Reducing the risk of denosumab-induced hypocalcemia in patients with advanced chronic kidney disease: a quality improvement initiative.

Unlabelled: Denosumab can improve bone health in advanced kidney disease (CKD) but is associated with hypocalcemia. We created a clinical care pathway focused on the safe provision of denosumab in advanced CKD that reduced the risk of hypocalcemia by 37% at our hospital. Similar pathways could be adopted and tested in other centers.

Medication reconciliation in hemodialysis patients.

Medication reconciliation is an effective process to reduce adverse drug events (ADEs) and harm associated with the loss of medication information as patients transfer between health care settings. Patients with end stage renal disease (ESRD) are at a high risk of experiencing drug-related problems (DRPs) because they take many medications, have multiple comorbidities, and require frequent medication changes. We evaluated the potential impact of medication reconciliation and optimization in the ambulatory care setting at the time of patient transfer from an in-centre dialysis unit to a satellite dialysis unit.

An update on the treatment and management of diabetic peripheral neuropathy.

It is clear that the majority of the evidence for symptomatic management of DPN is for either TCAs or anticonvulsants. The Canadian Diabetes Association recommends agents from these classes as first-line therapy. Though these agents appear to be effective, the management of neuropathic pain is still quite difficult and many patients only achieve partial relief from therapy while others find no relief.

Effectiveness of furosemide in patients on peritoneal dialysis.

Background: Residual renal function (RRF) is a marker for a good index of health and is associated with improved survival for individuals with end stage renal disease on peritoneal dialysis. As RRF declines with time on dialysis, fluid balance is more difficult to achieve. Urine output plays a vital role in fluid removal and it has been postulated that loop diuretics improve diuresis in peritoneal dialysis (PD) patients.

Laboratory assessment of kidney function.

It is important to be able to accurately predict the function of the kidneys by estimating GFR. GFR is a strong predictor for the onset and complications of CKD and it also allows us to dose-adjust medications. It, unfortunately, cannot be measured directly, so we have to depend on surrogate markers such as creatinine to estimate it.

An update on the treatment and management of stroke.

There have been huge advancements in the prophylaxis and treatment of stroke. The majority of patients who have a stroke are asymptomatic prior to the event. This makes it extremely important to identify high-risk patients and administer prophylaxis where appropriate.

A review of hypertension management in Canada.

Reducing a patient's global CV risk requires a multifactorial approach. Medication is only a part of a patient's therapy. Lifestyle modifications such as diet and exercise should be encouraged.

Diabetes mellitus Canadian clinical practice guidelines update.

Data from the National Diabetes Surveillance Strategy (NDSS) found the prevalence of physician-diagnosed diabetes in adults to be 4.8% (Health Canada Database, 2002). Population-based studies have found the prevalence rates to be much higher.

Potential drug interaction between simvastatin and danazol causing rhabdomyolysis.

Rhabdomyolysis is a life-threatening clinical and biochemical syndrome that results from injury to skeletal muscle. Hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) have been associated with myopathy and rhabdomyolysis. Although rhabdomyolysis is a rare adverse event associated with this class of drugs, their prevalent use in the management of dyslipidemia makes it increasingly important for clinicians to understand the nature of this condition.