Our faculty research broadens the knowledge of kidney disease.

Association of Family Ratings of Quality of End-of-Life Care With Stopping Dialysis Treatment and Receipt of Hospice Services

Claire A. Richards, Paul L. Hebert, Chuan-Fen Liu, Mary Ersek, Melissa W. Wachterman, Leslie L. Taylor, Lynn F. Reinke, Ann M. O’Hare

In this survey study of family members of patients with end-stage renal disease who were undergoing maintenance dialysis, the adjusted predicted probability of family rating the quality of end-of-life care as excellent was higher for patients who stopped dialysis before death than for patients who did not stop dialysis.

Genetics and ESKD Disparities in African Americans

Ebele M. Umeukeje, Bessie A.Young

African Americans have a 2- to 4-fold greater incidence of end-stage kidney disease (ESKD) than whites, which has long raised the possibility of a genetic cause for this disparity. Recent advances in genetic studies have shown a causal association of polymorphisms at the apolipoprotein L1 gene (APOL1) with the markedly increased risk for the nondiabetic component of the overall disparity in ESKD in African Americans.

Physician Judgment and Circulating Biomarkers Predict 28-Day Mortality in Emergency Department Patients

Daniel Henning; Pavan Bhatraju; Nicholas Johnson; Susanna Kosamo; Nathan Shapiro; Leila Zelnick; W. Liles; Mark Wurfel

OBJECTIVES: To determine whether biomarkers of endothelial activation and inflammation provide added value for prediction of in-hospital mortality within 28 days when combined with physician judgment in critically ill emergency department patients.

Alterations of Proximal Tubular Secretion in Autosomal Dominant Polycystic Kidney Disease

Ke Wang, Leila R. Zelnick, Yan Chen, Andrew N. Hoofnagle, Terry Watnick, Stephen Seliger, Bryan Kestenbaum

In autosomal dominant polycystic kidney disease (ADPKD), the GFR often remains normal despite significant nephron loss. Proximal tubular secretory clearance may be reduced in ADPKD before detectable changes in GFR.

Experiences of US Nephrologists in the Delivery of Conservative Care to Patients With Advanced Kidney Disease: A National Qualitative Study

Susan P.Y. Wong, Saritha Boyapati, Ruth A. Engelberg, Bjorg Thorsteinsdottir, Janelle S. Taylor, Ann M. O’Hare

This is a national qualitative study of nephrologist experiences and approaches to providing conservative care to patients who choose not to start maintenance dialysis. Nephrologists interviewed in this study describe a person-centered approach to care and being creative in improvising a care infrastructure for patients within health systems where dialysis is the default. The findings highlight the need to build the cultural and clinical infrastructure to support patients who do not wish to receive dialysis.

The relationship of volume overload and its control to hypertension in hemodialysis patients

Flythe JE, Bansal N

Hypertension is highly prevalent and associated with poor clinical outcomes among individuals receiving maintenance hemodialysis (HD). Volume overload is a key modifiable contributor to hypertension and cardiovascular disease in the HD population. Despite their importance, assessment and treatment of volume overload and hypertension remain major clinical challenges and have substantial implications for both clinical outcomes and patient experiences of care. This review will summarize current data on the diagnosis, epidemiology, pathophysiology, and clinical consequences of hypertension and volume overload in HD patients. We will also identify priorities for future research studies.

Cardiac and Stress Biomarkers and Chronic Kidney Disease Progression: The CRIC Study

Bansal N, Zelnick L, Shlipak MG, Anderson A, Christenson R, Deo R, Defilippi C, Feldman H, Lash J, He J, Kusek J, Ky B, Seliger S, Soliman EZ, Go AS; CRIC Study Investigators.

Increases in cardiac and stress biomarkers may be associated with loss of kidney function through shared mechanisms involving cardiac and kidney injury. We evaluated the associations of cardiac and stress biomarkers [N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hsTnT), growth differentiation factor 15 (GDF-15), soluble ST-2 (sST-2)] with progression of chronic kidney disease (CKD).

Target genes, variants, tissues and transcriptional pathways influencing human serum urate levels.

Tin A, Marten J, Halperin Kuhns VL, Li Y, Wuttke M, Kirsten H, Sieber KB, Qiu C, Gorski M, Yu Z, Giri A, Sveinbjornsson G, Li M, Chu AY, Hoppmann A, O'Connor LJ, Prins B, Nutile T, Noce D, Akiyama M, Cocca M, Ghasemi S, van der Most PJ, Horn K, Xu Y, Fuchsberger C, Sedaghat S, Afaq S, Amin N, Ärnlöv J, Bakker SJL, Bansal N, [...] Stefansson K, Susztak K, Scholz M, Heid IM, Hung AM, Teumer A, Pattaro C, Woodward OM, Vitart V, Köttgen A.

Elevated serum urate levels cause gout and correlate with cardiometabolic diseases via poorly understood mechanisms. We performed a trans-ancestry genome-wide association study of serum urate in 457,690 individuals, identifying 183 loci (147 previously unknown) that improve the prediction of gout in an independent cohort of 334,880 individuals. Serum urate showed significant genetic correlations with many cardiometabolic traits, with genetic causality analyses supporting a substantial role for pleiotropy.

Experiences of US Nephrologists in the Delivery of Conservative Care to Patients With Advanced Kidney Disease: A National Qualitative Study

Author links open overlay panelSusan P.Y. Wong, Saritha Boyapati, Ruth A. Engelberg, Bjorg Thorsteinsdottir, Janelle S.Taylor, Ann M. O’Hare

It is relatively unusual for US patients with advanced chronic kidney disease (CKD) to forgo initiation of maintenance dialysis. Our objective was to describe practice approaches of US nephrologists who have provided conservative care for members of this population.

Genome-Wide Association Study of Diabetic Kidney Disease Highlights Biology Involved in Glomerular Basement Membrane Collagen

Rany M. Salem, Jennifer N. Todd, Niina Sandholm, Joanne B. Cole, Wei-Min Chen, Darrell Andrews, Marcus G. Pezzolesi, Paul M. McKeigue, Linda T. Hiraki, Chengxiang Qiu, Viji Nair, Chen Di Liao, Jing Jing Cao, [....] Maria Luiza Caramori, Ian H. de Boer,[...], Stephen S. Rich, Joel N. Hirschhorn, Jose C. Florez and SUMMIT Consortium, DCCT/EDIC Research Group, GENIE Consortium

Although diabetic kidney disease demonstrates both familial clustering and single nucleotide polymorphism heritability, the specific genetic factors influencing risk remain largely unknown. To identify genetic variants predisposing to diabetic kidney disease, we performed genome-wide association study (GWAS) analyses. Through collaboration with the Diabetes Nephropathy Collaborative Research Initiative, we assembled a large collection of type 1 diabetes cohorts with harmonized diabetic kidney disease phenotypes. We used a spectrum of ten diabetic kidney disease definitions based on albuminuria and renal function.