Our research broadens the knowledge of kidney disease.

Medicaid Expansion and Incidence of Kidney Failure among Nonelderly Adults

Rebecca Thorsness, Shailender Swaminathan, Yoojin Lee, Benjamin D. Sommers, Rajnish Mehrotra, Kevin H. Nguyen, Daeho Kim, Maricruz Rivera-Hernandez and Amal N. Trivedi

Prior work suggests that uniform access to health insurance coverage and health care services reduces disparities in treatment and outcomes of patients with CKD. This study assessed whether expansions of Medicaid coverage to low-income adults in the United States under the Affordable Care Act (ACA) were associated with changes in the incidence rate of kidney failure. The authors found that, in the entire adult population aged 19–64 years, the ACA’s Medicaid expansions were associated with a statistically significant 3% relative reduction in kidney failure incidence in the early period (years 2 and 3) after expansion. However, this decline was not sustained in the later period (years 4 and 5) after expansion. Further research is needed to understand the relationship between expanding health insurance coverage and the incidence of kidney failure.

Retinal Capillary Nonperfusion on OCT-Angiography and Its Relationship to Kidney Function in Patients with Diabetes

Tom ES, Saraf SS, Wang F, Zhang Q, Vangipuram G, Limonte CP, de Boer IH, Wang RK, Rezaei KA.

Background. Diabetic retinopathy and kidney disease share underlying mechanisms of microvascular damage and are often comorbid in people with diabetes. We evaluated whether there is a relationship between retinal capillary perfusion as measured by swept-source optical coherence tomography angiography and estimated glomerular filtration rate (eGFR) and albuminuria in patients with diabetes and chronic kidney disease (CKD). Method. A cross-sectional pilot study was conducted at the University of Washington among a subset of participants with diabetes and CKD participating in a larger cohort study. Participants were excluded if they were known to have kidney disease from conditions other than diabetes. Ten participants (11 eyes) were included. Retinal nonperfusion (RNP) and vessel density (VD) were measured by swept-source optical coherence tomography angiography in 30° and 60° field of view (FOV) regions centered at the fovea.

KDOQI US Commentary on the KDIGO Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation

Chethan M. Puttarajappa, Carrie A. Schinstock Christine M. Wu, Nicolae Leca, Vineeta Kumar, Brahm S. Vasudev, Sundaram Hariharan

There is considerable variability among transplant centers in their approach to evaluation and decision-making regarding transplant candidacy. The 2020 KDIGO (Kidney Disease: Improving Guidelines Outcome) clinical practice guideline on the evaluation and management of candidates for kidney transplantation provides practice recommendations that can serve as a useful reference guide to transplant professionals. The guideline, covering a broad range of topics, was developed by an international group of experts from transplant and nephrology through a review of literature published until May 2019. A work group of US transplant nephrologists convened by NKF-KDOQI (National Kidney Foundation–Kidney Disease Quality Initiative) chose key topics for this commentary with a goal of presenting a broad discussion to the US transplant community. Each section of this article has a summary of the key KDIGO guideline recommendations, followed by a brief commentary on the recommendations, their clinical utility, and potential implementation challenges.

Development and Content Validity of a Patient-Reported Experience Measure for Home Dialysis

Matthew B. Rivara, Todd Edwards, Donald Patrick, Lisa Anderson, Jonathan HimmelfarbRajnish Mehrotra

The population of patients with kidney failure in the United States using home dialysis modalities is growing rapidly. Unlike for in-center hemodialysis, there is no patient-reported experience measure for assessment of patient experience of care for peritoneal dialysis or home hemodialysis. We sought to develop and establish content validity of a patient-reported experience measure for patients undergoing home dialysis using a mixed methods multiple stakeholder approach.

Professional roles and relationships during the COVID-19 pandemic: a qualitative study among US clinicians

Catherine R Butler, Susan P Y Wong, Elizabeth K Vig, Claire S Neely, Ann M O'Hare

Objective: The COVID-19 pandemic has transformed healthcare delivery in the USA, but there has been little empirical work describing the impact of these changes on clinicians. We conducted a study to address the following question: how has the pandemic impacted US clinicians' professional roles and relationships? Design: Inductive thematic analysis of semi-structured interviews. Setting: Clinical settings across the USA in April and May of 2020. Participants: Clinicians with leadership and/or clinical roles during the COVID-19 pandemic. Measures: Emergent themes related to professional roles and relationships.

Prevention of Urinary Stones With Hydration (PUSH): Design and Rationale of a Clinical Trial

Charles D Scales Jr, Alana C Desai, Jonathan D Harper, H Henry Lai, Naim M Maalouf, Peter P Reese, Gregory E Tasian, Hussein R Al-Khalidi, Ziya Kirkali, Hunter Wessells, Urinary Stone Disease Research Network, including Sandra Amaral, Janet Audrain-McGovern, Brittney Henderson, Kristen Koepsell, Adam Mussell, Jodi A Antonelli, Linda A Baker, Joyce Obiaro, Cynthia Rangel, Martinez Hill, Madeline Worsham, Fionnuala Cormack, Mathew Sorensen, Karyn Yonekawa, Holly Covert, Tristan Baxter, Elsa Ayala, Vincent Mellnick, Douglas Coplen, Juanita Taylor, Aleksandra Klim, Deborah Ksiazek, Sri Sivalingam, Katherine Dell, Juan Calle, Paige Gotwald, Marina Markovic, John Lieske, Andrew Rule, Stephen Erickson, Aaron Potrezke, Andrea Ferrero, David Sas, Angela Waits, Courtney Lenort, Kevin Weinfurt, Hayden Bosworth, Honqiu Yang, Laura Johnson, Angela Venetta, Omar Thompson

Rationale & objective: Although maintaining high fluid intake is an effective low-risk intervention for the secondary prevention of urinary stone disease, many patients with stones do not increase their fluid intake. Study design: We describe the rationale and design of the Prevention of Urinary Stones With Hydration (PUSH) Study, a randomized trial of a multicomponent behavioral intervention program to increase and maintain high fluid intake. Participants are randomly assigned (1:1 ratio) to the intervention or control arm. The target sample size is 1,642 participants. Setting & participants: Adults and adolescents 12 years and older with a symptomatic stone history and low urine volume are eligible. Exclusion criteria include infectious or monogenic causes of urinary stone disease and comorbid conditions precluding increased fluid intake.

Association of Obesity with Cardiovascular Risk Factors and Kidney Disease Outcomes in Primary Proteinuric Glomerulopathies

Shah P.P.,  Brady T.M., Meyers K.E.C.,  O’Shaughnessy M.M., Gibson K.L., Srivastava T., Zee J., Cattran D., Tuttle K.R., Gadegbeku C., Glenn D., Derebail V., Smith A., Wang C., Gillespie B.W., Bitzer M., Sethna C.B.

Obesity is a known risk factor for cardiovascular disease and contributes to the development and progression of kidney disease. However, the specific influence of obesity on outcomes in primary glomerular disease has not been well characterized. In this prospective cohort study, data were from 541 participants enrolled in the Nephrotic Syndrome Study Network (NEPTUNE), between 2010 and 2019, at 23 sites across North America. Blood pressure, lipids, and kidney disease outcomes including complete proteinuria remission, kidney failure, and chronic kidney disease progression were evaluated. Data were analyzed using linear and logistic regression with generalized estimating equations and time-varying Cox regression with Kaplan-Meier plots.

BP in Young Adults with CKD and Associations with Cardiovascular Events and Decline in Kidney Function

Alexander J. Kula, David K. Prince, Joseph T. Flynn, Nisha Bansal

Although young adults (aged 18–40 years) with CKD are at risk for poor cardiovascular and renal outcomes, with hypertension an important and potentially modifiable risk factor, they are largely absent from observational studies and clinical trials of BP in patients with CKD. To address this knowledge gap, this observational study provides a description of BP and its relation to outcomes specifically in young adults with CKD. It demonstrates that among young adults with CKD, higher BP is associated with cardiovascular events (particularly heart failure) and CKD progression. The study’s findings may provide a foundation for future work to develop best practices for BP management in young adults with CKD and improve outcomes.

Mixed Methods Research to Advance Nephrology

Mixed methods research combines elements of quantitative and qualitative methodologies in an effort to leverage their unique strengths and counterbalance their respective limitations. This article provides a concise overview of mixed methods research, highlighting the general forms and functions of mixing quantitative and qualitative methodologies, and concludes with an example from the nephrology literature to illustrate its application.

Changes in cancer incidence and outcomes among kidney transplant recipients in the United States over a thirty-year period

Christopher D. Blosser, Gregory Haber, Eric A. Engels

Recipients of kidney transplants have elevated cancer risk compared with the general population. Improvements over time in transplant care and cancer treatment may have affected incidence and outcomes of cancer among recipients of kidney transplant. To evaluate this, we used linked United States transplant and cancer registry data to study 101,014 adult recipients of kidney transplants over three decades (1987-1996, 1997-2006, 2007-2016). Poisson regression was used to assess trends in incidence for cancer overall and seven common cancers. Associations of cancer with risk of death-censored graft failure (DCGF) and death with functioning graft (DWFG) were evaluated with Cox regression. We also estimated absolute risks of DCGF and graft failure following cancer for recipients transplanted in 2007-2016. There was no significant change in the incidence of cancer overall or for six common cancers in recipients across the 1987-2016 period.