Our research broadens the knowledge of kidney disease.

Clinical and biomarker modifiers of vitamin D treatment response: the multi-ethnic study of atherosclerosis

Hsu S, Prince DK, Williams K, Allen NB, Burke GL, Hoofnagle AN, Li X, Liu KJ, McClelland RL, Michos ED, Psaty BM, Shea SJ, Rice KM, Rotter JI, Siscovick D, Tracy RP, Watson KE, Kestenbaum BR, de Boer IH.

Background: Different 25-hydroxyvitamin D (25(OH)D) thresholds for treatment with vitamin D supplementation have been suggested, and are derived almost exclusively from observational studies. Whether other characteristics including race/ethnicity, body mass index (BMI), and estimated glomerular filtration rate (eGFR) should also influence the threshold for treatment is unknown. Objective: Identify clinical and biomarker characteristics that modify the response to vitamin D supplementation.

Effects of caloric restriction and aerobic exercise on circulating cell-free mitochondrial DNA in patients with moderate-to-severe chronic kidney disease

Javier Jaramillo-Morales, Berfu Korucu, Mindy M Pike, Loren Lipworth, Thomas G. Stewart, Samuel AE Headley, Michael Germain, Gwenaelle Begue, Baback Roshanravan, Katherine R Tuttle, Jonathan Himmelfarb, Cassianne Robinson-Cohen, T. Alp Ikizler, and Jorge L Gamboa

Circulating cell-free mitochondrial DNA (ccf-mtDNA) may induce systemic inflammation, a common condition chronic kidney disease (CKD), by acting as a damaged-associated molecular pattern. We hypothesized that in patients with moderate to severe CKD, aerobic exercise would reduce ccf-mtDNA levels. We performed a post hoc analysis of a multicenter randomized trial (NCT01150851), measuring plasma concentrations of ccf-mtDNA at baseline and two and four months after aerobic exercise and caloric restriction. A total of 99 participants had baseline ccf-mtDNA, and 92 completed the study.

Improving Kidney Disease Research in the Black Community: The Essential Role of Black Voices in the APOLLO Study

Ana S. Iltis, Alexis Connell, Lori Cooper, Patrick O. Gee, Nichole M. Jefferson, Heather A. Johnson, Giftay Myah Kingston, Glenda V. Roberts, Norman Scott, Angenetta Smith, Salina Waddy, Leslie Woodard, James M. DuBois

The APOLLO Study: People with two copies of the risk variants in the apolipoprotein L1 gene (APOL1), termed G1 and G2, are more likely to develop kidney disease than those with zero or one copy, yet most do not develop kidney disease. These variants are found almost exclusively in people with African, particularly West African and sub-Saharan, ancestry, where they may protect against a potentially fatal parasitic infection. Approximately 13% of the U.S. Black population has two risk variants, though rates vary by ancestral region.

ISPD recommendations for the evaluation of peritoneal membrane dysfunction in adults: Classification, measurement, interpretation and rationale for intervention

Morelle J, Stachowska-Pietka J, Öberg C, Gadola L, La Milia V, Yu Z, Lambie M, Mehrotra R, de Arteaga J, Davies S.

Peritoneal dialysis (PD) uses the peritoneal membrane for dialysis. The peritoneal membrane is a thin layer of tissue that lines the abdomen. The lining is used as a filter to help remove extra fluid and poisonous waste from the blood. Everybody is unique. What is normal for one person’s membrane may be very different from another person’s. The kidney care team wants to provide each person with the best dialysis prescription for them and to do this they must evaluate the person’s peritoneal lining. Sometimes dialysis treatment itself can cause the membrane to change after some years. This means more assessments (evaluations) will be needed to determine whether the person’s peritoneal membrane has changed. Changes in the membrane may require changes to the dialysis prescription. This is needed to achieve the best dialysis outcomes. A key tool for these assessments is the peritoneal equilibration test (PET).

Association of VA Payment Reform for Dialysis with Spending, Access to Care, and Outcomes for Veterans with ESKD

Wang V, Swaminathan S, Corneau EA, Maciejewski ML, Trivedi AN, O'Hare AM, Mor V.

Because of the limited capacity of its own dialysis facilities, the Department of Veterans Affairs (VA) Veterans Health Administration routinely outsources dialysis care to community providers. Prior to 2011—when the VA implemented a process of standardizing payments and establishing national contracts for community-based dialysis care—payments to community providers were largely unregulated. This study examined the association of changes in the Department of Veterans Affairs payment policy for community dialysis with temporal trends in VA spending and veterans’ access to dialysis care and mortality.

Concomitant Lung and Kidney Disorders in Critically Ill Patients: Core Curriculum 2022.

Sanghavi SF, Freidin N, Swenson ER

The lungs and kidneys are cooperative and interdependent organs that secure the homeostasis of the body. Volume and acid–base disorders sit at the nexus between these two systems. However, lung–kidney interactions affect the management of many other conditions, especially among critically ill patients. Therefore, management of one system cannot proceed without a thorough understanding of the physiology of the other. This installment of AJKD’s Core Curriculum in Nephrology discusses the complex decision-making required in treating concomitant respiratory and kidney disorders. We cover systemic diseases of the pulmonary and glomerular capillaries, acute decompensated heart failure, management of acid-base disorders in acute respiratory distress syndrome and chronic obstructive pulmonary disease, and venous thromboembolism. Through a case-based approach, we weigh the factors affecting the risks and benefits of therapies to enable the reader to individualize treatment decisions in these challenging scenarios.

Increasing Age Predicts Increasing Residual Urine Volume.

Wolff BJ, Brennan K, Joyce CJ, Shannon MB, Brincat CA

Objectives: To determine reference values for postvoid residual (PVR) volume for patients referred to a tertiary urogynecology center. Methods: After Institutional Review Board approval, we performed a retrospective chart review of all new patients presenting to our referral center. We assessed associations between PVR and patient demographics, pelvic floor symptoms, and physical examination by Wilcoxon rank sum or Kruskal-Wallis tests as appropriate. A multivariable logistic regression model was used to calculate odds ratios for patient characteristics associated with PVR in the top age range-specific decile.

Terlipressin: Hopes Fulfilled or Dashed?

Pichler RH, Swenson ER, Leary PJ, Paine CH

One of the most dreaded complications of end-stage liver disease is hepatorenal syndrome AKI (HRS-AKI; formally known as hepatorenal syndrome 1 [HRS-1]). HRS-AKI carries a high mortality, and treatment options are limited. Guidelines recommend terlipressin as the first-line treatment of HRS-AKI; however, terlipressin has not been approved by the Food and Drug Administration (FDA) for use in the United States. The recently published CONFIRM study is the largest randomized, placebo-controlled study to evaluate the efficacy and safety of terlipressin

APOL1, Sickle Cell Trait, and CKD in the Jackson Heart Study

Bessie A. Young, James G. Wilson, Alex Reiner, Bryan Kestenbaum, Nora Franceschini, Nisha Bansal, Adolfo Correa, Jonathan Himmelfarb, Ronit Katz 

Apolipoprotein L1 (APOL1) high-risk variants are associated with an increased risk for chronic kidney disease (CKD) among African Americans. Less is known regarding the risk for the development of CKD and kidney failure (end-stage kidney disease [ESKD]) among African Americans with only 1 APOL1 risk variant or whether the risk is modified by sickle cell trait.

10-Year Risk Prediction Equations for Incident Heart Failure Hospitalizations in Chronic Kidney Disease: Findings from the Chronic Renal Insufficiency Cohort Study and the Multi-Ethnic Study of Atherosclerosis

Mehta R, Ning H, Bansal N, Cohen J, Srivastava A, Dobre M, Michos ED, Rahman M, Townsend R, Seliger S, Lash J, Isakova T, Lloyd-Jones D, Khan SS.

Background: Heart failure (HF) is a leading contributor of cardiovascular morbidity and mortality in the chronic kidney disease (CKD) population. HF risk prediction tools that utilize readily available clinical parameters to risk stratify individuals with CKD are needed. Methods: We included Black and White participants aged 30 to 79 years with CKD stages 2-4 enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study and without self-reported cardiovascular disease. We assessed model performance of the Pooled Cohort Equations to Prevent Heart Failure (PCP-HF) to predict incident HF hospitalizations and refit the PCP-HF in the CKD population using CRIC data-derived coefficients and survival