Arsh K Jain

London Health Sciences Centre · Department of Medicine

Background This study investigated the association of intra-abdominal adhesions with the risk of peritoneal dialysis (PD) catheter complications. Methods Individuals undergoing laparoscopic PD catheter insertion were prospectively enrolled from eight centers in Canada and the United States. Patients were grouped based on the presence of adhesions...

Background: Nirmatrelvir/Ritonavir was approved for use in high risk outpatients with coronavirus disease 2019 (COVID-19). However, patients with severe chronic kidney disease, were excluded from the phase 3 trial, and the drug is not recommended for those with a glomerular filtration rate < 30 ml/min/1.73m2. Based on available pharmacological dat...

Purpose of review: Outpatient hyperkalemia is a common problem with potentially deadly consequences. Potassium level thresholds to treat outpatient hyperkalemia are unstandardized and variable, leaving health care providers to rely on their own clinical judgment. This narrative review highlights the challenges of outpatient hyperkalemia management...

Background Haemodialysis centres have conventionally provided maintenance haemodialysis using a standard dialysate temperature (eg, 36·5°C) for all patients. Many centres now use cooler dialysate (eg, 36·0°C or lower) for potential cardiovascular benefits. We aimed to assess whether personalised cooler dialysate, implemented as centre-wide policy,...

Background: Obesity is, directly and indirectly, linked to the progression of chronic kidney disease (CKD). However, nephrologists' recognition of obesity and willingness to address and manage obesity are unknown. Objectives: The aim of this article is to investigate if obesity is recognized and documented in the clinical encounter and to examin...

Background While home dialysis therapies are more cost effective and may offer improved health-related quality of life, uptake compared to in-center hemodialysis remains low. Objective To test whether a web-based interactive health communication application (IHCA) compared to usual care would increase home dialysis use. Design Randomized control...

Background Small randomized trials demonstrated that a lower compared with higher dialysate temperature reduced the average drop in intradialytic blood pressure. Some observational studies demonstrated that a lower compared with higher dialysate temperature was associated with a lower risk of all-cause mortality and cardiovascular mortality. There...

Background: Small randomized trials demonstrated that a lower compared with higher dialysate temperature reduced the average drop in intradialytic blood pressure. Some observational studies demonstrated that a lower compared with higher dialysate temperature was associated with a lower risk of all-cause mortality and cardiovascular mortality. There...

Background Peritoneal dialysis (PD) is a more cost-effective therapy to treat kidney failure than in-center hemodialysis, but successful therapy requires a functioning PD catheter that causes minimal complications. In 2015, the North American Chapter of the International Society for Peritoneal Dialysis established the North American PD Catheter Reg...

Background and objectives: Current dosing recommendations for cephalosporin antibiotics are on the basis of pharmacokinetic studies and are frequently ignored in practice. This study was undertaken to investigate the clinical outcomes of failing to dose-reduce cephalosporin antibiotics in CKD. Design, setting, participants, & measurements: Retro...

Background: In primary care, patients with chronic kidney disease (CKD) are frequently prescribed excessive doses of antibiotics relative to their kidney function. We examined whether nephrology comanagement is associated with improved prescribing in primary care. Methods: In a retrospective propensity score-matched cross-sectional study, we stu...

Background: Beginning in February 2012, there was a shortage of injectable furosemide in the province of Ontario, Canada. The objective of this study was to assess the effects of the furosemide shortage on heart failure outcomes in Ontario, Canada. Methods: We determined which hospitals experienced a shortage of injectable furosemide using an on...

Antihypertensives are widely prescribed and could influence kidney stone risk by altering urinary calcium excretion. However, the impact of different classes of antihypertensives on kidney stone risk is unknown. To assess this impact, we conducted a retrospective, population-based cohort study using linked health administrative databases. Individua...

Background: Readmissions following hospital discharge among maintenance dialysis patients are common, potentially modifiable, and costly. Compared with patients receiving in-center hemodialysis (HD), patients receiving peritoneal dialysis (PD) have fewer routine dialysis clinic encounters and as a result may be more susceptible to a hospital readm...

Background Despite many advantages over facility-based therapies, less than 25 % of prevalent dialysis patients in Ontario are on a home therapy. Interactive health communication applications, web-based packages for patients, have been shown to have a beneficial effect on knowledge, social support, self-efficacy, and behavioral and clinical outcome...

Background The use of an incremental peritoneal dialysis (PD) strategy in a large contemporary patient population has not been described. Objective We report the use of this strategy in clinical practice, the prescriptions required, and the clearances achieved in a large center which has routinely used this approach for more than 10 years. Design...

Several pharmacological options are available for bowel preparation prior to colonoscopy. Isosmotic and non-absorbable options such as polyethlyene glycol (PEG) with balanced electrolyte solution are poorly palatable, but because they do not cause fluid shifts into the bowel they are considered safe for patients with low glomerular filtration rates...

Purpose of review: Acute kidney injury (AKI) is an increasingly common problem among hospitalized patients. Patients who survive an AKI-associated hospitalization are at higher risk of de novo and worsening chronic kidney disease, end-stage kidney disease, cardiovascular disease, and death. For hospitalized patients with dialysis-requiring AKI, ou...

Background/aims: Some angiotensin converting enzyme (ACE) inhibitors are efficiently removed from circulation by hemodialysis ('high dialyzability'), whereas others are not ('low dialyzability'). In patients receiving hemodialysis, this may influence the effectiveness of ACE inhibitors. Methods: Using linked healthcare databases we identified ol...

Background: Acute kidney injury (AKI) complicates 15-20% of hospitalizations, and AKI survivors are at increased risk of chronic kidney disease and death. However, less than 20% of patients see a nephrologist within 3 months of discharge, even though a nephrologist visit within 90 days of discharge is associated with enhanced survival. To address...

Neutral-pH, low-glucose degradation products solutions were developed in an attempt to lessen the adverse effects of conventional peritoneal dialysis solutions. A systematic review was performed evaluating the effect of these solutions on residual renal function, urine volume, peritoneal ultrafiltration, and peritoneal small-solute transport (dialy...

The antibiotic nitrofurantoin is commonly used to treat uncomplicated urinary tract infections. However, when this drug is used by patients with reduced kidney function, its urine concentration may be subtherapeutic. We conducted a population-based study of older women (mean age 79 years) in Ontario, Canada, whose estimated glomerular filtration ra...

Background Atenolol and metoprolol tartrate are commonly prescribed β-blockers. Atenolol elimination depends on kidney function, whereas metoprolol tartrate does not. We hypothesized that compared to metoprolol tartrate, initiating oral atenolol treatment would be associated with more adverse events in older adults, with the association most pronou...

The likelihood of peritoneal dialysis (PD) utilization following a PD catheter insertion attempt is poorly described. We explored the risk factors for PD nonuse, focusing on the method of PD catheter implantation. This population-based retrospective cohort study employed Ontario administrative health data to identify 3886 predialysis adults who had...

Early detection and treatment of chronic kidney disease (CKD) is important for slowing progression to renal failure and preventing cardiovascular events, but CKD is often not recognized and patients are referred to nephrologists too late for timely management. Automated laboratory reporting of estimated glomerular filtration rate (eGFR) has been in...

Objective To characterize the 90-day risk of hospitalization with pneumonia among patients treated with different anti-hypertensive drug classes. Design Population based cohort study using five linked databases. Participants Individuals over the age of 65 who filled a new outpatient prescription for one of four anti-hypertensive medications: ACE...

Background Standard doses of histamine2-receptor antagonists (H2RAs) may induce altered mental status in older adults, especially in those with chronic kidney disease (CKD). Methods Population-based cohort study of older adults who started a new H2RA between 2002 and 2011 was conducted. Ninety percent received the current standard H2RA dose in rou...

In recent years, there is an impression that there has been increasing use of tidal prescriptions in automated peritoneal dialysis (APD). This is occurring despite the evidence that tidal peritoneal dialysis (TPD) does not enhance peritoneal clearances (1,2). The trend to use more TPD is likely being driven by high rates of what is known as “drain...

Background Many older patients have chronic kidney disease (CKD), and a lower dose of anti-depressants paroxetine, mirtazapine and venlafaxine is recommended in patients with CKD to prevent drug accumulation from reduced elimination. Using information available in large population-based healthcare administrative databases, we conducted this study t...

Some studies but not others suggest angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) use prior to major surgery associates with a higher risk of postoperative acute kidney injury (AKI) and death. We conducted a large population-based retrospective cohort study of patients aged 66 years or older who received major...

Objectives: Bowel preparations are commonly prescribed drugs. Case reports and our clinical experience suggest that sodium picosulfate bowel preparations can precipitate severe hyponatremia in some older adults. At present, this risk is poorly quantified. We investigated the association between sodium picosulfate use and the risk of hyponatremia i...

Several observational studies of hemodialysis patients show an association between early dialysis therapy initiation and increased mortality. Few studies have examined this association among peritoneal dialysis patients. Retrospective cohort study. A cohort of 8,047 incident peritoneal dialysis patients who started dialysis therapy in 2001-2009 and...

The effect of surgeons' disrupted sleep on patient outcomes is not clearly defined. To assess if surgeons operating the night before have more complications of elective surgery performed the next day. Population-based, matched, retrospective cohort study using administrative health care databases in Ontario, Canada (2012 population, 13,505,900). Pa...

Prescribing excessive doses of oral antibiotics is common in chronic kidney disease (CKD) and in this population is implicated in more than one-third of preventable adverse drug events. To improve the care of patients with CKD, many ambulatory laboratories now report estimated glomerular filtration rate (eGFR). We sought to describe the rate of amb...

Early detection of CKD is important for slowing progression to renal failure and preventing cardiovascular events. Automated laboratory reporting of estimated GFR (eGFR) has been introduced in many health systems to improve CKD recognition, but its effect in large, United States-based health systems remains unclear. Using Veterans Affairs (VA) labo...

To evaluate the validity of the International Classification of Diseases, 10th Revision (ICD-10) diagnosis code for hyponatraemia (E87.1) in two settings: at presentation to the emergency department and at hospital admission. Population-based retrospective validation study. Twelve hospitals in Southwestern Ontario, Canada, from 2003 to 2010. Patien...

Evaluate the validity of the International Classification of Diseases, 10th revision (ICD-10) code for hyperkalaemia (E87.5) in two settings: at presentation to an emergency department and at hospital admission. Population-based validation study. 12 hospitals in Southwestern Ontario, Canada, from 2003 to 2010. Elderly patients with serum potassium...

Acute kidney injury is a serious complication of elective major surgery. Acute dialysis is used to support life in the most severe cases. We examined whether rates and outcomes of acute dialysis after elective major surgery have changed over time. We used data from Ontario's universal health care databases to study all consecutive patients who had...

In the last 15 years in Canada, there have been less stringent guidelines for peritoneal dialysis (PD) adequacy, availability of novel PD solutions, and lower PD-related peritonitis rates. Effects of these changes on outcomes of incident patients treated with PD during this period are unknown. Risk of PD technique failure and mortality were compare...

Many guidelines suggest that angiotensin-converting enzyme inhibitors and angiotensin-II receptor antagonists (collectively referred to as renin, angiotensin, aldosterone system blockers (RAAS blockers)) are the preferred treatment for hypertension in most patients with chronic kidney disease (CKD). Improving the recognition of CKD with the introdu...

Although there is a perception that the use of peritoneal dialysis is declining worldwide, compilations of global data are unavailable to test this hypothesis. We assessed longitudinal trends in the use of peritoneal dialysis from 1997 to 2008 in 130 countries. The preferred data sources were renal registries, followed by nephrology societies, heal...

The Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines suggest that clinicians use the estimated glomerular filtration rate (eGFR) measurements and minimize the use of timed urine creatinine clearance collection. The intent of this change was to improve recognition of chronic kidney disease. Here we used time-series modeling and interve...

Clinical decision support systems (CDSSs) have the potential to improve kidney-related drug prescribing by supporting the appropriate initiation, modification, monitoring, or discontinuation of drug therapy. Systematic review. We identified studies by searching multiple bibliographic databases (eg, MEDLINE and EMBASE), conference proceedings, and r...

Rapid kidney function decline (RKFD) predicts cardiovascular morbidity and mortality, but serial assessment of estimated GFR (eGFR) is not cost-effective for the general population. Here, we evaluated the predictive value of albuminuria and three thresholds of dipstick proteinuria to identify RKFD in 2,574 participants in a community-based prospect...

Statins abrogate ischemic renal injury in animal studies but whether they are renoprotective in humans is unknown. We conducted a population-based retrospective cohort study that included 213,347 older patients who underwent major elective surgery in the province of Ontario, Canada from 1995 to 2008. During the first 14 postoperative days, 1.9% (40...

Many laboratories now report estimated glomerular filtration rate (eGFR) when a serum creatinine measurement is ordered. A summary of the impact of eGFR reporting in health care systems around the world for which it has been adopted is lacking. Systematic review of MEDLINE, EMBASE, other major databases, and conference proceedings of major nephrolo...

Little evidence justifies the avoidance of glyburide in patients with impaired renal function. We aimed to determine if renal function modifies the risk of hypoglycaemia among patients using glyburide. We conducted a nested case-control study using administrative records and laboratory data from Ontario, Canada. We included outpatients 66 years of...

The simultaneous use of beta adrenergic receptor blockers (beta-blockers) and trimethoprim-sulfamethoxazole (TMP-SMX) may confer a high risk of hyperkalemia. Two nested case-control studies were conducted to examine the association between hospitalization for hyperkalemia and the use of TMP-SMX in older patients receiving beta-blockers. Linked heal...

Laboratory reporting of estimated glomerular filtration rate (GFR) has been widely implemented, with limited evaluation. To examine trends in nephrologist visits and health care resource use before and after estimated GFR reporting. Community-based cohort study (N = 1,135,968) with time-series analysis. Participants were identified from a laborator...

Randomized trials provide high-quality evidence for patient care. The Der Deutsche Diabetes Dialyse Studie (4D), a randomized study which demonstrated no benefit of statins among diabetic patients receiving hemodialysis, was published in July 2005. To determine effects of this study we conducted a retrospective, population-based, time series analys...

Serum creatinine alone can be difficult to interpret as a measure of kidney function such that chronic kidney disease might be under-recognized in the general population. In the province of Ontario, Canada, all outpatient laboratories now report estimated glomerular filtration rate (eGFR) in addition to serum creatinine. To determine the impact of...

Previous studies indicate that fluid loss during dialysis occurs from the leg extracellular fluid (ECF) maintaining the central blood volume (CBV). Our goal was to determine change in ECF and intracellular fluid (ICF) volumes for the segments of the body throughout the inter-dialytic period. Six conventional and five daily subjects on hemodialysis...