Diabetes, Kidney and Transplant

The Apheresis Unit performs Therapeutic Plasma Exchange, Red Cell Exchange, mononuclear cell collection for research and ABO Immunoadsorption for ABO incompatible kidney transplantation. We also participate in clinical trials.

8th Floor Cardinal Carter Wing North, Room 8-119
416-864-5614
Fax: 416-864-5964

Monday to Friday, 7:30 a.m. to 3.30 p.m.
24/7 on-call coverage for urgent cases

Referrals

• Please fax referrals to Dr. Katerina Pavenski at 416-864-3060

In addition to seeing adults living with Type 1 or Type 2 diabetes, the St. Michael’s Diabetes Clinic offers a specialized clinic for young adults (ages 18 to 24) with Type 1 or Type 2 diabetes. The team includes endocrinologists (diabetes doctors), diabetes nurse educators, registered dietitians and a social worker, chiropodist and pharmacist who will work collaboratively with you to create an individualized care plan.

Services include:

• Regular appointments with an endocrinologist for an initial assessment and follow up
• One-on-one appointments with team members
• Young Adult Diabetes Clinic
• Insulin Pump Program
• Continuous glucose monitoring
• Insulin Dose Adjustment Clinic
• Diabetes in Pregnancy Clinic
• Group education classes (currently on hold)
• Mentorship Program
• Osteoporosis Outreach Program (OPOutreach)

Location and Contact Information

Note: Some patient appointments are happening by phone due to the COVID-19 pandemic. If you are unsure if you have a phone or in-person appointment, please contact us.

Location: 61 Queen Street East, 7th Floor (across the street from the main hospital)

Telephone: To schedule, rebook or cancel appointments, call 416-867-3679. For all other inquiries call 416-867-7424.

Fax: 416-867-3654

Referrals

• Diabetes in Pregnancy Clinic Referral Form
• Diabetes Clinic Referral Form

The Endocrine Clinic specializes in the diagnosis and treatment of endocrine disorders, which may involve one of several hormone-producing glands like the thyroid, pituitary, adrenal, parathyroid, ovaries or testes. At the clinic, patients are seen by residents (doctors in training) and an endocrinologist.

Medication information for patients:

• Desmopressin – DDAVP
• Fludrocortisone
• Hydrocortisone
• Levothyroxine
• Methimazole and Propylthiouracil

Referrals

• Endocrine Clinic referral form

8 Cardinal Carter North
416-864-5228
416-864-5338 (North)
Monday to Saturday, 7:30 a.m. to 11:30 p.m.

Home dialysis training is scheduled Monday to Friday for six hours each day. Patients receive dialysis during the training sessions. After successful training, patients attend the Home Dialysis Clinic every eight weeks.

8 Cardinal Carter North
416-864-5794
Tuesday, 12:30 to 4 p.m.

The Interprofessional Resource Team (IRT) at St. Michael’s is an innovative team that has presence in patient care settings across the hospital. The team consists of registered nurses and clinical assistants.

2 Bond St. (booking office)
416-864-2364
NRTOFFICE@smh.ca
Monday to Sunday, 5:30 a.m. to 9:30 p.m.

In the clinic, patients are evaluated by the nephrologist (kidney doctor) and registered dietitian. This includes a review of medical history, physical examination, blood tests and two 24-hour urine collections. These results and the stone analysis can assist physicians to make a diagnosis and treat many factors which put patients at risk to form kidney stones. Specific suggestions for lifestyle changes, diet and medications can be made to manage and reduce the risk of stone formation. The appointment with the nephrologist (kidney doctor) and registered dietitian are virtual consultations (phone or video) until further notice due to COVID-19.

Resources

• Kidney stone patient education
• Referral from
• Preparing for your first visit with the dietitian
• 24-hour urine collection instructions
• Frequently asked questions

Contact

The Kidney Stone Prevention Clinic
61 Queen St. East, 9th floor
Toronto, Ontario M5C 2T2

Main line

Phone: 416-867-7460 ext. 48114
Fax: 416-867-3681
Email: stoneprevention@smh.ca

Registered dietitian

Phone: 416-867-7460 ext. 48043

Transplant is a treatment option for people with severe kidney disease. Founded in 1969, the St. Michael’s Kidney Transplant Program is one of the largest adult kidney transplant programs in Canada. At any given time, there are hundreds of patients being actively followed in the post-transplant ambulatory clinic.

The program receives referrals from more than 30 dialysis centres and kidney clinics in the Greater Toronto Area.

• Information for patients
• Information for health-care providers
• Information for living kidney donors

Location and contact

8th floor, 61 Queen Street East
Toronto, Ontario

Effective February 22, 2023, the 8^th floor of 61 Queen Street East will be home to the Transplant and Advanced Kidney Care Clinics (TAKCC) at St. Michael’s Hospital. The following two clinics will share the space:

1. 1. Kidney Transplant Program
   2. Multi Care Kidney Clinic (MCKC)

The newly renovated space offers an open environment with lots of natural light to support greater collaboration and enhanced kidney care at St. Michael’s Hospital.

Transplant clinics: 416-867-3665

Living donor clinic: 416-867-3676 or email LiveDonorTeam@smh.ca.

For urgent issues on weekends and after hours, call 416-864-5431 and request to speak with the nephrologist on-call.

Referrals

Please include all required test results with the referral package to facilitate completing the transplant assessment in a timely manner.

TGLN Kidney Transplant Referral Form

Information for patients

For more information about kidney transplantation, visit the Kidney Education Resources page.

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Information for health-care providers

The following information describes the patient services and resources available to kidney transplant candidates at St. Michael’s, our transplant evaluation process and timeline, and our communication standard.

What transplant options and services are available for patients at St. Michael’s?

We offer a variety of options for adult chronic kidney disease (CKD) patients who are interested in pursuing kidney transplant.

Deceased donor kidney transplant options:

• The provincial waiting list, managed by Trillium Gift of Life Network (TGLN)
• The Highly Sensitized Patient (HSP) Program, a national registry for patients with difficult-to-match antibody levels (cPRA ≥95%)
• The extended criteria donor (ECD) list, which reduces the waiting time for eligible older patients

Living donor kidney transplant options:

• Direct donation between compatible pairs, including donors from out-of-country
• Direct donation between blood-group incompatible donor-recipient pairs by desensitization using Glycosorb^® technology (the first in North America)
• The Kidney Paired Donation (KPD) Program, which works to match donors and recipients across Canada
• The List Exchange Program

Our multidisciplinary team provides a comprehensive suite of services for transplant candidates, recipients and living donors, including:

• Transplant candidate assessment
• Living donor candidate assessment, including out-of-country donors, when feasible
• Longitudinal multidisciplinary post-transplant follow-up care
• Patient health information website, print material, and group and individual in-person classes
• Opportunities to participate in clinical research trials
• Opportunities for patients and families to provide input via the Patient and Family Advisory Council

What are the steps involved in the transplant evaluation process?

We carefully evaluate each patient for transplant suitability. The following outlines the steps we take from initial referral to decision.

1. Referral package is sent by the primary nephrologist to the Kidney Transplant Program.
2. The referring clinician is notified of receipt within five days.
   • Incomplete packages are sent back to the referring clinician for completion.
   • Complete packages are triaged to a transplant RN coordinator for review.
3. All routine consults and appointments at St. Michael’s are booked within two weeks of receiving the referral .
4. The patient attends a Learn about Transplant class, is provided a “Transplant Passport” and completes tissue typing and an initial cPRA test at St. Michael’s.
5. The patient attends an initial assessment appointment with the transplant nephrologist and a transplant social worker at St. Michael’s.
6. The patient attends all additional routine testing and consults (e.g., CT, anesthesia consult, surgical consult) at St. Michael’s.
7. Additional testing or consultations may be required from the referring clinician.
8. A final decision is issued from the transplant nephrologist.

What should be included in the iliac Doppler report?

Iliac Dopplers have traditionally been done at St. Michael’s as part of determining suitability for kidney transplant. In an effort to ease the burden on patients, and based on requests to minimize visits to St. Michael’s, we are asking that you arrange for iliac Dopplers to be done at your hospital. Please include the results with the initial transplant referral package you send to us. We will continue to perform non-contrast CT scans of iliac vessels to assess for vascular calcification at St. Michael’s.

We understand that not all ultrasound departments are familiar with the requirements for pre-transplant iliac Dopplers. Our transplant surgeons are most concerned with the degree of iliac artery stenosis, as this will determine whether the renal allograft will be adequately perfused after the anastomosis with the donor renal artery. As such, we request that your report comment on the:

1. Aorta
2. Common iliac artery and vein
3. External iliac artery and vein
4. Internal iliac artery and vein.

For each of these vessels, we request that you assess for the following:

• Diameter
• Presence of aneurysm
• Presence of wall calcification or plaque
• Presence of flow (monophasic, biphasic or triphasic)
• Evidence of stenosis, location and an estimate of how severe (e.g., 50% occluded).

How do I find out the status of my patient’s transplant workup?

We will provide regular updates to let you know the status of each patient’s transplant workup. We will inform you:

1. When we have received the referral
2. If additional test results or reports are required
3. When the patient has seen the transplant nephrologist
4. Each time your patient has an appointment with us
5. When a decision has been made regarding the patient’s suitability for transplant

We also maintain regular contact with patients directly through mail or email to provide them the same updates.

In order to provide timely updates, it is important that we have the most current referral contact details. If a patient changes care teams or there are staff changes, please inform us as early as possible by email.

• For patients without a living donor: Meriam.Jayoma@unityhealth.to
• For patients with a potential living donor: Andreea.Gavrus@unityhealth.to

How long will my patient wait for a kidney?

From the time a referral is received, the transplant assessment takes three to nine months for recipients with a living donor and six to 12 months for recipients without a living donor. The specific timeframe depends on the medical complexity of the patient or kidney donor, his or her availability to attend appointments, and the completeness of the initial referral. For patients with a living donor not yet on dialysis, we try our best to complete the assessment to facilitate transplant pre-emptively before requiring dialysis.

If the recipient is approved for transplant, he or she may be added to the provincial wait list for a deceased donor kidney. Currently, the wait time in Ontario may be up to five to nine years, depending on the patient’s blood type and antibody level and the availability of organs. Each patient’s position on the wait list is determined by an allocation score, which is calculated as:

Allocation score = 0.1 point per 30 days on dialysis + 4*(cPRA/100)

As patients gain allocation points, they move up on the wait list.

For recipients with a living donor, surgery is usually scheduled six to 12 weeks after both the recipient and the donor have been cleared.

What can I do to prepare my patient for kidney transplant?

An informed patient is key for good health outcomes after transplant. All transplant candidates attend a mandatory Learn about Transplant class as the first step in the work-up process. Patients and family members receive written information throughout the transplant process about different transplant options, what to expect after transplant, how to prepare beforehand, being on the wait list and living donation. All of our patient education material is posted on our Kidney Education Resources page. We welcome you to use these resources to educate patients and their potential kidney donors.

If you’d like to increase your own transplant knowledge to better educate and inform patients, we encourage you to attend our next educational symposium for nephrology nurses and allied health professionals. Contact our team for details.

How long does a kidney transplant last?

Our graft survival rates are comparable to or exceed those seen in transplant centres across North America.

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Information for living kidney donors

Are you thinking about a being a kidney donor?

Our living donor transplant coordinator can help. Call 416-867-3676 or email LiveDonorTeam@smh.ca.

St. Michael’s Hospital Living Donor Transplant Program prides itself on:

• Being one of the largest living donor transplant programs in Canada.
• Participation in national Kidney Paired Donation Program.
• An expert team of surgeons who can perform keyhole donor surgery for a faster recovery. Minimally invasive (laparoscopic) surgery allows for a shorter hospital stay, less pain and a quicker return to employment for living donors.
• A health-care team dedicated to helping kidney donors and recipients have an excellent transplant experience.
• Innovative options, even if your kidney isn’t an exact match. We are the only transplant centre in North America offering blood type (ABO) incompatible transplant with Glycosorb^® Patients can receive a kidney from their living kidney donor even if the blood type is incompatible, with success rates comparable to other living donation transplants. Glycosorb^® immunoadsorption is a unique technology that circumvents complications associated with apheresis that is used in older ABOi techniques.

More information for potential donors can be found on the Kidney Education Resources page.

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The Lipids Clinic specializes in the diagnosis and treatment of abnormal lipid (cholesterol) levels. The team works with people who are at high risk for future cardiovascular disease.

At the clinic, you will be seen by a registered dietitian and a physician for assessment, medical treatment and advice on healthy living. The clinic is also involved in many research studies related to diet and medications that may reduce your risk of heart disease.

Information for patients:

• Portfolio eating plan
• Soluble fiber and cholesterol
• Plant sterols and cholesterol
• Cholesterol
• Triglycerides
• Omega-3 fatty acids
• Steps to heart healthy eating

8 Cardinal Carter North
416-864-5097
Sunday to Friday, 7 p.m. to 7 a.m.

The Department of Ophthalmology at St. Michael’s is a world-class facility recognized for excellence in patient eye care, research and teaching in the field of ophthalmology.

For more information, visit Ophtalmology.

The Osteoporosis and Metabolic Bone Disease Clinic uses state-of-the-art equipment and tests to investigate and manage osteoporosis and other metabolic bone diseases. Our multidisciplinary team is made up of endocrinologists, rheumatologists, internists, gynecologists, nurses and dietitians. The clinic was the first of its kind in Toronto and is also involved in cutting edge clinical research.

Medication information for patients:

• Denosumab
• Bisphosphonates

8th Floor 61 Queen St. E.
416-360-4000 ext. 3710

Effective February 22, 2023, the 8^th floor of 61 Queen Street East will be home to the Transplant and Advanced Kidney Care Clinics (TAKCC) at St. Michael’s Hospital. The following two clinics will share the space:

1. 1. Kidney Transplant Program
   2. Multi Care Kidney Clinic (MCKC)

The newly renovated space offers an open environment with lots of natural light to support greater collaboration and enhanced kidney care at St. Michael’s Hospital.

Renal Services includes a wide range of different kinds of dialysis as well as vascular and peritoneal dialysis (PD) access, renal clinical technology, kidney stone prevention and our renal transplant program. St. Michael’s offers a comprehensive range of services for patients at risk of kidney failure or who are in the later stages of kidney disease, with the goal of managing their health and educating them on kidney replacement options if required.

The kinds of dialysis services we offer include:

• Pre-dialysis/Multi Care Kidney Clinic: This clinic is for patients with end-stage renal disease who have not yet started dialysis or who are preparing for a kidney transplant.
• Hemodialysis: Safe and successful hemodialysis is a highly technical process involving sophisticated equipment and resources used to clean the patient’s blood. This is the most common type of dialysis.
• Peritoneal dialysis: Patients can choose between continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD). In CAPD, dialysis fluid is administered to the abdomen four to five times daily and is drained after several hours. There is no machinery required for this type of dialysis. In CCPD, the patient is attached to a machine that performs all the filling and draining of the fluid automatically. The machine administers the fluid every night for eight to 10 hours, and some patients require an additional fill during the day.
• Nocturnal Hemodialysis: This program is unique to St. Michael’s Hospital and provides treatment for patients who are either unable to perform home dialysis therapy or who are working towards home therapy. Patients are treated in the main hemodialysis unit overnight while they sleep, three times per week.
• Continuous renal replacement therapy (CRRT): For acute specialized treatments, the clinical technology department operates five continuous renal replacement therapy (CRRT) machines.
• Home dialysis: Our home dialysis programs provide education and training on either hemodialysis or peritoneal dialysis so patients are able to perform dialysis on themselves from the comfort of their own home.

45 Overlea Blvd, Unit 2, East York Town Centre
416-867-3700
Monday, Wednesday, Friday, 7 a.m. to 5 p.m.
Tuesday, Thursday, Saturday, 7 a.m. to 1 p.m.

The Division of Urology at St. Michael’s provides general urological care to the community, but also provides subspecialized care in the following areas:

• Kidney transplantation
• Robotic-assisted surgery
• Laparoscopic surgery
• Shock wave lithotripsy (SWL) for kidney stones
• Endourology (minimally invasive procedures for kidney stones)
• Cancer surgery for all urologic cancer including kidney, bladder and prostate

9th Floor 61 Queen St. E.
416-867-3710
Fax: 416-867-3709
Monday to Friday, 8 a.m. to 4 p.m.

Referrals

• Kidney Stone Clinic referral for physicians
• Shockwave Lithotripsy treatment / consultation requisition for urologists
• Kidney Stone Prevention Clinic referral form

Patient resources

• Getting ready for your shockwave lithotripsy
• After your shockwave lithotripsy
• Patient education website

8th Floor Cardinal Carter Wing – Hemodialysis South
PD Access Coordinator: 416-864-6060 ext. 5794
Vascular Access Coordinator: 416-864-6060 ext. 5228
bodyaccess@smh.ca

Referrals

• Dialysis body access referral form