Our faculty research broadens the knowledge of kidney disease.
Recognizing diversity in parietal epithelial cells
Parietal epithelial cells comprise a heterogeneous cell population lining Bowman's capsule. The study by Kuppe et al. focused on the peritubular region of Bowman's capsule and explored the cell biology of 2 poorly characterized subtypes—the intermediate and the cuboidal parietal epithelial cells. The early and exuberant proliferative response of these subgroups in murine focal segmental glomerulosclerosis (FSGS) and human glomerular tip lesions identified a novel hot spot for glomerular lesion formation.
An international Delphi survey helped develop consensus-based core outcome domains for trials in peritoneal dialysis
Shared decision-making about clinical care options in end-stage kidney disease is limited by inconsistencies in the reporting of outcomes and the omission of patient-important outcomes in trials. Here we generated a consensus-based prioritized list of outcomes to be reported during trials in peritoneal dialysis (PD). In an international, online, three-round Delphi survey, patients/caregivers and health professionals rated the importance of outcomes using a 9-point Likert scale (with 7–9 indicating critical importance) and provided comments.
“Not Shared” Need Not Mean “Not Patient Centered”: Deciding That a Patient Is Not a Candidate—Reply
In Reply As Blythe and colleagues outline, the “best interest” approach to decision making gives clinicians discretion to unilaterally carry out or withhold treatments without soliciting input from or collaborating with patients when they believe that this is in patients’ best interest. This approach assumes that clinicians know what interventions will be most beneficial and least harmful for individual patients. The difficulty with this approach, however, is that it is impossible to know how patients might weigh the benefits and harms of treatment without knowing their values and goals. Furthermore, clinicians often do not agree with their patients on what is most important near the end of life1 and cannot always accurately predict prognosis or the effects of treatment in individual patients.
A catalog of genetic loci associated with kidney function from analyses of a million individuals
Chronic kidney disease (CKD) is responsible for a public health burden with multi-systemic complications. Through trans-ancestry meta-analysis of genome-wide association studies of estimated glomerular filtration rate (eGFR) and independent replication (n = 1,046,070), we identified 264 associated loci (166 new). Of these, 147 were likely to be relevant for kidney function on the basis of associations with the alternative kidney function marker blood urea nitrogen (n = 416,178). Pathway and enrichment analyses, including mouse models with renal phenotypes, support the kidney as the main target organ.
Albuminuria, the HDL (High-Density Lipoprotein) Proteome, and Coronary Artery Calcification in Type 1 Diabetes Mellitus.
Albuminuria is an important risk factor for cardiovascular disease in diabetes mellitus. We determined whether albuminuria associates with alterations in the proteome of HDL (high-density lipoprotein) of subjects with type 1 diabetes mellitus and whether those alterations associated with coronary artery calcification.
Early Glomerular Hyperfiltration and Long-Term Kidney Outcomes in Type 1 Diabetes: The DCCT/EDIC Experience
Glomerular hyperfiltration has been considered to be a contributing factor to the development of diabetic kidney disease (DKD). To address this issue, we analyzed GFR follow-up data on participants with type 1 diabetes undergoing 125I-iothalamate clearance on entry into the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications study.
Association of Serum Uromodulin With ESKD and Kidney Function Decline in the Elderly: The Cardiovascular Health Study
Uromodulin is released by tubular epithelial cells into the serum and lower levels are associated with more severe interstitial fibrosis and tubular atrophy. Low serum uromodulin (sUMOD) levels are associated with mortality and cardiovascular disease. However, little is known about the association of sUMOD levels with long-term kidney outcomes in older adults, a population with a high prevalence of interstitial fibrosis and tubular atrophy.
SGLT2 inhibitor and incretin mimetic therapy for type 2 diabetes and chronic kidney disease
The pandemic of diabetes has become a global emergency. Despite increasing knowledge about diabetes prevention, this knowledge has not translated into action that effectively reduces diabetes prevalence in communities. The global picture projects an increase in people living with diabetes, from 425 million in 2017 to nearly 630 million by 2045, 1 and such an increase also means more people with diabetes complications. Chronic kidney disease develops in almost half of people with type 2 diabetes and is the leading cause of end-stage kidney disease worldwide.
Burden and Outcomes of Heart Failure Hospitalizations in Adults With Chronic Kidney Disease
Data on rates of heart failure (HF) hospitalizations, recurrent hospitalizations, and outcomes related to HF hospitalizations in chronic kidney disease (CKD) are limited. This study examined rates of HF hospitalizations and re-hospitalizations within a large CKD population and evaluated the burden of HF hospitalizations with the risk of subsequent CKD progression and death.
A turning point for chronic kidney disease in diabetes
The Study Of Diabetic Nephropathy with Atrasentan (SONAR) in The Lancet demonstrates a turning point in trial innovation.12 This double-blind, randomised, placebo-controlled trial tested the endothelin A receptor antagonist atrasentan in patients with chronic kidney disease and type 2 diabetes using an enrichment design to select participants on the basis of drug tolerance for safety and responder status for efficacy.