Rationale & Objective:Clinical information systems (CISs) can support case finding. However, standardized methods for identifying maintenance dialysis recipients and assessing how CIS transitions influence disease burden estimates are lacking. We aimed to develop and evaluate methods for identifying maintenance dialysis recipients across CIS transitions and examine trends in incidence and prevalence across the implementation timeline. Study Design:Population-based retrospective cohort study. Setting & Participants:Alberta residents aged ≥20 years, who initiated (incident) or received (prevalent) maintenance dialysis from January 2012 to March 2024, were identified using clinical data (historical kidney care program data and a new Epic-based CIS) versus administrative claims. Study periods included preimplementation (January 2012 to November 2019; use of historical program data), transition (November 2019 to November 2022; combination of data sources), and full implementation of the CIS (November 2022 to March 2024). Claims data were available throughout. Maintenance dialysis was defined as in-center hemodialysis for >90 days or initiation of peritoneal/home hemodialysis, regardless of duration. Results:The algorithms identified 7,766 incident cases from clinical data and 7,556 from claims, with 7,391 (93.2%) overlapping. Incidence rates increased slightly over time and were comparable between data sources. Prevalence estimates were higher in claims than historical program data preimplementation but converged during the full CIS implementation period. In 2023, CIS-based incidence was 218.5/million population versus 199.9/million population from claims, and CIS-based prevalence was 1,018.3 versus 1,006.8 from claims. Dialysis initiation dates aligned within 28 days for 84.6% of patients, and period prevalence agreed well between data sources. Limitations:Exclusion of patients with kidney failure receiving dialysis for <90 days. Conclusions:Standardized methods for identifying incident maintenance dialysis recipients showed agreement between CIS and claims-based data, whereas the use of historical kidney care program data underidentified prevalent patients in Alberta. These approaches can optimize the identification of maintenance dialysis recipients from routinely collected health information.

Rationale & Objective: Clinical guidelines de fi ne 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 identi fi ed 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 15-29 mL/ min/1.73 m( 2) ) diagnosed between April 1, 2015, and March 31, 2018, based on administrative and laboratory data. Exposure: Four outpatient eGFR-based algorithms, increasing in stringency, for defining cohorts with CKD G4 were evaluated: (1) a single test, (2) first eGFR < 30 mL/min/1.73 m (2) and a second eGFR 15-29 mL/min/1.73 m( 2) measured > 90 days apart (2 tests), (3) >= 2 eGFR measurements of < 30 mL/min/1.73 m (2) sustained for > 90 days (qualifying period) and the last eGFR in the qualifying period of 1529 mL/min/1.73 m( 2) (relaxed sustained), and (4) >= 2 consecutive measurements of 15-29 mL/ min/1.73 m( 2) for > 90 days (rigorous sustained). Outcome: Time to the earliest of death, eGFR improvement (a sustained increase in eGFR to >= 30 mL/min/1.73 m (2 )for > 90 days and > 25% increase from the index eGFR), or kidney failure. 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.

We interviewed families to explore their views on the role of family navigation (FN) to improve access to and use of health services for managing pediatric obesity. From March to December, 2020, we conducted individual, structured telephone interviews with adolescents with obesity (13-17 years old) and their caregivers from Edmonton and Calgary, Canada. Among our 37 participants (14 adolescents, 23 caregivers), most (n = 27; 73.0%) reported FN could improve their access to obesity management. Participants recommended several activities to support healthcare access and use, including appointment reminders, evening/weekend appointments, parking/transportation support, and in-clinic childcare, all of which help families to attend appointments over an extended period to support obesity management. Most participants preferred FN be offered by healthcare professional ‘navigators’ who were approachable, empathic, and compassionate since issues regarding health and obesity can be sensitive, emotional topics to discuss. Overall, families supported integrating FN into multidisciplinary pediatric obesity management to improve healthcare access and use by navigators who apply a range of practical strategies and relational skills to enhance long-term access and adherence to care.

Infants born to mothers with type 2 diabetes (T2D) and gestational diabetes (GDM) are at an increased risk of being overweight/obese. Modifiable lifestyle factors play a role in prevention of overweight and obesity. In 2017, the Canadian 24 h Movement Guidelines for the Early Years (CMG) were released. Alongside physical activity recommendations, sweetened beverage consumption (SBC) recommendations were also released by the American Academy of Pediatrics in 2017. The objective of this study was to determine the knowledge pregnant women with T2D and GDM have on the CMG and SBC recommendations, and to determine what factors affect this. A survey with questions regarding demographics, socioeconomic variables and the CMG and SBC recommendations was administered to pregnant women at Diabetes in Pregnancy clinics in Calgary, Alberta from July 2019 to January 2020. Surveys were analyzed utilizing the non-parametric Kruskall-Wallis Rank-Sum test, chi-square test and linear regression. A total of 79 respondents with T2D and GDM were collected. Respondents had the highest knowledge of SBC recommendations and the lowest knowledge of CMG recommendations. A bachelor's or higher degree was associated with significantly higher knowledge scores than a high-school education or less. In conclusion, pregnant women with T2D and GDM in this study had overall poor knowledge of the CMG and SBC recommendations, with less knowledge regarding the CMG. Level of education was found to be associated with knowledge regarding these recommendations. Future programs to improve education around infant and toddler physical activity and SBC recommendations may be beneficial for this patient population.

The COVID‐19 pandemic has led to significant public health measures that have resulted in decreased acute pediatric care utilization. We evaluated whether the rate of severe presentations of new onset type 1 diabetes (DM1), such as, diabetic ketoacidosis (DKA) has changed since the COVID‐19 public health measures were enacted.

Objective The COVID-19 pandemic has led to significant public health measures that have resulted in decreased acute pediatric care utilization. We evaluated whether the rate of severe presentations of new onset type 1 diabetes (DM1), such as, diabetic ketoacidosis (DKA) has changed since the COVID-19 public health measures were enacted. Research Design and Methods A retrospective chart review of children less than 18 years of age presenting with new onset DM1 during the pandemic period of March 17, 2020 to August 31, 2020 was conducted at two tertiary care pediatric hospitals in Alberta, Canada. Rates of DKA and severe DKA were compared to the same time period in the year 2019 (pre-pandemic control). Results The number of children presenting with newly diagnosed DM1 was similar during the pandemic year of 2020 compared with 2019 (107 children in 2020 vs. 114 in 2019). The frequency of DKA at DM1 onset was significantly higher in the pandemic period (68.2% vs 45.6%; p < 0.001) and incidence of severe DKA was also higher (27.1% in 2020 vs 13.2% in 2019; p = 0.01). Conclusions There was a significant increase in DKA and severe DKA in children presenting with new onset DM1 during the COVID-19 pandemic period. This emphasizes the need for educating health care professionals and families to be aware of the symptoms of hyperglycemia and the importance of early diagnosis and treatment even during public health measures for COVID-19.

Abstract OBJECTIVES: Growth hormone (GH) therapy is an effective treatment in addressing growth failure in children with GH deficiency (GHD). It has also been increasingly used in non-GH deficient (nGHD) conditions. We sought to report the growth response of GHD and nGHD patients who received GH therapy at a tertiary care center. METHODS: Data was collected from health records of patients followed in the endocrinology clinic at Alberta Children’s Hospital, Calgary, Canada, from 2005 to 2019, and used to analyze clinical responses based on indication for GH treatment. RESULTS: A total of 167 patient records (87 males and 80 females) were used for analysis. The average age at the start of GH therapy was 7.3 years (range 0.25 to 16.98 yrs). 74 patients were in the GHD group while 93 were nGHD. Of the patients in the nGHD group, the most common diagnosis were: idiopathic short stature (ISS)(n=45), Turner syndrome (TS)(n=26), and Prader Willi Syndrome (PWS)(n=8). The mean height velocity (HV) in year 1 was highest in the GHD group at 11.68 cm/year (n= 62, sd = 5.93), followed by ISS at 9.41cm/year (n = 52, sd = 4.34). The mean first year HV of those who had received chemotherapy (n= 5, mean = 5.48, sd = 1.92) or had Turner syndrome (n= 24, mean = 7.20, sd = 2.15) was significantly lower than both the GHD and ISS groups. GH peak during a GH stimulation test at baseline was not correlated to the first year height velocity while on GH treatment. However there was a negative linear correlation between baseline IGF1 level and first year height velocity (Spearman’s rho = 0.312216, p-value= 0.01516). Age at GH initiation was negatively correlated with height velocity during GH treatment. Height velocity over time decreased sharply from year 1 to year 3, and became stable for the remaining years of GH therapy. For the entire group, HV for years 1-5 was 9.81 (sd=4.83), 7.40 (sd=2.89), 6.29 (sd=2.38), 5.92 (sd=2.56), 5.66 (sd=2.51). There is no significant correlation between GH dose and height velocity response after adjusting for diagnosis. CONCLUSION: In our population, the response to GH therapy was consistent with those reported in the literature. Response to GH therapy was not associated with GH peak on stimulation but rather to baseline IGF-1 level and age at initiation. Although peak GH to stimulation is required to obtain public funding for GH therapy, these findings demonstrate that GH stimulation test results may not indicate which patients may benefit the most from GH therapy. Follow-up until final adult height will allow us to have a better understanding of the efficacy of GH therapy in patients with both GHD and nGHD conditions.