The Kidney Foundation of Canada

Dr. Amber Molnar 

Dr. Amber Molnar

McMaster University, ON

Risk factors for sub-optimal dialysis initiation

Co-applicant(s): Swapnil Hiremath; Ayub Akbari; Scott Kenneth Brimble; Pierre Antoine Brown 

2018-2020:  $100,000 |  Biomedical Research Grants  |  Category: Renal failure

Lay Summary

Chronic kidney disease affects approximately 730,000 Canadian adults. Patients with kidney disease are at risk of developing kidney failure. Patients with kidney failure require dialysis or a kidney transplant. Most patients are treated with dialysis. Ideally, dialysis should be started with a fistula or graft in the arm or a catheter placed into the abdomen.

Creation of a dialysis access can require months of advance planning under the care of a kidney specialist (nephrologist). Unfortunately, many patients start dialysis urgently during a hospital admission or start with a less desirable dialysis access, known as a central venous catheter (CVC). A CVC can be used immediately for dialysis and does not require advanced planning. Patients who start dialysis with a CVC or urgently during a hospital admission have an increased risk of poor outcomes, including death. Our study will provide a better understanding of why patients start dialysis so frequently with a CVC or in hospital. We will then design and test a treatment plan to help reduce the number of patients who start dialysis with a CVC or in hospital. Ultimately, our goal is to improve the care of patients with advanced kidney disease.


Amber Molnar started as a staff nephrologist at St Joseph’s Healthcare in Hamilton, Ontario in August 2015. She is an Assistant Professor with the Department of Medicine, Division of Nephrology at McMaster University and holds a cross appointment with the Department of Health Research Methods, Evidence and Impact.

She completed her nephrology and research training at the University of Ottawa. She was awarded a KRESCENT Post-doctoral Fellowship Award to support her research training and now holds a KRESCENT New Investigator Award. She is an Adjunct Scientist with the Institute for Clinical Evaluative Sciences. In this role, she is able to use large, provincial healthcare databases to answer research questions pertinent to patients with kidney disease. Her research program focuses on chronic kidney disease; specifically, improving the pre-dialysis care of patients with advanced chronic kidney disease and reducing cardiovascular complications in patients with chronic kidney disease.