Our faculty research broadens the knowledge of kidney disease.

Burden and Cost of Caring for US Veterans With CKD: Initial Findings From the VA Renal Information System (VA-REINS)

Saran, R., Pearson, A., Tilea, A., Shahinian, V., Bragg-Gresham, J., Heung, M., Hutton, D.W., Steffick, D., Zheng, K., Morgenstern, H., Gillespie, B.W., Leichtman, A., Young, E., O'Hare, A.M., Fischer, M., Hotchkiss, J., Siew, E., Hynes, D., Fried, L., Balkovetz, D., Sovern, K., Liu, C.-F., Crowley, S., Crowley, Fischer, Hynes, O'Hare, Fried, Hickam, E., Balkovetz, Hotchkiss, Liu, Sovern, Ferguson, R., Rodriguez, R., Cupples, S.,, Daniels, S.M., Loftus, S., Ashei, A., Francis, J., Graham, G., Lowe-Bey, F., Gunnar, W., Varga, J.H., Trautman, T., Brown, J., Rios, F., VA-REINS Steering Committee, VA Advisory Board 
 

Kidney disease is a common, complex, costly, and life-limiting condition. Most kidney disease registries or information systems have been limited to single institutions or regions. A national US Department of Veterans Affairs (VA) Renal Information System (VA-REINS) was recently developed. We describe its creation and present key initial findings related to chronic kidney disease (CKD) without kidney replacement therapy (KRT). Data from the VA’s Corporate Data Warehouse were processed and linked with national Medicare data for patients with CKD receiving KRT. Operational definitions for VA user, CKD, acute kidney injury, and kidney failure were developed.

Burden of Chronic Kidney Disease by KDIGO Categories of Glomerular Filtration Rate and Albuminuria: A Systematic Review

Molly Murton, Danielle Goff-Leggett, Anna Bobrowska, Juan Jose Garcia Sanchez, Glen James, Eric Wittbrodt, Stephen Nolan, Elisabeth Sörstadius, Roberto Pecoits-Filho, Katherine Tuttle 

The Kidney Disease: Improving Global Outcomes (KDIGO) 2012 guidelines recommend classifying patients by glomerular filtration rate (GFR) and albuminuria to predict chronic kidney disease (CKD) prognosis. The aim of this systematic review was to explore the epidemiological burden of CKD stratified by the KDIGO 2012 categories. MEDLINE® and Embase were searched for observational studies of patients with CKD with results stratified according to the KDIGO 2012 classification. Investigated outcomes were prevalence, incidence, and risk factors and complications of CKD, including mortality.

Incretin drugs in diabetic kidney disease: biological mechanisms and clinical evidence

Radica Z. Alicic, Emily J. Cox, Joshua J. Neumiller, Katherine R. Tuttle 

As the prevalence of diabetes continues to climb, the number of individuals living with diabetic complications will reach an unprecedented magnitude. The emergence of new glucose-lowering agents — sodium–glucose cotransporter 2 inhibitors and incretin therapies — has markedly changed the treatment landscape of type 2 diabetes mellitus. In addition to effectively lowering glucose, incretin drugs, which include glucagon-like peptide 1 receptor (GLP1R) agonists and dipeptidyl peptidase 4 (DPP4) inhibitors, can also reduce blood pressure, body weight, the risk of developing or worsening chronic kidney disease and/or atherosclerotic cardiovascular events, and the risk of death. Although kidney disease events have thus far been secondary outcomes in clinical trials, an ongoing phase III trial in patients with diabetic kidney disease will test the effect of a GLP1R agonist on a primary kidney disease outcome.

Cardio-Renal-Metabolic Care Models: Toward Achieving Effective Interdisciplinary Care

Janani Rangaswami, Katherine Tuttle, Muthiah Vaduganathan

The highly interdependent relationship between the heart and kidneys was described as early as in 1836 by Sir Richard Bright, who identified cardiac structural abnormalities in a series of patients with advanced chronic kidney disease.1 Around the same time in 1835, French chemists isolated phlorizin, a natural, nonselective inhibitor of SGLT1 (sodium glucose co-transporter 1) and SGLT2, as part of early attempts to create an animal model for diabetes. Since then, despite major developments in cardiorenal and metabolic medicine, there has been a relative chasm between availability of new approaches to optimize cardiovascular and kidney outcomes and their implementation in clinical practice. With the advent of the sodium glucose cotransporter 2 inhibitors (SGLT2is) and the glucagon-like receptor-1 agonists and other new cardiorenal protective therapies, the spheres of cardio-nephrology and metabolic medicine have converged in unprecedented ways with the potential for population-level improvements in multidomain health.

Telehealth for Home Dialysis in COVID-19 and Beyond: A Perspective From the American Society of Nephrology COVID-19 Home Dialysis Subcommittee

Susie Q.Lew, Eric L. Wallace, Vesh Srivatana, Bradley A. Warady, Suzanne Watnick, Jayson Hood, David L. White, Vikram Aggarwal, Caroline Wilkie, Mihran V. Naljayan, Mary Gellens, Jeffrey Perl, Martin J. Schreiber

Platforms have been developed or purchased to perform videoconferencing, and interdisciplinary dialysis teams have adapted to perform virtual visits. Telehealth experiences and challenges encountered by dialysis providers, clinicians, nurses, and patients have exposed health care disparities in areas such as access to care, bandwidth connectivity, availability of devices to perform telehealth, and socioeconomic and language barriers. Future directions in telehealth use, quality measures, and research in telehealth use need to be explored. Telehealth during the public health emergency has changed the practice of health care, with the post–COVID-19 world unlikely to resemble the prior era. The future impact of telehealth in patient care in the United States remains to be seen, especially in the context of the Advancing American Kidney Health Initiative.

Fibroblast Growth Factor 23 and Long-Term Cardiac Function: The Multi-Ethnic Study of Atherosclerosis

Ravi B. Patel, Hongyan Ning, Ian H. de Boer, Bryan Kestenbaum, João A.C. Lima, Rupal Mehta, Norrina B. Allen, Sanjiv J. Shah, Donald M. Lloyd-Jones

Although FGF23 (fibroblast growth factor 23) is associated with heart failure and atrial fibrillation, the mechanisms driving these associations are unclear. Sensitive measures of cardiovascular structure and function may provide mechanistic insight behind the associations of FGF23 with various cardiovascular diseases. In MESA (the Multi-Ethnic Study of Atherosclerosis), we evaluated the associations of baseline serum FGF23 (2000–2002) with measures of left ventricular (LV) and left atrial mechanical function on cardiac magnetic resonance at 10-year follow-up (2010–2012).

Health policy for dialysis care in Canada and the United States

Marcello Tonelli, Raymond Vanholder and Jonathan Himmelfarb

Contemporary dialysis treatment for chronic kidney failure is complex, is associated with poor clinical outcomes, and leads to high health costs, all of which pose substantial policy challenges. Despite similar policy goals and universal access for their kidney failure programs, the United States and Canada have taken very different approaches to dealing with these challenges. While US dialysis care is primarily government funded and delivered predominantly by private for-profit providers, Canadian dialysis care is also government funded but delivered almost exclusively in public facilities. Differences also exist for regulatory mechanisms and the policy incentives...

Meaning of empowerment in peritoneal dialysis: focus groups with patients and caregivers

Amanda Baumgart, Karine E Manera, David W Johnson, Jonathan C Craig, Jenny I Shen, Lorena Ruiz, Angela Yee-Moon Wang, Terence Yip, Samuel K S Fung, Matthew Tong, Achilles Lee, Yeoungjee Cho, Andrea K Viecelli, Benedicte Sautenet, Armando Teixeira-Pinto, Edwina A Brown, Gillian Brunier, Jie Dong, Nicole Scholes-Robertson, Tony Dunning, Rajnish Mehrotra, Saraladevi Naicker, Roberto Pecoits-Filho, Jeffrey Perl, Martin Wilkie, Allison Tong

While peritoneal dialysis (PD) can offer patients more independence and flexibility compared with in-center hemodialysis, managing the ongoing and technically demanding regimen can impose a burden on patients and caregivers. Patient empowerment can strengthen capacity for self-management and improve treatment outcomes. We aimed to describe patients’ and caregivers’ perspectives on the meaning and role of patient empowerment in PD.

Trajectory of Kidney Function: The Canary in Sepsis

Pavan K. Bhatraju, Mark M. Wurfel, Jonathan Himmelfarb

Acute kidney injury (AKI) is a common form of organ failure in sepsis, with incidence rates of 40–60%. Patients with sepsis-induced AKI have unacceptably high mortality rates. Despite the frequency of AKI complicating sepsis, treatments are limited. The Kidney Disease: Improving Global Outcomes consensus group defines AKI as an increase in serum creatinine or a decrease in urine output. However, the Kidney Disease: Improving Global Outcomes definition does not stratify patients on the basis of differences in AKI recovery patterns. Combining patients with different AKI recovery patterns may hide subgroups that are more tightly associated with clinical outcomes.

Dialysis initiation, modality choice, access, and prescription: Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Chan, C.T., Blankestijn, P.J., Dember, L.M., Gallieni, M., Harris, D.C.H., Lok, C.E., Mehrotra, R., Stevens, P.E., Wang, A.Y.-M., Cheung, M., Wheeler, D.C., Winkelmayer, W.C., Pollock, C.A., Conference Participants

Globally, the number of patients undergoing maintenance dialysis is increasing, yet throughout the world there is significant variability in the practice of initiating dialysis. Factors such as availability of resources, reasons for starting dialysis, timing of dialysis initiation, patient education and preparedness, dialysis modality and access, as well as varied “country-specific” factors significantly affect patient experiences and outcomes. As the burden of end-stage kidney disease (ESKD) has increased globally, there has also been a growing recognition of the importance of patient involvement in determining the goals of care and decisions regarding treatment. In January 2018, KDIGO (Kidney Disease: Improving Global Outcomes) convened a Controversies Conference focused on dialysis initiation, including modality choice, access, and prescription. Here we present a summary of the conference discussions, including identified knowledge gaps, areas of controversy, and priorities for research.