Letter from the editor.
CANNT Journal is privileged to present three distinct contributions in this edition that are somehow fortuitously interconnected. In our lead article, "Chaos through the continuum of kidney dysfunction: A conceptual framework", Boudreau and Dube describe how the patient, as a complex dynamic system, is intricately tied to the surrounding physical, social, and political environment that directly influences his or her health-related behaviour. Implicit in this is the unpredictability of living with chronic kidney disease (CKD). As the authors note, initiating renal replacement therapy (RRT) can precipitate chaos, but a modicum of balance can be achieved by the patient by making small changes in habits or behaviour that can enhance long-term health-related behaviours and out-comes (butterfly effect). However, for some, RRT (or, for that matter, renal transplant) is not a viable option. In "Conservative kidney management: An alternative care pathway for patients unlikely to benefit from dialysis", Wasylynuk and Davison present a body of work that serves as a bookend to the series that started with "Palliative care in patients with advanced chronic kidney disease" in CANNT Journal in 2015. Conservative kidney management (CKM) is a holistic and patient-centred approach to care that enhances quality of life. Finally, in a nod to the butterfly effect from a system level, I posit that Sivarajahkumar, So, and Battistella's article, "Antimicrobial stewardship: Is there a role in hemodialysis?", offers a way of ensuring some semblance of order through optimal and appropriate prescribing of antimicrobials in this day and age of multi-drug resistance, particularly among patients on hemodialysis, by coordinated means, e.g., education, guidelines/clinical pathways, antimicrobial order sets.
In this edition, we have also included the abstracts that will be showcased at the CANNT annual national meeting this October in Halifax. I invite you to read these abstracts, which appeal to a wide variety of audience interests. Halifax promises to be yet another banner conference and we are privileged to showcase diverse topics in nephrology that have the potential to further enrich our patients' lived experiences as they navigate through the uncertain continuum of CKD, and concurrently elevate our collective professional practice.
Jovina Bachynski CANNT Journal Editor-In-Chief