Canadian Journal of Kidney Health and Disease

Soret, Guillaume; Leidi, Antonio; Mavrakanas, Thomas A.

doi: 10.1177/20543581251404700pmid: 41466725

Jdiaa, Sara S.; Avila-Casado, Carmen; Sanchez-Guerrero, Jorge; Jauhal, Arenn

doi: 10.1177/20543581251394300pmid: 41466724

We report a case of biopsy-proven renal cortical necrosis in a 42-year-old man after bioprosthetic aortic valve replacement despite prophylactic anticoagulation. He had antiphospholipid syndrome with chronic thrombotic microangiopathy and triple-positive antibodies, leading to renal cortical necrosis manifested as severe non-reversible dialysis-dependent acute kidney injury. We identified 13 previously published reports of renal cortical necrosis due to antiphospholipid syndrome: 3 occurred postpartum, 2 after kidney transplantation, and 1 following salpingectomy for ectopic pregnancy.

Laurier, Noémie; Wong-Mersereau, Chloe; Sandal, Shaifali; Przybylak-Brouillard, Antoine; Taha, Ali; Messina, Alexander; Blum, Daniel; Weber, Catherine; Trinh, Emilie

doi: 10.1177/20543581251399138pmid: 41466723

Background:In 2022, we implemented an incremental hemodialysis (iHD) protocol to initiate twice-weekly treatment for eligible patients. This patient-centered approach aims to ease the transition to dialysis and enhance quality of life. However, limited data exists on how iHD is experienced by patients and health care providers (HCPs).Objective:The aim of the study was to explore the benefits and challenges of iHD from patients’ and HCPs’ perspectives, and to generate practical considerations for its implementation.Study Design:We conducted an exploratory descriptive qualitative study, guided by an interpretivist-constructivist paradigm, using semi-structured interviews (March-May 2024).Setting:The study was conducted in a tertiary care center.Participants:Participants included patients who were actively or had previously received iHD and HCPs caring for iHD patients.Methods:Interview data was analyzed thematically using inductive thematic analysis.Results:Ten patients and five HCPs were interviewed. Six major themes were identified: (1) better quality of life than conventional hemodialysis, (2) travel and financial benefits, (3) psychosocial and emotional impact similar to conventional hemodialysis, (4) coordination of care and logistics, (5) knowledge and training challenges, and (6) challenges when switching modality. Patients preferred iHD because it afforded them more time for participation in daily life activities. However, the start of a dialysis treatment remained “traumatic” for some patients. While HCPs recognized the greater quality of life for iHD patients, HCPs expressed a need for increased monitoring to ensure adequate care. Patients noticed an inconsistency in care coordination and reduced opportunities to see nephrologists. Some HCPs reported a lack of guidance on iHD. Finally, HCPs observed patients negotiating to stay on iHD even when it became unsafe.Limitations:The small sample size and single-center setting may limit the findings’ transferability.Conclusions:IHD was shown to offer quality of life advantages. However, the transition to iHD remained emotionally challenging for patients. Patients often exhibited resistance when moving from twice-weekly to a thrice-weekly schedule. Logistical issues for HCPs and educational barriers must be addressed to optimize delivery of iHD.

, ; Killin, Lauren; Bohm, Clara; Harris, Claire; MacRae, Jennifer M.; Shah, Nikhil; Thompson, Stephanie; Tonelli, Marcello; Luo, Bin; Sontrop, Jessica M.; Acedillo, Rey R.; Al-Jaishi, Ahmed A.; Anderson, Sierra; Antonsen, John; Bagga, Amit; Beaubien, Eliot; Berry, David; Blake, Peter G.; Brown, Pierre A.;

Cau, Alessandro; Elliott, Mark; Levin, Adeera; Karunarathna, Charith; Romann, Alexandra; Djurdjev, Ognjenka; Atiquzzaman, Mohammad; Bevilacqua, Micheli

doi: 10.1177/20543581251404101pmid: 41393272

Background:Autosomal dominant polycystic kidney disease (ADPKD) is the fourth leading cause of kidney failure in Canada and internationally. To date, patients with ADPKD have been excluded from trials of sodium-glucose cotransporter type 2 inhibitors (SGLT2i), which have been demonstrated to positively influence a wide range of kidney outcomes across the spectrum of chronic kidney disease (CKD). This exclusion was primarily due to theoretic safety concerns, particularly hastening disease progression due to vasopressin stimulation. As a result, there is a paucity of data on SGLT2i use among patients with ADPKD.Objectives:To estimate the risk of kidney dysfunction with SGLT2i treatment among patients with ADPKD.Design:Single-arm retrospective cohort study.Setting and patients:Adult patients (≥18 years old) with CKD with a primary diagnosis of ADPKD in British Columbia, Canada who had been exposed to any drug formulation containing empagliflozin, dapagliflozin or canagliflozin.Methods and measurements:We retrieved existing data from the province wide registry of patients with kidney disease and performed manual chart reviews on patients with ADPKD who were prescribed an SGLT2i from January 1, 2014, to December 31, 2024. The primary outcome was acute kidney injury (AKI). Secondary outcomes included eGFR slope before and after SGLT2i initiation, magnitude of “eGFR dip” after starting SGLT2i as well as the incidence of genitourinary (GU) infections requiring hospital admission, emergency room visit and/or outpatient diagnosis and treatment.Results:We included 17 patients on SGLT2i in our retrospective chart review with a median exposure of 20.89 months. While on an SGLT2i, one (6%) patient met criteria for AKI. Three patients (18%) had an eGFR dip of greater than 10% after starting an SGLT2i. Before SGLT2i initiation, the estimated eGFR slope was −0.2571 mL/min/1.73 m2. After initiation, the slope was −0.1435 mL/min/1.73 m2 (P = .48). Two patients (12%) had documentation of a urinary tract infection, neither of whom required hospitalization, or an emergency department visit.Limitations:The main limitation was the lack of a comparator group, thereby making it difficult to determine the true risk of AKI in our cohort of patients with ADPKD on SGLT2i. Other limitations include our retrospective study design and small sample size, which limits the generalizability of these results. The median exposure time of our cohort to SGLT2i was only 20.89 months and we had limited eGFR data beyond 2 years post-SGLT2i initiation. We did not have data on total kidney volume of these patients.Conclusions:In this cohort of 17 patients with ADPKD on SGLT2i, we did not observe any signs of adverse kidney outcomes and only two instances of GU infections occurred, neither requiring emergency visits or hospitalization. More high-quality evidence is needed to determine the safety and efficacy of SGLT2i in this population.

Vera-Ponce, Víctor Juan; Loayza-Castro, Joan A.; Vásquez-Romero, Luisa Erika Milagros; Zuzunaga-Montoya, Fiorella E.

doi: 10.1177/20543581251382479pmid: 41425702

Background:Chronic kidney disease (CKD) represents a global health concern, with particular significance in Latin America due to socioeconomic inequalities and heterogeneous health care systems.Objective:To determine the prevalence of CKD in Latin American populations through a systematic review with meta-analysis.Design:Systematic review and meta-analysis of observational studies following the PRISMA guidelines.Setting:Twelve Latin American countries (Argentina, Brazil, Chile, Colombia, Cuba, Ecuador, El Salvador, Haiti, Mexico, Nicaragua, Panama, and Peru).Patients:A total of 72 486 participants from 21 observational studies reporting CKD prevalence in Latin American populations.Measurements:The CKD prevalence according to Kidney Disease: Improving Global Outcomes (KDIGO) or Kidney Disease Outcomes Quality Initiative (K/DOQI) criteria, stratified by age groups (<60-65 vs ≥60-65 years), sex, CKD categories (G1-G5), and country.Methods:Systematic search in PubMed, SCOPUS, Web of Science, and EMBASE databases. Observational studies using standardized CKD diagnostic criteria were included without language restrictions. A meta-analysis was conducted using random-effects models with a Freeman-Tukey double arcsine transformation. The risk of bias was assessed using the Munn et al tool. Meta-regressions examined temporal trends and the effects of sample size.Results:The pooled CKD prevalence was 17.14% (95% confidence interval [CI] = 13.40-21.23%) with high heterogeneity (I2 = 99.5%). Age-stratified analysis revealed a prevalence of 11.66% (95% CI = 8.09%-15.79%) in younger adults and 28.29% (95% CI = 22.34%-34.64%) in older adults. Women showed a higher prevalence (19.23%) compared to men (16.75%). Country-specific estimates ranged from 7.26% in Ecuador to 27.14% in Haiti. Meta-regression showed no significant temporal trend (P = .178).Limitations:High between-study heterogeneity, most studies used single measurements rather than confirming chronicity, potential publication bias favoring higher prevalence studies, and limited representation from certain countries, which restricts generalizability.Conclusions:The prevalence of CKD in Latin America exhibits marked age-related differences, with consistently higher rates in older adults. These findings support the need for age-specific prevention strategies and standardized diagnostic approaches across the region.Trial registration:Not registered prospectively (limitation acknowledged).

Ruhl, Michelle; Burghall, Ashley; Groot, Brianna; Rosaasen, Nicola; Flood, Kayla; Davis, Keefe; Minakakis, Natasha; Wichart, Jenny; Mansell, Holly

doi: 10.1177/20543581251399080pmid: 41472832

Background:Kidney transplantation, a life-saving therapy for children with kidney disease, remains challenging to navigate for patients and families.Objective:To elucidate the experiences and educational needs of patients who have received a kidney transplant and their caregivers.Design:Qualitative descriptive study.Setting:One province in Canada (Saskatchewan)Patients:Patients who received a pediatric kidney transplant, transplant recipients and caregivers.Methods:Semi-structured interviews were conducted via video or by phone and recorded and transcribed verbatim in this qualitative descriptive study. Qualitative content analysis was used to analyze the data. Decontextualization involved an inductive approach, whereby the text was coded and organized into categories and subcategories. Dedoose® software was used to facilitate this process.Results:Twenty-three individuals participated, including 13 caregivers (aging in range from 20’s to 60’s) and 10 patients who had previously received a transplant (aging in range from adolescents to 40’s). Three categories emerged from their experiences: (1) the impact of the transplant on the individual (subcategories social, mental health, physical, lifestyle, returning to normal and new life perspective); (2) transplant expectations (transplant as a cure, unexpected experiences); and (3) the need for support throughout the transplant process (practical support, mental health support, healthcare support, support through shared-lived experiences, and challenges related to finding a community). Regarding education, participants identified the need for personalized, age-appropriate education delivered in digestible formats, with clear expectations, timely reinforcement, and emotional support tailored to both patients and caregivers.Limitations:Participants were recruited from a single small center in Canada. Patient participants had received their transplant at least 5 years prior to participation in the study and were reflecting on their past experiences.Conclusion:Feeling prepared for the transplant journey impacts the transplant experience and kidney transplant education can facilitate care and clarify expectations. The insights gathered from the study will help inform the development of educational resources for patients and caregivers.

Thorne, Jordan; Silver, Samuel A.; Blum, Daniel; Cote, Gabrielle; Ethier, Isabelle; Flood, Kayla; Harris, Claire; Hingwala, Jay; Mysore, Priyanka; Trinh, Emilie; More, Keigan

doi: 10.1177/20543581251391889pmid: 41466722

Purpose of program:In 2021, the Canadian Society of Nephrology (CSN) sent a needs assessment survey to nephrology residents, fellows, and program directors that identified a significant gap in Quality Improvement (QI) training. In response, the CSN’s Quality Improvement and Implementation Science (CSN-QUIS) committee launched a national nephrology fellow QI curriculum in 2022.Methods:The program integrates online learning with interactive virtual didactic sessions, including participation in a longitudinal QI project that is presented at the CSN Annual General Meeting (CSN AGM).Key findings:Since inception, the program has expanded to 13 nephrology training programs, including both adult and pediatric sites. Forty-one fellows have completed the full curriculum, with 76 trainees having completed at least one year and presented work at the CSN AGM. Feedback from participants has been overwhelmingly positive, particularly regarding the interactive format, real-world applicability, and national networking opportunities. Continuous fine-tuning of the curriculum itself has occurred in parallel with refinements made to session content, project scheduling, and presentation format based on learner input.Limitations:Barriers such as limited local QI mentorship have been mitigated through virtual faculty pairing, and resources such as software access and publication support have been provided to encourage project success.Implications:Herein, we report the development and initial experience of this national initiative, demonstrating that a structured, collaborative, and distributed QI curriculum is feasible, effective, and scalable across Canada.