Integrating risk-based care for patients with chronic kidney disease in the community
With only four easily accessible pieces of information, the Kidney Failure Risk Equation (KFRE) can calculate the likelihood that a person’s kidneys will fail in the next two to five years, and predict whether dialysis or transplantation will be required. The KFRE is used by kidney doctors worldwide, helping to ensure that patients with kidney disease receive the most appropriate care, based on an individualized level of risk. The KFRE can also assist physicians in having patient-centered discussions, in turn reducing the anxiety and fear that many people feel when diagnosed with kidney disease.
Since most people with kidney disease can be managed by their family doctor, we are currently conducting trials to test whether providing patients (and their physicians) with information about the risk of kidney failure based on the KFRE can improve quality of care, health literacy, and trust in the care that they are receiving.
Together with our partners from Manitoba Primary Care Research Network (MaPCRe) and Southern Alberta Primary Care Research Network (SAPCReN), we are operating a Randomized Controlled Trial in primary care clinics in multiple provinces.
Restructuring kidney care to meet the needs of 21st Century patients
The Can-SOLVE Triple I (Information, Interaction, Individualization) study is a multiphase, patient-oriented study in which researchers are working with health care providers and with individuals receiving in-Centre hemodialysis (HD). Through this study, we aim to develop innovative strategies that can improve patient experience and quality of care when receiving in-Centre HD. The three specific areas of our study are:
- Better information
- Improvement of health care provider and patient interaction
- More individualized care.
Currently, in Wave 2 of the study, we are developing two solutions, including a “hubs of care” intervention and a “web-app” intervention.
Kidney Check™
Kidney Check™ is a screening, triage, and treatment program in Indigenous communities spanning five provinces in Canada. Using portable lab testing equipment, screening teams travel to communities and test for chronic kidney disease and its risk factors, including diabetes and high blood pressure. This information is then used to determine an individual’s risk of chronic kidney disease, and deliver a treatment plan that is tailored to that risk. Treatment plans may include counselling, treatment recommendations, an appointment with a doctor, or direct referral to a kidney specialist.
Kidney Check™ helps to provide evidence to support the development of permanent chronic kidney disease screening programs in all Indigenous communities across Canada, in turn helping to decrease the burden of chronic kidney disease and kidney failure in these communities. With correct treatment and continued follow-up, the number of Indigenous people with chronic kidney disease will decline and fewer patients will progress to kidney failure that requires dialysis. This type of care model may be applicable to other high-risk chronic diseases in the future, such as HIV and mental health disorders.
Virtual Ward Incorporating Electronic Wearables (VIEWER)™
Chronic kidney disease patients are at high risk of dialysis initiation in the near future in addition to having an increased risk of adverse health events, such as weight loss, muscle weakness, fatigue, and memory loss. They are also more likely to visit the emergency department than other individuals.
The VIEWER™ study is being conducted to trial the feasibility of electronic wearable devices and tablet-based software to collect and observe health data from patients with advanced chronic kidney disease. The goal of this study is to use the data collected from these patients to develop a system that allows clinicians to predict when these adverse events are going to occur, and to intervene before they progress any further. Patients are instructed to use these devices once per day, and their vitals are transferred into a shared database for health care professionals to monitor remotely.
Exercise rehabilitation and symptoms in hemodialysis
People with kidney failure who start hemodialysis experience multiple difficult-to-treat symptoms such as fatigue, pain, and difficulty sleeping. This affects their ability to perform everyday activities and enjoy life, and likely increases the risks of hospitalization and death.
Researchers at CDIC are studying whether an exercise rehabilitation program administered to individuals on hemodialysis improves symptom burden (by decreasing the number and severity of symptoms) and their quality of life over one year. We will enroll a total of 200 volunteers who are receiving hemodialysis in three Canadian centres. Half of the participants will be randomized to receive usual care, which includes exercise counseling. The other half will be randomized to receive usual care plus a 26 week exercise rehabilitation program. We will then compare symptom burden and quality of life between groups over time.
The improvement of symptoms and quality of life in individuals on dialysis has been identified as a research priority in Canada. We hope to address this knowledge gap by showing that exercise rehabilitation improves symptom burden and quality of life in people receiving hemodialysis as compared to usual care.
In addition, the secondary goal of this study is to assess the effects of exercise on hospitalization, frailty, and heart function. The effects of exercise on these outcomes in people on hemodialysis are currently unknown. This information will help us plan and design a future study looking at the effects of exercise on longer term outcomes in hemodialysis. Improvements in such outcomes are important for individual health and could also reduce burden and costs to the healthcare system.
The Canadian Frailty Observation and Interventions Trials (CanFIT)
Frailty is highly prevalent in people with chronic kidney disease and is associated with comorbid conditions in cross-sectional studies. Longitudinal studies investigating the progression of frailty in those with advanced non-dialysis chronic kidney disease are lacking.
In progress since 2012, our CanFIT study is a longitudinal observational study following more than 600 people across three study sites in Winnipeg, and one in Regina. CanFIT aims to determine the natural history, prevalence of perceived and measured frailty, and its association with dialysis treatment choices and adverse outcomes in patients with advanced chronic kidney disease. It is the largest and longest-running study investigating frailty in people with advanced (pre-dialysis) chronic kidney disease.
Resistant Starch Prebiotic Effects in Chronic Kidney Disease (ReSPECKD) Study
In patients with chronic kidney disease, there is a buildup of toxins in the body originating from the bacteria in the gut, which can cause negative symptoms and lead to early dialysis initiation. The goal of the ReSPECKD study is to investigate whether the consumption of resistant starch from potatoes can reduce toxins and symptoms by altering the bacteria in the gut, therefore potentially helping people who have chronic kidney disease by reducing their symptoms and delaying the onset of dialysis.