Our faculty research broadens the knowledge of kidney disease.

Listing practices and graft utilization of hepatitis C–positive deceased donors in liver and kidney transplant

 
Kling, C.E.,  Perkins, J.D.,  Biggins, S.W.,  Johnson, C.K.,  Limaye, A.P.,  Sibulesky, L.

The opioid epidemic has resulted in increasing the incidence of hepatitis C virus in the general population and more deceased organ donors with hepatitis C in the United States. We aim to describe how the changing donor landscape affects patterns of liver and kidney transplantation among donors, waitlist candidates, and transplanted recipients.

Mineral Metabolism Disturbances and Arteriovenous Fistula Maturation

Kubiak RW, Zelnick LR, Hoofnagle AN, Alpers CE, Terry CM, Shiu YT, Cheung AK, de Boer IH, Robinson-Cohen C, Allon M, Dember LM, Feldman HI, Himmelfarb J, Huber TS, Roy-Chaudhury P, Vazquez MA, Kusek JW, Beck GJ, Imrey PB, Kestenbaum B; Hemodialysis Fistula Maturation Study Group.

The arteriovenous fistula (AVF) is central to haemodialysis treatment, but up to half of surgically created AVF fail to mature. Chronic kidney disease often leads to mineral metabolism disturbances that may interfere with AVF maturation through adverse vascular effects. This study tested associations between mineral metabolism markers and vein histology at AVF creation and unassisted and overall clinical AVF maturation.

One-Year Mortality After Dialysis Initiation Among Older Adults

Wachterman, M.W.,  O'Hare, A.M.,  Rahman, O.-K.,  Lorenz, K.A.,  Marcantonio, E.R.,  Alicante, G.K.,  Kelley, A.S. 

Shared decision making about dialysis, a potentially burdensome or harmful treatment for older adults, requires accurate estimates of prognosis.1 More than 120 000 people in the United States initiated chronic dialysis in 2015, half of whom were older than 65 years.2 The 1-year mortality rate after dialysis initiation for these older adults, based on the United States Renal Data System (USRDS) registry, is currently approximately 30%.2 However, the USRDS does not include all patients who start dialysis—most notably omitting those who die before an outpatient dialysis provider enters them into the registry.

Achieving a person-centered approach to dialysis discontinuation: An historical perspective

O'Hare, A.M., Murphy, E.,  Butler, C.R.,  Richards, C.A.

In this essay, we describe the evolution of attitudes toward dialysis discontinuation in historical context, beginning with the birth of outpatient dialysis in the 1960s and continuing through the present. From the start, attitudes toward dialysis discontinuation have reflected the clinical context in which dialysis is initiated. In the 1960s and 1970s, dialysis was only available to select patients and concerns about distributive justice weighed heavily. Because there was strong enthusiasm for new technology and dialysis was regarded as a precious resource not to be wasted, stopping treatment had negative moral connotations and was generally viewed as something to be discouraged.

Person-Centered Care for Older Adults With Kidney Disease: Core Curriculum 2019

This Core Curriculum article models a person-centered approach to care for older adults with kidney disease. We provide background information on the principles of person-centered care and outline ways in which this approach contrasts with the more disease-based approaches that dominate current medical education and practice. Using hypothetical cases, we discuss 3 clinical scenarios that arise commonly when caring for older adults with kidney disease.

Hypoglycemia in People with Type 2 Diabetes and CKD

Ahmad I, Zelnick LR, Batacchi Z, Robinson N, Dighe A, Manski-Nankervis JE, Furler J, O'Neal DN, Little R, Trence D, Hirsch IB, Bansal N, de Boer IH.

Among people with diabetes mellitus, CKD may promote hypoglycemia through altered clearance of glucose-lowering medications, decreased kidney gluconeogenesis, and blunted counter-regulatory response. We conducted a prospective observational study of hypoglycemia among 105 individuals with type 2 diabetes treated with insulin or a sulfonylurea using continuous glucose monitors.

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

Chan CT, Blankestijn PJ, Dember LM, Gallieni M, Harris DCH, Lok CE, Mehrotra R, Stevens PE, Wang AY, Cheung M, Wheeler DC, Winkelmayer WC, Pollock CA; 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.

Multicolor Flow Cytometry and Cytokine Analysis Provides Enhanced Information on Kidney Transplant Biopsies

Muczynski KA, Leca N, Anderson AE, Kieran N, Anderson SK

Current processing of renal biopsy samples provides limited information about immune mechanisms causing kidney injury and disease activity. We used flow cytometry with transplanted kidney biopsy samples to provide more information on the immune status of the kidney. To enhance the information available from a biopsy, we developed a technique for reducing a fraction of a renal biopsy sample to single cells for multicolor flow cytometry and quantitation of secreted cytokines present within the biopsy sample.

Complex Decision Making about Dialysis in Critically Ill Older Adults with AKI

Butler CR, O'Hare AM

AKI is extremely common in patients who are sick enough to be admitted to the ICU, and kidney dialysis is one of many treatments that might be initiated during an ICU stay. Although outcomes among critically ill older adults with AKI are known to be poor, there can be substantial heterogeneity in the risk of adverse outcomes among members of this group. There can also be marked differences in the preferences, goals, and values of individual patients when faced with potentially life-altering treatment choices. In this context, engaging patients and their families in a shared decision-making process is essential to supporting a patient-centered approach to care. However, available evidence suggests that, despite growing support for shared decision making, medical necessity and clinicians’ sense of patients’ best interest often drive decision making when the stakes are high

Albumin in Cirrhosis: More Than a Colloid

Paine CH, Biggins SW, Pichler RH

Albumin has repeatedly been shown to be beneficial in treating patients with decompensated cirrhosis. We reviewed the medical literature regarding indications for the use of intravenous albumin in cirrhosis, with particular focus on the ways in which albumin can help mitigate hepatorenal physiology.