Aminu Kasarawa Bello

Purpose of program: This conference report describes findings from activities to reposition the Canadian Chronic Kidney Disease (CKD) Clinic Network by identifying research priorities and actionable steps aligned with the 2024 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. The initiative aimed to identify priority actions to integrate clinical research and care through collaborative dialogue and community-driven planning. Sources of information: The 2024 KDIGO Clinical Practice Guideline for CKD served as the foundation to assess and prioritize relevant research areas. Insights were gathered through a national survey and a participatory workshop using World Café methodology. Methods: An anonymized online semi-structured survey was distributed to members of the Canadian CKD Clinic Network from April 4-14, 2025 to assess the perceived relevance and importance of the 2024 KDIGO CKD guideline research recommendations. This was followed by an in-person World Café workshop in May 2025 involving patients, clinicians, researchers, and administrators. Data collection included live graphic recording, table notes, and Post-it reflections, which were thematically analyzed. Key findings: The survey yielded responses from 80 network members, representing a 24% response rate. Survey results prioritized the need for research on: the impact of newer medications (SGLT2i, non-steroidal mineralocorticoid receptor antagonists) in patients intolerant of ACEi/ARB, implementation science to ensure uptake of proven therapies and symptom management, essential components for transition clinics for young people, tools for health literacy in different populations, strategies to prevent hyperkalemia, impact of medication deprescribing, effects of dietary restriction, and symptom identification, classification, and control. Attendees of the World Café (n=19) identified several network strengths, including its established relationships that drive national collaboration, willingness in knowledge sharing, and inclusion of the patient voice. Feedback emphasized the need for collaborative implementation and context-sensitive application of guidelines. The workshop also aligned the network’s future direction with Learning Health System principles, which embed research into routine care delivery, supporting goals with provincial and national CKD strategies, deepening patient engagement, shared measurement tools, and local-to-national learning loops. Actionable steps identified included enhancing visibility through a public-facing website, anchoring activities to sustainable national platforms, and exploring additional partnerships and collaborative research opportunities. Limitations: Only 24% of the CKD Clinic Network responded to the survey, and 19 members were present at the World Café, reflecting perspectives from only a small portion of the network. Therefore, the results may overlook key challenges or opportunities that did not surface due to missing perspectives of others within the kidney care community. Implications: This initiative demonstrates how engaging diverse perspectives can inform network transformation and future strategic research directions. The CKD Clinic Network is well-positioned to evolve into a responsive, patient-centred platform that drives learning and improvement in health care delivery across Canada’s kidney care system.

Purpose of program: Indigenous peoples in Canada experience a disproportionate burden of chronic kidney disease (CKD) yet face systemic, geographic, and cultural barriers to early detection and care. The Kidney Check program was established as a national initiative to address this gap by providing community-led, culturally safe, and integrated chronic disease screening. Sources of information: Kidney Check builds on the success of the First Nations Community-Based Screening to Improve Kidney Health and Prevent Dialysis (FINISHED) study in Manitoba and was expanded through the Can-SOLVE CKD Network. This report summarizes updated data from April 2023 to March 2024, capturing the implementation of Kidney Check across five provinces: Alberta (AB), British Columbia (BC), Manitoba (MB), Ontario (ON), and Saskatchewan (SK). Data sources include provincial program records, training logs, process measures, referral data, patient and provider testimonials, and qualitative evaluations from community members, providers, and patient partners. Methods: Kidney Check applies a standardized, mobile, point-of-care-testing (POCT)-based screening protocol for CKD, diabetes, and hypertension, adapted locally in collaboration with Indigenous communities. Implementation followed principles of Indigenous governance, data sovereignty (Ownership, Control, Access, Possession [OCAP]), and Two-Eyed Seeing, where both Western and Indigenous medicines and ways are acknowledged, respected, and practiced, with provincial adaptations tailored to local contexts. Information was synthesized across jurisdictions to identify process measures, barriers and facilitators to implementation, and early outcomes. Key findings: Since program inception, thousands of Indigenous participants have been screened across more than 50 communities. AB and BC demonstrated scale-up through train-the-trainer and community-embedded models, training over 30 providers and screening >700 participants in BC alone. Manitoba built on the FINISHED study to deliver screening in 10 communities, with nearly 700 participants screened. Ontario resumed screening in 2024, with >250 participants screened across five regional renal programs. Saskatchewan launched Kidney Check in 2023, screening 230 participants, with early identification of intermediate- and high-risk individuals. Across sites, facilitators included strong community partnerships, local hiring, and integration with existing health services. Barriers included logistical challenges (equipment, travel, quality assurance and quality control [QA/QC]), staffing constraints, and sustainability concerns. Limitations: Variation in infrastructure, referral pathways, and data systems across provinces limits cross-jurisdictional comparability. Long-term outcome data (eg, CKD progression, cardiovascular events, mortality) are not yet available. Implications: The Kidney Check program demonstrates that culturally safe, community-led, POCT-based screening for CKD and related chronic diseases is feasible, acceptable, and scalable across diverse Indigenous communities in Canada. Lessons learned highlight the central importance of Indigenous leadership, cultural safety, and flexible delivery models to advance health equity.

Objectives: To highlight data on interventions aimed at enhancing referral patterns from primary care to nephrology. Design: Systematic review and meta-analysis. Data sources: MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science and PsycINFO. Eligibility criteria: Studies reporting interventions aimed at decreasing referral volume, reducing wait times and/or increasing guideline-concordant referrals in adult patients with chronic kidney disease from primary care to specialist kidney care, from inception to 15 April 2024. Data extraction and synthesis: Studies were subcategorised based on taxonomy of initiatives, type of intervention and single versus multi-faceted interventions. Our primary outcomes were changes to referral volume, wait times and proportion of guideline-concordant referrals. Data were pooled using a random effects model and a meta-analysis was conducted using pooled mean difference (MD) and OR. Results: 20 studies used single and 13 used more than one intervention. Overall, interventions resulted in an increase in total referrals (MD: 19 referrals per month, 95% CI 7 to 30; I ² =98%; p2 =100%; p=0.08). These effects were consistent when stratified by single versus multi-faceted interventions, and by taxonomy of interventions. Interventions categorised as financial, regulatory or legislative incentives (n=2) led to an increase in guideline-concordant referrals (OR: 1.15, 95% CI 1.02 to 1.29; I ² : 0%; p=0.02). Organisational changes showed a non-significant reduction in wait time of 24 days (95% CI −64 to 15, I ² =99%; p=0.23) but tended to decrease guideline concordant referrals (OR: 0.17, 95% CI 0.03 to 0.86; I ² : 100%; p=0.03). Conclusion: Organisational changes decreased wait times. Overall, interventions increased referral volume and decreased guideline-concordant referrals. The data have implications for designing programmes to improve primary care-nephrology interface in kidney disease management.

Approximately 480 million individuals worldwide (~6% of the global population) are Indigenous peoples. Despite their diverse cultures and histories, the shared legacy of colonialism has profoundly shaped their health and socioeconomic status. This legacy is deeply intertwined with poverty, systemic racism and historical trauma, contributing to significant health disparities compared with non-Indigenous populations. Among the many chronic diseases disproportionately affecting Indigenous peoples, chronic kidney disease (CKD) stands out as a major public health concern. Indigenous peoples experience higher rates of CKD, yet they often face barriers to accessing responsive and culturally safe health-care services. Factors such as geographic isolation, socioeconomic disadvantages and systemic discrimination limit their access to preventive care, early disease detection and kidney replacement therapy, leading to worse health outcomes and higher mortality rates. Exposure to environmental and occupational risks and inadequate infrastructure further exacerbate CKD risk for Indigenous peoples. Here, we examine determinants of kidney disease and health among major Indigenous populations in Africa, Asia, Australia, Canada, Latin America, Aotearoa–New Zealand, the Pacific Islands and the USA. We discuss culturally safe and responsive strategies that can improve the delivery of kidney care and make policy recommendations for multiple levels of government to ensure health-care systems are equipped to meet the needs of Indigenous communities. By addressing these gaps and promoting cultural competence in kidney care, health-care providers can have a crucial role in reducing health disparities and improving Indigenous peoples’ kidney health worldwide.

Background: Care for mild to moderate chronic kidney disease (CKD) entails self-management from patients and clinical support from primary care and nephrology. To address the gap in self-management resources, My Kidneys My Health was codeveloped to support patients with CKD. Health care providers play a critical role in the implementation of patient resources; however, there is a gap in understanding providers’ perspectives in this role. Objective: This study develops and evaluates strategies to implement My Kidneys My Health into routine primary care and general nephrology clinical care. Methods: Health care providers working in Alberta, Canada, who support patients with CKD were invited to participate in our multistep study, guided by the Quality Implementation Framework. In step 1, we followed qualitative descriptive methodology to identify barriers and enablers to implementation using a directed content analysis and a deductive coding approach. Participants were invited to complete semistructured interviews from October 2021 to May 2022. In step 2, we identified, prioritized, codeveloped, and launched implementation strategies based on step 1 results using behavior change theory. Participants were invited to use the materials during the implementation period (May to October 2022). Website engagement was tracked through Google Analytics and document distribution tracking. In step 3, we conducted follow-up interviews with participants (October to December 2022) to evaluate implementation based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, following the same qualitative approach as step 1. Effectiveness was out of the scope of this study. Results: A total of 16 health care providers participated in step 1 qualitative interviews (8 from nephrology clinics and 5 from primary care or nonambulatory care). Participants shared an individual-level readiness and interest in sharing My Kidneys My Health with their patients. The key barriers to implementation included awareness, memory, time, motivation, and innovation accessibility. Implementation strategies were co-designed and implemented by step 1 participants (ie, educational sessions and materials, reminders, and implementation coaching). Notably, 9 health care providers participated in step 3 qualitative interviews. Participants shared their approach to tailoring implementation based on their patients and integrating the resource into their current practices. The resources developed were highly used by participants, with positive feedback on their usability and accessibility. Participants expressed motivation to continue sharing My Kidneys My Health; however, awareness and accessibility require further adaptations that can improve sustainability of implementation. Our rigorous approach allowed us to address behavior change and sustainability of implementation of My Kidneys My Health, as well as identify appropriate and tailored implementation strategies. Conclusions: There is a readiness to implement self-management supports for patients with early-stage CKD. A theory-informed approach and strategic implementation strategies can support sustainability.

Chronic kidney disease (CKD) disproportionately affects certain populations as demonstrated by well-established subnational geographic hotspots of CKD in Central America and South Asia. Using data from the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA), we aimed to systematically identify sub-national geographic or population clusters with high prevalence of CKD. The ISN-GKHA survey was conducted from July to September 2022, and included questions regarding whether a regional CKD hotspot existed in the respondents’ country and possible contributors. A CKD hotspot was defined as a population cluster with a high risk of kidney failure requiring dialysis or transplant, or people dying from kidney failure. Overall, 46 out of 162 responding countries reported subnational hotspots for CKD within their country. Hotspots were reported across all regions, except for the Middle East. Latin America had the highest percentage (12 of 21, 57%) of countries reporting a regional CKD hotspot followed by the regions of North and East Asia, and Western Europe. Adults aged 18 to 44 years and rural populations were most commonly identified as the primary groups affected. Clinical factors were most commonly identified as contributors to CKD (hypertension in 74% and diabetes in 72%), followed by cultural (e.g., diet and herbal medications in 67%), and environmental (e.g., polluted water in 43%) factors. Latin American countries more commonly reported climate, cultural, and environmental factors as contributors compared to other regions. Across the world, there are a number of subnational regions where in-country experts identify a disproportionately higher burden of CKD, commonly occurring among younger age groups with clinical, cultural, and environmental contributors specific to these geographic regions. In-depth studies, starting with systematic epidemiology efforts, are needed to investigate the aetiopathogenesis of these CKD hotspots around the world so that tailored interventions can be offered.

Objectives: Ramadan fasting is an Islamic religious practice involving abstinence from food and drink from dawn to sunset. Its consequences on kidney-relevant outcomes in patients with chronic kidney disease (CKD) and kidney transplant recipients remain unclear. Design: Systematic review and meta-analysis. Data sources: MEDLINE, Embase, Global Health, CINAHL (EBSCOhost), Scopus, Web of Science and Google Scholar were searched up to 18 September 2023. Eligibility criteria: We included observational studies among non-dialysis CKD and kidney transplant recipients who fasted during Ramadan and examined changes in kidney function. Data extraction and synthesis: Standardised methods were used by two independent reviewers to screen, select and extract data. Outcomes included changes in serum creatinine (SCr), estimated glomerular filtration rate (eGFR), proteinuria, blood pressure, electrolytes and adverse events—all pre- and post-Ramadan. Results were pooled using random effects modelling. Results: We included 32 observational studies with a total of 2592 participants. 21 studies reported on participants with CKD and 11 studies reported on kidney transplant recipients (studies variably including non-fasting control arms). Meta-analysis of 25 studies revealed that Ramadan fasting was not associated with changes to SCr for the following groups according to study design: CKD with a non-fasting arm (mean difference (MD)=0.82 µmol/L; 95% CI −7.22, 8.86; I ² =38%); transplant with a non-fasting arm (MD=−0.17 µmol/L; 95% CI −2.50, 2.15; I ² =0%) and CKD without a non-fasting arm (post–pre MD=13.84 µmol/L; 95% CI −3.78, 31.47; I ² =88%). For transplant studies without a non-fasting arm, lower SCr was associated with the post-Ramadan period (post–pre MD=−5.40 µmol/L; 95% CI –10.78, –0.02; I ² =0%). In the 18 studies that reported on eGFR, fasting during Ramadan was not associated with an effect on eGFR for any of the groups. Conclusion: We report inconsistent effects of Ramadan fasting on kidney function in CKD or kidney transplantation. Results should be interpreted with caution due to the significant limitations of the underlying studies.

In an era marked by a global demographic shift towards an aging society, there is a heightened prevalence of chronic kidney disease (CKD) among older adults. The burden of CKD spans from kidney-related complications to impacting psychological well-being, giving rise to depressive symptoms and caregiver burnout. This article delves into CKD prevention strategies within the context of aging, contributing to the discourse by exploring its multifaceted aspects. The prevention of CKD in the older adults necessitates a comprehensive approach. Primary prevention is centered on the modification of risk factors, acknowledging the intricate interplay of various comorbidities. Secondary prevention focuses on early CKD identification. Tertiary prevention aims to address factors contributing to CKD progression and complications, emphasizing the importance of timely interventions. This comprehensive strategy aims to enhance the quality of life for individuals affected by CKD, decelerating the deterioration of functional status. By addressing CKD at multiple levels, this approach seeks to effectively and compassionately care for the aging population.