Our research broadens the knowledge of kidney disease.

Supporting scholarship in palliative care across the medical specialties

In this essay, we share our experiences as three academic nephrologists at different stages in our careers who work closely with Randy Curtis at the University of Washington. Our experiences provide a window on Randy's remarkable ability to support scholarship in palliative care outside his own specialty of pulmonary and critical care medicine. We begin by providing a brief description of our experiences working with Randy and what this has meant to each of us. We then draw on these individual and collective experiences to distill out key practices that we think are especially conducive to supporting scholarship outside one's own area of specialization.

Integrated single-cell sequencing and histopathological analyses reveal diverse injury and repair responses in a participant with acute kidney injury: a clinical-molecular-pathologic correlation

Rajasree Menon, Andrew S. Bomback, Blue B. Lake, Christy Stutzke, Stephanie M. Grewenow, Steven Menez, Vivette D. D’Agati, Sanjay Jainfor, the Kidney Precision Medicine Project

The Kidney Precision Medicine Project (KPMP) and the Human Biomolecular Atlas Project (HuBMAP) have generated a comprehensive molecular atlas of the kidney from more than 400,000 cells that define healthy and injured cell types and states in AKI and chronic kidney disease. Using the atlas as a resource to perform deep interrogation of a biopsy from a patient participant with AKI, we applied single-cell analysis and detailed morphologic and pathway analysis to gain molecular insights into cellular diversity, injury states, and outcome.

Implications of Cross-System Use Among US Veterans With Advanced Kidney Disease in the Era of the MISSION Act: A Qualitative Study of Health Care Records

O'Hare AM, Butler CR, Laundry RJ, Showalter W, Todd-Stenberg J, Green P, Hebert PL, Wang V, Taylor JS, Van Eijk M, Matthews KL, Crowley ST, Carey E.

A Qualitative Study of Health Care Records: Question: What themes pertaining to cross-system use emerge from the review of the Veterans Affairs (VA) health system records of patients with advanced kidney disease?Findings: In this qualitative study of electronic health records of 1000 US veterans with advanced kidney disease, 3 dominant themes pertaining to VA-financed care outside the VA were identified. Themes described the VA as the mothership, the hidden work of veterans, and strain on the VA system. Meaning Findings of this qualitative analysis highlights the substantial strain on the VA system, VA staff and clinicians, and veterans and their families of cross-system use.

Establishing a core outcome measure for life participation in patients receiving peritoneal dialysis: A Standardised Outcomes in Nephrology–Peritoneal Dialysis consensus workshop report

Cheetham MS, Wilkie M, Loud F, Manera KE, Ju A, Figueiredo A, Farragher J, Hurst H, Jassal SV, Mehrotra R, Morton RL, Schwartz D, Shen JI, Walker R, Cho Y, Johnson DW, Craig JC, Anumudu S, Baumgart A, Gonzalez AM, Scholes-Robertson N, Viecelli AK, Tong A; SONG-PD Life Participation Workshop Investigators.

Background: Life participation is an outcome of critical importance to patients receiving peritoneal dialysis (PD). However, there is no widely accepted or validated tool for measuring life participation in patients receiving PD. Methods: Online consensus workshop to identify the essential characteristics of life participation as a core outcome, with the goal of establishing a patient-reported outcome measure for use in all trials in patients receiving PD. Thematic analysis of transcripts was performed.

Using human-centered design principles to create a decision aid on conservative kidney management for advanced kidney disease

Susan P. Y. Wong, Taryn Oestreich, Bridgett Chandler, J. Randall Curtis

Background: Most patients are unaware of approaches to treating advanced chronic kidney disease (CKD) other than dialysis. Methods: We developed a dedicated decision aid on conservative kidney management using human-centered design principles in 3 phases: 1) Discovery: engagement of informants to understand their needs; 2) Design: multiple rapid cycles of ideation, prototyping, and testing of a decision aid with a small group of informants; and 3) Implementation: testing the decision aid in real-world settings with attention to how the decision aid can be further refined.

Prevalence of SGLT2i and GLP1RA use among US adults with type 2 diabetes

Limonte CP, Hall YN, Trikudanathan S, Tuttle KR, Hirsch IB, de Boer IH, Zelnick LR

Aims: To determine national prevalence of sodium-glucose contransporter-2 inhibitor (SGLT2i) and glucagon-like peptide-1 receptor agonist (GLP1RA) use among adults with type 2 diabetes mellitus (T2DM). Methods: We studied adults with T2DM and eGFR ≥ 30 mL/min/1.73 m2 who participated in the cross-sectional National Health and Nutrition Examination Survey (NHANES), focusing on the 2017-2020 examination cycle, a key time period prior to widespread dissemination of pivotal trial results and corresponding clinical practice guidelines.

Learnings from Throwing Paint at the Wall for COVID-19 with an SGLT2 Inhibitor

What really was the biologic rationale for giving hydroxychloroquine or ivermectin for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection? Conversely, why were so many people opposed to vaccines made by scientifically sound methodology? Although these are, admittedly, rhetoric questions, they represent common prevailing thoughts that permeated cultures and societies worldwide. In sum, the COVID-19 pandemic has been a story of a public health emergency with desperate attempts to try (e.g., hydroxychloroquine, ivermectin) or, contrarily, avoid (e.g., vaccines) almost anything if a story could be concocted for it.

Kidney microphysiological models for nephrotoxicity assessment

Mahadeo A, Yeung CK, Himmelfarb J, Kelly EJ

Nephrotoxicity testing is an important step in preclinical development of new molecular entities (NMEs) and has traditionally been performed in 2-D cell culture systems and animal models. However, 2-D culture systems fail to replicate complex in vivo microenvironment and animal models face interspecies differences including the overexpression of drug transporters. In the last decade, 3-D microphysiological systems (MPS) have been developed to address these concerns. Here, we review recent advancements in kidney MPS and their application in drug-induced toxicity testing and kidney disease research.

Safety of Empagliflozin in Patients With Type 2 Diabetes and Chronic Kidney Disease: Pooled Analysis of Placebo-Controlled Clinical Trials

Tuttle KR, Levin A, Nangaku M, Kadowaki T, Agarwal R, Hauske SJ, Elsäßer A, Ritter I, Steubl D, Wanner C, Wheeler DC.

OBJECTIVE: To assess the safety of empagliflozin in patients with type 2 diabetes and moderate to severe chronic kidney disease (CKD) (category G3–4) enrolled in clinical trials.

Kidney Disease, Hypertension Treatment, and Cerebral Perfusion and Structure

Kurella Tamura M, Gaussoin S, Pajewski NM, Zaharchuk G, Freedman BI, Rapp SR, Auchus AP, Haley WE, Oparil S, Kendrick J, Roumie CL, Beddhu S, Cheung AK, Williamson JD, Detre JA, Dolui S, Bryan RN, Nasrallah IM; SPRINT Research Group (includes Watnick S).

The safety of intensive blood pressure (BP) targets is controversial for persons with chronic kidney disease (CKD). We studied the effects of hypertension treatment on cerebral perfusion and structure in individuals with and without CKD.