Adeera Levin

• MD FRCPC
• Division Head at University of British Columbia

Objective To evaluate the work productivity loss in people experiencing long COVID symptoms more than two years after infection. Methods In a cross-sectional study, employed adults from British Columbia (BC), Canada, who had a PCR-confirmed SARS-CoV-2 infection more than two years earlier, completed an online survey incorporating the Valuation of...

There are known sex (i.e., biological) and gender (i.e., social) differences in the epidemiology and outcomes of chronic kidney disease. In this issue of the JCI, van Eeghen et al. provide a prospective multicenter observational study of transgender individuals initiating masculinizing and feminizing hormone therapy. Testosterone and estrogen with...

Background Evidence to guide use of apixaban in people with atrial fibrillation (AF) and chronic kidney disease (CKD) in routine clinical practice has been limited. We assessed comparative safety (major bleeding) and effectiveness (ischemic stroke and death) of apixaban versus warfarin in patients with AF across the spectrum of non-dialysis-depende...

Background We investigated the long-term effect of COVID-19 on 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 pr...

A core feature of universal health coverage is equitable access to affordable care not exposing people to financial hardship. This study aims to provide a global overview on availability and access to medications and health technologies for delivery of optimal kidney care. An international survey of stakeholders (clinicians, policymakers, and patie...

Background Sodium-glucose co-transporter-2 (SGLT2) inhibitors improve glycemia and reduce insulin requirements in type 1 (T1D) and type 2 (T2D) diabetes. While SGLT2 inhibitors lower cardiovascular disease (CVD) and end-stage kidney disease (ESKD) risk in T2D, no dedicated cardiorenal outcome trials in T1D have been done to date. Using validated ri...

Introduction Symptoms from post COVID-19 condition (PCC) can impair functioning in working-age adults. However, there is uncertainty about the relationship between PCC and work outcomes. This study aimed to assess health-related adverse work outcomes in individuals with a PCC history compared with others who had COVID-19. Methods This was a cross-...

Chronic kidney disease (CKD) is defined by persistent abnormalities of kidney function or structure that have consequences for the health. A progressive decline of excretory kidney function has effects on body homeostasis. CKD is tightly associated with accelerated cardiovascular disease and severe infections, and with premature death. Kidney failu...

Aim SGLT2 inhibitors may be underused in older adults with type 2 diabetes due to concerns about safety and tolerability. This pooled analysis of the CANVAS Program and CREDENCE trial examined the efficacy and safety of canagliflozin according to age. Methods Pooled individual participant data from the CANVAS Program ( n = 10 142) and CREDENCE tri...

Vulnerable populations, such as the elderly, children, displaced people, and refugees, often encounter challenges in accessing healthcare. In this study, we used data from the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to describe kidney care access and delivery to vulnerable populations across...

Chronic kidney disease (CKD) disproportionately affects certain populations as demonstrated by well-established subnational geographic hotspots of CKD in Central America and South Asia. Using data from the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA), we aimed to systematically identify sub-nation...

In low- and lower-middle-income countries (LLMICs), delivering equitable kidney care presents substantial challenges, resulting in significant disparities in disease management and treatment outcomes for people with kidney failure. This comprehensive report leveraged data from the International Society of Nephrology-Global Kidney Health Atlas (ISN-...

Background National strategies to address chronic kidney disease (CKD) are crucial to support kidney health. Lack of political support in the form of policy decisions and funding leads to fragmentation of kidney care and catastrophic health expenditure. This study used data from the third iteration of the International Society of Nephrology Global...

Background Empagliflozin exerted positive cardiorenal effects in the EMPA-KIDNEY trial; this study reports active trial plus post-trial data. Methods In this trial, patients with an estimated glomerular filtration rate 20-<45; or 45-<90mL/min/1.73m² and urinary albumin-to-creatinine ratio of ≥200mg/g received either empagliflozin 10mg daily or mat...

Background: Patients with IgA nephropathy and severe proteinuria have a high lifetime risk of kidney failure. The efficacy and safety of the selective endothelin type A receptor antagonist atrasentan in reducing proteinuria in patients with IgA nephropathy are incompletely understood. Methods: We are conducting a phase 3, multinational, double-b...

Acute kidney injury (AKI) is a significant cause of morbidity and mortality, especially in low and lower-middle income countries. Data from the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) were used to evaluate the organization of structures and services for the provision of AKI care in world coun...

OBJECTIVE To assess changes in key measures of kidney care using data reported in 2019 and 2023. DESIGN Cross sectional survey in 148 countries. SETTING Surveys from International Society of Nephrology Global Kidney Health Atlas between 2019 and 2023 that included participants from countries in Africa (n=36), Eastern and Central Europe (n=16), Lati...

Aim Optimal care for patients with kidney failure reduces the risks of adverse health outcomes, including cardiovascular events and death. We evaluated data from the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN‐GKHA) to assess the capacity for quality service delivery for kidney failure care across coun...

Introduction Endothelin A (ETA) receptor activation is a driver of proteinuria, kidney inflammation, and fibrosis in IgA nephropathy (IgAN). Atrasentan, a selective ETA receptor antagonist, has potential to reduce proteinuria and preserve kidney function in IgAN. ALIGN (NCT04573478) is a phase 3, randomized, double-blind, placebo-controlled clinica...

Background and hypothesis Hyperuricaemia and gout are common in chronic kidney disease (CKD). We aimed to assess the effects of sodium-glucose co-transporter-2 (SGLT2) inhibition on uric acid (urate) and gout in patients with CKD. Methods The EMPA-KIDNEY trial randomised 6609 patients with CKD (estimated glomerular filtration rate [eGFR] ≥20 and <...

Background An adequate workforce is needed to guarantee optimal kidney care. We used the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to provide an assessment of the global kidney care workforce. Methods We conducted a multinational cross-sectional survey to evaluate the global capacity of kidney care and assessed data...

Background Worldwide, the uptake of peritoneal dialysis (PD) compared with hemodialysis remains limited. This study assessed organizational structures, availability, accessibility, affordability and quality of PD worldwide. Methods This cross-sectional study relied on data from kidney registries as well as survey data from stakeholders (clinicians...

Background Hemodialysis (HD) is the most commonly utilized modality for kidney replacement therapy worldwide. This study assesses the organizational structures, availability, accessibility, affordability and quality of HD care worldwide. Methods This cross-sectional study relied on desk research data as well as survey data from stakeholders (clini...

Background Data monitoring and surveillance systems are the cornerstone for governance and regulation, planning, and policy development for chronic disease care. Our study aims to evaluate health systems capacity for data monitoring and surveillance for kidney care. Methods We leveraged data from the third iteration of the International Society of...

Background Kidney transplantation (KT) is the preferred modality of kidney replacement therapy with better patient outcomes and quality of life compared with dialytic therapies. This study aims to evaluate the epidemiology, accessibility and availability of KT services in countries and regions around the world. Methods This study relied on data fr...

Background Conservative kidney management (CKM) describes supportive care for people living with kidney failure who choose not to receive or are unable to access kidney replacement therapy (KRT). This study captured the global availability of CKM services and funding. Methods Data came from the International Society of Nephrology Global Kidney Hea...

Background Governance, health financing, and service delivery are critical elements of health systems for provision of robust and sustainable chronic disease care. We leveraged the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to evaluate oversight and financing for kidney care worldwide. Methods...

Background Many questions remain about the maintenance dialysis population who survived COVID-19. Previous literature has focused on outcomes associated with the initial SARS-CoV-2 infection but it may underestimate the impact of disease. This study describes the long-term morbidity and mortality among patients receiving maintenance dialysis in Ont...

Background Home dialysis therapies have limited uptake in most regions despite recognized benefits such as increasing patients’ independence, and several domains of quality of life with cost savings in some systems. Objective To perform a scoping review of published literature to identify tools and guides used in systematically screening and asses...

Introduction The TESTING trial demonstrated that corticosteroids reduce the risk of kidney failure in patients with IgA nephropathy (IgAN) but increase the risk of serious adverse events. Reliable noninvasive biomarkers are needed to identify patients who would benefit most from corticosteroid therapy. Previous studies suggest glomerular macrophage...

Aim To explore the effect of canagliflozin on kidney and cardiovascular events and safety outcomes in individuals with type 2 diabetes and chronic kidney disease across geographic regions and racial groups. Materials and Methods A stratified Cox proportional hazards model was used to assess efficacy and safety outcomes by geographic region and rac...

Inflammation mediated by interleukin-6 (IL-6) is strongly associated with cardiovascular risk. Here we evaluated clazakizumab, a monoclonal antibody targeting the IL-6 ligand, in a phase 2b dose-finding study. Adults with cardiovascular disease and/or diabetes receiving maintenance dialysis with high-sensitivity C-reactive protein (hs-CRP) ≥ 2 mg l...

Background There is a lack of contemporary data describing global variations in vascular access for hemodialysis (HD). We used the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to highlight differences in funding and availability of hemodialysis accesses used for initiating HD across world regions....

Introduction Kidney failure treated with hemodialysis (HD), or peritoneal dialysis (PD) is a major global health problem that is associated with increased risks of death and hospitalization. This study aimed to compare the incidence and causes of death and hospitalization during the first year of HD or PD among countries. Methods The third iterati...

Purpose of Review Chronic kidney disease (CKD)-associated pruritus is a common, persistent, and distressing itch experienced by patients across the CKD spectrum. Although the disorder is associated with adverse outcomes and poor health-related quality of life, it remains underdiagnosed and undertreated. The purpose of this narrative review is to of...

Background People living with chronic kidney disease (CKD) face an increased risk of severe outcomes such as hospitalization or death from COVID-19. COVID-19 vaccination is a vital approach to mitigate the risk and severity of infection in patients with CKD. Limited information exists regarding the factors that shape COVID-19 vaccine uptake, includ...

Introduction The therapeutic effects of steroids in immunoglobulin A nephropathy (IgAN) global (TESTING) study reported that methylprednisolone reduces the risk of major kidney events in individuals with IgAN at high risk of disease progression compared to supportive care alone but is associated with increased serious adverse events (SAEs) primaril...

Importance Psychiatric symptoms are reportedly common among adults with post–COVID-19 condition (PCC). However, nationally representative data regarding symptom prevalence, treatment uptake, and barriers to care are needed to inform the development of care models. Objectives To evaluate the prevalence of psychiatric symptoms in US adults with PCC...

Background Malnutrition and protein-energy wasting (PEW) are nutritional complications of advanced chronic kidney disease (CKD) that contribute to morbidity, mortality, and decreased quality of life. No previous studies have assessed the effect of oral nutritional supplements (ONSs) on patient-reported symptom burden among patients with non-dialysi...

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. C...

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 In the context of the novel coronavirus (COVID-19), the service for RACE was expanded to include a Long-COVID RACE line. 1 We report here the types and frequencies of questions asked to...

Background Chronic kidney disease (CKD) is associated with a lower serologic response to vaccination compared to the general population. There is limited information regarding the serologic response to coronavirus disease 2019 (COVID-19) vaccination in the non-dialysis-dependent CKD (NDD-CKD) population, particularly after the third dose and whethe...

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 t...

OBJECTIVE The study was undertaken because it was unknown whether the duration of type 2 diabetes modifies the effects of sodium–glucose cotransporter 2 inhibitor canagliflozin on cardiovascular (CV) and kidney outcomes. RESEARCH DESIGN AND METHODS This post hoc analysis of the CANagliflozin cardioVascular Assessment Study (CANVAS) Program (N = 10...

BACKGROUND: This study evaluated the effects of canagliflozin in patients with type 2 diabetes with and without prevalent cardiovascular disease (secondary and primary prevention). METHODS AND RESULTS: This was a pooled participant-level analysis of the CANVAS (Canagliflozin Cardiovascular Assessment Study) Program and CREDENCE (Canagliflozin and R...

Background and hypothesis Kidney Failure Risk Equation(KFRE) can play a better role in vascular access(VA) planning in patients with CKD requiring hemodialysis(HD). We described the eGFR referral-based VA creation and utilization pattern and investigated the utility of KFRE score as an adjunct variable in VA planning. Methods Patients with CKD age...

Background Care gaps remain in modern health care despite the availability of robust, evidence-based medications. Although sodium-glucose cotransporter-2 (SGLT2) inhibitors have demonstrated profound benefits in improving both cardiovascular and kidney outcomes in patients, the uptake of these medications remain suboptimal, and the causes have not...

Background Following onset of the COVID-19 pandemic, chronic kidney disease (CKD) clinics in BC shifted from established methods of mostly in-person care delivery to virtual care (VC) and thereafter a hybrid of the two. Objectives To determine strengths, weaknesses, quality-of-care delivery, and key considerations associated with VC usage to infor...

Many COVID-19 survivors have post-COVID-19 conditions, and females are at a higher risk. We sought to determine (1) how protein levels change from acute to post-COVID-19 conditions, (2) whether females have a plasma protein signature different from that of males, and (3) which biological pathways are associated with COVID-19 when compared to restri...

Aim Vascular and peritoneal access are essential elements for sustainability of chronic dialysis programs. Data on availability, patterns of use, funding models, and workforce for vascular and peritoneal accesses for dialysis at a global scale is limited. Methods An electronic survey of national leaders of nephrology societies, consumer representa...

Background There is a lack of randomized controlled trial data regarding differences in immunogenicity of varying COVID-19 mRNA vaccine regimens in chronic kidney disease (CKD) populations. Methods We conducted a randomized controlled trial at three kidney centres in Toronto, Ontario, Canada evaluating the SARS-CoV-2 antibody response following th...

Importance Chronic kidney disease (low estimated glomerular filtration rate [eGFR] or albuminuria) affects approximately 14% of adults in the US. Objective To evaluate associations of lower eGFR based on creatinine alone, lower eGFR based on creatinine combined with cystatin C, and more severe albuminuria with adverse kidney outcomes, cardiovascul...

Neutralization of Omicron subvariants by different bivalent vaccines has not been well evaluated. This study characterizes neutralization against Omicron subvariants in 98 individuals on dialysis or with a kidney transplant receiving the BNT162b2 (BA.4/BA.5) or mRNA-1273 (BA.1) bivalent COVID-19 vaccine. Neutralization against Omicron BA.1, BA.5, B...