Our research broadens the knowledge of kidney disease.

Body mass index and chronic kidney disease outcomes after acute kidney injury: a prospective matched cohort study

Helen L. MacLaughlin, Mindy Pike, Nicholas M. Selby, Edward Siew, Vernon M. Chinchilli, Andrew Guide, Thomas G. Stewart, Jonathan Himmelfarb, Alan S. Go, Chirag R. Parikh, Nasrollah Ghahramani, James Kaufman, T. Alp Ikizler & Cassianne Robinson-Cohen for the ASSESS-AKI Study Investigators

Acute kidney injury (AKI) and obesity are independent risk factors for chronic kidney disease (CKD). This study aimed to determine if obesity modifies risk for CKD outcomes after AKI. This prospective multisite cohort study followed adult survivors after hospitalization, with or without AKI. The primary outcome was a combined CKD event of incident CKD, progression of CKD and kidney failure.

Patient-reported outcomes in hemodialysis vascular access: A call to action

Karen Woo, Robert Fuld, Amanda Grandinetti, Jeffrey Lawson, Terry Litchfield, Mark Ohan, John Devin Peipert, Matthew B Rivara, Glenda Roberts, Prabir Roy-Chaudhury, Margo Underwood, Robert J Nordyke

The limited implementation of PROs in clinical trials, patient registries, quality measurement, and other research settings has significantly constrained the patient voice in evaluation of vascular access outcomes and vascular access decision-making. To address these issues, the Kidney Health Initiative, a public-private partnership between the American Society of Nephrology and the U.S. Food and Drug Administration, assembled an interdisciplinary workgroup to enhance uptake of access-related PROs The workgroup provided recommendations for actions to promote the widespread utilization of vascular access-related PRO measures in five categories: (1) development of vascular access-specific PRO measures, (2) ensuring comprehensive assessment when using vascular access PRO measures, (3) ensuring accessibility and applicability of vascular access PRO measures to all end stage kidney disease populations, (4) establishing universal guidelines and accepted vascular access PRO measures, and (5) engaging stakeholders across all facets.

Associations of Microvascular Complications With the Risk of Cardiovascular Disease in Type 1 Diabetes

Rose Gubitosi-Klug, Xiaoyu Gao, Rodica Pop-Busui, Ian H. de Boer, Neill White, Lloyd P. Aiello, Ryan Miller, Jerry Palmer, William Tamborlane, Amisha Wallia, Mikhail Kosiborod, John M. Lachin, Ionut Bebu the DCCT/EDIC Research Group

We examined whether the presence of microvascular complications was associated with increased subsequent risk of cardiovascular disease (CVD) among participants with type 1 diabetes in the Diabetes Control and Complications Trial and Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study followed for >35 years.

Chronic Kidney Disease in Diabetes: Guidelines from KDIGO

Kamlesh Khunti, Ian H de Boer, Peter Rossing

The Kidney Disease: Improving Global Outcomes (KDIGO) group, an international organization dedicated to nephrology clinical practice guidelines, has developed a new guideline for management of diabetes with CKD. Team-Based Care: People with diabetes and CKD have high risks of CKD progression, cardiovascular disease (CVD), and mortality, which can be reduced with a comprehensive approach to lifestyle and risk factor management in combination with appropriate pharmacotherapy. Optimal care includes primary care, cardiology, nephrology, endocrinology, psychology, nutrition, and disease management nursing support.

Time-Updated Changes in Estimated GFR and Proteinuria and Major Adverse Cardiac Events: Findings from the Chronic Renal Insufficiency Cohort (CRIC) Study

Jordana B Cohen, Wei Yang, Liang Li, Xiaoming Zhang, Zihe Zheng, Paula Orlandi, Nisha Bansal, Rajat Deo, James P Lash, Mahboob Rahman, Jiang He, Tariq Shafi, Jing Chen, Debbie L Cohen, Kunihiro Matsushita, Michael G Shlipak, Myles Wolf, Alan S Go, Harold I Feldman, CRIC Study Investigators

Rationale and objective: Evaluating repeated measures of estimated glomerular filtration rate (eGFR) and urine protein-to-creatinine ratio (UPCR) over time may enhance our ability to understand the association between changes in kidney parameters and cardiovascular disease risk. Study design: Prospective cohort study. Setting and participants: Annual visit data from 2,438 participants in the Chronic Renal Insufficiency Cohort. Exposures: Average and slope of eGFR and UPCR in time-updated, one-year exposure windows.

3D Cell Culture Models: Drug Pharmacokinetics, Safety Assessment, and Regulatory Consideration

Hongbing Wang, Paul C. Brown, Edwin C.Y. Chow, Lorna Ewart, Stephen S. Ferguson, Suzanne Fitzpatrick, Benjamin S. Freedman, Grace L. Guo, William Hedrich, Scott Heyward, James Hickman, Nina Isoherranen, Albert P. Li, Qi Liu, Shannon M. Mumenthaler, James Polli, William R Proctor, Alexandre Ribeiro, Jian-Ying Wang, Ronald L Wange, Shiew-Mei Huang

This article reviews the current application and challenges of 3D culture systems in drug PK, safety and efficacy assessment, and provides a focused discussion and regulatory perspectives on the liver-, intestine-, kidney- and neuron-based 3D cellular models.

What Is the “Maintenance” in Maintenance Dialysis?

Taylor R.House, Susan P.Y.Wong

It is time that we adopt a more patient-centered mindset when caring for patients on dialysis. Other studies indicate that while staying alive is important to patients, their independence and how they spend their time when they are not on dialysis may be of greater value to most. However, nephrologists are more attuned to addressing patients’ biomedical markers of disease activity and risk factors for mortality than patients’ personal goals and function.

Comparison of host endothelial, epithelial and inflammatory response in ICU patients with and without COVID-19: a prospective observational cohort study

Pavan K. Bhatraju, Eric D. Morrell, Leila Zelnick, Neha A. Sathe, Xin-Ya Chai, Sana S. Sakr, Sharon K. Sahi, Anthony Sader, Dawn M. Lum, Ted Liu, Neall Koetje, Ashley Garay, Elizabeth Barnes, Jonathan Lawson, Gail Cromer, Mary K. Bray, Sudhakar Pipavath, Bryan R. Kestenbaum, W. Conrad Liles, Susan L. Fink, T. Eoin West, Laura Evans, Carmen Mikacenic, Mark M. Wurfel 

Analyses of blood biomarkers involved in the host response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral infection can reveal distinct biological pathways and inform development and testing of therapeutics for COVID-19. Our objective was to evaluate host endothelial, epithelial and inflammatory biomarkers in COVID-19.

Magnesium and Cardiovascular Disease in CKD: The Mysteries of a Humble Divalent Cation

Alexander J. Kula, Nisha Bansal

Despite its abundance, magnesium is an enigmatic electrolyte. Within the intracellular compartment, magnesium is the most abundant cation second only to potassium. Numerous biochemical processes, many of them essential for life, require magnesium as a cofactor. However, magnesium remains underappreciated clinically, particularly in nephrology, because concentrations are monitored and treated only in specific disease states such as torsades de pointes or preeclampsia. However, there has been an increase in epidemiologic research investigating the relationship between serum magnesium levels and outcomes (specifically cardiovascular outcomes), bringing renewed attention to this often “forgotten” electrolyte.

Lessons Learned: Nephrology Training Program Adaptation in the Time of COVID

Nisha Bansal, Yoshio N. Hall, Kamalanathan K. Sambandam, Amanda K. Leonberg-Yoo

The COVID-19 pandemic has prompted rapid changes to medical education. Across the U.S., graduate medical education programs have had to navigate abrupt declines in outpatient medical care, marked fluctuations in inpatient volume and acuity, and a rapid shift to online education. Through our shared experiences across nephrology fellowship programs in three different U.S. regions, we identified three domains in which we faced the greatest challenges: changes in care delivery models, curricular adaptation, and fellow wellbeing. Here, we outline the specific challenges in these areas and highlight opportunities for innovation in nephrology fellowship training, stimulated by the COVID-19 disruption.