News and Events

Multi-intervention Management of Calciphylaxis: A Report of 7 Cases

American Journal of Kidney Disease

Corisande Baldwin, Myriam Farah, Marianna Leung, Paul Taylor, Ronald Werb, Mercedeh Kiaii, and Adeera Levin

Calcific uremic arteriolopathy (calciphylaxis) is a devastating but rare complication seen predominantly in dialysis patients that often is fatal. Because of the rarity of the disease and the multifactorial nature of its cause, no clinical trials have been conducted to date to determine the best therapy for the condition. We report a case series of 7 patients at a single institution in whom a systematic multi-interventional treatment strategy was implemented, consisting of trigger-agent cessation (calcium-based phosphate binders, alphacalcidol, and warfarin), wound management, and antibiotic therapy, supplemented by intensified hemodialysis (4 hours daily for 7 days followed by 5-6 times weekly), intravenous sodium thiosulfate (12.5-25 g intravenously 3 times a week), and attempted oxygen therapy (given through a face mask or hyperbaric chamber as tolerated by patient circumstance). Treatments selected were based on literature review, consensus discussion, and attempts to address the physiologic disturbances that underlie the condition. All 7 patients identified with biopsy-proven calcific uremic arteriolopathy were treated with this regimen in 2007-2010, with 6 of 7 showing complete recovery. We suggest that consistent implementation of a multi-interventional approach may alter the course of this devastating disease. Further studies are needed to confirm and extend these findings. Read more… (PDF)

A quality improvement project to enhance the management of hyperkalemia in hospitalized patients

British Columbia Medical Journal

Tasleem Rajan, Nadia Widmer, Haerin Kim, Natasha Dehghan, Majid Alsahafi, Adeera Levin

The reported incidence of hyperkalemia in hospitalized patients is between 1 and 10%.1-3 The majority of cases are due to medications including angiotensin converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARBs) and potassium sparing diuretics, such as spironolactone. Severe hyperkalemia is a life threatening condition that may result in muscle paralysis or fatal arrhythmias, and requires prompt measures to reduce the serum potassium. However, there is little consistency in the management of hyperkalemia among clinicians at various levels of training. Providing residents with user-friendly management guidelines for hyperkalemia increased the proportion of cases managed according to best available evidence, and significantly reduced the cost associated with treatment. Read more… (MS Word)

Systematic Review: Kidney Transplantation Compared With Dialysis in Clinically Relevant Outcomes

American Journal of Transplantation

M. Tonellia, N. Wiebea, G. Knollb, A. Belloa, S. Brownec, D. Jadhavb, S. Klarenbacha and J. Gill

Individual studies indicate that kidney transplantation is associated with lower mortality and improved quality of life compared with chronic dialysis treatment. We did a systematic review to summarize the benefits of transplantation, aiming to identify characteristics associated with especially large or small relative benefit. Results were not pooled because of expected diversity inherent to observational studies. Risk of bias was assessed using the Downs and Black checklist and items related to time-to-event analysis techniques. MEDLINE and EMBASE were searched up to February 2010. Cohort studies comparing adult chronic dialysis patients with kidney transplantation recipients for clinical outcomes were selected. We identified 110 eligible studies with a total of 1,922,300 participants. Most studies found significantly lower mortality associated with transplantation, and the relative magnitude of the benefit seemed to increase over time (p < 0.001). Most studies also found that the risk of cardiovascular events was significantly reduced among transplant recipients. Quality of life was significantly and substantially better among transplant recipients. Despite increases in the age and comorbidity of contemporary transplant recipients, the relative benefits of transplantation seem to be increasing over time. These findings validate current attempts to increase the number of people worldwide that benefit from kidney transplantation. Read more… (PDF)

BC hosts peritoneal dialysis conference

Western Canada PD DaysWestern Canada PD Days is a showcase for innovative projects and cutting-edge approaches to the delivery of peritoneal dialysis as experienced by the four western provinces. National and international PD experts will be on hand to share their knowledge and enthusiasm for peritoneal dialysis.

The conference is being held February 23 to 25, 2012 in downtown Vancouver at the Renaissance Vancouver Harbourside Hotel. Complete conference details, including program, registration and accommodation information is available at the BC Renal Agency web site.