Global Dialysis Perspective: Canada

Blake, Peter G.

doi:10.34067/kid.0000462019

Cited by 18 publications

(21 citation statements)

References 14 publications

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“…In Ontario alone, there are about 13,330 chronic dialysis patients [16]. In Canada, MHD is provided by not-for-profit Renal Programs in large academic in-centre hemodialysis associated with medical schools and community hospitals [17]. Ontario has 27 Renal Programs treating MHD patients and delivers HD at approximately 100 sites [16].…”

Section: A Covid-19 and Hemodialysis Patients And Dialysis Unitsmentioning

confidence: 99%

Modelling COVID -19 transmission in a hemodialysis centre using simulation generated contacts matrices

Tofighi

Asgary

Merchant

et al. 2021

Preprint

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The COVID-19 pandemic has been particularly threatening to the patients with end-stage kidney disease (ESKD) on intermittent hemodialysis and their care providers. Hemodialysis patients who receive life-sustaining medical therapy in healthcare settings, face unique challenges as they need to be at a dialysis unit three or more times a week, where they are confined to specific settings and tended to by dialysis nurses and staff with physical interaction and in close proximity. Despite the importance and critical situation of the dialysis units, modelling studies of the SARS-CoV-2 spread in these settings are very limited. In this paper, we have used a combination of discrete event and agent-based simulation models, to study the operations of a typical large dialysis unit and generate contact matrices to examine outbreak scenarios. We present the details of the contact matrix generation process and demonstrate how the simulation calculates a micro-scale contact matrix comprising the number and duration of contacts at a micro-scale time step. We have used the contacts matrix in an agent-based model to predict disease transmission under different scenarios. The results show that micro-simulation can be used to estimate contact matrices, which can be used effectively for disease modelling in dialysis and similar settings.

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Section: A Covid-19 and Hemodialysis Patients And Dialysis Unitsmentioning

confidence: 99%

Modelling COVID -19 transmission in a hemodialysis centre using simulation generated contacts matrices

Tofighi

Asgary

Merchant

et al. 2021

Preprint

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“…Canada —According to the Canadian Organ replacement Register, about 70% patients receive in‐center HD, 20% are on PD and 4%‐5% on home HD 59 . Like the United States, hemodialysis schedule in Canada is typically 3‐4 hours long, thrice a week and mainly driven by Kt/V urea .…”

Section: Measuring and Reporting Of Dialysis Adequacy Indicators Acromentioning

confidence: 99%

“…With high blood flow rates (~400 mL/min), Kt/V urea is achieved in shorter (<4 hours) time and ultrafiltration rates are not usually controlled 56 . PD covers a larger proportion (20%) of patients in Canada as compared to the United States (7%) with automated PD being the predominant modality 59 . More frequent and nocturnal therapies are more commonly practiced than in the United States, mostly for better fluid control 47 .…”

Section: Measuring and Reporting Of Dialysis Adequacy Indicators Acromentioning

confidence: 99%

“…Canada-According to the Canadian Organ replacement Register, about 70% patients receive in-center HD, 20% are on PD and 4%-5% on home HD. 59 Like the United States, hemodialysis schedule in Canada is typically 3-4 hours long, thrice a week and mainly driven by Kt/V urea . With high blood flow rates (~400 mL/min), Kt/V urea is achieved in shorter (<4 hours) time and ultrafiltration rates are not usually controlled.…”

Section: North Americamentioning

confidence: 99%

“…United States, although the bundling reimbursement system has caused an uptick in recent years. Nevertheless, the centers routinely assess dialysis adequacy and report the mean weekly Kt/V urea at ≥2.Canada-According to the Canadian Organ replacement Register, about 70% patients receive in-center HD, 20% are on PD and 4%-5% on home HD 59. Like the United States, hemodialysis schedule in…”

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confidence: 99%

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Achieving dialysis adequacy: A global perspective

Bharati

Jha

2020

Seminars in Dialysis

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Attempts to quantify the performance of dialysis therapy had started even before maintenance dialysis became widely available. Initial efforts in 1950s were centered around measuring the ability of a dialyzer to remove the solute mass, leading to coinage of the terms "clearance" and "dialysance". 1 The concept of adequacy, or the understanding that patient outcome was linked to performance of dialyzer, gathered pace in the 1970s on the basis of work by Babb and Scribner (square-meter hour hypothesis), Kopp (liter-kilogram concept) and Kjellstrand (time/ kg or liter). 1 It is interesting to note that all of these early models include time on dialysis as an important component, with the understanding that removal of "middle molecules" had important bearing on outcomes. The relative importance of, and interaction between, diffusion and ultrafiltration was also starting to be understood in the 1970s. The decades of 1980s and 1990s were heavily influenced by work of Gotch and Sargent who used mathematical modeling of urea kinetics on data from the National Cooperative Dialysis Study (NCDS) and that popularized the concept Kt/V urea (originally articulated by Babb-Scribner) of an adequate normalized dialysis dose (ie, dialyzer clearance of urea (K) and treatment time (t) with respect to its distribution volume (V)). 2 Daugirdas and Tattersall created simple equations that lent themselves to automatic calculation. In parallel, Lowrie came up with an alternate metric-urea reduction ratio (URR), but all of these continued to highlight the primacy of small solute clearance. The term "dialysis adequacy" was mostly used to denote "an appropriate dialysis dose" reflecting urea clearance. 3,4 The inadequacy of this measure was recognized relatively early, in particular from the work of Teschan and colleagues that led to the currently accepted standard dialysis frequency-thrice a week. They also

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Comparison of catheters or new arteriovenous fistulas for commencement of haemodialysis in pregnant women with chronic kidney disease: an international observational study

et al. 2022

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Background Evidence surrounding vascular access options for commencing dialysis in pregnancy complicated by chronic kidney disease (CKD) is limited. Creation of new arteriovenous fistulas (AVFs) in pregnant women is rare. Methods Retrospective cohort study of approaches to vascular access in pregnancy in centres in Australia, the United Kingdom (UK) and Canada (2002–2018). Results Twenty-three women with advanced CKD commenced dialysis in pregnancy (n = 20) or planned to commence (n = 3). Access at dialysis start was a tunnelled catheter (n = 13), temporary catheter (n = 1), AVF created pre-conception but used in pregnancy (n = 3) and AVF created during pregnancy (n = 3). No women commencing dialysis with an AVF required a catheter. No differences in perinatal outcomes were observed comparing AVFs and catheters at dialysis commencement. No AVFs were created in pregnancy in Canadian women. From Australia and the UK, 10 women had a new AVF created in pregnancy, at median gestation 14.5 weeks (IQR 12.5, 20.75). Four women still needed a catheter for dialysis initiation and 3 eventually used the new AVF. Six AVFs were successfully used in pregnancy at median gestation 24 weeks (IQR 22.5, 28.5), 2 were successfully created but not used and 2 had primary failure. No catheter-associated complications were identified except one episode of catheter-related sepsis. Conclusions Catheter-related complications were minimal. In selected women, with sufficient pre-planning, an AVF can be created and successfully used during pregnancy to minimise catheter use if preferred. Pre-conception counselling in advanced CKD should include discussing vascular access options reflecting local expertise and patient preferences. Graphic abstract

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Global Dialysis Perspective: Canada

Cited by 18 publications

References 14 publications

Modelling COVID -19 transmission in a hemodialysis centre using simulation generated contacts matrices

Modelling COVID -19 transmission in a hemodialysis centre using simulation generated contacts matrices

Achieving dialysis adequacy: A global perspective

Comparison of catheters or new arteriovenous fistulas for commencement of haemodialysis in pregnant women with chronic kidney disease: an international observational study

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