The Impact of Laboratory-based Prompts on the Management of Patients with Chronic Kidney Disease
Progression and management of chronic kidney disease among Aboriginals
Access to and Quality of Cardiac Care for Aboriginals
Validation of a Coding Algorithm to Define Chronic Kidney Disease using Administrative Data
Relation between residence location, care quality and cardiovascular events in people with diabetes and chronic kidney disease
Classification of Chronic Kidney Disease Stage
Which Vascular Access for Hemodialysis?  Balancing actual benefits with unintended consequences

The Impact of Laboratory-based Prompts on the Management of Patients with Chronic Kidney Disease:

Background:
Despite the risk of kidney failure and adverse cardiovascular events, evidence suggests that patients with CKD do not receive appropriate kidney or cardio-protective medications such as aspirin, cholesterol-lowering agents and ACE inhibitors.

Goal of Research:
To determine if the use of a laboratory prompt (compared to the standard GFR prompt) can improve the proportion of patients treated with appropriate reno and cardio-protective agents.

Progression and management of chronic kidney disease among Aboriginals

Background:
Aboriginal people in Canada require dialysis for end-stage renal disease (ESRD) at rates two to four times higher than non-Aboriginal people.  While undiagnosed CKD  may be contributing to higher ESRD rates among Aboriginal populations, more rapid progression of kidney dysfunction also contributes.

Goal of Research:
To determine the role of  1)  undiagnosed or unmeasured CKD, 2)  clinical factors including poorly controlled diabetes and dyslipidemia and proteinuria, and 3) lack of appropriate CKD care in kidney failure among Aboriginals

Access to and Quality of Cardiac Care for Aboriginals

Background:
Studies suggest that race/ethnicity may influence access to care, use of specialized procedures, treatments  and  preventive services .  Several factors are known to effect access to health care including rural location of residence, poverty, language barriers and cultural beliefs.  The limited research conducted in Canada suggests that Aboriginal people experience decreased access to care, as well as inequities in the quality of care. 

Goal of Research:
To determine if differences in access to cardiac care exist for Aboriginals compared to non-First Nations people, particularly in patients with diabetes and chronic kidney disease (a high risk group)

Validation of a Coding Algorithm to Define Chronic Kidney Disease using Administrative Data

Background:
Administrative data are potential sources for surveillance . They are a timely and cost-effective source of data. Currently in Canada there are no mechanisms in place to monitor the occurrence of CKD and obtain details regarding its management and complications

Goal of Research:
To determine the validity of an administrative database derived algorithm for defining CKD, compared to the gold standard of an estimated glomerular filtration rate (eGFR) based on serum creatinine measurements

Relation between residence location, care quality and cardiovascular events in people with diabetes and chronic kidney disease

Background:
Worldwide, the prevalence of diabetes is approximately two-fold higher in urban dwellers compared with rural-dwellers.  Clinical experience suggests that remote areas have more kidney failure, compared with urban regions.  Others have shown that rural-dwellers with diabetes often receive suboptimal care compared.

Goal of Research:
To determine the geographic location of the patient with diabetes and chronic kidney disease , elements of care as currently delivered, and the association between better care quality and clinical outcomes.

Classification of Chronic Kidney Disease Stage

Background:
Current schemes for classifying severity of CKD depend predominantly on estimated GFR. However, considerable evidence suggests that the presence of proteinuria is also strongly associated with adverse outcomes and therefore should be included in staging schemes. 

Goal of Research:
To devise a method for classifying CKD that incorporated both GFR and proteinuria

Which Vascular Access for Hemodialysis?  Balancing actual benefits with unintended consequences

Background:
The arteriovenous fistula is the preferred vascular access for its superior longevity and lower complication rates as compared to grafts and central venous catheters. However, However, arteriovenous fistulas require time to mature and approximately 30% of them never become suitable for use. Unintended consequences of programs promoting the arteriovenous fistula  have never been studied in relation to a change in health policy.

Goal of Research:
To assess the impact of promoting arteriovenous fistula on vascular access care in both pre-hemodialysis and hemodialysis patients.

Other Projects:

This is an abbreviated list of ongoing research projects. Information on other projects can be obtained by contacting one of the AKDN investigators. A list of selected AKDN publications is available at Selected publications of AKDN Researchers page