Our faculty research broadens the knowledge of kidney disease.

Sleep-HD trial: short and long-term effectiveness of existing insomnia therapies for patients undergoing hemodialysis

Mark Unruh, Daniel Cukor, Tessa Rue, Kashif Abad, Maria-Eleni Roumelioti, Susan M. McCurry, Patrick Heagerty, Rajnish Mehrotra

Patients with end-stage kidney disease (ESKD) treated with hemodialysis (HD) experience many distressing symptoms. One frequently reported symptom is insomnia. There are unique issues about HD treatments and schedules that disrupt regular sleep/wake routines and possibly contribute to the high severity of insomnia. Despite evidence for broad-ranging health effects of insomnia, very few clinical trials have tested the efficacy of treatments for HD patients. Cognitive-behavioral therapy for insomnia (CBT-I) is a recommended first-line therapy but largely inaccessible to HD patients in the United States, partly because they commit considerable amounts of time to thrice-weekly dialysis treatments. Another important reason could be the logistical and reimbursement challenges associated with providing behavioral health care at the dialysis center. CBT-I delivered by telehealth can overcome barriers to access, but its efficacy has never been rigorously tested for these patients. Pharmacotherapy is the most widely used treatment for insomnia; however, some drugs presently used are unsafe as they are associated with a higher risk for death for HD patients (benzodiazepines and zolpidem-like drugs). The efficacy and safety of other medications (trazodone) for the treatment of insomnia has never been tested for patients treated with HD.

Race, Ancestry, and Vitamin D Metabolism: The Multi-Ethnic Study of Atherosclerosis

Simon Hsu, Andrew N Hoofnagle, Deepak K Gupta, Orlando M Gutierrez, Carmen A Peralta, Steven Shea, Norrina B Allen, Gregory Burke, Erin D Michos, Joachim H Ix, David Siscovick, Bruce M Psaty, Karol E Watson, Bryan Kestenbaum, Ian H de Boer, Cassianne Robinson-Cohen

A comprehensive characterization of racial/ethnic variations in vitamin D metabolism markers may improve our understanding of differences in bone and mineral homeostasis and the risk of vitamin D–related diseases. Objective: Describe racial/ethnic differences in vitamin D metabolism markers and their associations with genetic ancestry.

Cardiac Biomarkers and Risk of Mortality in CKD (the CRIC Study)

Ke Wang, Leila R. Zelnick, Amanda Anderson, Jordana Cohen, Mirela Dobre, Rajat Deo, Harold Feldman, Alan Go, Jesse Hsu, Bernard Jaar, Mayank Kansal, Michael Shlipak, Elsayed Soliman, Panduranga Rao, Matt Weir, Nisha Bansal

Cardiovascular disease (CVD) is the leading cause of mortality among individuals with chronic kidney disease (CKD). Cardiac biomarkers of myocardial distention, injury, and inflammation may signal unique pathways underlying CVD in CKD. In this analysis, we studied the association of baseline levels and changes in 4 traditional and novel cardiac biomarkers with risk of all-cause, CV, and non-CV mortality in a large cohort of patients with CKD.

Optimism is associated with chronic kidney disease and rapid kidney function decline among African Americans in the Jackson Heart Study

LáShauntá M. Glovera, Crystal Butler-Williams, Loretta Cain-Shields, Allana T. Forded, Tanjala S. Purnelle, Bessie Young, Mario Sims

Investigate the association of dispositional optimism with chronic kidney disease (CKD) and rapid kidney function decline (RKFD) and determine if there is modification by age, sex, and educational attainment among African Americans. Optimism was measured using the 6-item Life Orientation Test-Revised scale (categorized into tertiles and log transformed) among participants from the Jackson Heart Study

Do-not-resuscitate orders among patients with ESKD admitted to the intensive care unit: A bird's eye view

Jennifer S. Scherer and Ann M. O’Hare

The goal of advance care planning (ACP) is to help elucidate, clarify, and communicate patients’ values, goals, and care preferences. Engaging patients and their families in an iterative and ongoing process of ACP can help to ensure that they receive care that is congruent with their core values in situations where they may be unable to speak or advocate for themselves. During ACP, patients’ preferences related to cardiopulmonary resuscitation and other treatments along with their preferred surrogate decision maker(s) are typically documented in their medical record (e.g., advance directive, do-not-resuscitate [DNR] order, Provider Orders for Life Sustaining Treatment, and Medical Orders for Life Sustaining Treatment). To uphold personhood throughout the course of illness and across the continuum of care, ACP should ideally be integrated with patients’ other care processes; informed by their evolving experience of illness, prognostic awareness, and understanding of treatment options; and grounded in their cultural and social identities.

End-of-life care among US adults with ESKD who were waitlisted or received a kidney transplant, 2005-2014

Butler, C.R., Reese, P.P., Perkins, J.D., Hall, Y.N., Randall Curtis, J., Tamura, M.K., O'Hare, A.M

For patients with ESKD, hoping for or receiving a kidney transplant can shape prognostic expectations and care processes. In this manuscript, the authors describe more intensive, inpatient-oriented patterns of end-of-life care for patients with ESKD who had been waitlisted for a kidney transplant or received a transplant, compared with other patients with ESKD. Patients who died while on the transplant waitlist were also less likely to have received hospice services and less likely to have discontinued dialysis before death. Because there are powerful defaults favoring use of aggressive interventions to prolong life in most health systems in the United States, these findings suggest that the broad relevance of advance care planning for patients with ESKD extends to the relatively healthy segment of this population that has engaged in the transplant process.

How Safe Is a Native Kidney Biopsy?

Kidney biopsies are performed to investigate the cause of suspected parenchymal disease. Although these biopsies provide important diagnostic and prognostic information guiding therapeutic decisions, the benefits must be weighed against the potential harms of the biopsy procedure.

Systematic Review and Meta-Analysis of Native Kidney Biopsy Complications

Emilio D. Poggio, Robyn L. McClelland, Kristina N. Blank, Spencer Hansen, Shweta Bansal, Andrew S. Bomback, Pietro A. Canetta, Pascale Khairallah, Krzysztof Kiryluk, Stewart H. Lecker, Gearoid M. McMahon, Paul M. Palevsky, Samir Parikh, Sylvia E. Rosas, Katherine Tuttle, Miguel A. Vazquez, Anitha Vijayan, Brad H. Rovin and for the Kidney Precision Medicine Project

Native kidney biopsies are commonly performed in the diagnosis of acute kidney diseases and CKD. Because of the invasive nature of the procedure, bleeding-related complications are not uncommon. The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases–sponsored Kidney Precision Medicine Project requires that all participants undergo a kidney biopsy; therefore, the objective of this analysis was to study complication rates of native kidney biopsies performed using automated devices under kidney imaging.

International consensus definitions of clinical trial outcomes for kidney failure: 2020

Adeera Levin, Rajiv Agarwal, William G. Herrington, Hiddo L. Heerspink, Johannes F.E. Mann, Shahnaz Shahinfar, Katherine R. Tuttle, Jo-AnnDonner, Vivekanand Jha, Masaomi Nangaku, Dick D. Zeeuw, Meg J. Jardine, Kenneth W. Mahaffey, Aliza M. Thompson, Mary Beaucage, Kate Chong, Glenda V. Roberts, Duane Sunwold, Hans Vorster, Madeleine Warren, Sandrine Damster, Charu Malik, Vlado Perkovic

Kidney failure is an important outcome for patients, clinicians, researchers, healthcare systems, payers, and regulators. However, no harmonized international consensus definitions of kidney failure and key surrogates of progression to kidney failure exist specifically for clinical trials. The International Society of Nephrology convened an international multi-stakeholder meeting to develop consensus on this topic. A core group, experienced in design, conduct, and outcome adjudication of clinical trials, developed a database of 64 randomized trials and the 163 included definitions relevant to kidney failure.

Cardiorenal Protection With the Newer Antidiabetic Agents in Patients With Diabetes and Chronic Kidney Disease: A Scientific Statement From the American Heart Association

Janani Rangaswami, Vivek Bhalla, Ian H de Boer, Alexander Staruschenko, Johanna A Sharp, Radhika Rajgopal Singh, Kevin Bryan Lo, Katherine Tuttle, Muthiah Vaduganathan, Hector Ventura, Peter A McCullough, American Heart Association Council on the Kidney in Cardiovascular Disease; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; and Council on Lifestyle and Cardiometabolic Health

Chronic kidney disease (CKD) with type 2 diabetes (T2D) is a major public health problem, resulting in significant cardiovascular and kidney adverse outcomes worldwide. Despite the widespread use of standard-of-care therapies for CKD with T2D over the past few decades, rates of progression to end-stage kidney disease remain high with no beneficial impact on its accompanying burden of cardiovascular disease. The advent of the newer classes of antihyperglycemic agents, including SGLT2 (sodium glucose cotransporter 2) inhibitors and GLP-1 (glucagon-like peptide-1) receptor agonists, has changed the landscape of therapeutic options for patients with CKD with T2D, with demonstration of significant reductions in cardiovascular adverse events and progression to end-stage kidney disease. Several potential mechanisms exist through which these beneficial effects are achieved in both drug classes, which may be independent of their antihyperglycemic effects. This scientific statement summarizes the current literature on the cardiorenal protective effects with SGLT2 inhibitors and GLP-1 receptor agonists in patients with CKD and T2D.