News and Events

Technique Survival and Determinants of Technique Failure in In-Center Nocturnal Hemodialysis: A Retrospective Observational Study

Canadian Journal of Kidney Health andDisease

Published: December 7, 2020
DOI: https://doi.org/10.1177/2054358120975305

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.

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Performance of StatSensor Point-of-Care Device for Measuring Creatinine in Patients With Chronic Kidney Disease and Postkidney Transplantation

Canadian Journal of Kidney Health and Disease

Published: November 12, 2020
DOI: https://doi.org/10.1177/2054358120970716

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.

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Pretransplant Calculated Panel Reactive Antibody in the Absence of Donor-Specific Antibody and Kidney Allograft Survival

Clinical Journal of the American Society of Nephrology

Published: January 2021
DOI: https://doi.org/10.2215/CJN.13640820

James H. Lan, Matthew Kadatz, Doris T. Chang, Jagbir Gill, Howard M. Gebel and John S. Gill

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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A Framework to Ensure Patient Partners Have Equal and Contributing Voices Throughout the Research Program Evaluation Process

Canadian Journal of Kidney Health and Disease

Published: November 26, 2020
DOI: https://doi.org/10.1177/2054358120970093

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).

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Management of Patients With Glomerulonephritis During the COVID-19 Pandemic: Recommendations From the Canadian Society of Nephrology COVID-19 Rapid Response Team

Canadian Journal of Kidney Health and Disease

Published: November 26, 2020
DOI: https://doi.org/10.1177/2054358120968955

Sarah M. Moran, Sean Barbour, Christine Dipchand, Jocelyn S. Garland, Michelle Hladunewich, Arenn Jauhal, Joanne E. Kappel, Adeera Levin, Sanjay Pandeya, Heather N. reich, Susan Thanabalasingam, Dorothy Thomas, Jefrrey C. Ma, Chrisitne White.

Kidney programs across Canada face challenges delivering care during the COVID-19 pandemic. Chronic kidney disease (CKD) and preexisting autoimmune diseases may increase the risk of COVID-19-related complications. In addition, physical distancing has impacted the ways in which health care providers deliver care.

To date, international and national nephrology societies have provided few, if any, recommendations for nondialysis care in the setting of the COVID-19 pandemic. In response to this, the Canadian Society of Nephrology/Societe canadienne de nephrology (CSN/SCN) has created recommendations in an effort to provide optimal care to patients with glomerulonephritis (GN) while we ensure the safety of the health care team.

This document provides suggestions on how to provide the best possible care for patients living with GN during the COVID-19 pandemic. Patients with GN have health care needs that differ from those of patients with other forms of kidney disease, including CKD, end-stage kidney disease including transplantation. The care of other patients with kidney disease, including those with less advanced forms of CKD, is outside the scope of this document.

The recommendations outlined in this guidance document represent best practices based on information available at the time of writing on April 24, 2020.

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Availability, Accessibility, and Quality of Conservative Kidney Management Worldwide

CJASN
Clinical Journal of the American Society of Nephrology

Published: January 2021
DOI: https://doi.org/10.2215/CJN.09070620

Meaghan Lunney, Aminu K. Bello, Adeera Levin, Helen Tam-Tham, Chandra Thomas, Mohamed A. Osman, Feng Ye, et al.

People with kidney failure typically receive KRT in the form of dialysis or transplantation. However, studies have suggested that not all patients with kidney failure are best suited for KRT. Additionally, KRT is costly and not always accessible in resource-restricted settings. Conservative kidney management is an alternate kidney failure therapy that focuses on symptom management, psychologic health, spiritual care, and family and social support. Despite the importance of conservative kidney management in kidney failure care, several barriers exist that affect its uptake and quality.

Respondents from 160 countries completed the survey, and 154 answered questions pertaining to conservative kidney management. Of these, 124 (81%) stated that conservative kidney management was available. Accessibility was low worldwide, particularly in low-income countries. Less than half of countries utilized multidisciplinary teams (46%); utilized shared decision making (32%); or provided psychologic, cultural, or spiritual support (36%). One-quarter provided relevant health care providers with training on conservative kidney management delivery.

Overall, conservative kidney management is available in most countries; however, it is not optimally accessible or of the highest quality.

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Anticoagulation for Patients with Atrial Fibrillation and End Stage Renal Disease on Dialysis: A National Survey

Canadian Journal of Cardiology

Published: December 10, 2020
DOI: https://doi.org/10.1016/j.cjca.2020.12.005

Laura F. Halperin, MD; May K. Lee, MSc; Janet Liew, BSc; Sandra Lauck, PhD; Darren Kong, Andrew D. Krahn, MD; Marc W. Deyell, MD MSc; Jason G. Andrade, MD; Nathaniel M. Hawkins, MD; Santabhanu Chakrabarti, MD; Ah Fan John Yeung- Lai-Wah, MD; Matthew T. Bennett, MD; Christopher Cheung, MD; Adeera Levin, MD; Daniel I. Schwartz, MD; Zachary W. Laksman, MD.

End stage renal disease patients on dialysis have increased risk of embolic stroke and bleeding. Stroke prevention studies with anticoagulation for atrial fibrillation (AF) patients have excluded patients on dialysis, and there remains no consensus on their management. We developed a survey to explore practices surrounding AF patients on dialysis. Our survey demonstrated heterogeneity of anticoagulation use these patients.
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Dr Jag Gill awarded Kidney Foundation Organ Donation and Transplantation award

From the Kidney Foundation of Canada–

Dr. Jag Gill’s passion is focused in kidney transplantation and his research interests are in transplant epidemiology and database analyses, examining access to transplantation, expansion of organ donation, and the impact of donor status on post-transplant health outcomes. Dr. Gill started his journey as a graduate from Medicine at the University of BC in 2001 and completed his post-graduate training in Internal Medicine and Nephrology at UBC in 2006. From there, Dr. Gill completed a post-doctoral fellowship in kidney transplantation at the University of California, Los Angeles as part of the Kidney Foundation’s KRESCENT program. To top it off, he went on to obtain a Masters degree in Public Health from Harvard University.

We are fortunate Dr. Gill returned to Vancouver in 2008 and where he has been on staff at St. Paul’s Hospital ever since. His current role is Medical Director of the Kidney Transplant program at St. Paul’s hospitalalong with his role as Associate Professor at UBC Division of Nephrology.

Dr. Jag Gill has collaborated with the BC & Yukon Branch over the years. Whenever the opportunity arose to raise awareness on organ donation and kidney disease, Dr. Gill stepped up, acting as media spokesperson on behalf of Kidney Foundation on local TV stations and particularly on South Asian radio stations, agreeing to be featured in an article in the prominent South Asian Magazine, Drishti Magazine. Most recently, Dr. Gill co-hosted the inaugural Starry Nights Gala helping to bring together community leaders to collectively raise funds and to start important discussions on organ donation.

We are proud to call Dr. Jag Gill one of BC’s own. Congratulations Dr. Jag on being the very worthy recipient of the Kidney Foundation’s Organ Donation & Transplantation Award.

 

The Kidney Foundation of Canada Organ Donation & Transplantation Award is presented to an individual, group or organization that merits special recognition for outstanding contribution to organ donation or transplantation.

 

UBC Department of Medicine offers new Data Science & Health continuing professional development

 

 

The UBC Department of Medicine  invites you to join us at the inaugural Data Science & Health 2020 Continuing Professional Development course. This event is MOC1/Mainpro+ accredited and will be the first of a series of annual conferences on this topic. We are excited to launch this new forum, designed to address the needs of health care providers to help improve their understanding of current data science concepts in health care research, and how to optimally integrate data science and digital health into the delivery of care. Visit bit.ly/DataScienceHealth for more information or to register.

Program structure:

    • 1-year access to online presentations beginning late October 2020 from leading UBCdata scientists and health researchers for self-paced learning on Canvas.
    • A companion virtual event featuring live keynotes and interactive panel discussions,with a focus on audience engagement. The event will take place on November 03, 202012:00 pm – 3:00 pm via Zoom.
    • Access to workshop series in collaboration with the Faulty of Applied Sciences to helpkeep the momentum going. Partner with engineers to apply what you’ve learned and move your data science project forward.

International consensus definitions of clinical trial outcomes for kidney failure: 2020

Kidney International

Published: October 1, 2020
DOI: https://doi.org/10.1016/j.kint.2020.07.013

Adeera Levin, Rajiv Agarwal, William G. Herrington, Hiddo L. Heerspink, Johannes F.E. Mann, Shahnaz Shahinfar, Katherine R. Tuttle, Jo-Ann Donner, Vivekanand Jha, Masaomi Nangaku, Dick de Zeeuw, Meg J. Jardine, Kenneth W. Mahaffey, Aliza M. Thompson, Mary Beaucage, Kate Chong, Glenda V. Roberts, Duane Sunwold, Hans Vorster, Madeleine Warren, Sandrine Damster, Charu Malik, Vlado Perkovic

Kidney failure is an important outcome for patients, clinicians, researchers, healthcare systems, payers, and regulators. However, no harmonized international consensus definitions of kidney failure and key surrogates of progression to kidney failure exist specifically for clinical trials. The International Society of Nephrology convened an international multi-stakeholder meeting to develop consensus on this topic. A core group, experienced in design, conduct, and outcome adjudication of clinical trials, developed a database of 64 randomized trials and the 163 included definitions relevant to kidney failure. Using an iterative process, a set of proposed consensus definitions were developed and subsequently vetted by the larger multi-stakeholder group of 83 participants representing 18 different countries. The consensus of the meeting participants was that clinical trial kidney failure outcomes should be comprised of a composite that includes receipt of a kidney transplant, initiation of maintenance dialysis, and death from kidney failure; it may also include outcomes based solely on laboratory measurements of glomerular filtration rate: a sustained low glomerular filtration rate and a sustained percent decline in glomerular filtration rate. Discussion included important considerations, such as (i) recognition of existing nomenclature for kidney failure; (ii) applicability across resource settings; (iii) ease of understanding for all stakeholders; and (iv) avoidance of inappropriate complexity so that the definitions can be used across ranges of populations and trial methodologies. The final definitions reflect the consensus for use in clinical trials.

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