Our faculty research broadens the knowledge of kidney disease.

Commentary on Risks of Living Kidney Donation: Current State of Knowledge on Core Outcomes Important to Donors

Bryan R. Kestenbaum, Stephen L. Seliger

In this evidence-based nephrology review, Lentine et al. discuss the growing evidence regarding short- and long-term risks of living kidney donation. Adopting a patient-centered approach to characterizing and prioritizing these risks, the authors identify four potential risk categories.

Integrated epigenomic profiling reveals endogenous retrovirus reactivation in renal cell carcinoma

Siebenthall, K.T.,  Miller, C.P.,  Vierstra, J.D.,  Mathieu, J.d,,  Tretiakova, M.,  Reynolds, A.,  Sandstrom, R.,  Rynes, E.,  Haugen, E.,  Johnson, A.,  Nelson, J.,  Bates, D.,  Diegel, M.,  Dunn, D.,  Frerker, M.,  Buckley, M.,  Kaul, R.,  Zheng, Y.,  Himmelfarb, J.,  Ruohola-Baker, H.,  Akilesh, S.

Transcriptional dysregulation drives cancer formation but the underlying mechanisms are still poorly understood. Renal cell carcinoma (RCC) is the most common malignant kidney tumor which canonically activates the hypoxia-inducible transcription factor (HIF) pathway. Despite intensive study, novel therapeutic strategies to target RCC have been difficult to develop. Since the RCC epigenome is relatively understudied, we sought to elucidate key mechanisms underpinning the tumor phenotype and its clinical behavior.

Evidence-based therapy for undocumented immigrants with ESRD

Haemodialysis options for undocumented immigrants with end-stage renal disease range from standard of care thrice-weekly treatments to emergency-only haemodialysis. This latter approach is associated with poor patient outcomes and high costs. The time has come for the nephrology community to demand an end to the practice of emergency-only haemodialysis.

A Conceptual Framework of Palliative Care across the Continuum of Advanced Kidney Disease

Lam DY, Scherer JS, Brown M, Grubbs V, Schell JO.

Kidney palliative care is a growing discipline within nephrology. Kidney palliative care specifically addresses the stress and burden of advanced kidney disease through the provision of expert symptom management, caregiver support, and advance care planning with the goal of optimizing quality of life for patients and families. The integration of palliative care principles is necessary to address the multidimensional impact of advanced kidney disease on patients. In particular, patients with advanced kidney disease have a high symptom burden and experience greater intensity of care at the end of life compared with other chronic serious illnesses.

Neighborhood Social Context and Kidney Function Over Time: The Multi-Ethnic Study of Atherosclerosis

Hicken MT, Katz R, Peralta CA, Crews DC, Kramer HJ

Although socioeconomic status has been associated with chronic kidney disease (CKD), little is known about its relationship to residential neighborhood context. Secondary analysis of the Multi-Ethnic Study of Atherosclerosis (MESA), a prospective cohort study designed to investigate the development and progression of subclinical cardiovascular disease.

Patient and Caregiver Priorities for Outcomes in Peritoneal Dialysis: Multinational Nominal Group Technique Study

Manera KE, Johnson DW, Craig JC, Shen JI, Ruiz L, Wang AY, Yip T, Fung SKS, Tong M, Lee A, Cho Y, Viecelli AK, Sautenet B, Teixeira-Pinto A, Brown EA, Brunier G, Dong J, Dunning T, Mehrotra R, Naicker S, Pecoits-Filho R, Perl J, Wilkie M, Tong A

The absence of accepted patient-centered outcomes in research can limit shared decision-making in peritoneal dialysis (PD), particularly because PD-related treatments can be associated with mortality, technique failure, and complications that can impair quality of life. We aimed to identify patient and caregiver priorities for outcomes in PD, and to describe the reasons for their choices.

Body Weight and eGFR during Body Weight and eGFR during Dulaglutide Treatment in Type 2 Diabetes and Moderate-to-Severe Chronic Kidney Disease (AWARD-7). Treatment in Type 2 Diabetes and Moderate-to-Severe Chronic Kidney Disease (AWARD-7)

Tuttle KR, Lakshmanan MC, Rayner B, Zimmermann AG, Woodward DB, Botros FT

In patients with T2D and moderate‐to‐severe CKD, dulaglutide treatment led to body weight (BW) loss and lesser eGFR decline compared to insulin glargine. Since BW may affect muscle mass, creatinine‐based eGFR can be altered independent of kidney function. Cystatin C‐based eGFR is not affected by muscle mass. The objective of this post‐hoc analysis was to evaluate if lesser eGFR decline with dulaglutide was related to BW loss.

Development of an International Standard Set of Value-Based Outcome Measures for Patients With Chronic Kidney Disease: A Report of the International Consortium for Health Outcomes Measurement (ICHOM) CKD Working Group

Verberne WR, Das-Gupta Z, Allegretti AS, Bart HAJ, van Biesen W, García-García G, Gibbons E, Parra E, Hemmelder MH, Jager KJ, Ketteler M, Roberts C, Al Rohani M, Salt MJ, Stopper A, Terkivatan T, Tuttle KR, Yang CW, Wheeler DC, Bos WJW

Value-based health care is increasingly promoted as a strategy for improving care quality by benchmarking outcomes that matter to patients relative to the cost of obtaining those outcomes. To support the shift toward value-based health care in chronic kidney disease (CKD), the International Consortium for Health Outcomes Measurement (ICHOM) assembled an international working group of health professionals and patient representatives to develop a standardized minimum set of patient-centered outcomes targeted for clinical use.

Calcimimetics and Bundled Reimbursement

Lin E, Watnick S

Since 2011, the Centers for Medicare & Medicaid Services has provided reimbursement for renal dialysis services furnished to Medicare beneficiaries through a bundled payment system known as the Prospective Payment System. Medications that have no injectable equivalent, known as “oral-only medications,” are currently excluded from the bundle and are paid separately through Medicare Part D. Thus, before the development of etelcalcetide, the first injectable calcimimetic, calcimimetics were reimbursed outside the bundle. Etelcalcetide’s introduction and approval for use in Medicare triggered a transition payment for a minimum of 2 years that will eventually result in the incorporation of calcimimetics into the dialysis bundle. Consequently, providers may face incentives to reduce calcimimetic use when the transition period has expired.

The association of glycated hemoglobin with mortality and ESKD among persons with diabetes and chronic kidney disease

Limkunakul C, de Boer IH, Kestenbaum BR, Himmelfarb J, Ikizler TA, Robinson-Cohen C

Diabetic kidney disease (DKD) is the leading cause of end stage kidney disease (ESKD) and is associated with a considerably shortened lifespan. While glucose-lowering therapy targeting glycated hemoglobin (HbA1c) <7% is proven to reduce the risk of developing DKD, its effects on complications of DKD are unclear. We examined the associations of HbA1c with risks of progression to ESKD and death within a clinic-based study of CKD. We hypothesized that higher HbA1c concentrations would be associated with increased risks of ESKD and death.