Our faculty research broadens the knowledge of kidney disease.

Transforming Care for Patients and Providers - Perspective from Nonprofit Providers

Suzanne Watnick and Jeffrey Silberzweig

As Chief Medical Officers of not-for-profit organizations, we often find ourselves addressing the needs of many stakeholders, focusing on patient care as our central mission and figuring how to achieve this with resources available. Along with our nephrologist colleagues and our dialysis organizations’ leadership and staff, we seek to provide the best possible care for our patients. This discussion will focus on the potential consequences of the AAKH initiative for our patients, nephrologists, and dialysis organizations.

Advancing American Kidney Health: An Introduction

On July 10, 2019, President Trump announced a sweeping set of initiatives collectively called Advancing American Kidney Health, designed to reduce the incidence of kidney failure, make more treatment options for dialysis available to a larger number of patients, and increase the number of available organs for kidney transplantation. With a series of 10 articles, CJASN wishes to communicate to its readers the opinion on the proposal of a wide range of stakeholders.

Trends in Mortality Among Patients Initiating Maintenance Dialysis in Puerto Rico Compared to US States, 2006-2015

Maricruz Rivera-Hernandez, Shailender Swaminathan, Rebecca Thorsness, Yoojin Lee, Rajnish Mehrotra, Benjamin D.Sommers, Amal N.Trived

Although the incidence of end-stage kidney disease is 34% higher in US Hispanics than non-Hispanics, the latter have a lower mortality rate following initiation of dialysis (107 vs 206 per 1,000 patient-years). Outcomes have not been examined in Puerto Rico, a US territory where 4 million Hispanic Americans reside. Puerto Rico outperforms the US states and the District of Columbia on some measures of coverage and access, but substantial problems with quality of care have been documented. In this study, we compared 1-year mortality rates and predialysis nephrology care among Hispanics in Puerto Rico and Hispanics and whites in the states who initiated maintenance hemodialysis or peritoneal dialysis between 2006 and 2015.

Association of High‐Density Lipoprotein Particles and High‐Density Lipoprotein Apolipoprotein C‐III Content With Cardiovascular Disease Risk According to Kidney Function: The Multi‐Ethnic Study of Atherosclerosis

Julio A. Lamprea‐Montealegre, Robyn L. McClelland, James D. Otvos, Samia Mora, Manja Koch, Majken K. Jensen, Ian H. de Boer

Chronic kidney disease is associated with structural and compositional abnormalities in high‐density lipoprotein particles (HDLp). We examined associations of HDLp size, particle subfractions, and apolipoprotein C‐III content with incident cardiovascular disease (CVD) events across categories of estimated glomerular filtration rate (eGFR). Analyses included 6699 participants in MESA (Multi‐Ethnic Study of Atherosclerosis).

Rationale and design of a multicenter Chronic Kidney Disease (CKD) and at-risk for CKD electronic health records-based registry: CURE-CKD

Keith C. Norris, O. Kenrik Duru, Radica Z. Alicic, Kenn B. Daratha, Susanne B. Nicholas, Sterling M. McPherson, Douglas S. Bell, Jenny I. Shen, Cami R. Jones, Tannaz Moin, Amy D. Waterman, Joshua J. Neumiller, Roberto B. Vargas, Alex A. T. Bui, Carol M. Mangione, Katherine R. Tuttle & on behalf of the CURE-CKD investigators

Chronic kidney disease (CKD) is a global public health problem, exhibiting sharp increases in incidence, prevalence, and attributable morbidity and mortality. There is a critical need to better understand the demographics, clinical characteristics, and key risk factors for CKD; and to develop platforms for testing novel interventions to improve modifiable risk factors, particularly for the CKD patients with a rapid decline in kidney function. We describe a novel collaboration between two large healthcare systems (Providence St. Joseph Health and University of California, Los Angeles Health) supported by leadership from both institutions, which was created to develop harmonized cohorts of patients with CKD or those at increased risk for CKD (hypertension/HTN, diabetes/DM, pre-diabetes) from electronic health record data.

Graft immaturity and safety concerns in transplanted human kidney organoids

Sun Ah Nam, Eunjeong Seo, Jin Won Kim, Hyung Wook Kim, Hong Lim Kim, Kyuryung Kim, Tae-Min Kim, Ji Hyeon Ju, Ivan G. Gomez, Kohei Uchimura, Benjamin D. Humphreys, Chul Woo Yang, Jae Yeon Lee, Jin Kim, Dong Woo Cho, Benjamin S. Freedman, Yong Kyun Kim

For chronic kidney disease, regeneration of lost nephrons with human kidney organoids derived from induced pluripotent stem (iPS) cells is proposed to be an attractive potential therapeutic option. It remains unclear, however, whether organoids transplanted into kidneys in vivo would be safe or functional. Here, we purified kidney organoids and transplanted them beneath the kidney capsules of immunodeficient mice to test their safety and maturity. Kidney organoid grafts survived for months after transplantation and became vascularized from host mouse endothelial cells.

Serum 25-hydroxyvitamin-D and nonalcoholic fatty liver disease: Does race/ethnicity matter? Findings from the MESA cohort

El Khoudary SR, Samargandy S, Zeb I, Foster T, de Boer IH, Li D, Budoff MJ

Low serum 25-hydroxyvitamin D (25(OH)D) is associated with higher nonalcoholic fatty liver disease (NAFLD) risk in studies of mainly white participants. Significant racial/ethnic differences exist in serum 25(OH)D and NAFLD prevalence questioning extending this association to other racial/ethnic groups. We tested whether the association between serum 25(OH)D and NAFLD vary by race/ethnicity.

Impact of race on the association of mineral metabolism with heart failure: the Multi-Ethnic Study of Atherosclerosis

Cassianne Robinson-Cohen, Michael Shlipak, Mark Sarnak, Ronit Katz, Carmen Peralta, Bessie Young, Andrew N Hoofnagle, Moyses Szklo, Joachim H Ix, Bruce M Psaty, Ian H de Boer, Bryan Kestenbaum, Nisha Bansal

Alterations in mineral metabolism, such as high phosphorus, high parathyroid hormone (PTH) and high fibroblast growth factor-23 (FGF-23) have been identified as potential risk factors for heart failure (HF). Important differences in the prevalence of mineral metabolism abnormalities and in the risk of HF have been reported across race/ethnic groups. In this study, we evaluated whether the associations of mineral metabolism markers with HF differed by race/ethnicity.

Race and Mortality in CKD and Dialysis: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study

Ku E, Yang W, McCulloch CE, Feldman HI, Go AS, Lash J, Bansal N, He J, Horwitz E, Ricardo AC, Shafi T, Sondheimer J, Townsend RR, Waikar SS, Hsu CY; CRIC Study Investigators

Few studies have investigated racial disparities in survival among dialysis patients in a manner that considers risk factors and mortality during the phase of kidney disease before maintenance dialysis. Our objective was to explore racial variations in survival among dialysis patients and relate them to racial differences in comorbid conditions and rates of death in the setting of kidney disease not yet requiring dialysis therapy.

Effect of Vitamin D and Omega-3 Fatty Acid Supplementation on Kidney Function in Patients With Type 2 Diabetes

Ian H. de Boer, Leila R. Zelnick, John Ruzinski, Georgina Friedenberg, Julie Duszlak, Vadim Y. Bubes, Andrew N. Hoofnagle, Ravi Thadhani, Robert J. Glynn, Julie E. Buring, Howard D. Sesso, JoAnn E. Manson

Chronic kidney disease (CKD) is a common complication of type 2 diabetes that can lead to end-stage kidney disease and is associated with high cardiovascular risk. Few treatments are available to prevent CKD in type 2 diabetes. The objective is to test whether supplementation with vitamin D3 or omega-3 fatty acids prevents development or progression of CKD in type 2 diabetes.