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Article ; Online: In patients with CKD having CT with contrast media, no prehydration and prehydration did not differ for AKI.

Pannu, Neesh

2020 Volume 173, Issue 2, Page(s) JC8

Abstract: Source citation: Timal RJ, Kooiman J, Sijpkens YWJ, et al. ...

Abstract	Source citation: Timal RJ, Kooiman J, Sijpkens YWJ, et al.
MeSH term(s)	Acute Kidney Injury ; Adult ; Contrast Media/adverse effects ; Humans ; Renal Insufficiency, Chronic/complications ; Sodium Bicarbonate ; Tomography, X-Ray Computed
Chemical Substances	Contrast Media ; Sodium Bicarbonate (8MDF5V39QO)
Language	English
Publishing date	2020-07-20
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	336-0
ISSN	1539-3704 ; 0003-4819
ISSN (online)	1539-3704
ISSN	0003-4819
DOI	10.7326/ACPJ202007210-009
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Article ; Online: Opportunities in digital health and electronic health records for acute kidney injury care.

Selby, Nicholas M / Pannu, Neesh

Current opinion in critical care

2022 Volume 28, Issue 6, Page(s) 605–612

Abstract: Purpose of review: The field of digital health is evolving rapidly with applications relevant to the prediction, detection and management of acute kidney injury (AKI). This review will summarize recent publications in these areas.: Recent findings: ... ...

Abstract	Purpose of review: The field of digital health is evolving rapidly with applications relevant to the prediction, detection and management of acute kidney injury (AKI). This review will summarize recent publications in these areas. Recent findings: Machine learning (ML) approaches have been applied predominantly for AKI prediction, but also to identify patients with AKI at higher risk of adverse outcomes, and to discriminate different subgroups (subphenotypes) of AKI. There have been multiple publications in this area, but a smaller number of ML models have robust external validation or the ability to run in real-time in clinical systems. Recent studies of AKI alerting systems and clinical decision support systems continue to demonstrate variable results, which is likely to result from differences in local context and implementation strategies. In the design of AKI alerting systems, choice of baseline creatinine has a strong effect on performance of AKI detection algorithms. Summary: Further research is required to overcome barriers to the validation and implementation of ML models for AKI care. Simpler electronic systems within the electronic medical record can lead to improved care in some but not all settings, and careful consideration of local context and implementation strategy is recommended.
MeSH term(s)	Humans ; Electronic Health Records ; Acute Kidney Injury/diagnosis ; Acute Kidney Injury/therapy ; Creatinine ; Algorithms
Chemical Substances	Creatinine (AYI8EX34EU)
Language	English
Publishing date	2022-08-04
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	1235629-3
ISSN	1531-7072 ; 1070-5295
ISSN (online)	1531-7072
ISSN	1070-5295
DOI	10.1097/MCC.0000000000000971
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Zs.A 4999: Show issues

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Article ; Online: Sex as a biological variable in acute kidney injury.

Dahiya, Anita / Pannu, Neesh / Soranno, Danielle E

Current opinion in critical care

2023 Volume 29, Issue 6, Page(s) 529–533

Abstract: Purpose of review: The purpose of this review is to provide an overview of the preclinical and clinical studies investigating sex as a biological variable, as well as the impact of gender, on the development of and progression of acute kidney injury ( ... ...

Abstract	Purpose of review: The purpose of this review is to provide an overview of the preclinical and clinical studies investigating sex as a biological variable, as well as the impact of gender, on the development of and progression of acute kidney injury (AKI). Recent findings: Despite a matched degree of ischemia-reperfusion AKI based on measured glomerular filtration rates, male and female mice demonstrated important sex biases in cardiorenal outcomes (1). Although the 2012 Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guideline for AKI reported that female sex is associated with increased rates of hospital acquired AKI, subsequent meta-analyses do not show increased risk of AKI in women. Recent large scale, multicenter epidemiologic studies suggest males have higher rates of hospital acquired AKI. However, women have been consistently shown to have worse renal outcomes after AKI. There may be also be gender-based differences in presentation to care and management. Summary: Sex is an important biological variable in animal models of acute kidney injury. The impact of sex on AKI likely varies based on the etiology of AKI. Preclinical studies demonstrate the nuances of sex chromosomes, sex hormones and epigenetic factors on AKI, however these have not been well studied in humans. Gender may also impact processes of care, treatment and clinical outcomes related to AKI. The scientific rigor and reproducibility of translational studies benefit from the consideration of sex and gender.
MeSH term(s)	Humans ; Male ; Female ; Animals ; Mice ; Reproducibility of Results ; Risk Factors ; Acute Kidney Injury/therapy ; Kidney ; Glomerular Filtration Rate ; Retrospective Studies ; Multicenter Studies as Topic
Language	English
Publishing date	2023-09-21
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	1235629-3
ISSN	1531-7072 ; 1070-5295
ISSN (online)	1531-7072
ISSN	1070-5295
DOI	10.1097/MCC.0000000000001091
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Zs.A 4999: Show issues

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Article ; Online: Overview of Diagnostic Criteria and Epidemiology of Acute Kidney Injury and Acute Kidney Disease in the Critically Ill Patient.

Birkelo, Bethany C / Pannu, Neesh / Siew, Edward D

Clinical journal of the American Society of Nephrology : CJASN

2022 Volume 17, Issue 5, Page(s) 717–735

Abstract: Since the ... ...

Abstract	Since the description
MeSH term(s)	Acute Disease ; Acute Kidney Injury/diagnosis ; Acute Kidney Injury/epidemiology ; Acute Kidney Injury/etiology ; Artificial Intelligence ; Biomarkers ; Critical Illness ; Female ; Humans ; Male
Chemical Substances	Biomarkers
Language	English
Publishing date	2022-03-15
Publishing country	United States
Document type	Journal Article ; Review ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2226665-3
ISSN	1555-905X ; 1555-9041
ISSN (online)	1555-905X
ISSN	1555-9041
DOI	10.2215/CJN.14181021
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Article ; Online: Personalising haemodialysis treatment with incremental dialysis for incident patients with end-stage kidney disease: an implementation study protocol.

Armstrong, Marni / Wityk Martin, Tracy Lynn / Zimmermann, Gabrielle L / Drall, Kelsea / Pannu, Neesh I

BMJ open

2024 Volume 14, Issue 1, Page(s) e075195

Abstract: Introduction: Incremental dialysis is a personalised dialysis prescription based on residual kidney function that allows for the initial use of shorter duration, less frequent and less intense dialysis. It has been associated with enhanced quality of ... ...

Abstract	Introduction: Incremental dialysis is a personalised dialysis prescription based on residual kidney function that allows for the initial use of shorter duration, less frequent and less intense dialysis. It has been associated with enhanced quality of life and decreased healthcare costs when compared with conventional dialysis. While nephrologists report prescribing incremental dialysis, few dialysis programmes offer a systematic approach in offering and evaluating its use. To move evidence into practice, and in order to improve the safety and quality of providing incremental dialysis care, we have designed an implementation study. This study aims to evaluate the systematic assessment of patients starting facility-based haemodialysis for eligibility for incremental dialysis, and the prescription and monitoring of incremental dialysis treatment. Methods and analysis: A hybrid effectiveness and implementation study design is being used to evaluate the implementation of the programme at dialysis sites in Alberta, Canada. The Reach, Effectiveness, Adoption, Implementation and Maintenance framework will be used to capture individual-level and organisational-level impact of the project. Clinical outcomes related to kidney function will be monitored on an ongoing basis, and patient-reported outcomes and experience measures will be collected at baseline and then quarterly throughout the first year of dialysis. Ethics and dissemination: The study was approved by the Health Research Ethics Board of the University of Alberta. The study is funded by the Strategic Clinical Networks of Alberta Health Services. The study will help answer important questions on the effectiveness of incremental dialysis, and inform the acceptability, adoption, feasibility, reach and sustainability of incremental dialysis within provision of haemodialysis care.
MeSH term(s)	Humans ; Renal Dialysis/methods ; Quality of Life ; Kidney Failure, Chronic/therapy ; Peritoneal Dialysis ; Alberta
Language	English
Publishing date	2024-01-29
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2023-075195
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Article ; Online: Which patients benefit from initiation of dialysis for AKI?

Pannu, Neesh

Clinical journal of the American Society of Nephrology : CJASN

2014 Volume 9, Issue 4, Page(s) 635–637

MeSH term(s)	Acute Kidney Injury/therapy ; Female ; Humans ; Male ; Patient Selection ; Renal Dialysis
Language	English
Publishing date	2014-03-20
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	2226665-3
ISSN	1555-905X ; 1555-9041
ISSN (online)	1555-905X
ISSN	1555-9041
DOI	10.2215/CJN.01730214
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Zs.A 6584: Show issues

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Article: Advancing Community Care and Access to Follow-up After Acute Kidney Injury Hospitalization: Design of the AFTER AKI Randomized Controlled Trial.

Bhatt, Meha / Benterud, Eleanor / Palechuk, Taylor / Bignell, Coralea / Ahmed, Nasreen / McBrien, Kerry / James, Matthew T / Pannu, Neesh

Canadian journal of kidney health and disease

2024 Volume 11, Page(s) 20543581241236419

Abstract: Background: Acute kidney injury (AKI) is a common complication among hospitalized patients with long-term implications including chronic kidney disease (CKD). Although models are available to predict the risk of advanced CKD after AKI, there is limited ... ...

Abstract	Background: Acute kidney injury (AKI) is a common complication among hospitalized patients with long-term implications including chronic kidney disease (CKD). Although models are available to predict the risk of advanced CKD after AKI, there is limited evidence regarding follow-up for patients with AKI after hospital discharge, resulting in variable follow-up care. A risk-stratified follow-up approach may improve appropriateness and efficiency of management for CKD among patients at risk of declining kidney function following AKI. Objective: The objective was to compare and evaluate the use of a risk-stratified approach to follow-up care vs usual care for patients with AKI after hospital discharge. Design: This study was a pragmatic randomized controlled trial. Setting: This study was conducted in 2 large urban hospitals in Alberta, Canada. Patients: Hospitalized patients with AKI (KDIGO stage 2 or 3) not previously under the care of a nephrologist, expected to survive greater than 90 days being discharged home. Measurements: We will evaluate whether guideline-recommended CKD care processes are initiated within 90 days, including statin use, angiotensin-converting enzyme inhibitor (ACEi)/angiotensin II receptor blocker (ARB) use in those with proteinuria or diabetes, and nephrologist follow-up if sustained eGFR <30 mL/min/1.73 m Methods: Patients with AKI will be enrolled and randomized near the time of hospital discharge. In the intervention group, low risk patients will receive information regarding AKI, medium risk patients will additionally receive follow-up guidance sent to their primary care physician, and high-risk patients will additionally receive follow-up with a nephrologist. Participants in the intervention and usual care group will receive a requisition for urine testing and bloodwork at 90 days following hospital discharge. Telephone follow-up will be conducted for all study participants at 90 days and 1 year after hospital discharge. Bivariate tests of association will be conducted to evaluate group differences at the follow-up time points. Limitations: We expect there may be challenges with recruitment due to the significant co-existence of comorbidity in this population. Conclusions: If the trial shows a positive effect on these processes for kidney care, it will inform larger-scale trial to determine whether this intervention reduces the incidence of long-term clinical adverse events, including CKD progression, cardiovascular events, and mortality following hospitalization with AKI.
Language	English
Publishing date	2024-03-16
Publishing country	England
Document type	Journal Article
ZDB-ID	2765462-X
ISSN	2054-3581
ISSN	2054-3581
DOI	10.1177/20543581241236419
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Article ; Online: Use of sodium-glucose cotransporter 2 inhibitors in Alberta adults with chronic kidney disease: a cross-sectional study identifying care gaps to inform knowledge translation.

Lau, Darren / Pannu, Neesh / Yeung, Roseanne O / Scott-Douglas, Nairne / Klarenbach, Scott

CMAJ open

2023 Volume 11, Issue 1, Page(s) E101–E109

Abstract: Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors have important kidney and cardiovascular benefits in adults with chronic kidney disease. Among adults with diabetes, we characterized the prevalence of chronic kidney disease eligible for ... ...

Abstract	Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors have important kidney and cardiovascular benefits in adults with chronic kidney disease. Among adults with diabetes, we characterized the prevalence of chronic kidney disease eligible for SGLT2 inhibitor treatment, based on definitions of eligibility from trials and diabetes guidelines, and assessed the predictors of SGLT2 inhibitor use. Methods: We conducted a cross-sectional study using linked administrative data from Alberta Health in adults with diabetes (2002-2019). Chronic kidney disease was defined as an estimated glomerular filtration rate (eGFR) less than 90 mL/min/1.73 m Results: Of 446 315 adults with diabetes, 76 630 (17.2%, guideline-based definition; 12 867 [2.9%], trial-based definition) had chronic kidney disease eligible for SGLT2 inhibitor treatment. A total of 7.1% used SGLT2 inhibitors. Older age, lower hemoglobin A Interpretation: Many adults with chronic kidney disease would derive heart and kidney benefits from treatment with SGLT2 inhibitors but had low SGLT2 inhibitor use as of 2019. Efforts will be needed to address lower use of SGLT2 inhibitors among female, older and lower-income adults, and to enhance primary care and promote awareness of the benefits of SGLT2 inhibitors independent of glycemic control.
MeSH term(s)	Humans ; Adult ; Female ; Sodium-Glucose Transporter 2 Inhibitors/therapeutic use ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2/drug therapy ; Diabetes Mellitus, Type 2/epidemiology ; Diabetes Mellitus, Type 2/complications ; Alberta/epidemiology ; Translational Science, Biomedical ; Renal Insufficiency, Chronic/epidemiology ; Proteinuria/complications ; Sodium ; Glucose
Chemical Substances	Sodium-Glucose Transporter 2 Inhibitors ; Sodium (9NEZ333N27) ; Glucose (IY9XDZ35W2)
Language	English
Publishing date	2023-01-31
Publishing country	Canada
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2701622-5
ISSN	2291-0026 ; 2291-0026
ISSN (online)	2291-0026
ISSN	2291-0026
DOI	10.9778/cmajo.20210281
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Article: Population-Based Analysis of Nonsteroidal Anti-inflammatory Drug Prescription in Subjects With Chronic Kidney Disease.

Armstrong, Marni J / Zhang, Kevin / Ye, Feng / Klarenbach, Scott W / Pannu, Neesh I

Canadian journal of kidney health and disease

2023 Volume 10, Page(s) 20543581221149621

Abstract: Background: Pain is a prevalent symptom experienced by patients with chronic kidney disease (CKD) and appropriate management of pain is an important element of comprehensive care. Nonsteroidal anti-inflammatory drugs (NSAID) are known to be nephrotoxic ... ...

Abstract	Background: Pain is a prevalent symptom experienced by patients with chronic kidney disease (CKD) and appropriate management of pain is an important element of comprehensive care. Nonsteroidal anti-inflammatory drugs (NSAID) are known to be nephrotoxic in persons with CKD. Objective: This study examined the pattern of NSAID prescribing practices in a population based-cohort of patients with CKD. Design: Retrospective cohort study using linked population-based health care data. Setting: Entire province of Alberta, Canada. Participants: All adults in Alberta with eGFR defined CKD G3 or greater between 2009 and 2017 were included. Measurements: CKD was defined using at least 2 outpatient serum creatinine (SCr) greater than 90 days apart; the date of second SCr measurement was used as index date. We determined the incidence of hyperkalemia using the peak serum potassium. Prescription drug information was obtained from the Pharmaceutical Information Network (PIN) database. Methods: All patients were followed from the index date until March 31, 2019, with a minimum follow-up of 2 years. Prescription drug information and the follow-up laboratory testing of serum creatinine and serum potassium were obtained. Patients with kidney failure defined as eGFR < 15 mL/min per 1.73 m Results: A total of 170 574 adults (mean age 76.3; 44% male) with CKD were identified and followed for a median of 7 years; 27% were dispensed at least 1 NSAID prescription. While there was a trend toward fewer prescriptions in patients with more advanced CKD ( Limitations: Data collected were from clinical and administrative databases not created for research purposes. The study cohort is limited to subjects who sought medical care and had a serum creatinine measurement obtained. Measurement of NSAID use is limited to those who were dispensed a prescription, over-the-counter NSAIDs use is not captured. Conclusions: Despite guidelines advocating cautious use of NSAIDs in patients with CKD, this study indicates that there is a discrepancy from best practice recommendations. Effective strategies to better support and educate prescribers, as well as patients, may help reduce inappropriate prescribing and adverse events.
Language	English
Publishing date	2023-01-18
Publishing country	England
Document type	Journal Article
ZDB-ID	2765462-X
ISSN	2054-3581
ISSN	2054-3581
DOI	10.1177/20543581221149621
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Article ; Online: Variations in Incidence and Prognosis of Stage 4 CKD Among Adults Identified Using Different Algorithms: A Population-Based Cohort Study.

Rath, Mitchell / Ravani, Pietro / James, Matthew T / Pannu, Neesh / Ronksley, Paul E / Liu, Ping

American journal of kidney diseases : the official journal of the National Kidney Foundation

2023 Volume 83, Issue 5, Page(s) 578–587.e1

Abstract: Rationale & objective: Clinical guidelines define chronic kidney disease (CKD) as abnormalities of kidney structure or function for>3 months. Assessment of the duration criterion may be implemented in different ways, potentially impacting estimates of ... ...

Abstract	Rationale & objective: Clinical guidelines define chronic kidney disease (CKD) as abnormalities of kidney structure or function for>3 months. Assessment of the duration criterion may be implemented in different ways, potentially impacting estimates of disease incidence or prevalence in the population, individual diagnosis, and treatment decisions, especially for more severe cases. We investigated differences in incidence and prognosis of CKD stage G4 identified by 1 of 4 algorithms. Study design: Population-based cohort study in Alberta, Canada. Setting & participants: Residents>18 years old with incident CKD stage G4 (eGFR 15-29mL/min/1.73m Exposure: Four outpatient eGFR-based algorithms, increasing in stringency, for defining cohorts with CKD G4 were evaluated: (1) a single test, (2) first eGFR<30mL/min/1.73m Outcome: Time to the earliest of death, eGFR improvement (a sustained increase in eGFR to≥30mL/min/1.73m Analytical approach: For each of the 4 cohorts, incidence rates and event-specific cumulative incidence functions at 1 year from cohort entry were estimated. Results: The incidence rates of CKD G4 decreased as algorithms became more stringent, from 190.7 (single test) to 79.9 (rigorous sustained) per 100,000 person-years. The 2 cohorts based on sustained reductions in eGFR were of comparable size and 1-year event-specific probabilities. The 2 cohorts based on a single test and a 2-test sequence were larger and experienced higher probabilities of eGFR improvement. Limitations: A short follow-up period of 1 year and a predominantly White population. Conclusions: The use of more stringent algorithms for defining CKD G4 results in substantially lower estimates of disease incidence, the identification of a group with a lower probability of eGFR improvement, and a higher risk of kidney failure. These findings can inform implementation decisions of disease definitions in clinical reporting systems and research studies. Plain-language summary: Although guidelines recommend>3 months to define chronic kidney disease (CKD), the methods for defining specific stages, particularly G4 (eGFR 15-29mL/min/1.73m
MeSH term(s)	Humans ; Algorithms ; Male ; Female ; Incidence ; Prognosis ; Renal Insufficiency, Chronic/epidemiology ; Renal Insufficiency, Chronic/diagnosis ; Middle Aged ; Glomerular Filtration Rate ; Aged ; Alberta/epidemiology ; Cohort Studies ; Adult ; Severity of Illness Index
Language	English
Publishing date	2023-12-10
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	604539-x
ISSN	1523-6838 ; 0272-6386
ISSN (online)	1523-6838
ISSN	0272-6386
DOI	10.1053/j.ajkd.2023.10.010
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