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  • 1
    Online Resource
    Online Resource
    Impact of Pretransplant and New-Onset Diabetes After Transplantation on the Risk of Major Adverse Cardiovascular Events in Kidney Transplant Recipients: A Population-based Cohort Study
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Transplantation Vol. 105, No. 11 ( 2021-11), p. 2470-2481
    Details
    In: Transplantation, Ovid Technologies (Wolters Kluwer Health), Vol. 105, No. 11 ( 2021-11), p. 2470-2481
    Abstract: Pretransplant diabetes and new-onset diabetes after transplant (NODAT) are known risk factors for vascular events after kidney transplantation, but the incidence and magnitude of the risk of major adverse cardiovascular events (MACE) and cardiac deaths remain uncertain in recent era. Methods. A population cohort study of kidney transplant recipients identified using data from linked administrative healthcare databases from Ontario, Canada. The incidence rates of MACE (expressed as events with 95% confidence interval [95% CI] per 1000 person-years were reported according to diabetes status of pretransplant diabetes, NODAT, or no diabetes. Extended Cox regression model was used to examine the association between diabetes status, MACE, and cardiac death. Results. Of 5248 recipients, 1973 (38%) had pretransplant diabetes, and 799 (15%) developed NODAT with a median follow-up of 5.5 y. The incidence rates (95% CI) of MACE for recipients with pretransplant diabetes, NODAT, and no diabetes between 1 and 3 y posttransplant were 38.1 (32.1-45.3), 12.6 (6.3-25.2), and 11.8 (9.2-15.0) per 1000 person-years, respectively. Compared with recipients with pretransplant diabetes, recipients with NODAT experienced a lower risk of MACE (adjusted hazard ratio, 0.59; 95% CI, 0.47-0.74) but not cardiac death (adjusted hazard ratio, 0.97; 95% CI, 0.61-1.55). The rate of MACE and cardiac death was lowest in patients without diabetes. Conclusions. Patients with pretransplant diabetes incur the greatest rate of MACE and cardiac deaths after transplantation. Having NODAT also bears high burden of vascular events compared with those without diabetes, but the magnitude of the increased rate remains lower than recipients with pretransplant diabetes.
    Type of Medium: Online Resource
    ISSN: 0041-1337
    URL: Article
    DOI: 10.1097/TP.0000000000003639
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2035395-9
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  • 2
    Online Resource
    Online Resource
    The Frequency of Routine Blood Sampling and Patient Outcomes Among Maintenance Hemodialysis Recipients
    Elsevier BV ; 2020
    In:  American Journal of Kidney Diseases Vol. 75, No. 4 ( 2020-04), p. 471-479
    Details
    In: American Journal of Kidney Diseases, Elsevier BV, Vol. 75, No. 4 ( 2020-04), p. 471-479
    Type of Medium: Online Resource
    ISSN: 0272-6386
    URL: Article
    DOI: 10.1053/j.ajkd.2019.08.016
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
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  • 3
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    Risk Factors and Outcomes of Early Hospital Readmission in Canadian Kidney Transplant Recipients: A Population-Based Multi-Center Cohort Study
    SAGE Publications ; 2021
    In:  Canadian Journal of Kidney Health and Disease Vol. 8 ( 2021-01), p. 205435812110609-
    Details
    In: Canadian Journal of Kidney Health and Disease, SAGE Publications, Vol. 8 ( 2021-01), p. 205435812110609-
    Abstract: Early hospital readmissions (EHRs) occur commonly in kidney transplant recipients. Conflicting evidence exists regarding risk factors and outcomes of EHRs. Objective: To determine risk factors and outcomes associated with EHRs (ie, hospitalization within 30 days of discharge from transplant hospitalization) in kidney transplant recipients. Design: Population-based cohort study using linked, administrative health care databases. Setting: Ontario, Canada. Patients: We included 5437 kidney transplant recipients from 2002 to 2015. Measurements: Risk factors and outcomes associated with EHRs. We assessed donor, recipient, and transplant risk factors. We also assessed the following outcomes: total graft failure, death-censored graft failure, death with a functioning graft, mortality, and late hospital readmission. Methods: We used multivariable logistic regression to examine the association of each risk factor and the odds of EHR. To examine the relationship between EHR status (yes vs no [reference]) and the outcomes associated with EHR (eg, total graft failure), we used a multivariable Cox proportional hazards model. Results: In all, 1128 kidney transplant recipients (20.7%) experienced an EHR. We found the following risk factors were associated with an increased risk of EHR: older recipient age, lower income quintile, several comorbidities, longer hospitalization for initial kidney transplant, and older donor age. After adjusting for clinical characteristics, compared to recipients without an EHR, recipients with an EHR had an increased risk of total graft failure (adjusted hazard ratio [aHR]: 1.46, 95% CI: 1.29, 1.65), death-censored graft failure (aHR: 1.62, 95% CI: 1.36, 1.94), death with graft function (aHR: 1.34, 95% CI: 1.13, 1.59), mortality (aHR: 1.41, 95% CI: 1.22, 1.63), and late hospital readmission in the first 0.5 years of follow-up (eg, 0 to 〈 0.25 years: aHR: 2.11, 95% CI: 1.85, 2.40). Limitations: We were not able to identify which readmissions could have been preventable and there is a potential for residual confounding. Conclusions: Results can be used to identify kidney transplant recipients at risk of EHR and emphasize the need for interventions to reduce the risk of EHRs. Trial registration: This is not applicable as this is a population-based cohort study and not a clinical trial.
    Type of Medium: Online Resource
    ISSN: 2054-3581 , 2054-3581
    URL: Article
    DOI: 10.1177/20543581211060926
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2765462-X
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  • 4
    Online Resource
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    Childhood food insecurity and incident asthma: A population-based cohort study of children in Ontario, Canada
    Public Library of Science (PLoS) ; 2021
    In:  PLOS ONE Vol. 16, No. 6 ( 2021-6-9), p. e0252301-
    Details
    In: PLOS ONE, Public Library of Science (PLoS), Vol. 16, No. 6 ( 2021-6-9), p. e0252301-
    Abstract: Childhood food insecurity has been associated with prevalent asthma in cross-sectional studies. Little is known about the relationship between food insecurity and incident asthma. Methods We used administrative databases linked with the Canadian Community Health Survey, to conduct a retrospective cohort study of children 〈 18 years in Ontario, Canada. Children without a previous diagnosis of asthma who had a household response to the Household Food Security Survey Module (HFSSM) were followed until March 31, 2018 for new asthma diagnoses using a validated administrative coding algorithm. We used multivariable Cox proportional hazard models to examine the association between food insecurity and incident asthma, and adjusted models sequentially for clinical and clinical/socioeconomic risk factors. As additional analyses, we examined associations by HFSSM respondent type, severity of food insecurity, and age of asthma diagnosis. Moreover, we assessed for interaction between food security and child’s sex, household smoking status, and maternal asthma on the risk of incident asthma. Results Among the 27,746 included children, 5.1% lived in food insecure households. Over a median of 8.34 years, the incidence of asthma was 7.33/1000 person-years (PY) among food insecure children and 5.91/1000 PY among food secure children (unadjusted hazard ratio [HR] 1.24, 95% CI 1.00 to 1.54, p = 0.051). In adjusted analyses associations were similar (HR 1.16, 95% CI 0.91 to 1.47, p = 0.24 adjusted for clinical risk factors, HR 1.24, 95% CI 0.97 to 1.60, p = 0.09 adjusted for clinical/socioeconomic factors). Associations did not qualitatively change by HFSSM respondent type, severity of food insecurity, and age of asthma diagnosis. There was no evidence of interaction in our models. Conclusions Food insecure children have numerous medical and social challenges. However, in this large population-based study, we did not observe that childhood food insecurity was associated with an increased risk of incident asthma when adjusted for important clinical and socioeconomic confounders.
    Type of Medium: Online Resource
    ISSN: 1932-6203
    URL: Article
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    DOI: 10.1371/journal.pone.0252301
    DOI: 10.1371/journal.pone.0252301.t001
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    DOI: 10.1371/journal.pone.0252301.s001
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    DOI: 10.1371/journal.pone.0252301.r001
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    DOI: 10.1371/journal.pone.0252301.r003
    DOI: 10.1371/journal.pone.0252301.r004
    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2021
    detail.hit.zdb_id: 2267670-3
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  • 5
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    Comparison of All-Cause Mortality Between Canadian Kidney Transplant Recipients and Patients With Cancer: A Population-Based Cohort Study
    SAGE Publications ; 2021
    In:  Canadian Journal of Kidney Health and Disease Vol. 8 ( 2021-01), p. 205435812110562-
    Details
    In: Canadian Journal of Kidney Health and Disease, SAGE Publications, Vol. 8 ( 2021-01), p. 205435812110562-
    Abstract: Understanding rates of mortality in kidney transplant recipients relative to other common diseases can enhance our understanding of the mortality burden in kidney transplant recipients. Objective: To compare the survival probability in Canadian female and male kidney transplant recipients with patients with common cancers (female: breast, colorectal, lung, or pancreas; male: prostate, colorectal, lung, or pancreas) in a contemporary population. Design: Population-based cohort study using linked administrative health care databases. Setting: Ontario, Canada. Patients: A total of 6888 incident kidney transplant recipients (median age was 50 and 51 years in females and males, respectively) and a total of 532 452 incident patients with cancer (median age range 60 to 72 years across cancer types) from 1997 to 2015. Measurements: All-cause mortality. Methods: The survival of study participants was described using the Kaplan-Meier product limit estimator. The rate of survival was compared between kidney transplant recipients and patients with cancer using extended Cox regression with a Heaviside function. Results: Kidney transplant recipients had a higher survival probability compared with all cancer types. For example, male kidney transplant recipients had a 5-year survival probability of 89.6% (95% confidence interval [CI]: 88.6%-90.5%) compared with 83.3% (95% CI: 83.1%-83.5%) in patients with prostate cancer, and 14.0% (95% CI: 13.7%-14.3%), 56.1% (95% CI: 55.7%-56.5%), and 9.1% (95% CI: 8.5%-9.7%) in patients with lung, colorectal, and pancreas cancer, respectively. After presenting survival probabilities by age at cohort entry and after adjusting for clinical characteristics, similar results were found with a few exceptions. Unlike the unadjusted analysis, in the adjusted analysis males with prostate cancer had a significantly higher survival compared with kidney transplant recipients and females with breast cancer had higher survival compared with kidney transplant recipients at 2+ years of follow-up. In a subpopulation of the cohort who had information available on cancer stage (ie, stages 1-4), we generally found similar results to our primary analysis with kidney transplant recipients having a higher survival probability compared with each cancer stage. However, female kidney transplant recipients had a lower survival probability compared with females with stage 1 breast cancer, whereas male kidney transplant recipients had a lower survival probability compared with males with stage 1 to 3 prostate cancer. Limitations: External generalizability, residual confounding, and cancer stage could only be provided for a subpopulation. Conclusion: Mortality in kidney transplant recipients is lower than in patients with several cancer types. These results improve our understanding of the mortality burden in this population and reaffirm kidney transplantation as a good treatment option for end-stage kidney disease but also highlight the continuing need to improve posttransplant survival. Trial registration: This is not applicable as this is a population-based cohort study and not a clinical trial.
    Type of Medium: Online Resource
    ISSN: 2054-3581 , 2054-3581
    URL: Article
    DOI: 10.1177/20543581211056234
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2765462-X
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  • 6
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    Taking score of Early Warning Scores
    University of Western Ontario, Western Libraries ; 2021
    In:  University of Western Ontario Medical Journal ( 2021-03-11)
    Details
    In: University of Western Ontario Medical Journal, University of Western Ontario, Western Libraries, ( 2021-03-11)
    Abstract: Early warning scores (EWS) and similar decision aids that rely on patient vital signs to predict patient risk of deterioration may play an important role in mitigating costs incurred as a result of the need to escalate care. Their use on medical and surgical wards as well as in emergency departments has become increasingly common. In these settings EWSs show potential in being able to alert medical staff to patients at high risk allowing for early intervention and increased monitoring in their care. Beyond the predictive ability of EWSs, factors such as institutional capacity, patient characteristics, and staff training on EWS protocols may also play an important role in determining the effectiveness, and consequently the cost effectiveness, of EWSs. If executed appropriately, the preventive opportunities created by EWSs may have substantial benefits for both patients and the healthcare system as a whole. Prudent implementation is therefore essential when introducing new EWSs and future assessments should evaluate these components as well.
    Type of Medium: Online Resource
    ISSN: 2560-8274 , 0042-0336
    URL: Article
    DOI: 10.5206/uwomj.v89i2.10518
    Language: Unknown
    Publisher: University of Western Ontario, Western Libraries
    Publication Date: 2021
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