Background We investigated the long-term effect of COVID-19 on estimated glomerular filtration rate (eGFR) trajectory and the association with progression to kidney failure in patients with CKD. Methods Patients living with non-dialysis-dependent CKD from British Columbia, Canada infected with COVID-19 (cases) were matched 1:2 to non-COVID-19-infected controls on variables including pre-COVID-19 annual rate of eGFR decline. Patients were followed from 90 days from the date of COVID-19 diagnosis. The Cox proportional hazard model was used for the primary outcome of kidney failure, defined as a composite of eGFR reaching <15 ml/min/1.73 m(2), initiation of maintenance dialysis or kidney transplantation. A linear mixed regression model was used to calculate the annual rate of change in eGFR. Results The study included 802 patients: 268 cases and 534 controls. The median age was 70 years and 54% were male. Over approximate to 3 years of follow-up, the risk of developing kidney failure did not differ significantly between cases and controls. The annual rate of eGFR decline was 2.05 ml/min/1.73 m(2) among cases versus 1.35 ml/min/1.73 m(2) among controls, representing a rate difference of 0.71 ml/min/1.73 m(2) (P = .02). Conclusion In patients with non-dialysis-dependent CKD who survived at least 90 days without requiring dialysis, COVID-19 was not associated with an increased long-term risk of kidney failure over 3 years but was associated with a greater annual decline in eGFR. Future research with longer follow-up is required to examine if this difference persists and leads to increased risk for kidney failure.

Introduction:We investigated the implications of implementing race-free Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2021 equation among real-world patients with chronic kidney disease (CKD) from British Columbia (BC), Canada. Methods:This study included nondialysis-dependent patients with CKD aged ≥19 years who were registered in the Patient Records and Outcome Management Information System (PROMIS) as of March 31, 2016 (index date) with ≥1 serum creatinine measurement within 1 year before the index date. Patients with a history of kidney transplantation before the index date were excluded. CKD-EPI 2021 versus 2009 equation was the exposure variable. Difference in mean estimated glomerular filtration rate (eGFR) and number (%) of patients reclassified to a different eGFR category were estimated. We used Fine and Gray subdistribution hazard model to investigate the association between change in eGFR category and progression to kidney failure (incident maintenance dialysis or kidney transplantation) within 2 years. Results:A total of 11,604 patients (median age 73 years, 52% male) were included. Compared to the 2009 equation, eGFR from 2021 equation was on average 2.7 ml/min per 1.73 m2 higher. Variation was higher among males. Overall, ∼17% of the study sample were reclassified to a category with higher eGFR by 2021 equation (switchers). The highest proportion (28%) of patients were reclassified from G5 to G4. The risk of progressing to kidney failure was 22% less among switchers compared to nonswitchers; adjusted subdistribution hazard ratio (HR) (95% confidence interval [CI]) is 0.78 (0.65, 0.94). Conclusion:CKD-EPI 2021 equation appeared to provide higher eGFR compared to 2009 equation. This higher eGFR values appeared to be concordant with subsequent real-world CKD progression outcomes. Higher eGFR from the 2021 equation may have substantial clinical implications in both diagnosis as well as long-term care of patients with CKD.

Background and objective: Acute kidney injury (AKI) affects up to 20% of hospitalizations and is associated with chronic kidney disease, cardiovascular disease, increased mortality, and increased health care costs. Proper documentation of AKI in discharge summaries is critical for optimal monitoring and treatment of these patients once discharged. Currently, there is limited literature evaluating the quality of discharge communication after AKI. This study aimed to evaluate the accuracy and quality of documentation of episodes of AKI at a tertiary care center in British Columbia, Canada. Methods, design, setting, patients, and measurements: This was a retrospective chart review study of adult patients who experienced AKI during hospital admission between January 1, 2018, and December 31, 2018. Laboratory data were used to identify all admissions to the cardiac and general medicine ward complicated by AKI defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria. A random sample of 300 AKI admissions stratified by AKI severity (eg, stages 1, 2, and 3) were identified for chart review. Patients were excluded if they required ongoing renal replacement therapy after admission, had a history of kidney transplant, died during their admission, or did not have a discharge summary available. Discharge summaries were reviewed for documentation of the following: presence of AKI, severity of AKI, AKI status at discharge, practitioner and laboratory follow-up plans, and medication changes. Results: A total of 1076 patients with 1237 AKI admissions were identified. Of the 300 patients selected for discharge summary review, 38 met exclusion criteria. In addition, AKI was documented in 140 (53%) discharge summaries and was more likely to be documented in more severe AKI: stage 1, 38%; stage 2, 51%; and stage 3, 75%. Of those with their AKI documented, 94 (67%) documented AKI severity, and 116 (83%) mentioned the AKI status or trajectory at the time of discharge. A total of 239 (91%) of discharge summaries mentioned a follow-up plan with a practitioner, but only 23 (10%) had documented follow-up with nephrology. Patients with their AKI documented were more likely to have nephrology follow-up than those without AKI documented (17% vs 1%). Regarding laboratory investigations, 92 (35%) of the summaries had documented recommendations. In summaries that included medications typically held during AKI, only about half made specific reference to those medications being held, adjusted, or documented a post-discharge plan for that medication. For those with nonsteroidal anti-inflammatory drugs (NSAIDs) listing, 64% of discharge summaries mentioned holding, and 9% mentioned a discharge plan. For those with angiotensin converting enzyme inhibitor (ACEi)/angiotensin II receptor blocker (ARB) listing, 38% mentioned holding these medications, and 46% mentioned a discharge plan. In summaries with diuretics listed, 35% mentioned holding, and 51% included a discharge plan. Conclusions and limitations: We found suboptimal quality and completeness of discharge reporting in patients hospitalized with AKI. This may contribute to inadequate follow-up and post-hospitalization care for this patient population. Strategies are required for increasing the presence and quality of AKI reporting in discharge summaries. Limitations include our definition of AKI based on lab criteria, which may have missed some of the injuries that met the criteria based on urine output. Another limitation is that our definition of AKI based on the highest and lowest creatinine during admission may have led to some overclassification. In addition, without outpatient laboratories, it is possible that we have not captured the true baseline creatinine in some patients.

Background. The Kidney Failure Risk Equation (KFRE) can play a better role in vascular access (VA) planning in patients with chronic kidney disease (CKD) requiring hemodialysis (HD). We described the VA creation and utilization pattern under existing estimated glomerular filtration rate (eGFR)-based referral, and investigated the utility of KFRE score as an adjunct variable in VA planning. Methods. Patients with CKD aged >= 18 years with eGFR <20 mL/min/1.73 m2 who chose HD as dialysis modality from January 2010 to August 2020 were included from a population-based database in British Columbia, Canada. Modality selection date was the index date. Exposures were categorized as (i) current eGFR-based referral, (ii) eGFR-based referral plus KRFE 2-year risk score on index date (KFRE-2) >40% and (iii) eGFR-based referral plus KFRE-2 <= 40%. We estimated the proportion of patients who started HD on arteriovenous fistula/graft (AVF/G) within 2 years, indicating timely pre-emptive creation, and the proportion of patients in whom AVF/G was created but did not start HD within 2 years, indicating too-early creation. Results. Study included 2581 patients, median age 71 years, 60% male. Overall, 1562(61%) started HD and 276 (11%) experienced death before HD initiation within 2 years. Compared with current referral, the proportion of patients who started HD on AVF/G was significantly higher when KFRE-2 was considered in addition to current referral (49% vs 58%, P-value <.001). Adjunct KFRE-2 significantly reduced too-early creation (31% vs 18%, P-value <.001). Conclusions. KFRE in addition to existing eGFR-based referral for VA creation has the potential to improve VA resource utilization by ensuring more patients start HD on AVF/G and may minimize too-early/unnecessary creation. Prospective research is necessary to validate these findings.

Real time access to guidance for physicians has been offered through Rapid Access to Consultative Expertise (RACE) in British Columbia (BC) for the past 12 years. [1][1] In the context of the novel coronavirus (COVID-19), the service for RACE was expanded to include a Long-COVID RACE line. [1][1] We report here the types and frequencies of questions asked to General Internal Medicine (GIM) experts in Long-COVID, by general practitioners in BC. 149 calls over an 11-month period were tracked by GIM experts, and analysis of the call themes was undertaken. These calls mainly involved consults regarding the post-infection COVID-19 symptoms being experienced by Primary Care Practitioners’ patients. Respiratory symptoms were the leading type of symptoms reported, with shortness of breath, cough, fatigue, and fevers being the most common, respectively. This data will be used to inform future resource utilization and provide insights on the usage of the Long-COVID RACE line.### Competing Interest StatementThe authors have declared no competing interest.### Funding StatementThis study did not receive any funding.### Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:Ethics committee of UBC Providence Health Care Research waived ethical approval for this work. Under Article 2.5 of the Tri Council Policy Statement, QA/QI activities are not subject to institutional ethical review.I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.YesAll data produced in the present work are contained in the manuscript. [1]: #ref-1

Aims The aim of this study was to determine the comparative effectiveness and safety of direct oral anticoagulants (DOACs) and warfarin in adults with atrial fibrillation (AF) by level of kidney function. Methods and results We pooled findings from five retrospective cohorts (2011-18) across Australia and Canada of adults with; a new dispensation for a DOAC or warfarin, an AF diagnosis, and a measure of baseline estimated glomerular filtration rate (eGFR). The outcomes of interest, within 1 year from the cohort entry date, were: (1) the composite of all-cause death, first hospitalization for ischaemic stroke, or transient ischaemic attack (effectiveness), and (2) first hospitalization for major bleeding defined as an intracranial, upper or lower gastrointestinal, or other bleeding (safety). Cox models were used to examine the association of a DOAC vs. warfarin with outcomes, after 1:1 matching via a propensity score. Kidney function was categorized as eGFR >= 60, 45-59, 30-44, and <30 mL/min/1.73 m(2). A total of 74 542 patients were included in the matched analysis. DOAC initiation was associated with greater or similar effectiveness compared with warfarin initiation across all eGFR categories [pooled HRs (95% CIs) for eGFR categories: 0.74(0.69-0.79), 0.76(0.54-1.07), 0.68(0.61-0.75) and 0.86(0.76-0.98)], respectively. DOAC initiation was associated with lower or similar risk of major bleeding than warfarin initiation [pooled HRs (95% CIs): 0.75(0.65-0.86), 0.81(0.65-1.01), 0.82(0.66-1.02), and 0.71(0.52-0.99), respectively). Associations between DOAC initiation, compared with warfarin initiation, and study outcomes were not modified by eGFR category. Conclusion DOAC use, compared with warfarin use, was associated with a lower or similar risk of all-cause death, ischaemic stroke, and transient ischaemic attack and also a lower or similar risk of major bleeding across all levels of kidney function.

Background: In acute COVID-19, plasma D-Dimer is a useful biomarker and venous thromboembolism (VTE) is common. However, it is less clear whether this is the case during long-term recovery. Objectives: To report D-Dimer values and incidence of new VTE ≥90 days following COVID-19. Methods: In British Columbia (BC), patients supported at the Post-COVID-19 Recovery Clinics underwent routine investigations including D-Dimer as part of a learning health system. Among patients with a positive D-Dimer (≥500ng/mL) test 90–180 days following COVID-19 symptom onset, we performed a retrospective chart review to determine whether imaging for VTE was done. Results: There were 806 patients reviewed. Of these, 252 (30.3%) had a positive D-Dimer. Imaging was pursued in 56 (6.9%) and 9 (1.1%) were diagnosed with new VTE.Interpretation: At ≥90 days post COVID-19, D-Dimer is often positive, but it is relatively rare to diagnose new VTE. RésuméContexte: Dans les cas de COVID-19 aiguë, le D-dimère est un biomarqueur plasmatique utile et la thromboem-bolie veineuse (TEV) est fréquente. Toutefois, on ignore si c’est le cas au cours du rétablissement à long terme. Objectifs: Connaître les taux plasmatiques de D-dimères et la fréquence d’une nouvelle TEV à 90 jours ou plus après avoir contracté la COVID-19. Méthodologie: En Colombie-Britannique, les patients suivis par les cliniques de rétablissement de la COVID-19 ont subi des examens systématiques, dont le dosage des D-dimères, dans le cadre d’un système de santé apprenant. Chez les patients ayant obtenu un résultat positif au dosage des D-dimères (≥ 500 ng/mL) de 90 à 180 jours après l’apparition des symptômes de la COVID19, nous avons effectué un examen rétrospectif de leur dossier pour savoir si un examen d’imagerie pour la détection d’une TEV a été réalisé. Résultats: Nous avons évalué 806 patients. De ce nombre, 252 (30,3 %) ont obtenu un résultat positif au dos-age des D-dimères. Un examen d’imagerie a été réalisé chez 56 patients (6,9 %) et un diagnostic de nouvelle TEV a été posé chez 9 d’entre eux (1,1 %). Interprétation: Quatre-vingt-dix jours ou plus après avoir contracté la COVID-19, le dosage des D-dimères est souvent positif, mais le diagnostic d’une nouvelle TEV est relativement rare.

Background: Acute kidney injury (AKI) increases the risk of hospital readmission, chronic kidney disease, and death. Therefore, effective communication in discharge summaries is essential for safe transitions of care. Objective: The objectives of this study were to determine the quality of discharge summaries in AKI survivors and identify predictors of higher quality discharge summaries. Design: Retrospective chart review. Setting: Tertiary care academic center in Ontario, Canada. Patients: We examined the discharge summary quality of 300 randomly selected adult patients who survived a hospitalization with AKI at our tertiary care hospital, stratified by AKI severity. We included 150 patients each from 2015 to 2016 and 2018 to 2019, before and after introduction of a post-AKI clinic in 2017. Measurements: We reviewed charts for 9 elements of AKI care to create a composite score summarizing discharge summary quality. Methods: We used multivariable logistic regression to identify predictors of discharge summary quality. Results: The median discharge summary composite score was 4/9 (interquartile range, 2-6). The least frequently mentioned elements were baseline creatinine (n = 55, 18%), AKI-specific follow-up labs (n = 66, 22%), and medication recommendations (n = 80, 27%). The odds of having a higher quality discharge summary (composite score ≥4/9) was greater for every increase in baseline creatinine of 25 μmol/L (adjusted odds ratio [aOR]: 1.27; 95% confidence interval [CI]: 1.03, 1.56), intrarenal etiology (aOR: 2.32; 95% CI: 1.26, 4.27), and increased AKI severity (stage 2 aOR: 2.57; 95% CI: 1.35, 4.91 and stage 3 aOR: 3.36; 95% CI: 1.56, 7.22). There was no association between discharge summary quality and the years before and after introduction of a post-AKI clinic (aOR: 0.77; 95% CI: 0.46, 1.29). Limitations: The single-center study design limits generalizability. Conclusions: Most discharge summaries are missing key AKI elements, even in patients with severe AKI. These gaps suggest several opportunities exist to improve discharge summary communication following AKI.

AbstractBackground: Systematic evaluation of patients with the post-COVID-19 infections using standardized symptom assessment tools and laboratory testing in the context of clinical care has not been reported previously. Methods: This is a cohort of individuals referred to post-COVID-19 recovery clinics in British Columbia from July 9, 2020 to March 10, 2022. The purpose of the clinics was to systematically assess patients for 3-month post-COVID-19 infections, using validated symptom assessment tools for shortness of breath, fatigue, neuro-psychiatric symptoms, and organ dysfunction as measured by laboratory tests. Patients were referred according to specified criteria, including hospitalization or persistence of symptoms. For our analysis, we included the patients who were referred and evaluated at 3-month post-COVID-19 infection with persistent symptoms. The period chosen corresponds to waves 1–4 in British Columbia.Results: In total, 892 patients were included (median [IQR] age, 53 [42,63] years, with 54.0% females, 39.7% white ethnicity, and 62.0% hospitalized). Shortness of breath (85.9%), fatigue (75.7%), weakness (56.1%), memory problem (47.3%), and myalgia (45.6%) were the most common symptoms reported. Phenotypes of different patients and wave of infection were found associated with different long COVID-19 clinical manifestations after controlling for vaccination status and the underlying comorbidities. Conclusions: Using validated symptom assessment tools, we describe the variability, severity, and frequency of symptoms in this cohort with long COVID-19. Further studies are required to assess the heterogeneity of the long COVID-19 manifestations using standardized assessments to better target therapeutic treatments. RésuméContexte: L’évaluation systématique des patients après une infection par le SRAS-CoV-2à l’aide d’outils normalisés d’évaluation des symptômes et d’examens de laboratoire dans le contexte des soins cliniques n’a jamais été mise en évidence auparavant. Méthodologie: Il s’agit d’une cohorte de personnes orientées vers des cliniques de rétablissement de la COVID-19 en Colombie-Britannique entre le 9 juillet 2020 et le 10 mars 2022. Ces cliniques visent à évaluer systématiquement les patients trois mois après avoir contracté la COVID-19, à l’aide d’outils d’évaluation des symptômes validés pour l’essoufflement, la fatigue, les symptômes neuropsychiatriques et le dysfonctionnement organique mesurés par des examens de laboratoire.L’orientation des patients vers ces cliniques a été effectuée selon des critères prédéfinis, y compris l’hospitalisation ou la persistance des symptômes. Aux fins de notre analyse, nous avons retenu les patients qui ont été orientés et évalués trois mois après avoir contracté la COVID-19 et qui présentaient des symptômes persistants. La période choisie correspond aux vagues 1 à 4 de COVID-19 en Colombie-Britannique. Résultats: Au total, 892 patients ont fait partie de l’analyse (âge médian de 53 ans,écart interquartile [EIQ] de 42 à 63; 54,0% sont des femmes; 39,7% sont de race blanche; 62,0% ont été hospitalisés). L’essoufflement (85,9%), la fatigue (75,7%), la faiblesse (56,1%), les troubles de la mémoire (47,3%) et la myalgie (45,6%) sont les symptômes mentionnés le plus souvent. On constate que les différents phénotypes des patients et la vague au cours de laquelle est survenue l’infection sont associés à des symptômes différents de la COVID-19 longue après la prise en compte du statut vaccinal et des affections comorbides sous-jacentes. Conclusions: À l’aide d’outils validés d’évaluation des symptômes, nous décrivons la variabilité, la gr-avité et la fréquence des symptômes chez cette cohorte de patients atteints de la COVID-19 longue. D’autres études sont nécessaires pour évaluer l’hétérogénéité des symptômes de la COVID-19 longue au moyen d’évaluations normalisées afin de mieux cibler les traitements curatifs.

ABSTRACT Background We investigated the effect of Post–Acute COVID Syndrome or “long-COVID” on kidney function among patients followed in post-COVID recovery clinics (PCRC) in British Columbia, Canada. Methods Long-COVID patients referred to PCRC between July 2020 to April 2022, aged ≥18 years who had an estimated glomerular filtration rate (eGFR) value recorded at 3 months from the coronavirus disease 2019 (COVID-19) diagnosis (index) date were included. Those requiring renal replacement therapy prior to index date were excluded. Primary outcome was change in eGFR and urine albumin–creatinine ratio (UACR) after COVID-19 infection. The proportion of patients in each of the six eGFR categories (<30, 30–44, 45–59, 60–89, 90–120 and >120 mL/min/1.73 m2) and three UACR categories (<3, 3–30 and >30 mg/mmol) in all of the study time points were calculated. Linear mixed model was used to investigate change in eGFR over time. Results The study sample included 2212 long-COVID patients. Median age was 56 years, 51% were male. Half (∼47%–50%) of the study sample had normal eGFR (≥90 mL/min/1.73 m2) from COVID-19 diagnosis to 12 months post-COVID and <5% of patients had an eGFR <30 mL/min/1.73 m2. There was an estimated 2.96 mL/min/1.73 m2 decrease in eGFR within 1 year after COVID-19 infection that was equivalent to 3.39% reduction from the baseline. Decline in eGFR was highest in patients hospitalized for COVID-19 (6.72%) followed by diabetic patients (6.15%). More than 40% of patients were at risk of CKD. Conclusions People with long-COVID experienced a substantial decline in eGFR within 1 year from the infection date. The prevalence of proteinuria appeared to be high. Close monitoring of kidney function is prudent among patients with persistent COVID-19 symptoms.

Rationale & Objective: The benefit-risk profile of rivaroxaban versus warfarin for atrial fibrillation (AF) in patients with chronic kidney disease is uncertain. We compared rivaroxaban with warfarin across the range of kidney function in adults with AF.Study Design: Multicenter retrospective cohort.Setting & Participants: Adults with AF and a measure of estimated glomerular filtration rate (eGFR); using administrative data from 5 jurisdictions across Australia and Canada (2011-2018). Kidney function was categorized as eGFR >_60, 45-59, 30-44, and <30 mL/min/1.73 m2. Patients receiving dialysis and kidney transplant recipients were excluded.Exposures: New dispensation of either rivaroxaban or warfarin. Outcomes: Composite (1) effectiveness outcome (all-cause death, ischemic stroke, or transient ischemic attack) and (2) major bleeding events (intracranial, gastrointestinal, or other) at 1 year.Analytical Approach: Cox proportional hazards models accounting for propensity score matching were performed independently in each jurisdiction and then pooled using random-effects meta analysis. Results: 55,568 patients (27,784 rivaroxaban-warfarin user matched pairs; mean age 74 years, 46% female, 33.5% with eGFR <60 mL/min/1.73 m2) experienced a total of 4,733 (8.5%) effectiveness and 1,144 (2.0%) bleeding events. Compared to warfarin, rivaroxaban was associated with greater or similar effectiveness across a broad range of kidney function (pooled HRs of 0.72 [95% CI, 0.66- 0.78], 0.78 [95% CI, 0.58-1.06], 0.70 [95% CI, 0.57-0.87], and 0.78 [95% CI, 0.62-0.9 9]) for eGFR >_60, 45-59, 30-44, and <30 mL/min/ 1.73 m2, respectively). Rivaroxaban was also associated with similar risk of major bleeding across all eGFR categories (pooled HRs of 0.75 [95% CI, 0.5 6-1.00], 1.01 [95% CI, 0.79-1.3 0], 0.87 [95% CI, 0.6 6-1.15], and 0.63 [95% CI, 0.37-1.0 9], respectively).Limitations: Unmeasured treatment selection bias and residual confounding.Conclusions: In adults with AF, rivaroxaban compared with warfarin was associated with lower or similar risk of all-cause death, ischemic stroke and transient ischemic attack and similar risk of bleeding across a broad range of kidney function.

Background:Little was known about how chronic hyperkalemia (cHK) in patients with chronic kidney disease (CKD) is managed in British Columbia, Canada. Objective:To investigate the trend in sodium polystyrene sulfonate (SPS) and calcium polystyrene sulfonate (CPS) utilization and their efficacy in treating cHK in CKD patients from British Columbia, Canada. Study Design:Retrospective cohort. Setting & Patients:CKD patients aged ≥18 years, followed in Kidney Care Clinic (KCC), who had at least 2 potassium values ≥5.0 mmol/L separated by no more than 91 days during the period of June 1, 2015, to July 31, 2021, were included. Index date was the first date of the 2 potassium values ≥5.0 mmol/L. Patients who received SPS or CPS within 90 days before index date were excluded. Patients who were on dialysis or received kidney transplantation on or before index date were also excluded. Exposure:Continuous exposure to SPS and CPS. Outcome:SPS/CPS prescription utilization trend was described by the proportion of patients ever treated with SPS/CPS, median time in days between cHK diagnosis and initiating treatment with SPS/CPS, total and median number of SPS/CPS prescriptions dispensed. Change in mean serum potassium concentration before and after a 90-day continuous treatment with SPS/CPS was estimated. Analytical Approach:Descriptive. Results:This study included 10 495 patients with cHK (median age 74 years, 60% were male). Median follow-up time was 625 days. Only 2864 (27%) patients were dispensed at least 1 prescription of either SPS or CPS. A total 7300 prescriptions were dispensed; median prescriptions dispensed per patients were 2 (interquartile range [IQR]: 1-3). Median time from index date to the first prescription dispensing date was 154 days (IQR: 36-455). Continuous 90-day treatment with SPS/CPS decreased the mean serum potassium concentration by 0.60 mmol/L, from 5.58 to 4.98 mmol/L. Limitations:Descriptive observational study without control group. Conclusions:In British Columbia, only 1 in 4 CKD patients with cHK were dispensed with SPS/CPS, mostly with higher degrees of hyperkalemia. These medications appeared to be moderately effective in reducing the serum potassium concentration. Future research is necessary to evaluate the comparative effectiveness of newer generation medications.

Introduction: Several jurisdictions have adopted a more conservative approach to anemia in patients receiving dialysis amid safety concerns from target hemoglobin studies. It is largely unknown if this has contributed to a change in clinical outcomes. Methods: A national registry was used to identify 35,945 adult patients who initiated and were maintained on dialysis for >= 90 days in Canada from January 2007 to December 2015. Outcomes were ascertained until March 2017 via linkage with hospital discharge diagnoses. Cox proportional hazards models were used to investigate the association between the era of dialysis initiation and the primary composite outcome (acute myocardial infarction [AMI], stroke, or mortality). Results: The mean hemoglobin at dialysis initiation decreased from 102.9 g/l in 2007 to 95.5 g/l in 2015, corresponding with a higher prevalence of hemoglobin <80 g/l (8% to 17%) and a reduction in erythropoiesis stimulating agent (ESA) use (49% to 44%). After multivariable adjustment, Era 3 (2013-2015) was associated with an 8% relative risk reduction in the primary outcome compared with Era 1 (2007-2009) (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.88-0.96), a 10% relative reduction in mortality (HR 0.90, 95% CI 0.85-0.94) but no significant change in AMI or stroke. In a model without era, neither hemoglobin nor ESA use was an independent predictor of outcome. Conclusion: There have been modest declines in average hemoglobin values and ESA use among incident dialysis patients in Canada with no change in major cardiovascular outcomes. Patient survival has improved over time, likely for reasons other than anemia management.

Chronic kidney disease (CKD) is defined as abnormalities of kidney structure or function that are present for at least 3 months. In epidemiological studies, CKD is usually defined by a glomerular filtration rate (GFR) <60 mL/min/1.73 m(2) and/or a urinary albumin:creatinine ratio >= 30 mg/g (>= 3 mg/mmol). In these studies, the prevalence of CKD often exceeds 10%, increases markedly with age, and varies by race. Major risk factors for CKD include hypertension, diabetes, and vascular disease. In developing countries, infection and glomerulonephritis are important contributors. Although end-stage renal disease (ESRD) is the most commonly recognized outcome, CKD confers an increased risk for all-cause mortality, cardiovascular events, acute kidney injury, infection, hospitalizations, and frailty. Although our knowledge and understanding of the epidemiology of CKD has improved substantially over the past decade, significant gaps remain, most notably in the developing world.