan
- Department of Medicine, Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Swapnil Hiremath
- Department of Medicine, Ottawa Hospital, University of Ottawa, Ontario, Canada.,Division of Nephrology, Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Danielle Moorman
- Division of Nephrology, Department of Medicine, Queens University, Kingston, Ontario, Canada
| | - Rita S Suri
- Division of Nephrology, Department of Medicine, McGill University, Montreal, Québec, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - Tim Ramsay
- Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Deborah Zimmerman
- Department of Medicine, Ottawa Hospital, University of Ottawa, Ontario, Canada.,Division of Nephrology, Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Suri RS, Antonsen JE, Banks CA, Clark DA, Davison SN, Frenette CH, Kappel JE, MacRae JM, Mac-Way F, Mathew A, Moist LM, Qirjazi E, Tennankore KK, Vorster H. Management of Outpatient Hemodialysis During the COVID-19 Pandemic: Recommendations From the Canadian Society of Nephrology COVID-19 Rapid Response Team. Can J Kidney Health Dis 2020; 7:2054358120938564. [PMID: 32963790 PMCID: PMC7488889 DOI: 10.1177/2054358120938564] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/04/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose: To collate best practice recommendations on the management of patients receiving in-center hemodialysis during the COVID-19 pandemic, based on published reports and current public health advice, while considering ethical principles and the unique circumstances of Canadian hemodialysis units across the country. Sources of information: The workgroup members used Internet search engines to retrieve documents from provincial and local hemodialysis programs; provincial public health agencies; the Centers for Disease Control and Prevention; webinars and slides from other kidney agencies; and nonreviewed preprints. PubMed was used to search for peer-reviewed published articles. Informal input was sought from knowledge users during a webinar. Methods: Challenges in the care of hemodialysis patients during the COVID-19 pandemic were highlighted within the Canadian Senior Renal Leaders Forum discussion group. The Canadian Society of Nephrology (CSN) developed the COVID-19 rapid response team (RRT) to address these challenges. They identified a pan-Canadian team of clinicians and administrators with expertise in hemodialysis to form the workgroup. One lead was chosen who drafted the initial document. Members of the workgroup reviewed and discussed all recommendations in detail during 2 virtual meetings on April 7 and April 9. Disagreements were resolved by consensus. The document was reviewed by the CSN COVID-19 RRT, an ethicist, an infection control expert, a community nephrologist, and a patient partner. Content was presented during an interactive webinar on April 11, 2020 attended by 269 kidney health professionals, and the webinar and first draft of the document were posted online. Final revisions were made based on feedback received until April 13, 2020. CJKHD editors reviewed the parallel process peer review and edited the manuscript for clarity. Key findings: Recommendations were made under the following themes: (1) Identification of patients with COVID-19 in the dialysis unit, (2) hemodialysis of patients with confirmed COVID-19, (3) hemodialysis of patients not yet known to have COVID-19, (4) visitors; (5) testing for COVID-19 in the dialysis unit; (6) resuscitation, (6) routine hemodialysis care, (7) hemodialysis care under fixed dialysis resources. Limitations: Because of limitations of time and resources, and the large number of questions, formal systematic review was not undertaken. The recommendations are based on expert opinion and subject to bias. The parallel review process that was created may not be as robust as the standard peer review process. Implications: We hope that these recommendations provide guidance for dialysis unit directors, clinicians, and administrators on how to limit risk from infection and adverse outcomes, while providing necessary dialysis care in a setting of finite resources. We also identify a number of resource allocation priorities, which we hope will inform decisions at provincial funding agencies.
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Affiliation(s)
- Rita S Suri
- Division of Nephrology, Department of Medicine/Research Institute, McGill University, Montreal, QC, Canada.,Centre de recherche de l'Université de Montréal, Montreal, QC, Canada
| | - John E Antonsen
- Hemodialysis Committee, British Columbia Renal Agency, Vancouver, Canada
| | - Cheryl A Banks
- Prince Edward Island Provincial Renal Program, Summerside, Canada
| | - David A Clark
- Division of Nephrology, Department of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, Canada
| | - Sara N Davison
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Charles H Frenette
- Division of Infectious Diseases, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Joanne E Kappel
- Division of Nephrology, Department of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Jennifer M MacRae
- Division of Nephrology, Department of Medicine, University of Calgary/Alberta Health Services, Canada
| | - Fabrice Mac-Way
- CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Division of Nephrology, Department of Medicine, Université Laval, QC, Canada
| | - Anna Mathew
- Division of Nephrology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Louise M Moist
- Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
| | - Elena Qirjazi
- Division of Nephrology, Department of Medicine, University of Calgary/Alberta Health Services, Canada
| | - Karthik K Tennankore
- Division of Nephrology, Department of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, Canada
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Tennankore KK, Gunaratnam L, Suri RS, Yohanna S, Walsh M, Tangri N, Prasad B, Gogan N, Rockwood K, Doucette S, Sills L, Kiberd B, Keough-Ryan T, West K, Vinson A. Frailty and the Kidney Transplant Wait List: Protocol for a Multicenter Prospective Study. Can J Kidney Health Dis 2020; 7:2054358120957430. [PMID: 32963793 PMCID: PMC7488612 DOI: 10.1177/2054358120957430] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/15/2020] [Indexed: 01/06/2023] Open
Abstract
Background: Understanding how frailty affects patients listed for transplantation has
been identified as a priority research need. Frailty may be associated with
a high risk of death or wait-list withdrawal, but this has not been
evaluated in a large multicenter cohort of Canadian wait-listed
patients. Objective: The primary objective is to evaluate whether frailty is associated with death
or permanent withdrawal from the transplant wait list. Secondary objectives
include assessing whether frailty is associated with hospitalization,
quality of life, and the probability of being accepted to the wait list. Design: Prospective cohort study. Setting: Seven sites with established renal transplant programs that evaluate patients
for the kidney transplant wait list. Patients: Individuals who are being considered for the kidney transplant wait list. Measurements: We will assess frailty using the Fried Phenotype, a frailty index, the Short
Physical Performance Battery, and the Clinical Frailty Scale at the time of
listing for transplantation. We will also assess frailty at the time of
referral to the wait list and annually after listing in a subgroup of
patients. Methods: The primary outcome of the composite of time to death or permanent wait-list
withdrawal will be compared between patients who are frail and those who are
not frail and will account for the competing risks of deceased and live
donor transplantation. Secondary outcomes will include number of
hospitalizations and length of stay, and in a subset, changes in frailty
severity over time, change in quality of life, and the probability of being
listed. Recruitment of 1165 patients will provide >80% power to identify
a relative hazard of ≥1.7 comparing patients who are frail to those who are
not frail for the primary outcome (2-sided α = .05), whereas a more
conservative recruitment target of 624 patients will provide >80% power
to identify a relative hazard of ≥2.0. Results: Through December 2019, 665 assessments of frailty (inclusive of those for the
primary outcome and all secondary outcomes including repeated measures) have
been completed. Limitations: There may be variation across sites in the processes of referral and listing
for transplantation that will require consideration in the analysis and
results. Conclusions: This study will provide a detailed understanding of the association between
frailty and outcomes for wait-listed patients. Understanding this
association is necessary before routinely measuring frailty as part of the
wait-list eligibility assessment and prior to ascertaining the need for
interventions that may modify frailty. Trial Registration: Not applicable as this is a protocol for a prospective observational
study.
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Affiliation(s)
- Karthik K Tennankore
- Division of Nephrology, Department of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, Canada
| | - Lakshman Gunaratnam
- Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
| | - Rita S Suri
- Division of Nephrology and Research Institute, Department of Medicine, McGill University/Centre de Recherche de l'Université de Montréal, QC, Canada
| | | | - Michael Walsh
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada.,Population Health Research Institute, Hamilton Health Sciences/McMaster University, ON, Canada.,St. Joseph's Healthcare Hamilton, ON, Canada
| | - Navdeep Tangri
- Department of Medicine and Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | | | - Nessa Gogan
- Division of Nephrology, Department of Medicine, Horizon Health Network, Dalhousie University, Saint John, NB, Canada
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Department of Medicine, Department of Community Health and Epidemiology, School of Health Administration, Halifax, NS, Canada
| | - Steve Doucette
- Research Methods Unit, Nova Scotia Health Authority, Halifax, Canada
| | - Laura Sills
- Multi-Organ Transplant Program, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | | | - Tammy Keough-Ryan
- Division of Nephrology, Department of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, Canada
| | - Kenneth West
- Division of Nephrology, Department of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, Canada
| | - Amanda Vinson
- Division of Nephrology, Department of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, Canada
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Affiliation(s)
- Rita S. Suri
- Kidney Clinical Research Unit University of Western Ontario London, Ontario, Canada
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31
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Lee EJ, Patel A, Acedillo RR, Bachynski JC, Barrett I, Basile E, Battistella M, Benjamin D, Berry D, Blake PG, Chan P, Bohm CJ, Clemens KK, Cook C, Dember L, Dirk JS, Dixon S, Fowler E, Getchell L, Gholami N, Goldstein C, Hahn E, Hogeterp B, Huang S, Hughes M, Jardine MJ, Kalatharan S, Kilburn S, Lacson E, Leonard S, Liberty C, Lindsay C, MacRae JM, Manns BJ, McCallum J, McIntyre CW, Molnar AO, Mustafa RA, Nesrallah GE, Oliver MJ, Pandes M, Pandeya S, Parmar MS, Rabin EZ, Riley J, Silver SA, Sontrop JM, Sood MM, Suri RS, Tangri N, Tascona DJ, Thomas A, Wald R, Walsh M, Weijer C, Weir MA, Vorster H, Zimmerman D, Garg AX. Cultivating Innovative Pragmatic Cluster-Randomized Registry Trials Embedded in Hemodialysis Care: Workshop Proceedings From 2018. Can J Kidney Health Dis 2019; 6:2054358119894394. [PMID: 31903190 PMCID: PMC6933546 DOI: 10.1177/2054358119894394] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/24/2019] [Indexed: 12/12/2022] Open
Abstract
Hemodialysis is a life-sustaining treatment for persons with kidney failure. However, those on hemodialysis still face a poor quality of life and a short life expectancy. High-quality research evidence from large randomized controlled trials is needed to identify interventions that improve the experiences, outcomes, and health care of persons receiving hemodialysis. With the support of the Canadian Institutes of Health Research and its Strategy for Patient-Oriented Research, the Innovative Clinical Trials in Hemodialysis Centers initiative brought together Canadian and international kidney researchers, patients, health care providers, and health administrators to participate in a workshop held in Toronto, Canada, on June 2 and 3, 2018. The workshop served to increase knowledge and awareness about the conduct of innovative, pragmatic, cluster-randomized registry trials embedded into routine hemodialysis care and provided an opportunity to discuss and build support for new trial ideas. The workshop content included structured presentations, facilitated group discussions, and expert panel feedback. Partnerships and promising trial ideas borne out of the workshop will continue to be developed to support the implementation of future large-scale trials.
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Affiliation(s)
| | | | - Rey R. Acedillo
- Division of Nephrology, Department of
Medicine, London Health Sciences Centre, ON, Canada
- Department of Epidemiology and
Biostatistics, Western University, London, ON, Canada
| | | | | | - Erika Basile
- Office of Human Research Ethics, Western
University, London, ON, Canada
| | - Marisa Battistella
- Department of Pharmacy, University
Health Network, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy,
University of Toronto, ON, Canada
| | - Derek Benjamin
- Royal Victoria Regional Health Centre,
Barrie, ON, Canada
| | - David Berry
- Algoma Regional Renal Program, Sault
Area Hospital, Sault Ste. Marie, ON, Canada
| | - Peter G. Blake
- Division of Nephrology, Department of
Medicine, London Health Sciences Centre, ON, Canada
- Ontario Renal Network, Cancer Care
Ontario, Toronto, Canada
| | - Patricia Chan
- Division of Nephrology, Department of
Medicine, Michael Garron Hospital, Toronto, ON, Canada
| | - Clara J. Bohm
- Department of Internal Medicine, Max
Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Kristin K. Clemens
- ICES, ON, Canada
- Department of Epidemiology and
Biostatistics, Western University, London, ON, Canada
- Division of Endocrinology and
Metabolism, Department of Medicine, Western University, London, ON, Canada
- St. Joseph’s Health Care London, ON,
Canada
| | - Charles Cook
- Transplant Ambassador Program, Grand
River Hospital, Kitchener, ON, Canada
| | - Laura Dember
- Renal, Electrolyte and Hypertension
Division, Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Stephanie Dixon
- ICES, ON, Canada
- Department of Epidemiology and
Biostatistics, Western University, London, ON, Canada
| | | | | | | | - Cory Goldstein
- Rotman Institute of Philosophy,
Western University, London, ON, Canada
| | | | | | - Susan Huang
- Division of Nephrology, Department of
Medicine, London Health Sciences Centre, ON, Canada
| | | | - Meg J. Jardine
- Innovation & Kidney Research, The
George Institute for Global Health, UNSW Sydney, Newtown, NSW, Australia
| | | | | | | | | | | | | | - Jennifer M. MacRae
- Division of Nephrology, Department of
Medicine, University of Calgary, AB, Canada
| | - Braden J. Manns
- Department of Medicine, Cumming School
of Medicine, University of Calgary, AB, Canada
| | - Janice McCallum
- Ontario Renal Network, Cancer Care
Ontario, Toronto, Canada
- Renal Services, London Health Sciences
Centre, ON, Canada
| | - Christopher W. McIntyre
- Kidney Clinical Research Unit, Lawson
Health Research Institute, London, ON, Canada
- Department of Medical Biophysics,
Schulich School of Medicine and Dentistry, Western University, London, ON,
Canada
| | - Amber O. Molnar
- ICES, ON, Canada
- Division of Nephrology, Department of
Medicine, McMaster University, Hamilton, ON, Canada
| | - Reem A. Mustafa
- Division of Nephrology and
Hypertension, Department of Internal Medicine, University of Kansas Medical Center,
Kansas City, USA
| | - Gihad E. Nesrallah
- Division of Nephrology, Department of
Medicine, Humber River Hospital, Toronto, ON, Canada
| | - Matthew J. Oliver
- Division of Nephrology, Department of
Medicine, University of Toronto, ON, Canada
| | | | | | | | | | | | - Samuel A. Silver
- Division of Nephrology, Kingston
Health Sciences Center, Queen’s University, Kingston, ON, Canada
| | - Jessica M. Sontrop
- ICES, ON, Canada
- Division of Nephrology, Department of
Medicine, London Health Sciences Centre, ON, Canada
- Kidney Clinical Research Unit, Lawson
Health Research Institute, London, ON, Canada
| | - Manish M. Sood
- ICES, ON, Canada
- Division of Nephrology, Department of
Medicine, University of Ottawa, ON, Canada
| | - Rita S. Suri
- Division of Nephrology, Department of
Medicine, McGill University, Montreal, QC, Canada
- Canadian Nephrology Trials Network,
Canada
| | - Navdeep Tangri
- Chronic Disease Innovation Centre,
Winnipeg, MB, Canada
- Department of Internal Medicine,
University of Manitoba, Winnipeg, Canada
| | - Daniel J. Tascona
- Ontario Renal Network, Cancer Care
Ontario, Toronto, Canada
- Orillia Soldiers’ Memorial Hospital,
ON, Canada
| | | | - Ron Wald
- St. Michael’s Hospital, Toronto, ON,
Canada
- Division of Nephrology, Department of
Medicine, University of Toronto, ON, Canada
| | - Michael Walsh
- Division of Nephrology, Department of
Medicine, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute,
Hamilton, ON, Canada
| | - Charles Weijer
- Department of Epidemiology and
Biostatistics, Western University, London, ON, Canada
- Rotman Institute of Philosophy,
Western University, London, ON, Canada
| | - Matthew A. Weir
- ICES, ON, Canada
- Division of Nephrology, Department of
Medicine, London Health Sciences Centre, ON, Canada
- Kidney Clinical Research Unit, Lawson
Health Research Institute, London, ON, Canada
| | - Hans Vorster
- Ontario Renal Network, Cancer Care
Ontario, Toronto, Canada
| | - Deborah Zimmerman
- Division of Nephrology, Department of
Medicine, University of Ottawa, ON, Canada
| | - Amit X. Garg
- ICES, ON, Canada
- Division of Nephrology, Department of
Medicine, London Health Sciences Centre, ON, Canada
- Department of Epidemiology and
Biostatistics, Western University, London, ON, Canada
- Kidney Clinical Research Unit, Lawson
Health Research Institute, London, ON, Canada
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Hecking M, McCullough KP, Port FK, Bieber B, Morgenstern H, Yamamoto H, Suri RS, Jadoul M, Gesualdo L, Perl J, Robinson BM. Self-reported Urine Volume in Hemodialysis Patients: Predictors and Mortality Outcomes in the International Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2019; 74:425-428. [PMID: 31005373 DOI: 10.1053/j.ajkd.2019.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 02/27/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Manfred Hecking
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
| | | | - Friedrich K Port
- Arbor Research Collaborative for Health, Ann Arbor, MI; Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Brian Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI
| | - Hal Morgenstern
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI; Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI; Department of Urology, Medical School, University of Michigan, Ann Arbor, MI
| | - Hiroyasu Yamamoto
- Division of Nephrology and Hypertension, Internal Medicine, Jikei University School of Medicine, Toyko, Japan
| | - Rita S Suri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM), Montreal, Quebec, Canada
| | - Michel Jadoul
- Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Loreto Gesualdo
- Nephrology, Dialysis, and Transplantation, Department of Emergency Organ Transplantation, University of Bari Aldo Moro, Altamura, Italy
| | - Jeffrey Perl
- St. Michael's Hospital, Toronto, Ontario, Canada
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Abstract
The use of frequent hemodialysis (HD) is growing, with the hope of improving outcomes in end-stage renal disease. We narratively review the three randomized trials, 15 comparative cohort studies, and several case series of frequent HD that empirically demonstrate the potential efficacy and adverse effects of these regimens. Taken together, the randomized studies suggest frequent HD may result in left ventricular mass regression. This effect is most pronounced when left ventricular mass is abnormal, but attenuated by significant residual urine output. Both frequent short and long HD consistently improved blood pressure control and reduced antihypertensive use, despite greater weekly interdialytic weight gains. Serum phosphate was lowered. Frequent short daytime HD improved health-related quality of life, while frequent long overnight HD did not. Regarding adverse effects, frequent HD patients underwent significantly more procedures to salvage arteriovenous vascular accesses. An absolute increase in hypotensive episodes was observed with frequent short HD, while frequent long HD accelerated residual renal function loss and increased perceived caregiver burden. The effect of frequent HD on mortality is controversial, due to conflicting results and limitations of published studies. Finally, pregnancy outcomes may be substantially better with frequent long HD. On the basis of these data, we suggest frequent HD is most likely to benefit patients with left ventricular hypertrophy particularly if there is minimal urine output, those unable to attain dry weight on a thrice weekly schedule, and pregnant women. All patients receiving frequent HD should be advised of and monitored for potential risks.
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Affiliation(s)
- Rita S Suri
- Department of Medicine, University of Montreal, Montreal, Canada
| | - Alan S Kliger
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Garg AX, Suri RS, Eggers P, Finkelstein FO, Greene T, Kimmel PL, Kliger AS, Larive B, Lindsay RM, Pierratos A, Unruh M, Chertow GM. Patients receiving frequent hemodialysis have better health-related quality of life compared to patients receiving conventional hemodialysis. Kidney Int 2017; 91:746-754. [PMID: 28094031 DOI: 10.1016/j.kint.2016.10.033] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/19/2016] [Accepted: 10/27/2016] [Indexed: 10/20/2022]
Abstract
Most patients with end-stage kidney disease value their health-related quality of life (HRQoL) and want to know how it will be affected by their dialysis modality. We extended the findings of two prior clinical trial reports to estimate the effects of frequent compared to conventional hemodialysis on additional measures of HRQoL. The Daily Trial randomly assigned 245 patients to receive frequent (six times per week) or conventional (three times per week) in-center hemodialysis. The Nocturnal Trial randomly assigned 87 patients to receive frequent nocturnal (six times per week) or conventional (three times per week) home hemodialysis. All patients were on conventional hemodialysis prior to randomization, with an average feeling thermometer score of 70 to 75 (a visual analog scale from 0 to 100 where 100 is perfect health), an average general health scale score of 40 to 47 (a score from 0 to 100 where 100 is perfect health), and an average dialysis session recovery time of 2 to 3 hours. Outcomes are reported as the between-treatment group differences in one-year change in HRQoL measures and analyzed using linear mixed effects models. After one year in the Daily Trial, patients assigned to frequent in-center hemodialysis reported a higher feeling thermometer score, better general health, and a shorter recovery time after a dialysis session compared to standard thrice-weekly dialysis. After one year in the Nocturnal Trial, patients assigned to frequent home hemodialysis also reported a shorter recovery time after a dialysis session, but no statistical difference in their feeling thermometer or general health scores compared to standard home dialysis schedules. Thus, patients receiving day or nocturnal hemodialysis on average recovered approximately one hour earlier from a frequent compared to conventional hemodialysis session. Patients treated in an in-center dialysis facility reported better HRQoL with frequent compared to conventional hemodialysis.
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Affiliation(s)
- Amit X Garg
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada.
| | - Rita S Suri
- Department of Medicine, Section of Nephrology, Centre de Recherche, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Paul Eggers
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Fredric O Finkelstein
- Yale School of Medicine and Yale New Haven Health System, New Haven, Connecticut, USA
| | - Tom Greene
- University of Utah Medical Center, Salt Lake City, Utah, USA
| | - Paul L Kimmel
- Division of Kidney Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Alan S Kliger
- Yale School of Medicine and Yale New Haven Health System, New Haven, Connecticut, USA
| | - Brett Larive
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Robert M Lindsay
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada
| | | | - Mark Unruh
- Department of Internal Medicine, Division of Nephrology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Glenn M Chertow
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
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Nesrallah GE, Li L, Suri RS. Comparative effectiveness of home dialysis therapies: a matched cohort study. Can J Kidney Health Dis 2016; 3:19. [PMID: 27006781 PMCID: PMC4802626 DOI: 10.1186/s40697-016-0105-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 02/04/2016] [Indexed: 01/26/2023] Open
Abstract
Background Home dialysis is being increasingly promoted among patients with end-stage renal disease, but the comparative effectiveness of home hemodialysis and peritoneal dialysis is unknown. Objective To determine whether patients receiving home daily hemodialysis have reduced mortality risk compared with matched patients receiving home peritoneal dialysis. Design This study is an observational, propensity-matched, new-user cohort study. Setting Linked electronic data were from the United States Renal Data System (USRDS) and a large dialysis provider’s database. Patients The patients were adults receiving in-center hemodialysis in the USA between 2004 and 2011 and registered in the USRDS. Measurements Baseline comorbidities, demographics, and outcomes for both groups were ascertained from the United States Renal Data System. Methods We identified 3142 consecutive adult patients initiating home daily hemodialysis (≥5 days/week for ≥1.5 h/day) and matched 2688 of them by propensity score to 2688 contemporaneous US patients initiating home peritoneal dialysis. We used Cox regression to compare all-cause mortality between groups. Results After matching, the two groups were well balanced on all baseline characteristics. Mean age was 51 years, 66 % were male, 72 % were white, and 29 % had diabetes. During 10,221 patient-years of follow-up, 1493/5336 patients died. There were significantly fewer deaths among patients receiving home daily hemodialysis than those receiving peritoneal dialysis (12.7 vs 16.7 deaths per 100 patient-years, respectively; hazard ratio (HR) 0.75; 95 % CI 0.68–0.82; p < 0.001). Similar results were noted with several different analytic methods and for all pre-specified subgroups. Limitations We cannot exclude residual confounding in this observational study. Conclusions Home daily hemodialysis was associated with lower mortality risk than home peritoneal dialysis. Electronic supplementary material The online version of this article (doi:10.1186/s40697-016-0105-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gihad E Nesrallah
- The Li Ka Shing Knowledge Institute, Keenan Research Center, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8 Canada ; Nephrology Program, Humber River Regional Hospital, Toronto, Ontario Canada ; Division of Nephrology, Western University, London, Ontario Canada
| | - Lihua Li
- Division of Nephrology, Western University, London, Ontario Canada
| | - Rita S Suri
- Division of Nephrology, Western University, London, Ontario Canada ; Centre de Recherche, Centre Hospitalier de l'Université de Montréal, Montréal, Québec Canada
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Rigatto C, Walsh M, Zalunardo N, Clase CM, Manns BJ, Madore F, Samuel SM, Morgan CJ, Wolfs W, Suri RS. Establishing a Canadian national clinical trials network for kidney disease: proceedings of a planning workshop. Can J Kidney Health Dis 2015; 2:46. [PMID: 26583070 PMCID: PMC4650502 DOI: 10.1186/s40697-015-0080-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 10/28/2015] [Indexed: 11/10/2022] Open
Abstract
Knowledge generation through randomized controlled trials (RCTs) is critical to advance the medical evidence base, inform decision-making, and improve care and outcomes. Unfortunately, nephrology has typically lagged behind other medical specialties in this regard. The establishment of formal clinical trial networks can facilitate the successful conduct of RCTs and has significantly increased the number of RCTs performed worldwide in other medical specialties. No such formal network of nephrology trialists exists in Canada. On April 24, 2014, the Canadian Kidney Knowledge Translation and Generation Network (CANN-NET) Clinical Trials Committee held a stakeholder engagement meeting to address this gap and improve the nephrology clinical trial landscape in Canada. The meeting was held in Vancouver in association with the 2014 Canadian Society of Nephrology Annual General Meeting and was co-sponsored by the Kidney Foundation of Canada and CANN-NET. Attendees included nephrologists from university- and non-university-affiliated nephrology practices, administrators, and representatives from the Kidney Foundation of Canada. Through structured presentations and facilitated group discussions, the group explored the extent to which nephrology trials are currently happening in Canada, barriers to leading or participating in larger investigator-initiated trials, and strategies to improve clinical trial output in nephrology in Canada. The themes and action items arising from this meeting are discussed.
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Affiliation(s)
- Claudio Rigatto
- Department of Medicine, University of Manitoba, Winnipeg, MB Canada
| | - Michael Walsh
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Nadia Zalunardo
- Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | | | - Braden J Manns
- Department of Medicine, University of Calgary, Calgary, AB Canada ; Department of Community Health Sciences, University of Calgary, Calgary, AB Canada
| | - François Madore
- Centre de Recherche, Hôpital du Sacré-Cœur de Montréal, University de Montréal, Montreal, QC Canada
| | - Susan M Samuel
- Department of Community Health Sciences, University of Calgary, Calgary, AB Canada ; Department of Pediatrics, University of Calgary, Calgary, AB Canada
| | | | - Wim Wolfs
- Kidney Foundation of Canada, Montreal, QC Canada
| | - Rita S Suri
- Centre de Recherche, Centre Hospitalier de l'Université de Montréal, University de Montréal, Montreal, QC Canada ; Section de Néphrologie, Centre Hospitalier de l'Université de Montréal, University of Montreal, 1058 rue St. Denis, Montreal, QC H2X 3J4 Canada
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Daugirdas JT, Depner TA, Inrig J, Mehrotra R, Rocco MV, Suri RS, Weiner DE, Greer N, Ishani A, MacDonald R, Olson C, Rutks I, Slinin Y, Wilt TJ, Rocco M, Kramer H, Choi MJ, Samaniego-Picota M, Scheel PJ, Willis K, Joseph J, Brereton L. KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 Update. Am J Kidney Dis 2015; 66:884-930. [DOI: 10.1053/j.ajkd.2015.07.015] [Citation(s) in RCA: 603] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 07/31/2015] [Indexed: 12/13/2022]
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Suri RS, Li L, Nesrallah GE. The risk of hospitalization and modality failure with home dialysis. Kidney Int 2015; 88:360-8. [PMID: 25786099 PMCID: PMC4526768 DOI: 10.1038/ki.2015.68] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 12/20/2015] [Accepted: 01/22/2015] [Indexed: 12/13/2022]
Abstract
While home dialysis is being promoted, there are few comparative effectiveness studies of home-based modalities to guide patient decisions. To address this, we matched 1116 daily home hemodialysis (DHD) patients by propensity scores to 2784 contemporaneous USRDS patients receiving home peritoneal dialysis (PD), and compared hospitalization rates from cardiovascular, infectious, access-related or bleeding causes (prespecified composite), and modality failure risk. We performed similar analyses for 1187 DHD patients matched to 3173 USRDS patients receiving in-center conventional hemodialysis (CHD). The composite hospitalization rate was significantly lower with DHD than with PD (0.93 vs. 1.35/patient-year, hazard ratio=0.73 (95% CI=0.67–0.79)). DHD patients spent significantly fewer days in hospital than PD patients (5.2 vs. 9.2 days/patient-year), and significantly more DHD patients remained admission-free (52% DHD vs. 32% PD). In contrast, there was no significant difference in hospitalizations between DHD and CHD (DHD vs. CHD: 0.93 vs. 1.10/patient-year, hazard ratio 0.92 (0.85–1.00)). Cardiovascular hospitalizations were lower with DHD than with CHD (0.68 (0.61–0.77)), while infectious and access hospitalizations were higher (1.15 (1.04–1.29) and 1.25 (1.08–1.43), respectively). Significantly more PD than DHD patients switched back to in-center HD (44% vs. 15% 3.4 (2.9–4.0)). In this prevalent cohort, home DHD was associated with fewer admissions and hospital days than PD, and a substantially lower risk of modality failure.
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Affiliation(s)
- Rita S Suri
- 1] Department of Medicine, Section of Nephrology, Centre de Recherche, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada [2] Division of Nephrology, Western University, London, Ontario, Canada
| | - Lihua Li
- Division of Nephrology, Western University, London, Ontario, Canada
| | - Gihad E Nesrallah
- 1] Department of Nephrology, Humber River Regional Hospital, Toronto, Ontario, Canada [2] The Li Ka Shing Knowledge Institute, Keenan Research Centre, St. Michael's Hospital, Toronto, Ontario, Canada
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Weir MA, Dixon SN, Fleet JL, Roberts MA, Hackam DG, Oliver MJ, Suri RS, Quinn RR, Ozair S, Beyea MM, Kitchlu A, Garg AX. β-Blocker dialyzability and mortality in older patients receiving hemodialysis. J Am Soc Nephrol 2014; 26:987-96. [PMID: 25359874 DOI: 10.1681/asn.2014040324] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Some β-blockers are efficiently removed from the circulation by hemodialysis ("high dialyzability") whereas others are not ("low dialyzability"). This characteristic may influence the effectiveness of the β-blockers among patients receiving long-term hemodialysis. To determine whether new use of a high-dialyzability β-blocker compared with a low-dialyzability β-blocker associates with a higher rate of mortality in patients older than age 66 years receiving long-term hemodialysis, we conducted a propensity-matched population-based retrospective cohort study using the linked healthcare databases of Ontario, Canada. The high-dialyzability group (n=3294) included patients initiating atenolol, acebutolol, or metoprolol. The low-dialyzability group (n=3294) included patients initiating bisoprolol or propranolol. Initiation of a high- versus low-dialyzability β-blocker was associated with a higher risk of death in the following 180 days (relative risk, 1.4; 95% confidence interval, 1.1 to 1.8; P<0.01). Supporting this finding, we repeated the primary analysis in a cohort of patients not receiving hemodialysis and found no significant association between dialyzability and the risk of death (relative risk, 1.0; 95% confidence interval, 0.9 to 1.3; P=0.71). β-Blocker exposure was not randomly allocated in this study, so a causal relationship between dialyzability and mortality cannot be determined. However, our findings should raise awareness of this potentially important drug characteristic and prompt further study.
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Affiliation(s)
- Matthew A Weir
- Department of Medicine, Division of Nephrology, and Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada;
| | - Stephanie N Dixon
- Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, London, Ontario, Canada
| | - Jamie L Fleet
- Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada
| | - Matthew A Roberts
- Department of Renal Medicine, Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Daniel G Hackam
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Department of Medicine, Division of Clinical Neurosciences, Western University, London, Ontario, Canada
| | - Matthew J Oliver
- Department of Medicine, Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - Rita S Suri
- Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada; Department of Medicine, University of Montreal, Montreal, Quebec, Canada; and
| | - Robert R Quinn
- Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, Canada
| | - Sundus Ozair
- Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada
| | - Michael M Beyea
- Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada
| | - Abhijat Kitchlu
- Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada
| | - Amit X Garg
- Department of Medicine, Division of Nephrology, and Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, London, Ontario, Canada
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Suri RS, Larive B, Hall Y, Kimmel PL, Kliger AS, Levin N, Kurella Tamura M, Chertow GM. Effects of frequent hemodialysis on perceived caregiver burden in the Frequent Hemodialysis Network trials. Clin J Am Soc Nephrol 2014; 9:936-42. [PMID: 24721892 PMCID: PMC4011443 DOI: 10.2215/cjn.07170713] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 01/28/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients receiving hemodialysis often perceive their caregivers are overburdened. We hypothesize that increasing hemodialysis frequency would result in higher patient perceptions of burden on their unpaid caregivers. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In two separate trials, 245 patients were randomized to receive in-center daily hemodialysis (6 days/week) or conventional hemodialysis (3 days/week) while 87 patients were randomized to receive home nocturnal hemodialysis (6 nights/week) or home conventional hemodialysis for 12 months. Changes in overall mean scores over time in the 10-question Cousineau perceived burden scale were compared. RESULTS In total, 173 of 245 (70%) and 80 of 87 (92%) randomized patients in the Daily and Nocturnal Trials, respectively, reported having an unpaid caregiver at baseline or during follow-up. Relative to in-center conventional dialysis, the 12-month change in mean perceived burden score with in-center daily hemodialysis was -2.1 (95% confidence interval, -9.4 to +5.3; P=0.58). Relative to home conventional dialysis, the 12-month change in mean perceived burden score with home nocturnal dialysis was +6.1 (95% confidence interval, -0.8 to +13.1; P=0.08). After multiple imputation for missing data in the Nocturnal Trial, the relative difference between home nocturnal and home conventional hemodialysis was +9.4 (95% confidence interval, +0.55 to +18.3; P=0.04). In the Nocturnal Trial, changes in perceived burden were inversely correlated with adherence to dialysis treatments (Pearson r=-0.35; P=0.02). CONCLUSION Relative to conventional hemodialysis, in-center daily hemodialysis did not result in higher perceptions of caregiver burden. There was a trend to higher perceived caregiver burden among patients randomized to home nocturnal hemodialysis. These findings may have implications for the adoption of and adherence to frequent nocturnal hemodialysis.
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Affiliation(s)
- Rita S Suri
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Nesrallah GE, Mustafa RA, MacRae J, Pauly RP, Perkins DN, Gangji A, Rioux JP, Steele A, Suri RS, Chan CT, Copland M, Komenda P, McFarlane PA, Pierratos A, Lindsay R, Zimmerman DL. Canadian Society of Nephrology Guidelines for the Management of Patients With ESRD Treated With Intensive Hemodialysis. Am J Kidney Dis 2013; 62:187-98. [DOI: 10.1053/j.ajkd.2013.02.351] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 02/14/2013] [Indexed: 11/11/2022]
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Mustafa RA, Zimmerman D, Rioux JP, Suri RS, Gangji A, Steele A, MacRae J, Pauly RP, Perkins DN, Chan CT, Copland M, Komenda P, McFarlane PA, Lindsay R, Pierratos A, Nesrallah GE. Vascular Access for Intensive Maintenance Hemodialysis: A Systematic Review for a Canadian Society of Nephrology Clinical Practice Guideline. Am J Kidney Dis 2013; 62:112-31. [DOI: 10.1053/j.ajkd.2013.03.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 03/27/2013] [Indexed: 11/11/2022]
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Thomson BKA, Dixon SN, Huang SHS, Leitch RE, Suri RS, Chan CT, Lindsay RM. Modifiable variables affecting interdialytic weight gain include dialysis time, frequency, and dialysate sodium. Hemodial Int 2013; 17:576-85. [PMID: 23782770 DOI: 10.1111/hdi.12056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Interdialytic weight gain (IDWG) is associated with hypertension, left ventricular hypertrophy, and all-cause mortality. Dialysate sodium concentration may cause diffusion gradients with plasma sodium and influence subsequent IDWG. Dialysis time and frequency may also influence the outcomes of this Na(+) gradient; these have been overlooked. Our objective was to identify modifiable factors influencing IDWG. We performed a retrospective multivariable regression analyses of data from 86 home hemodialysis patients treated by hemodialysis modalities differing in frequency and session duration to determine factors involved that predict IDWG. Age, diabetic status, and residual renal function did not correlate with IDWG in the univariable analysis. However, using a combination of backwards selection and Akaike information criterion to build our model, we created an equation that predicted IDWG on the basis of serum albumin, age, patient sex, dialysis frequency, and the diffusive balance of sodium, represented by the product of the duration of dialysis and the patient plasma to dialysate Na(+) gradient. This equation was internally validated using bootstrapping, and externally validated in a temporally distinct patient population. We have created an equation to predict IDWG on the basis of independent factors readily available before a dialysis session. The modifiable factors include dialysis time and frequency, and dialysate sodium. Patient sex, age, and serum albumin are also correlated with IDWG. Further work is required to establish how improvements in IDWG influence cardiovascular and other clinical outcomes.
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Affiliation(s)
- Benjamin K A Thomson
- Division of Nephrology, Department of Medicine, London Health Sciences Centre and Western University, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada
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Thomson BK, Huang SHS, Leitch RE, Dixon S, Heidenheim P, Suri RS, Chan CT, Lindsay RM. Pre to post-dialysis plasma sodium change better predicts clinical outcomes than dialysate to plasma sodium gradient in quotidian hemodialysis. Hemodial Int 2013; 17:548-56. [DOI: 10.1111/hdi.12044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Rosemary E. Leitch
- Division of Nephrology; Department of Medicine; London Health Sciences Centre and Western University; London
| | | | - Paul Heidenheim
- Division of Nephrology; Department of Medicine; London Health Sciences Centre and Western University; London
| | | | - Christopher T. Chan
- Division of Nephrology; Department of Medicine; The Toronto General Hospital; University Health Network; Toronto; Ontario; Canada
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Zimmerman DL, Nesrallah GE, Chan CT, Copland M, Komenda P, McFarlane PA, Gangji A, Lindsay R, MacRae J, Pauly RP, Perkins DN, Pierratos A, Rioux JP, Steele A, Suri RS, Mustafa RA. Dialysate calcium concentration and mineral metabolism in long and long-frequent hemodialysis: a systematic review and meta-analysis for a Canadian Society of Nephrology clinical practice guideline. Am J Kidney Dis 2013; 62:97-111. [PMID: 23591289 DOI: 10.1053/j.ajkd.2013.02.357] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 02/01/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients treated with conventional hemodialysis (HD) develop disorders of mineral metabolism that are associated with increased morbidity and mortality. More frequent and longer HD has been associated with improvement in hyperphosphatemia that may improve outcomes. STUDY DESIGN Systematic review and meta-analysis to inform the clinical practice guideline on intensive dialysis for the Canadian Society of Nephrology. SETTING & POPULATION Adult patients receiving outpatient long (≥5.5 hours/session; 3-4 times per week) or long-frequent (≥5.5 hours/session, ≥5 sessions per week) HD. SELECTION CRITERIA FOR STUDIES We included clinical trials, cohort studies, case series, case reports, and systematic reviews. INTERVENTIONS Dialysate calcium concentration ≥1.5 mmol/L and/or phosphate additive. OUTCOMES Fragility fracture, peripheral arterial and coronary artery disease, calcific uremic arteriolopathy, mortality, intradialytic hypotension, parathyroidectomy, extraosseous calcification, markers of mineral metabolism, diet liberalization, phosphate-binder use, and muscle mass. RESULTS 21 studies were identified: 2 randomized controlled trials, 2 reanalyses of data from the randomized controlled trials, and 17 observational studies. Dialysate calcium concentration ≥1.5 mmol/L for patients treated with long and long-frequent HD prevents an increase in parathyroid hormone levels and a decline in bone mineral density without causing harm. Both long and long-frequent HD were associated with a reduction in serum phosphate level of 0.42-0.45 mmol/L and a reduction in phosphate-binder use. There was no direct evidence to support the use of a dialysate phosphate additive. LIMITATIONS Almost all the available information is related to changes in laboratory values and surrogate outcomes. CONCLUSIONS Dialysate calcium concentration ≥1.5 mmol/L for most patients treated with long and long-frequent dialysis prevents an increase in parathyroid hormone levels and decline in bone mineral density without increased risk of calcification. It seems prudent to add phosphate to the dialysate for patients with a low predialysis phosphate level or very low postdialysis phosphate level until more evidence becomes available.
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Affiliation(s)
- Deborah L Zimmerman
- Division of Nephrology, Kidney Research Centre of the Ottawa Hospital Research Institute, Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada.
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Suri RS, Larive B, Sherer S, Eggers P, Gassman J, James SH, Lindsay RM, Lockridge RS, Ornt DB, Rocco MV, Ting GO, Kliger AS. Risk of vascular access complications with frequent hemodialysis. J Am Soc Nephrol 2013; 24:498-505. [PMID: 23393319 DOI: 10.1681/asn.2012060595] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Frequent hemodialysis requires using the vascular access more often than with conventional hemodialysis, but whether this increases the risk for access-related complications is unknown. In two separate trials, we randomly assigned 245 patients to receive in-center daily hemodialysis (6 days per week) or conventional hemodialysis (3 days per week) and 87 patients to receive home nocturnal hemodialysis (6 nights per week) or conventional hemodialysis, for 12 months. The primary vascular access outcome was time to first access event (repair, loss, or access-related hospitalization). Secondary outcomes were time to all repairs and time to all losses. In the Daily Trial, 77 (31%) of 245 patients had a primary outcome event: 33 repairs and 15 losses in the daily group and 17 repairs, 11 losses, and 1 hospitalization in the conventional group. Overall, the risk for a first access event was 76% higher with daily hemodialysis than with conventional hemodialysis (hazard ratio [HR], 1.76; 95% confidence interval [CI], 1.11-2.79; P=0.017); among the 198 patients with an arteriovenous (AV) access at randomization, the risk was 90% higher with daily hemodialysis (HR, 1.90; 95% CI, 1.11-3.25; P=0.02). Daily hemodialysis patients had significantly more total AV access repairs than conventional hemodialysis patients (P=0.011), with 55% of all repairs involving thrombectomy or surgical revision. Losses of AV access did not differ between groups (P=0.58). We observed similar trends in the Nocturnal Trial, although the results were not statistically significant. In conclusion, frequent hemodialysis increases the risk of vascular access complications. The nature of the AV access repairs suggests that this risk likely results from increased hemodialysis frequency rather than heightened surveillance.
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Affiliation(s)
- Rita S Suri
- Kidney Clinical Research Unit, University of Western Ontario, Room A2-346, Victoria Hospital, 800 Commissioners Road East, London, Ontario N6A 4G5, Canada.
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Suri RS, Lindsay RM, Bieber BA, Pisoni RL, Garg AX, Austin PC, Moist LM, Robinson BM, Gillespie BW, Couchoud CG, Galland R, Lacson EK, Zimmerman DL, Li Y, Nesrallah GE. A multinational cohort study of in-center daily hemodialysis and patient survival. Kidney Int 2013; 83:300-7. [DOI: 10.1038/ki.2012.329] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Ornt DB, Larive B, Rastogi A, Rashid M, Daugirdas JT, Hernandez A, Kurella Tamura M, Suri RS, Levin NW, Kliger AS. Impact of frequent hemodialysis on anemia management: results from the Frequent Hemodialysis Network (FHN) Trials. Nephrol Dial Transplant 2013; 28:1888-98. [PMID: 23358899 DOI: 10.1093/ndt/gfs593] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The extent to which anemia management is facilitated by more frequent hemodialysis (HD) is controversial. We hypothesized as a preselected outcome that patients receiving HD six times (6×) compared with three times (3×) per week would require lower doses of erythropoietin-stimulating agents (ESA) and/or achieve higher blood hemoglobin (Hb) concentrations. METHODS Subjects enrolled in the Frequent Hemodialysis Network (FHN) daily and nocturnal trials were studied. As the primary outcome for anemia, the dose of ESAs was recorded at 4-month intervals and the monthly dose of intravenous iron (IV Fe) was reported. Serum iron, transferrin saturation and ferritin were measured at baseline and then at 4-month intervals, whereas Hb concentration was measured monthly. RESULTS There was no significant treatment effect in the 6× versus 3× treatment groups on logESA dose or the ratio of log of ESA dose to Hb concentration in either trial. In the daily trial, Hb concentrations increased significantly in the 6× versus 3× group, at Month 12 compared with baseline (0.3 g/dL; 95% CI: 0.05-0.58, P<0.021), but both groups had Hb concentrations in the usual target range. In the daily trial, the weekly logESA dose and the logESA dose to Hb concentration ratio tended to decline more in the 6× versus 3× group. This trend was not observed in the nocturnal trial. IV Fe doses were significantly lower in the 6× compared with the 3× group by Month 12 in the nocturnal trial, but not different in the daily trial. CONCLUSIONS In the FHN Daily and Nocturnal Trials, more frequent HD did not have a significant or clinically important effect on anemia management.
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Affiliation(s)
- Daniel B Ornt
- College of Health Sciences and Technology, Rochester Institute of Technology, Rochester, NY, USA.
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Huang SHS, Tirona RG, Ross C, Suri RS. Case report: atenolol overdose successfully treated with hemodialysis. Hemodial Int 2013; 17:652-5. [PMID: 23347063 DOI: 10.1111/hdi.12020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 12/14/2012] [Indexed: 11/29/2022]
Abstract
Owing to the drug's favorable hydrophilic and pharmacokinetic characteristics, a number of case reports have demonstrated effective treatment of atenolol overdose with hemodialysis. However, the efficiency of atenolol clearance throughout hemodialysis treatments has not previously been examined. In this report, a patient with impaired renal function was successfully treated with two 5-hour intermittent high-flux high-efficiency hemodialysis therapies after atenolol overdose. Serial atenolol levels were measured during his hemodialysis treatments. We observed an over 50% plasma atenolol concentration reduction after each 5-hour hemodialysis therapy. Hemodialysis therapy is an effective treatment for atenolol overdose, especially in patients with impaired renal function.
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Affiliation(s)
- Shih-Han S Huang
- Department of Medicine, London Health Sciences Centre, Nephrology Division, Western University, London, Canada
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