How Canada can better embed randomized trials into clinical care

In the most recent issue of the Canadian Medical Association Journal, Drs. Srinivas MurthyRobert A. Fowler and Andreas Laupacis wrote an editorial about how the speed with which the UK executed the nation-wide priority-driven RECOVERY trial is not currently possible in Canada. 

From the editorial: “Those who manage and fund Canada’s health care systems need to view high-priority trials as an integral part of clinical care and to provide adequate and stable infrastructure funding, thus avoiding the current time-consuming and expensive process of developing separate data-sharing agreements and contracts with many hospitals and organizations. ”

You view the editorial online or download a PDF copy.

Recent Publications by Network Members

As a network, we want to showcase the work being done by our members. Listed below are recent publications by some of our network members in chronological order. If you have a publication you want to be posted, please send the title and first author to Alicia (amurdoch@cansolveckd.ca). These publications will also be highlighted in our quarterly newsletter.

Frailty and the Kidney Transplant Wait List: Protocol for a Multicenter Prospective Study

Can J Kidney Health Dis., 10 Sep 2020
Karthik K. Tennankore (CNTN Scientific Operations and Executive Committees co-chair),  Lakshman Gunaratnam, Rita S. Suri (CNTN Scientific Operations and Executive Committees member), Seychelle YohannaMichael WalshNavdeep TangriBhanu Prasad (CNTN Communications and Engagement Committee member)Nessa GoganKenneth RockwoodSteve DoucetteLaura SillsBryce KiberdTammy Keough-RyanKenneth WestAmanda Vinson

Feasibility Study of a Randomized Controlled Trial Investigating Renal Denervation as a Possible Treatment Option in Patients With Loin Pain Hematuria Syndrome

Can J Kidney Health Dis., 26 Aug 2020

Bhanu Prasad (Communications and Engagement committee member), Maryam Jafari, Kaval Kour, Kunal Goyal, Francisco Garcia

Nephrologist views regarding cannabinoid use in advanced chronic kidney disease and dialysis: a survey

J Pain Symptom Manage., 14Aug2020

David Collister (Scientific Operations and Executive committee member),  Karthik Tennankore (Scientific Operations and Executive committee member), Sara N. Davison, Ron Wald, Christian Rabbat, Michael Walsh

Barriers to home hemodialysis across Saskatchewan, Canada: A cross-sectional survey of in-centre hemodialysis patients

Can J Kidney Health Dis., 10Aug2020

Lucas Diebel, Maryam Jafari, Sachin Shah, Christine Day, Connie McNaught, Bhanu Prasad (Communications and Engagement committee member)

A cluster randomized controlled trial for the Evaluation of routinely Measured PATient reported outcomes in HemodialYsis care (EMPATHY): a study protocol

BMC Health Serv Res., 10 Aug 2020

Jeffrey A JohnsonFatima Al SayahRobert BuzinskiBonnie CorradettiSara N DavisonMeghan J ElliottScott KlarenbachBraden MannsKara Schick-MakaroffHilary ShortChandra Thomas, Michael Walsh

Canadian Society of Nephrology Commentary on the Kidney Disease Improving Global Outcomes 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder

Can J Kidney Health Dis., 04 Aug 2020

Rachel M. Holden, Reem A. Mustafa, R. Todd Alexander, Marisa Battistella, Micheli U. Bevilacqua, Greg Knoll, Fabrice Mac-Way, Martina Resilerova, Ron Wald, Philip D. Acott, Patrick Feltmate, Allan Grill, Kailash K. Jindal, Meena Karsanji, Bryce A. Kiberd, Sara Mahdavi, Kallee McCarron, Amber O. Molnar (CNTN Communications and Engagement Committee co-chair), Maury Pinsk, Celia Rodd, Steven D. Soroka, Amanda J. Vinson, Deborah Zimmerman, Catherine M. Clase (CNTN Scientific Operations Committee member)

Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury

N Engl J Med, 16 Jul 2020

Sean M BagshawRon WaldNeill K J AdhikariRinaldo BellomoBruno R da CostaDidier DreyfussBin DuMartin P GallagherStéphane Gaudry, Eric A HosteFrançois LamontagneMichael JoannidisGiovanni LandoniKathleen D LiuDaniel F McAuleyShay P McGuinnessJavier A NeyraAlistair D NicholMarlies OstermannPaul M PalevskyVille PettiläJean-Pierre QuenotHaibo QiuBram RochwergAntoine G SchneiderOrla M SmithFernando ThoméKevin E ThorpeSuvi VaaraMatthew WeirAmanda Y WangPaul YoungAlexander Zarbock, STARRT-AKI InvestigatorsCanadian Critical Care Trials Group, the Australian and New Zealand Intensive Care Society Clinical Trials Group, the United Kingdom Critical Care Research Group, the Canadian Nephrology Trials Network, and the Irish Critical Care Trials Group.

Economic Benefits of Switching From Intravenous to Subcutaneous Epoetin Alfa for the Management of Anemia in Hemodialysis Patients

Can J Kidney Health Dis., 04 Jun 2020

Bhanu Prasad (Communications and Engagement Committee member), Maryam Jafari, Julie Toppings, Linda Gross, Joanne Kappel, Flora Au

Frequency, Timing, and Prediction of Major Bleeding Complications From Percutaneous Renal Biopsy

Can J Kidney Health Dis., 25 May 2020

Melissa Schoor (Capacity Building Committee member), Pavel S Roshanov, Matthew A Weir, Andrew A House

The Burden of Frailty on Mood, Cognition, Quality of Life, and Level of Independence in Patients on Hemodialysis: Regina Hemodialysis Frailty Study

Can J Kidney Health Dis., 02 May 2020

Maryam Jafari, Kaval Kour, Shelley Giebel, Idunnu Omisore, Bhanu Prasad (Communications and Engagement Committee member)

Plasma Exchange and Glucocorticoids in Severe ANCA-Associated Vasculitis

N Engl J Med., 13 Feb 2020 Feb

Michael Walsh, Peter A Merkel, Chen-Au Peh, Wladimir M Szpirt, Xavier Puéchal, Shouichi FujimotoCarmel M HawleyNader KhalidiOliver FloßmannRon WaldLouis P GirardAdeera LevinGina GregoriniLorraine HarperWilliam F ClarkChristian PagnouxUlrich SpecksLucy SmythVladimir TesarToshiko Ito-IharaJanak Rashme de ZoysaWojciech SzczeklikLuis Felipe Flores-SuárezSimon CaretteLoïc GuillevinCharles D PuseyAlina L CasianBiljana BrezinaAndrea MazzettiCarol A McAlearElizabeth BroadhurstDonna ReidlingerSamir MehtaNatalie IvesDavid R W JaynePEXIVAS Investigators

The Do’s and Don’ts of Patient Engagement

Patient engagement is a relatively new way of conducting research in Canada and many researchers are probably still wondering how to do it well. Dr. Simon Hatcher and his team at the Ottawa Hospital developed a graphic novel style tip sheet, “Top 10 Recommendations for Researchers Working with Lived Experience Partners“.

The comic was created by people with lived experience of suicide at the REFLECT research forum which brought together patients and caregivers as well as suicide prevention researchers, trainees and policy-makers.

The top 10 recommendations are:

  1. Use common and clear language
  2. Allow for customization to patient partner’s needs. Be flexible.
  3. Be authentic in the approach to patient-oriented research. Avoid tokenism.
  4. Define roles. Invite and acknowledge everyone’s contributions.
  5. Balance power dynamics.
  6. Invite patient partners to do more than what they are recruited for.
  7. Compensate fairly and as a matter of course. Reimburse expenses.
  8. Build relationships through honesty and trust.
  9. Ensure governance through integrity and accountability.
  10. Establish and encourage continuous communication and feedback.

Feasibility study into LPHS

Dr. Bhanu Prasad and his research team are conducting a feasibility study of a randomized controlled trial investigating renal denervation as a possible treatment option in patients with Loin Pain Hematuria Syndrome (LPHS). Dr. Prasad presented this study at the CNTN meeting in November 2019 in Washington, D.C and we look forward to hearing more about the study at future CNTN meetings.

Loin Pain Hematuria Syndrome (LPHS) is a poorly understood clinical condition characterized by severe pain localized to the kidney but in the absence of identifiable urinary tract disease. Case reports/series have shown renal denervation via catheter-based radiofrequency ablation to be an effective therapeutic option for the treatment of LPHS. To determine whether catheter-based renal denervation is a meaningful addition to the treatment options in these often difficult to treat LPHS patients, a randomized clinical trial is needed. Prior to conducting a definitive trial that focuses on patient outcomes, ensuring the feasibility of undertaking such a trial is required. As such, we will conduct a single-centre randomized control feasibility trial designed to determine viability and provide framework and direction for a larger trial.

The research team will conduct a double-blinded, parallel-group, partial crossover, sham-controlled, randomized feasibility trial on 10 LPHS patients at the Regina General Hospital, Saskatchewan. Participants will be randomized into either renal denervation (treatment group) or a sham treatment (control group). Data (pain, quality of life, mood, disability) will be collected from both groups at baseline, 6 weeks, 3 and 6 months after the intervention. After the initial 6-month follow-up is over, the participants who received the sham procedure will cross over into the treatment group and will be followed for an additional 6 months in the same manner as the treatment group.

The lessons learnt from this trial will lay the framework and direction for conducting a multi-site randomized controlled trial involving a larger cohort of patients.

CSN e-Poster available for viewing

On behalf of the network, an abstract was submitted and accept for the CSN annual general meeting entitled, “A New Vision for Nephrology Trials in Canada” . The meeting was cancelled but the poster was submitted and can be found on the Can-SOLVE CKD website and the CSN poster website.

As part of the Can-SOLVE CKD virtual network update, a short 7-minute presentation was given by Alicia Murdoch, the CNTN coordinator. You can view the recording of the presentation here.

CNTN represented on CSN Board of Directors

The Canadian Society of Nephrology (CSN) announced their new president and board of directors today. We are pleased to share that 3 CNTN committee members are on the new board.

Rita Suri, member of the Scientific Operations and Executive committees, will be the chair of the CSN Scientific committee.

 

 

 

Amber Molnar, co-chair of the Communications and Engagement committee, will be representing the province of Ontario on the CSN board.

 

 

 

Bhanu Prasad, member of the Communications and Engagement committee, will be the chair of the CSN Community Nephrology committee.

 

 

 

Congratulations to everyone who was elected to the board.

COVID-19 Related Trials Listing

Below is a list of COVID-19 specific study websites and websites with study lists.  As the number of COVID-19 related studies increases, we will do our best to keep this page updated.

  • Health care workers and those living with COVID-19 positive people in Alberta, Manitoba and Quebec are eligible to participate in a trial of post-exposure prophylaxis at http://covid-19research.ca
  • COVID-19-COS project brings together patients, the public and health professionals to identify, prioritise and agree on the most important outcomes for research in COVID-19. Round 1 is planned to close on April 10, visit https://www.covid-19-cos.org/ to participate.
  • COVID-19 Resources Canada lists ongoing Canadian trials that can be sorted by Principal Investigator, Institution or Research Category.

Active Canadian trials listed on ClinicalTrials.gov can be found here.

COVID-19 Trial Management Resources

As the COVID-19 pandemic continues, most hospitals have halted all non-emergency visits, greatly affecting the conduct of clinical trials. Below are links to both Health Canada and the US Food and Drug Administration (FDA) guidance on the management of clinical trials during this time, as well as various Canadian research organizations. This post will be updated as more resources come to our attention.

We are working to collect a list of trial resources to help trialist overcome challenges and keep their research program moving forward. If you have had success or suggestions that you can share, please email amurdoch@cansolveckd.ca.

Canadian Institutes for Health Research FAQs on Impact of COVID-19 – https://cihr-irsc.gc.ca/e/51917.html#faq

Health Canada Guidance on Management of Clinical Trials during the COVID-19 pandemic – https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/announcements/management-clinical-trials-during-covid-19-pandemic.html

US FDA Guidance for Clinical Trials during COVID-19 – https://www.fda.gov/media/136238/download

COVID-19 Resources Canada – https://covid19resources.ca/activeresearch.html

Clinical Trials Ontario –  https://www.ctontario.ca/covid-19-clinical-trial-resources/

Clinical Trials BC – https://www.clinicaltrialsbc.ca/updates-for-clinical-trials-bc-regarding-covid-19/

Canadian Institute of Health Information (CIHI)  – https://www.cihi.ca/en/covid-19-resources

Spring Meeting Cancelled

In response to the current situation and in light of the cancellation of the CSN Annual General Meeting, we will be cancelling the 2020 CNTN Spring Meeting in order to maintain the health and well-being our team, our members, and the community at large. If you have any questions, please contact Alicia Murdoch at amurdoch@cansolveckd.ca.

We thank you for your patience and continued support as we navigate this challenging, and unprecedented, situation.