The Kidney Failure Risk Equation Study by researcher Dr. Navdeep Tangri and his colleagues at CDIC has led to the development of a simple and reliable tool that is used with patients who have kidney disease to accurately predict which patients are at risk of kidney failure.
Integrating risk-based care for patients with Chronic Kidney Disease in the community
Using just 4 easily accessible pieces of information, the Kidney Failure Risk Equation calculates the likelihood that a person’s kidneys will fail in the next 2 to 5 years, requiring dialysis or transplantation. The KFRE is used by kidney doctors worldwide, and helps ensure that people with kidney disease receive the most appropriate care, based on individualized level of risk. The KFRE also can assist physicians have patient-centered discussions, in turn reducing anxiety and fear many people feel when being diagnosed with kidney disease.
Since most people with kidney disease can be managed by their family doctor, with our partners from MaPCReN and SAPCReN, we are currently conducting a Randomized Controlled Trial in primary care clinics in Alberta & Manitoba, testing whether providing patients (& their physicians) information about the risk of kidney failure based on the KFRE improves quality of care, health literacy, & trust in the care that they are receiving.
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 individuals receiving in-centre hemodialysis (HD), and with healthcare providers, to develop innovative strategies to improve patient experience and quality of care in in-centre HD in three specific areas: better information, improve healthcare provider/patient interaction, and 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 is a screening, triage and treatment program in Indigenous communities across five provinces in Canada. Using portable lab testing equipment, screening teams travel to communities and test for CKD and its risk factors, including diabetes and high blood pressure. This information will be used to determine an individual’s risk of CKD, and each person will receive a treatment plan that is tailored to their risk. This may include counseling, treatment recommendations, an appointment with a doctor, or direct referral to a kidney specialist. This study will help to provide evidence to support the development of permanent CKD screening programs in all Indigenous communities across Canada, in turn helping decrease the burden of CKD and kidney failure in these communities. With correct treatment and continued follow-up, the number of Indigenous people with CKD will decline and fewer patients will progress to kidney failure requiring dialysis. This type of care model may be applicable to other high risk chronic disease in the future such as HIV and mental health.
Virtual Ward Incorporating Electronic Wearables (VIEWER)
Chronic Kidney Disease (CKD) patients are at high risk of dialysis initiation in the near future and have 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 CKD 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 use these devices once per day, and their vitals are transferred into a shared database for health care professionals to remotely monitor.
Exercise rehabilitation and symptoms in hemodialysis
People with kidney failure who start hemodialysis have multiple symptoms such as fatigue, pain and difficulty sleeping, which are difficult to treat. This affects their ability to perform everyday activities, enjoy life, and likely increases risks of hospitalization and dying. We are studying whether an exercise rehabilitation program administered to individuals on hemodialysis improves symptom burden (the number and severity of symptoms) and quality of life over 1 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 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, a 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 effect 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 health care system.
The Canadian Frailty Observation and Interventions Trials (CanFIT)
Frailty is highly prevalent in people with chronic kidney disease (CKD) and is associated with comorbid conditions in cross-sectional studies. Longitudinal studies investigating the progression of frailty in those with advanced non-dialysis CKD are lacking. In progress since 2012, our CanFIT study is a longitudinal observational study following more than 600 people across 3 study sites in Winnipeg, and 1 in Regina, aiming 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 CKD. It is the largest and longest running study investigating frailty in people with advanced (pre-dialysis) CKD.
Resistant Starch Prebiotic Effects in Chronic Kidney Disease (ReSPECKD) Study
In patients with Chronic Kidney Disease (CKD), 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 and therefore potentially helping people who have CKD by reducing their symptoms and delaying the onset of dialysis.