Estimating renal function before and during pregnancy has clinical importance: kidney dysfunction can affect maternal and perinatal health. Glomerular hyperfiltration is a typical physiological adaptation to pregnancy, reflected by a decrease in levels of serum creatinine (SCr) with advancing gestational age. Creatinine-based equations used to estimate glomerular filtration may misclassify renal function during pregnancy, 1 as they depend on a steady state of creatinine balance. Moreover, a 24-hour collection of urine to measure cre-atinine clearance is impractical. 2 Accordingly, physicians typically rely on SCr level. Previous studies attempted to define a normal SCr level in pregnancy, but they had few participants and may have been confounded by sampling bias. 3,4 The current study was undertaken to generate gestational age-specific estimates of renal function-before, during, and after pregnancy-among women without antecedent kidney disease.
Childhood transplant recipients have a 30-times greater cancer incidence versus the general population. Further investigation is needed to guide screening strategies in this at-risk population.
Background. This is the first time deemed consent, where the entire population of a jurisdiction is considered to have consented for donation unless they have registered otherwise, will be implemented in North America. While relatively common in other regions of the world-notably Western Europe-it is uncertain how this practice will influence deceased donation practices and attitudes in Canada. Methods. We describe a Health Canada funded program of research that will evaluate the implementation process and full impact of the deceased organ donation legislation and the health system transformation in Nova Scotia that includes opt-out consent. Results. There is a need to evaluate the impact of these changes to inform not only Nova Scotia and Atlantic Canada, but also other provincial, national, and international stakeholders. Conclusions. We establish a rigorous academic framework that we will use to evaluate this significant health system transformation.
Background:Many patients who receive chronic hemodialysis have a limited life expectancy comparable to that of patients with metastatic cancer. However, patterns of home palliative care use among patients receiving hemodialysis are unknown.Objectives:We aimed to undertake a current-state analysis to inform measurement and quality improvement in palliative service use in Ontario.Methods:We conducted a descriptive study of outcomes and home palliative care use by Ontario residents maintained on chronic dialysis using multiple provincial healthcare datasets. The period of study was the final year of life, for those died between January 2010 and December 2014.Results:We identified 9611 patients meeting inclusion criteria. At death, patients were (median [Q1, Q3] or %): 75 (66, 82) years old, on dialysis for 3.0 (1.0-6.0) years, 41% were women, 65% had diabetes, 29.6% had dementia, and 13.9% had high-impact neoplasms, and 19.9% had discontinued dialysis within 30 days of death. During the last year of life, 13.1% received ⩾1 home palliative services. Compared with patients who had no palliative services, those who received home palliative care visits had fewer emergency department and intensive care unit visits in the last 30 days of life, more deaths at home (17.1 vs 1.4%), and a lower frequency of deaths with an associated intensive care unit stay (8.1 vs 37.8%).Conclusions:Only a small proportion of patients receiving dialysis in Ontario received support through the home palliative care system. There appears to be an opportunity to improve palliative care support in parallel with dialysis care, which may improve patient, family, and health-system outcomes.
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