Our research broadens the knowledge of kidney disease.
BP in Young Adults with CKD and Associations with Cardiovascular Events and Decline in Kidney Function
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
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.
Integrating Conservative kidney management Options and advance care Planning Education (COPE) into routine CKD care: A protocol for a pilot randomised controlled trial
Predialysis education for patients with advanced chronic kidney disease (CKD) typically focuses narrowly on haemodialysis and peritoneal dialysis as future treatment options. However, patients who are older or seriously ill may not want to pursue dialysis and/or may not benefit from this treatment. Conservative kidney management, a reasonable alternative treatment, and advance care planning (ACP) are often left out of patient education and shared decision-making. In this study, we will pilot an educational intervention (Conservative Kidney Management Options and Advance Care Planning Education—COPE) to improve knowledge of conservative kidney management and ACP among patients with advanced CKD who are older and/or have poor functional status.
The longitudinal relationship between patient-reported outcomes and clinical characteristics among patients with focal segmental glomerulosclerosis in the Nephrotic Syndrome Study Network
Understanding the relationship between clinical and patient-reported outcomes (PROs) will help support clinical care and future clinical trial design of novel therapies for focal segmental glomerulosclerosis (FSGS).
Rationale and design of the Kidney Precision Medicine Project
Chronic kidney disease (CKD) and acute kidney injury (AKI) are common, heterogeneous, and morbid diseases. Mechanistic characterization of CKD and AKI in patients may facilitate a precision-medicine approach to prevention, diagnosis, and treatment. The Kidney Precision Medicine Project aims to ethically and safely obtain kidney biopsies from participants with CKD or AKI, create a reference kidney atlas, and characterize disease subgroups to stratify patients based on molecular features of disease, clinical characteristics, and associated outcomes. An additional aim is to identify critical cells, pathways, and targets for novel therapies and preventive strategies.
Innovating and invigorating the clinical trial infrastructure for glomerular diseases
The current treatment of glomerular diseases is based largely on expert opinion, and small clinical studies from many years ago. Thankfully, there has been recent intense interest from the pharmaceutical industry in bringing drugs for glomerular diseases to trial, despite past failures. This is due, in part, to research efforts that have increasingly revealed molecular mechanisms of disease, facilitating the development of targeted therapeutics, as well as work undertaken by the larger nephrology community to support the use of surrogate end points, such as proteinuria, as efficacy end points in clinical trials of glomerular disease. Such efforts highlight how effective data sharing can greatly facilitate drug development for rare diseases.
Patient perspectives and involvement in precision medicine research
A lack of patient perspectives and involvement in the development of scientific inquiries at the discovery phase has been a major barrier to clinical translation of knowledge that advances patient care. Although patient partners have recently become involved in the clinical phase of nephrology research, they were largely absent in the discovery phase until KPMP. To conduct scientific inquiry guided toward clinically meaningful benefit and build public trust, a major goal of the KPMP from its inception has been inclusion of patients as equal partners for priority setting, study design and conduct, and dissemination of findings.
Clinical Evidence and Proposed Mechanisms for Cardiovascular and Kidney Benefits from Glucagon-like Peptide-1 Receptor Agonists
Coincident with the diabetes pandemic, diabetic complications—especially kidney disease and cardiovascular disease—have become large-scale public health problems. Glucagon-like peptide-1 (GLP-1) receptor agonists, a newer class of anti-hyperglycemic therapies, represent a major advance in the treatment of these complications in type 2 diabetes. In addition to effectively treating hyperglycemia, they have a low intrinsic risk of hypoglycemia and promote reductions in blood pressure and body weight. Furthermore, in clinical trials of GLP-1 receptor agonists, the risks of cardiovascular events and new or worsening diabetic kidney disease (DKD) were reduced. As a result, guidelines from major professional organizations now recommend GLP-1 receptor agonists for patients with type 2 diabetes, to reduce the risk of atherosclerotic cardiovascular disease or DKD.
Facility-Level Variation in Dialysis Use and Mortality Among Older Veterans With Incident Kidney Failure
Question - To what extent do dialysis use and mortality vary among older adults with incident kidney failure, and are these variations associated with patient or facility factors? Findings - In this cohort study of 8695 older adults with incident kidney failure, dialysis use varied widely across Veterans Affairs facilities with minimal variation in mortality. Most of the variation was associated with patient characteristics, and no correlation was found between the facility-level rate of dialysis use and mortality. Meaning - Results of this study suggest that there is marked variation in dialysis use practices for older adults across Veterans Affairs facilities.