Journal of the American Society of Nephrology
Editorial in the JASN about strengthening the argument for prevention of CKD.
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Published: December 11, 2020
Megumi Oshima, Meg J. Jardine, Rajiv Agarwal, George Bakris, Christopher P. Cannon, David M. Charytan, Dick de Zeeuw, Robert Edwards, Tom Greene, Adeera Levin, Soo Kun Lim, Kenneth W. Mahaffey, Bruce Neal, Carol Pollock, Norman Rosenthal, David C. Wheeler, Hong Zhang, Bernard Zinman, Vlado Perkovic and Hiddo J.L. Heerspink
Canagliflozin slows the progression of chronic kidney disease in patients with type 2 diabetes and induces a reversible acute drop in estimated glomerular filtration rate (eGFR), believed to be a hemodynamic effect. Predictors of the initial drop and its association with long-term eGFR trajectories and safety outcomes are unknown. To assess this, we performed a post-hoc analysis of 4289 participants in the CREDENCE trial with type 2 diabetes and chronic kidney disease equally split into treatment and placebo groups who had eGFR measured at both baseline and week three. The eGFR was categorized at week three as greater than a 10% decline; between 0 and 10% decline; and no decline. Long-term eGFR trajectories and safety outcomes were estimated in each category of acute eGFR change by linear mixed effects models and Cox regression after adjustment for baseline characteristics and medications use. Significantly more participants in the canagliflozin (45%) compared to the placebo (21%) group experienced an acute drop in eGFR over 10%. An over 30% drop occurred infrequently (4% of participants with canagliflozin and 2% with placebo). The odds ratio for a drop in eGFR over 10% with canagliflozin compared to placebo was significant at 3.03 (95% confidence interval 2.65, 3.47). Following the initial drop in eGFR, multivariable adjusted long-term eGFR trajectories, as well as overall and kidney safety profiles, in those treated with canagliflozin were similar across eGFR decline categories. Thus, although acute drops in eGFR over 10% occurred in nearly half of all participants following initiation of canagliflozin, the clinical benefit of canagliflozin was observed regardless. Additionally, safety outcomes were similar among subgroups of acute eGFR drop.
Canadian Journal of Kidney Health and Disease
Published: February 5, 2021
The COVID-19 pandemic has widespread implications not only for clinical practice but also for academic medicine and postgraduate training. The need to promote physical distancing and flexibility within our department has generated important revisions to the core curriculum for the Adult Nephrology Training Program in Vancouver, Canada. We reviewed available educational resources and objectives to develop curricular adaptations informed by staff and trainee feedback. We describe existing changes to formal training in British Columbia (BC), which will be tailored as the pandemic evolves, and anticipate them to have lasting impact on the way we structure training programs in the future. Standardization and harmonization of modified curriculum may be possible across Canada with sharing of these learnings.
Journal of the American Society of Nephrology
Published: March, 2021
John S. Gill, Richard N. Formica and Barbara Murphy
Beginning in 2023, the Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act (H.R. 5534; also known as the Immuno bill) in the United States, will add a new Medicare option solely to cover immunosuppressive drugs for kidney transplant recipients. Patients may enroll beginning 36 months after a transplant if they have no other health insurance and are otherwise ineligible for Medicare. Enrollees will pay a monthly premium equal to 35% of standard immunosuppressive drug costs currently estimated to be $243/mo. For prevalent kidney transplant recipients who have lost or will lose Medicare benefits due to the 3-year post-transplant time limit on coverage in the Medicare ESKD program, the bill will provide access to essential drugs to prevent allograft rejection for the life of their transplant. An analysis by the Department of Health and Human Services (HHS) estimated that the Immuno bill will prevent approximately 375 allograft failures annually, and the Congressional Budget Office (CBO) projects Medicare savings of $400 million over 10 years. Legislation proposing extension of immunosuppressive drug coverage have been introduced in Congress for the past two decades, and the passage of the Immuno bill represents a huge victory for current and future transplant recipients. The entire kidney community is indebted to the primary bill sponsors Senator Bill Cassidy, MD (Republican LA); Senator Dick Durbin (Democrat IL); Rep. Michael Burgess, MD (Republican TX); and Rep. Ron Kind (Democrat WI) and the many House and Senate members for their enduring support.
UBC Nephrology is pleased to welcome two new fellows to our home dialysis program.
Dr. Nisha Rao completed her nephrology training in a number of spots in Australia, most recently the Bendigo Health Centre in the State of Victoria. Dr. Rao started at VGH on March 1st and will be at VGH for Block 10 as well.
Dr. Raphael Harrisson completed his nephrology training at the University of Laval in Quebec City, completing his fellowship on June 30, 2020. Dr. Harrisson started at SPH on March 1st and will be at SPH for Block 10 also.
World Kidney Day 2021 is all about “Living Well with Kidney Disease.” The objective is to increase education and awareness about effective symptom management and patient empowerment, with the ultimate goal of encouraging meaningful participation in every-day life. Whilst effective measures to prevent kidney disease and its progression are important, patients with kidney disease – including those who depend on dialysis and transplantation – and their care-partners should also feel supported, especially during pandemics and other challenging periods, by the concerted efforts of kidney care communities.
WKD calls for the inclusion of life participation as a key focus in the care of patients with CKD and as a building block towards delivering the ultimate goal of
living well with kidney disease.
To learn more, visit the World Kidney Day website>>
Published: December 7, 2020
Michael E. Schachter, Marc J. Saunders, Ayub Akbari, Julia M. Caryk, Ann Bugeja, Edward G. Clark, Karthik K. Tennankore, Dan J. Martinusen
Long-duration (7-8 hours) hemodialysis provides benefits compared with conventional thrice-weekly, 4-hour sessions. Nurse-administered, in-center nocturnal hemodialysis (INHD) may expand the population to whom an intensive dialysis schedule can be offered.
INHD is a sustainable modality, even among older patients. Higher frailty associates with INHD technique failure and greater missed treatments. Inclusion of a CFS threshold of ≤4 into INHD inclusion criteria may help to identify individuals most likely to realize the long-term benefits of INHD.
Published: November 12, 2020
Melissa Nataatmadja, Angela W. S. Fung, Beryl Jacobson, Jack Ferera, Eva Bernstein, Paul Komenda, Andre Mattman, David Seccombe, Adeera Levin
The StatSensor is a point-of-care device which measures creatinine in capillary whole blood. Previous studies reported an underestimation of the creatinine measurements at high creatinine concentrations and were performed in the prestandardization era for creatinine. The results of our study suggest that the limiting characteristics of the StatSensor device are not only bias, but also imprecision. The level of imprecision observed may influence clinical decision-making and limit the usefulness of StatSensor as a CKD screening tool. If choosing to utilize it for either screening for or monitoring CKD, it is essential that clinicians understand the limitations of point-of-care devices and apply this knowledge to test interpretation.
Published: January 2021
Panel reactive antibody informs the likelihood of finding an HLA-compatible donor for transplant candidates, but has historically been associated with acute rejection and allograft survival because testing methods could not exclude the presence of concomitant donor-specific antibodies. Despite new methods to exclude donor-specific antibodies, panel reactive antibody continues to be used to determine the choice of induction and maintenance immunosuppression. The study objective was to determine the clinical relevance of panel reactive antibody in the absence of donor-specific antibodies.
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Published: November 26, 2020
David R. Hillier, Mila Tang, William Clark, Cynthia MacDonald, Carol Connolly, Chantal Large, Malcom King, Joel Singer, Adeera Levin, Braden Manns, Ana Konvalinka, James Scholey, Norman D. Rosenblum on Behalf of the Can-SOLVE CKD Network.
Traditionally, peer review was a closed process conducted only by individuals working in the research field. To establish a more integrated and patient-centered approach, one of Canada’s largest kidney research networks (Can-SOLVE CKD) has created a Research Operations Committee (ROC) that includes patients as key members. The ROC represents one way for achieving meaningful patient-oriented research (POR).