Publications by authors named "Gregory Hundemer"
Background: Primary aldosteronism can be treated medically but there is no standardised method to evaluate treatment outcomes. We aimed to develop criteria for assessing the outcomes of targeted medical treatment of primary aldosteronism, analyse outcomes across an international cohort, and identify factors associated with a complete treatment response.
Methods: An international panel of 31 primary aldosteronism experts used the Delphi method to reach consensus on the definition of complete, partial, or absent biochemical and clinical outcomes of medical treatment of primary aldosteronism.
Introduction: Tacrolimus is an immunosuppressant commonly administered in transplant recipients. Given its narrow therapeutic range and susceptibility to various influencing variables, determining its optimal dosage is challenging. This systematic review seeks to identify effective analytical modelling techniques and methods for optimal tacrolimus dose prediction in solid transplant recipients.
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- * A study in Ontario analyzed data from over 6,000 patients with eating disorders, revealing significant correlations between electrolyte issues and increased risks of hospitalization, cardiac events, and mortality.
- * The most common electrolyte abnormalities found were hypokalaemia and hyponatraemia, with those affected showing a higher mortality rate (15.7%) compared to those without such abnormalities (5.6%).
Context: Renin-angiotensin-aldosterone system (RAAS) activation is closely linked to obesity; however, the sex-specific associations between RAAS activity and body composition among individuals without obesity are not well understood.
Objective: To investigate the associations of aldosterone and renin with body composition according to sex in the general population.
Design: Population-based cohort study.
Background: Electrolytes (sodium, potassium, calcium, magnesium, chloride, phosphate) are required in specific amounts for proper functioning of the human body. Although the body has different organ systems, such as the kidneys, that regulate electrolyte levels in the blood, electrolyte abnormalities occur frequently in people with eating disorders. The objective of this review will be to examine the association between electrolyte imbalances and adverse outcomes in people with eating disorders.
View Article and Find Full Text PDFWilson disease is a rare autosomal recessive genetic disorder of copper metabolism that leads to copper accumulation and subsequent organ dysfunction. While classically considered a condition that primarily affects the liver and nervous system, Wilson disease and its treatments can also result in a wide range of kidney complications as well. We present the case of a 31-year-old female with a longstanding (> 10 year) history of Wilson disease who developed acute-onset nephrotic syndrome including heavy proteinuria, hypoalbuminemia, and edema after being transitioned from zinc to D-penicillamine for copper chelation therapy.
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- The study aims to identify significant reductions in estimated glomerular filtration rate (eGFR) among younger adults (<65 years) to help guide prevention strategies for kidney and cardiovascular diseases.
- A retrospective analysis of 8.7 million adults in Ontario, Canada, revealed that lower eGFR percentiles (especially ≤10th) are linked to worse health outcomes, including increased risk of kidney failure and all-cause mortality, particularly in younger individuals.
- Findings suggest that a population-based understanding of eGFR percentiles can enhance the recognition and management of at-risk younger adults, as those with lower eGFR values are often not referred for further evaluation.
Article Synopsis
- The study examines sex-based differences in the evaluation and management of late-onset hypertension among older adults in Ontario, Canada.
- It finds that females and males had similar rates of guideline-recommended investigations and medication prescriptions, indicating no significant disparities in initial hypertension management.
- The research suggests that there are likely no meaningful differences between the sexes in the initial management of late-onset hypertension, which may not explain the observed cardiovascular outcome disparities between genders.
Background: Despite a lack of clinical trial data, β-blockers are widely prescribed to dialysis patients. Whether specific β-blocker agents are associated with improved long-term outcomes compared with alternative β-blocker agents in the dialysis population remains uncertain.
Methods: We analyzed data from an international cohort study of 10 125 patients on maintenance hemodialysis across 18 countries that were newly prescribed a β-blocker medication within the Dialysis Outcomes and Practice Patterns Study (DOPPS).
Article Synopsis
- Clinicians often rely on estimated glomerular filtration rate (eGFR) to guide medication dosing for kidney transplant recipients (KTRs), but the most effective eGFR equations for this purpose are still unclear.
- A study of 415 stable KTRs in Canada and New Zealand compared various eGFR equations, looking at factors such as medication dosing accuracy relative to established metrics like Cockcroft-Gault creatinine clearance and measured GFR.
- Results indicated that using nonindexed eGFR equations (which consider actual body surface area) significantly reduced medication dosing errors, especially in obese patients, and highlighted the superiority of specific recent equations for accurate dosing guidance.
Key Points: Nearly half of all patients with CKD who progress to kidney failure initiate dialysis in an unplanned fashion, which is associated with poor outcomes. Machine learning models using routinely collected data can accurately predict 6- to 12-month kidney failure risk among the population with advanced CKD. These machine learning models retrospectively deliver advanced warning on a substantial proportion of unplanned dialysis events.
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- A study analyzed cardiovascular outcomes in 266,273 older adults (≥66 years) newly diagnosed with hypertension in Ontario, Canada, to understand sex differences.
- Results showed that women had a lower incidence of major cardiovascular events and mortality compared to men over a median follow-up of 6.6 years.
- The findings indicate that sex plays a significant role in cardiovascular risks associated with late-onset hypertension, suggesting the need for tailored approaches in diagnosis and treatment for this demographic.
Background: Equity, diversity and inclusion (EDI) in the healthcare field are crucial in meeting the healthcare needs of a progressively diverse society. In fact, a diverse healthcare workforce enables culturally sensitive care, promotes health equity and enhances the understanding of various needs and patients' viewpoints, potentially resulting in more effective patient treatment and improved patient outcomes. Despite this, information on the effectiveness of policies or programmes promoting EDI in health institutions is scarce.
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- Social determinants of health, like education, employment, marital status, and living situation, significantly affect whether patients with chronic kidney disease choose haemodialysis or peritoneal dialysis.
- A study of 981 patients showed that lower levels of education and being unemployed reduced the likelihood of selecting peritoneal dialysis, while being single and living alone also had similar negative impacts on this decision.
- The findings suggest that addressing these social factors could help improve access and outcomes for patients transitioning from advanced chronic kidney disease to kidney failure.
Purpose Of Review: The conventional definition of chronic kidney disease (CKD) primarily relies on the identification of albuminuria or a decline in estimated glomerular filtration rate (eGFR). For many years, a straightforward eGFR threshold of <60 ml/min/1.73 m 2 has been widely adopted as the standard for defining CKD.
View Article and Find Full Text PDFBackground: Primary aldosteronism, characterized by overt renin-independent aldosterone production, is a common but underrecognized form of hypertension and cardiovascular disease. Growing evidence suggests that milder and subclinical forms of primary aldosteronism are highly prevalent, yet their contribution to cardiovascular disease is not well characterized.
Methods: This prospective study included 1284 participants between the ages of 40 and 69 years from the randomly sampled population-based CARTaGENE cohort (Québec, Canada).
Background: Despite efforts to provide evidence-based care for people living with kidney disease, health care provider goals and priorities are often misaligned with those of individuals with lived experience of disease. Coupled with competing interests of time, resources, and an abundance of suitable guideline topics, identifying and prioritizing areas of focus for the Canadian nephrology community with a patient-oriented perspective is necessary and important. Similar priority-setting exercises have been undertaken to establish research priorities for kidney disease and to standardize outcomes for kidney disease research and clinical care; however, research priorities are distinct from priorities for guideline development.
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