Publications by authors named "Jennifer Macrae"
Article Synopsis
- - Exercise can significantly benefit people on peritoneal dialysis (PD), but there's limited understanding among PD clinicians about how to effectively counsel patients on exercise.
- - A survey distributed to 609 PD clinicians revealed their desire for individualized and accessible exercise programs, highlighting specific exercises, overcoming barriers, and patient-relevant outcomes.
- - Clinicians recognize that PD patients can and should participate in exercise, valuing the role of exercise professionals, but emphasize the need for better education on exercise safety and benefits to promote widespread acceptance.
Article Synopsis
- * The study included 60 adult patients starting hemodialysis in Alberta, Canada, examining the effects of sex assigned at birth and gender identity on changes in physical and mental health quality of life over three months.
- * Results showed that women on conventional hemodialysis experienced improved physical health, while those on incremental hemodialysis noted better mental health; no changes were seen in male participants regardless of the type of hemodialysis.
Background: It is unclear whether the use of higher dialysate bicarbonate concentrations is associated with clinically relevant changes in the pre-dialysis serum bicarbonate concentration.
Objective: The objective is to examine the association between the dialysate bicarbonate prescription and the pre-dialysis serum bicarbonate concentration.
Design: This is a retrospective cohort study.
Introduction: There is little evidence on the ideal frequency of routine blood work in maintenance dialysis patients to manage complications, including anemia, mineral bone disease (MBD), and hyperkalemia. Recent quality improvement studies from Ontario showed no negative impacts when decreasing the frequency from monthly to every 6 weeks in conventional in-center hemodialysis (ICHD) patients. In December 2020, Alberta Kidney Care-South (AKC-S) reduced the frequency of routine blood work from every 6 weeks to every 8 weeks for ICHD patients.
View Article and Find Full Text PDFImportance: People with kidney failure receiving maintenance dialysis visit the emergency department (ED) 3 times per year on average, which is 3- to 8-fold more often than the general population. Little is known about the factors that contribute to potentially preventable ED use in this population.
Objective: To identify the clinical and sociodemographic factors associated with potentially preventable ED use among patients receiving maintenance dialysis.
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.
Methods: Survey questions were directed at understanding the funding modules for obtaining vascular access and types of accesses used to initiate dialysis.
Background: People receiving hemodialysis experience high symptom burden that contributes to low functional status and poor health-related quality of life. Management of symptoms is a priority for individuals receiving hemodialysis but limited effective treatments exist. There is emerging evidence that exercise programming can improve several common dialysis-related symptoms.
View Article and Find Full Text PDFArticle Synopsis
- Low physical activity and functional impairment are common among people on peritoneal dialysis (PD), but exercise can improve their physical and mental health.
- A survey of 108 PD patients, mainly from Canada and the UK, revealed that most are aware of exercise benefits and 71% engage in physical activity regularly, though there are significant inconsistencies in advice received about safe exercises.
- Gaps in knowledge among healthcare providers and patients highlight the need for better education and evidence-based guidelines regarding exercise, particularly concerning weightlifting, fluid management, and swimming activities.
Background: Individuals receiving hemodialysis often experience concurrent symptoms during treatment and frequently report feeling unwell after dialysis. The degree to which intradialytic symptoms are related, and which specific symptoms may impair health-related quality of life (HRQoL) is uncertain.
Objectives: To explore intradialytic symptoms clusters, and the relationship between intradialytic symptom clusters with dialysis treatment recovery time and HRQoL.
Background: Early interventions in CKD have been shown to improve health outcomes; however, gaps in access to nephrology care remain common. Nurse practitioners can improve access to care; however, the quality and outcomes of nurse practitioner care for CKD are uncertain.
Methods: In this propensity score-matched cohort study, patients with CKD meeting criteria for nurse practitioner care were matched 1:1 on their propensity scores for ( 1 ) nurse practitioner care versus primary care alone and ( 2 ) nurse practitioner versus nephrologist care.
Article Synopsis
- Updates to the Kidney Disease Outcomes Quality Initiative highlight the importance of collaborative decision-making in vascular access (VA) for patients undergoing hemodialysis, but little is known about how patients, caregivers, and healthcare providers engage in this process.
- A qualitative study was conducted with 42 participants, including patients, caregivers, and healthcare providers, at five hemodialysis centers in Calgary to understand their perspectives on VA selection.
- While some views aligned on optimizing patient preparedness and the importance of trusting relationships, significant differences were noted in priorities, experiences influencing decisions, and endpoints for reviewing VA choices.
Article Synopsis
- - This review aimed to identify and evaluate physical function tests for standardized use in chronic kidney disease (CKD) to improve evidence synthesis in clinical settings.
- - Researchers analyzed 50 studies involving over 21,000 participants and found that the Short Physical Performance Battery (SPPB), Timed-up-and-go (TUG), and Sit-to-stand tests showed favorable clinimetric properties for CKD assessment.
- - The SPPB was highlighted as having the strongest evidence for reliability and validity among various physical function tests, emphasizing the need for standardization of measurement tools in CKD research and clinical practice.
Background: Modality transitions represent a period of significant change that can impact health related quality of life (HRQoL). We explored the HRQoL of adults transitioning to new or different dialysis modalities.
Methods: We recruited eligible adults (≥ 18) transitioning to dialysis from pre-dialysis or undertaking a dialysis modality change between July and September 2017.
Article Synopsis
- - Despite evidence showing that exercise improves physical function and quality of life for people with chronic kidney disease, dedicated exercise programs are not standard in kidney care.
- - The review investigates barriers to integrating exercise rehabilitation into kidney care by comparing it with other chronic illness management practices, highlighting what needs to change for better acceptance.
- - For exercise to be a sustainable part of kidney care, it’s crucial to focus on outcomes valued by patients, apply effective implementation strategies, and treat exercise as a legitimate medical treatment.
Article Synopsis
- Low physical activity and poor function are linked to higher risks of complications and mortality in patients on peritoneal dialysis (PD), making exercise crucial for maintaining their independence.
- A global survey of PD clinicians revealed that a significant majority (94%) support structured exercise programs for PD patients and believe they can safely engage in physical activities.
- Clinicians from lower middle-income countries are more likely to encourage physical activity compared to those from high-income countries, highlighting the need for better exercise counseling and structured plans in PD care.
Background: Patient-reported outcomes (PROs) are increasingly mandated in kidney care to incorporate patients' perspectives.
Objectives: We assessed whether educational support for clinicians using electronic (e)PROs could enhance person-centered care.
Design: A process evaluation, using a mixed methods longitudinal comparative concurrent design was undertaken of educational support to clinicians on routine use of ePROs.
Background: Hypertension is the leading global cause of cardiovascular disease and premature mortality in women. The effects of postmenopausal hormone therapy (HT) on blood pressure are uncertain but may be related to route of estrogen administration and formulation of estrogen. We sought to determine the association between route of administration and formulation of estrogen HT and hypertension risk in postmenopausal women.
View Article and Find Full Text PDFIntroduction: Intradialytic cycling is often performed during the first half of hemodialysis because of concerns regarding increased frequency of intradialytic hypotension (IDH) late in hemodialysis. This increases exercise program resource needs and limits utility of intradialytic cycling to treat dialysis-related symptoms.
Methods: This multicenter, randomized, crossover trial compared IDH rate when cycling during the first half versus the second half of hemodialysis in 98 adults on maintenance hemodialysis.
Obstructive sleep apnea (OSA) is common in heart and kidney disease, both conditions prone to fluid retention. Nocturnal rostral fluid shift contributes to the pathogenesis of OSA in men more than women, suggesting a potential role for sex differences in body fluid composition in the pathogenesis of OSA, with men having a predisposition to more severe OSA due to an underlying volume expanded state. Continuous positive airway pressure (CPAP) increases intraluminal pressure in the upper airway and mitigates the rostral fluid shift; this, in turn, may prevent fluid redistribution from other parts of the body to the upper airway.
View Article and Find Full Text PDFBackground: People with kidney failure treated with dialysis are at increased risk of SARS-CoV-2 infection, and severe COVID-19 outcomes such as hospitalization and death. Though there are well-defined sex differences in outcomes for the general population with COVID-19, we do not know whether this translates into kidney failure populations. We aimed to estimate the differences in COVID-19 symptoms and clinical outcomes between males and females treated with maintenance dialysis.
View Article and Find Full Text PDFArticle Synopsis
- Collaborative decision-making in vascular access emphasizes understanding patient preferences, especially when there isn't a clear best choice, involving patients, caregivers, and clinicians in discussions.
- The study involved interviews with 42 participants in Alberta's hemodialysis programs, focusing on how decisions about vascular access are influenced by prior choices related to kidney therapy and care goals.
- Effective shared decision-making is aided by timely information exchange and opportunities to reassess vascular access options, while a lack of collaboration often leads to less desirable choices like catheter use.
Background: Postmenopausal hormone therapy (HT) is associated with increased cardiovascular risk. Although the route of estrogen administration may play a role in mediating risk, previous studies have not controlled for concomitant progestin use.
Objective: To investigate the association between the route of estrogen therapy (oral or non-oral) HT use, without concomitant progestin, and blood pressure and arterial stiffness in postmenopausal women.
Article Synopsis
- Oral contraceptives are linked to a higher risk of hypertension and increased blood pressure, but the impact of non-oral hormonal contraceptives (NOHC) on these issues is less clear.
- A review of 25 studies found that injectable contraceptives may increase blood pressure compared to non-hormonal options, while the hormonal intra-uterine device and vaginal rings might lower blood pressure.
- Overall, NOHCs show varying effects on blood pressure based on the type used, highlighting the need for further research to understand the cardiovascular risks associated with these contraceptives.
Young women with chronic kidney disease (CKD) have disproportionately increased risk of cardiovascular mortality. Reduced anti-Müllerian hormone (AMH) is linked to poor cardiovascular outcomes in the general population, but whether AMH is associated with increased cardiovascular risk in the high-risk CKD population is unknown. This study examined the association between AMH and vascular function, validated markers of cardiovascular risk, in women with CKD.
View Article and Find Full Text PDFIntroduction: Sex influences the cardiovascular risk associated with body mass index (BMI) in older adults. Whether this risk differs by sex in younger adults is unknown. We aimed to evaluate the association between measures of adiposity and arterial stiffness and reninangiotensin-aldosterone system (RAAS) activity in younger adults, stratified by sex.
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