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Tyrone Harrison, MD, PhD

Award:  KRESCENT New Investigator Award
Institution: University of Calgary
Year: 2023-2026

Study title: Improving perioperative risk prediction for people with kidney disease

Dr Tyrone Harrison MD PhD is an assistant professor of Medicine at the University of Calgary, where he works as a health services researcher and nephrologist. He completed his Nephrology clinical training in 2018, followed by a PhD in Health Services Research at the University of Calgary in 2022 which was sponsored by a KRESCENT post-doctoral fellowship. His current research program is focused on integrating person-centredness within risk prediction strategies and population-based cohort studies for people with chronic diseases.

His KRESCENT New Investigator award will help support work aiming to (1) identify priorities for research for people with kidney disease having surgery, (2) translate these into population-based studies of these outcomes, and (3) develop risk prediction tools for these patient-prioritized outcomes in Alberta and Manitoba.
Lay Summary
Risk of surgery for people with kidney failure: Bringing the patient voice to research Background: People with kidney failure have up to 16 times more surgeries than people without kidney disease, with worse outcomes afterwards including a higher risk of heart attacks and death. Canadian healthcare guidelines recommend that doctors use tools, called risk prediction models, to estimate risk of these negative outcomes. Patients can use this information to make important decisions including whether they should have the surgery. Current risk tools focus on outcomes that doctors and researchers think are important. It is likely that things such as length of stay in hospital or outcomes related to physical function, are more important for those with kidney failure, and tools should be developed for these instead.

In these projects, we are trying to identify what is most important to people with kidney failure as they have surgery and develop tools to predict their risk.

Methods: Our team has extensive experience doing patient-focused kidney health and risk prediction research. We will conduct this work together with our patient partners to ensure that we are keeping the patients as our most important motivation.

Project 1: Predicting risk of heart attacks and dying after surgery for people with kidney failure. We have developed 3 tools to predict the risk of people with kidney failure having a heart attack or dying after surgery. However, we need to make sure that it does well in other places. We have already started working with researchers in Manitoba to test our risk models. We will use some statistical tests to tell us if these models perform well, and if so we can go on to use them in other places and test them in clinical trials.

Project 2: What events after surgery are most important to patients with kidney failure? We want to know what outcomes after surgery matter most to patients. Our first task is to gather a group of patients with kidney failure who have had surgery, their caregivers, healthcare workers, and researchers. We will use a series of surveys to identify the surgery outcomes that are most important for this group. We will then compare the risk of these important outcomes between people with kidney failure and others in Alberta. Finally, we will develop a new risk prediction tool specifically for people with kidney failure having surgery with provincial health data from Alberta and Manitoba. Once developed, we can test them to see if they improve the outcomes of this group.

Project 3: Developing a tool to monitor kidney failure patients having surgery. Alberta is launching a province-wide electronic health system (Connect Care) in all hospitals. We want to make a tool that will be used to monitor important outcomes for people with kidney failure having surgery. We will include patients and other interested health care workers and leaders to co-design this tool, and then build this ‘registry’ into Connect Care. We will use the registry to study relationships between surgical variables (like time between dialysis and surgery) and poor outcomes after surgery (such as time to discharge and others that are identified in Project 2).

Project 4: Improving how we predict who will come back to hospital after being discharged. We will gather patients, health care providers and leaders from Alberta to identify how a risk tool should be used to predict the risk of being admitted back to hospital for people with kidney failure having surgery. We will then use cutting edge methods to identify the best tool to be used to predict this outcome in Alberta. We will test the tools within Ontario and Denmark.

Conclusion: We can improve outcomes for Canadians with kidney failure having surgery, and this work will identify, research, and predict outcomes that are important to and prioritized by patients. Our team is ready to launch into these projects, and support from the KRESCENT New Investigator program would fundamentally impact the ability for this work to be conducted. Once these tools are developed, we can test them to see if they improve the experience or outcomes of people with kidney failure having surgery.