David Collister

Canadian researchers should be aware the there is a motion before the Parliamentary Standing Committee on Science and Research to force Tricouncils to hand over disaggregated peer review data on all applications:
Applicant names, profiles, demographics
Reviewers names, profiles, comments, and scores

All we have here in Canada is low dose Testing prednisone then MMF 😔 once the proteinuria rebounds

Putting these patients in ASI trials locally too

Do you use steroidal MRAs if you don’t have access to a finerenone or aldosterone synthase inhibitor trial?

Dr. Moorthy reviewing the WHO global action plan for clinical trial ecosystem strengthening at the 4th Annual ACT meeting in Cape Breton, NS. We are making progress in Canada but lots of work to do!
@cvcualberta.bsky.social @csnscn.bsky.social @ualberta.bsky.social

The percentage in the placebo arm reflects that potassium fluctuations in HD are common related to missed dialysis, diet and other factors. Other takeaway is that hyperkalemia is manageable and typically harm patients.

I think we are all excited to see how to anti-inflammatory hypothesis pans out over the next couple of years as well

And stayed tuned for some secondary papers in addition to the ones already published on run-in adherence assessment (study within a trial) and heart failure event definitions in dialysis RCTs (meta-epidemiological)

Late to the party but important takeaways: large publically funded international trials are feasible in dialysis, run-ins are great, low dose spironolactone is safe and consider it’s use in HFrEF in dialysis or PD for low K+ or for volume, we don’t believe the sex subgroup analysis #NephJC

Some really interesting stories in this one!

We need a Canadian registry!

Local approach in the couple of places I’ve practiced in Canada is to intensify with daily HD because of the morbidity and mortality of calciphylaxis. Does this mean you would keep on PD if adequate MBD parameters? Could this be a domain in BEAT-Calci? I doubt given lack of equipoise.

When I order eGFR cys it’s because I think eGFR Cr is falsely high or low and I have a clinical reason for this which I already know affects prognosis (e.g. cirrhosis, malignancy, neuromuscular disease, athlete). How was this accounted for?

Would you accept 0.3mg po every other day over prednisone for “idiopathic” pericarditis?

What’s your treatment for idiopathic pericarditis in PD?
NSAIDs will cause loss of RRF and risk of UGIB. Colchicine at even low doses=diarrhea (and myopathy/cytopenias). Prednisone or try colchicine 0.3-0.6mg po daily to see if tolerated? Defer to cardiology? @askrenal.bsky.social #askrenal

Great paper! Would like to see this work also done in Alberta where I suspect MRP, remuneration model, work up and evaluation process, access to weight loss programs and navigators all play a role.

Figure 5 demonstrates the average number of steps completed toward receiving a kidney transplant which varied from 11.7 (95% CI: 9.3, 14.8) to 44.0 (95% CI: 38.6, 50.1) steps per 100 patient-years across RRPs.

In patients receiving #maintenancedialysis, there is substantial variability across the 4 steps required to receive a #kidneytransplant with the rate of referral varying almost 8-fold across Ontario’s Regional Renal Programs
@lhsccanada.bsky.social @csnscn.bsky.social

doi.org/10.1177/2054...

Figure 1. ACHIEVE study flowchart.

Design of the international #ACHIEVE trial comparing spironolactone to placebo in over 2500 people receiving #dialysis for #kidneyfailure.
@csnscn.bsky.social @cjkhd.bsky.social

doi.org/10.1177/2054...

The differential effects of sex hormone therapy on kidney function: insights into biological sex differences - PubMed There are known sex (i.e., biological) and gender (i.e., social) differences in the epidemiology and outcomes of chronic kidney disease. In this issue of the JCI, van Eeghen et al. provide a prospecti...

It was a pleasure to work with Dr. Adeera Levin on this JCI editorial re: the impact of gender affirming hormone therapy on blood/urine biomarkers and renal plasma flow/iohexol plasma GFR. Provides new insights to sex based differences in kidney function.

pubmed.ncbi.nlm.nih.gov/40309772/

Searching for Fire Amid the Smoke: Will Cannabinoids Prove Useful and Safe for Those With CKD? - PubMed Searching for Fire Amid the Smoke: Will Cannabinoids Prove Useful and Safe for Those With CKD?

Really enjoyed writing this editorial on the PK of Sativex in healthy controls and CKD from Denmark with Brendan Smyth from Sydney:

pubmed.ncbi.nlm.nih.gov/40303213/

Stay tuned for our PK study of oral THC/CBD (MPL-001) in CKD/dialysis @lastwalsh.bsky.social @csnscn.bsky.social @cntn

So weird

I used this to find my current position. Definitely worth checking out, we have some fantastic institutions in Canada.

I think the only place that does bone biopsy in Canada is in Quebec! Wish we had it availability locally.

What’s the eGFR? 31 is probably different than 59 for the risk of adverse events. I don’t think I would have any concerns re: bisphosphonate but would monitor PTH more closely than usual and if it drops or there is an AE consider an alternative.

Agree with getting what you can on board ASAP

Congrats @kidneydoc101.bsky.social

Here are our thoughts!

www.kireports.org/article/S246...

Sus

Usually will start with LMWH then transition to 5mg po bid or 2.5mg po bid depending on weight/age with F/U anticoagulation clinic. I have never specifically loaded in dialysis.

Does it matter assuming they were already in ICU and could easily get norepinephrine? 🤫

Risk of potential cyst growth can cardiorenal benefits based on degree of albuminuria. It’s a tough one eh?