Kristin Kyomi Clemens

Purpose of Review: Obesity is a major and growing public health concern in Canada and an important contributor to chronic kidney disease (CKD). Indigenous Peoples in Canada experience a disproportionately high burden of obesity and CKD, driven by complex social, cultural, environmental, and biological factors. This review synthesizes the literature on factors contributing to obesity among Indigenous Peoples in Canada and discusses implications for kidney health. Methods: A narrative review was conducted using predefined search terms related to obesity, Indigenous Peoples, Canada, and CKD. Following screening in Covidence, 44 studies were selected from 131 eligible articles based on relevance and contribution to emerging themes. Key Findings: Obesity among Indigenous Peoples in Canada is influenced by an interconnected network of determinants, including dietary transition, food insecurity, socioeconomic inequities, reduced physical activity, environmental change, cultural disruption, historical trauma, systemic racism, and limited access to culturally safe healthcare. Biological and genetic factors may also contribute. These determinants increase CKD risk directly through obesity-related kidney injury and indirectly through diabetes and hypertension. Barriers to obesity treatment, including limited access to bariatric surgery, pharmacotherapy, and culturally appropriate care, may further contribute to disparities in kidney health and transplantation access. Limitations: The literature is limited by reliance on cross-sectional and self-reported data, a lack of longitudinal studies, underrepresentation of urban Indigenous populations, and limited evaluation of culturally relevant measures of health and obesity. Implications: Addressing obesity among Indigenous Peoples requires culturally grounded, community-led, and system-level interventions that improve food security, healthcare access, and culturally safe obesity management. Such approaches may contribute to reducing CKD burden and advancing kidney health equity.

Background: Obesity and chronic kidney disease (CKD) often coexist and compound the risk of adverse health outcomes including dysglycemia and accelerated CKD progression. Obesity also limits access to kidney transplantation. The objectives of this study were to (1) understand current weight-management practices in CKD centres across Canada and (2) describe the availability of weight-management services nationwide. Methods: We conducted a cross-sectional, quantitative, online survey of English-speaking nephrologists practicing in Canada in 2025. The 23-question survey was developed based on a literature review and the content expertise of investigators. It was reviewed by nephrologists to ensure clarity, appropriateness, and ease of completion. Survey questions focused on the availability of dietitian services, exercise supports, behavioural counselling, weight-management consultations, and use of weight-loss medications in kidney outpatient clinics and dialysis units (including hemodialysis and peritoneal dialysis). The survey was administered via Qualtrics and distributed through the Canadian Society of Nephrology to nephrologists who care for patients with advanced CKD. Results: Between April 7 and June 12, 2025, 56 valid and complete responses were received, an estimated 15% response rate. Respondents primarily practised in Ontario (36%), Quebec (20%), British Columbia (18%), and Alberta (14%), with fewer respondents from the Territories and Atlantic provinces. Clinicians reported initiating weight-management discussions with patients when they felt obesity was contributing to poor health or impacting eligibility for transplant. While almost all nephrologists reported having access to a dietitian, over 60% were uncertain about the specific role of the dietitian in weight management. Gaps in the availability and coordination of behavioural coaching, physiotherapy, and exercise services were frequently cited. Over 60% of nephrologists reported prescribing weight-loss medications despite limited evidence supporting their efficacy and safety in patients with advanced CKD. Conclusions: Weight management is a recognized health priority in patients with advanced CKD, yet there are gaps in management. The nephrology community would benefit from weight-management services that reduce morbidity and improve transplant access for patients with CKD.

Background: Large randomised controlled trials (RCTs) of obesity interventions have excluded those with advanced chronic kidney disease (CKD) including recipients of dialysis. Obesity management is critically important to their health and healthcare, including their ability to access kidney transplant. Objective: To describe the vanguard phase of a large, pragmatic, open-label RCT testing the effectiveness of a multi-component weight management programme vs standard of obesity care in advanced CKD. Methods: We are conducting an open-label RCT evaluating a 26-week multicomponent weight management programme (inclusive of monthly virtual coaching; semaglutide to a maximum dose of 2.0 mg/week; and behavioural, dietary and exercise counselling) for those with advanced CKD. Adults aged 18 years or older with a body mass index ≥35 kg/m ² with or without diabetes, who are receiving dialysis or have >10% risk of end-stage kidney disease requiring renal replacement therapy over 2 years (based on the Kidney Failure Risk Equation) are included. Our primary success criterion is the recruitment of at least 50 participants (83% of target) within 12 months of site initiation Feasibility, adherence, safety and selected efficacy outcomes will be summarised descriptively. The acceptability of the intervention will be explored using qualitative methods. The study was initiated in September 2024 with a target completion date of December 2027. Trial registration: NCT06396416 .

Severe hypercalcemia is commonly attributed to malignancy. Maintaining a broad differential diagnosis is important in patients with end-organ disease. We present a 47-year-old man with end-stage alcoholic cirrhosis who presented to the outpatient clinic with profound hypercalcemia. His albumin-corrected calcium was 16.8 mg/dL (SI: 4.2 mmol/L) (reference range, 8.5-10.1 mg/dL [SI: 2.1-2.5 mmol/L]) and he had an acute kidney injury. Laboratory evaluation revealed a suppressed parathyroid hormone. Imaging excluded malignancy. Workup for adrenal insufficiency suggested partial secondary disease as a contributing factor. With aggressive fluid hydration and corticosteroids, his symptoms and biochemistry improved. His calcium remained mildly elevated consistent with ongoing cirrhosis-related hypercalcemia. This case underscores the importance of maintaining a broad differential for severe hypercalcemia and considering cirrhosis itself as an etiologic factor.

Objective To examine gaps in the care of people with polycystic ovary syndrome (PCOS) in Canada from a patient perspective and identify opportunities for improvement. Data sources PubMed, Embase, Web of Science, and Scopus databases. Study selection Observational studies, randomized controlled trials, mixed-methods studies, cross-sectional studies, and qualitative studies were included that examined the experiences of patients with PCOS in Canada. Synthesis Screening of titles and abstracts was performed independently by 2 reviewers, with conflicts resolved by a third blinded reviewer. Full-text screening was completed by 4 reviewers. A total of 2098 citations were identified using a broad search strategy and 9 studies met inclusion criteria. Information on the care experience of patients with PCOS was extracted and synthesized using a Knowledge-to-Action framework. Three main themes emerged: 1) there is opportunity to address delays in PCOS diagnosis and provide clearer treatment recommendations to patients; 2) there is a need to address the psychological impacts of PCOS; and 3) there may be opportunities to improve the clinical care experiences of people with PCOS. Conclusion The authors propose that expedited diagnosis of PCOS, attending to patients’ mental health needs, personalized lifestyle modifications and education, and strategies to promote positive patient experiences may help to improve PCOS care. Résumé Objectif Examiner les lacunes dans les soins aux personnes atteintes du syndrome des ovaires polykystiques (SOPK) au Canada du point de vue des patientes et cerner des possibilités d’amélioration. Sources de l’information Les bases de données PubMed, Embase, Web of Science et Scopus. Sélection des études Les études observationnelles, les essais randomisés contrôlés, les études à méthodes mixtes, les études transversales et les études qualitatives qui examinaient les expériences de patientes souffrant du SOPK au Canada ont été inclus. Synthèse Le dépouillement des titres et des résumés a été effectué indépendamment par 2 réviseurs, et les conflits ont été résolus en aveugle par un troisième réviseur. L’examen des textes intégraux a été réalisé par 4 réviseurs. Au total, 2098 citations ont été trouvées au moyen d’une large stratégie de recension, et 9 études répondaient aux critères d’inclusion. L’information concernant l’expérience des soins par les patientes atteintes du SOPK a été extraite et résumée au moyen d’un référentiel de passage du savoir à l’action. Trois thèmes principaux ont été cernés : 1) il existe des possibilités de remédier aux retards dans le diagnostic du SOPK et de présenter des recommandations de traitement plus claires aux patientes; 2) il est nécessaire de se préoccuper des impacts psychologiques du SOPK; et 3) il pourrait y avoir des possibilités d’améliorer les expériences des soins cliniques que font les personnes atteintes du SOPK. Conclusion Les auteurs proposent qu’un diagnostic plus rapide du SOPK, une attention accordée aux besoins en santé mentale des patientes, la personnalisation des modifications au mode de vie et de l’éducation, de même que des stratégies pour favoriser des expériences positives chez les patientes pourraient aider à améliorer les soins pour le SOPK.

Background: Obesity is a chronic disease which directly contributes to the onset and progression of chronic kidney disease (CKD). For patients with advanced CKD (CKD G4-5D), kidney transplantation is the optimal treatment to improve morbidity and quality of life. However, obesity is a barrier to transplantation, due to an associated risk of postoperative complications and decreased graft survival. Objective: We sought to understand patient experiences with weight management and CKD to inform future studies in this area. Design: Descriptive qualitative study. Setting: London, Ontario, Canada. Participants: Individuals with CKD G4-5D and experiences with obesity and weight management. Methods: We interviewed 12 participants with CKD G4-5ND, using thematic analysis and a phenomenological framework. We explored their beliefs, experiences, and expectations of weight loss management. An inductive, open coding technique was used to generate themes that informed our understanding of their shared experiences. Results: We identified 6 themes from our data: strengths and gaps in healthcare support, influence of social circles and systems, past experiences with weight loss, limitations of current health status, knowledge and motivation around weight management, and personal autonomy in treatment choices. Limitations: Small homogenous population limits generalizability, self-report of weight loss attempts without numerical data. Conclusions: Our study emphasizes opportunities for healthcare providers to identify and address potential unmet needs in weight management, while also guiding patient-centered conversations on this topic.

Objective Patients receiving haemodialysis are at very high risk of fragility fracture, yet there are no proven treatments for fracture prevention. We will advance a pilot study on the feasibility of a large, pragmatic, randomised controlled trial (RCT) of denosumab for fragility fracture prevention in haemodialysis. Trial design PRevEnting FracturEs in REnal Disease-1 is a pragmatic, open-label, pilot study of an RCT of a denosumab care pathway embedded in routine care haemodialysis centres. Methods We will recruit at least 60 participants at high risk of fracture from at least 6 haemodialysis centres in Ontario, Canada. They must be aged 40 years or older, have access to provincial drug coverage, have appropriate baseline calcium and parathyroid hormone levels and be deemed suitable for denosumab by their kidney care provider. Participants will be randomised 1:1 to denosumab (with supports to mitigate hypocalcaemia) versus usual care using block randomisation by a central statistician (computer-generated sequence). Primary outcomes include recruitment feasibility and adherence. Secondary outcomes include safety (hypocalcaemia) and participant satisfaction with our protocol and processes. Study investigators and data analysts will be blind to treatment allocation. We will present results descriptively. The trial was approved by Clinical Trials Ontario and local research ethics boards across study sites. Results Primary and secondary outcomes will be published on trial completion. Conclusions This pilot will inform the feasibility of conducting a large-scale, efficiently run, pragmatic RCT to test whether a denosumab care pathway safely reduces the risk of fragility fracture in patients receiving haemodialysis. Results have the potential to transform fracture care in real-world patients with kidney and metabolic bone disease. Trial registration number NCT05096195.