Our research broadens the knowledge of kidney disease.

Assessment of kidney proximal tubular secretion in critical illness

Pavan K. Bhatraju, Xin-Ya Chai, Neha A. Sathe, John Ruzinski, Edward D. Siew, Jonathan Himmelfarb, Andrew N. Hoofnagle, Mark M. Wurfel, Bryan R. Kestenbaum

Serum creatinine concentrations (SCr) are used to determine the presence and severity of acute kidney injury (AKI). SCr is primarily eliminated by glomerular filtration; however, most mechanisms of AKI in critical illness involve kidney proximal tubules, where tubular secretion occurs. Proximal tubular secretory clearance is not currently estimated in the ICU. Our objective was to estimate the kidney clearance of secretory solutes in critically ill adults.

Kidney recipients with allograft failure, transition of kidney care (KRAFT): A survey of contemporary practices of transplant providers

Tarek Alhamad  Michelle Lubetzky  Krista L. Lentine  Emmanuel Edusei  Ronald Parsons  Martha Pavlakis  Kenneth J. Woodside  Deborah Adey  Christopher D. Blosser  Beatrice P. Concepcion  John Friedewald  Alexander Wiseman  Neeraj Singh  Su‐Hsin Chang  Gaurav Gupta  Miklos Z. Molnar  Arpita Basu  Edward Kraus  Song Ong  Arman Faravardeh  Ekamol Tantisattamo  Leonardo Riella  Jim Rice  Darshana M. Dadhania 

Despite improvement of long‐term kidney allograft survival, allograft failure with return to dialysis is common. It is estimated that 12% of patients on the current kidney transplant waiting list have had a prior failed transplant. Returning to dialysis remains a major challenge for patients and providers. Patients face a higher risk of morbidity and mortality in addition to depression and social challenges during the transition period when immunosuppresion is not well monitored. The estimated mortality rate in patients with failed allograft is 16% in the first year following allograft failure with persistently increased risk compared to those starting dialysis without a prior failed transplant. Two major causes of mortality after returning to dialysis are infections and cardiovascular disease

The NIH Somatic Cell Genome Editing program

Krishanu Saha, Erik J. Sontheimer, P. J. Brooks, Melinda R. Dwinell, Charles A. Gersbach, David R. Liu, Stephen A. Murray, Shengdar Q. Tsai, Ross C. Wilson, Daniel G. Anderson, Aravind Asokan, Jillian F. Banfield, Krystof S. Bankiewicz, Gang Bao, Jeff W. M. Bulte, Nenad Bursac, Jarryd M. Campbell, Daniel F. Carlson, Elliot L. Chaikof, Zheng-Yi Chen, R. Holland Cheng, Karl J. Clark, David T. Curiel, James E. Dahlman, Benjamin E. Deverman, Mary E. Dickinson, Jennifer A. Doudna, Stephen C. Ekker, Marina E. Emborg, Guoping Feng, Benjamin S. Freedman, David M. Gamm, Guangping Gao, Ionita C. Ghiran, Peter M. Glazer, Shaoqin Gong, Jason D. Heaney, Jon D. Hennebold, John T. Hinson, Anastasia Khvorova, Samira Kiani, William R. Lagor, Kit S. Lam, Kam W. Leong, Jon E. Levine, Jennifer A. Lewis, Cathleen M. Lutz, Danith H. Ly, Samantha Maragh, Paul B. McCray Jr, Todd C. McDevitt, Oleg Mirochnitchenko, Ryuji Morizane, Niren Murthy, Randall S. Prather, John A. Ronald, Subhojit Roy, Sushmita Roy, Venkata Sabbisetti, W. Mark Saltzman, Philip J. Santangelo, David J. Segal, Mary Shimoyama, Melissa C. Skala, Alice F. Tarantal, John C. Tilton, George A. Truskey, Moriel Vandsburger, Jonathan K. Watts, Kevin D. Wells, Scot A. Wolfe, Qiaobing Xu, Wen Xue, Guohua Yi, Jiangbing Zhou & The SCGE Consortium

The United States National Institutes of Health (NIH) Somatic Cell Genome Editing (SCGE) Consortium aims to accelerate the development of safer and more-effective methods to edit the genomes of disease-relevant somatic cells in patients, even in tissues that are difficult to reach. Here we discuss the consortium’s plans to develop and benchmark approaches to induce and measure genome modifications, and to define downstream functional consequences of genome editing within human cells.

Microvascular Benefits of New Antidiabetic Agents: A Systematic Review and Network Meta-Analysis of Kidney Outcomes

Ashley S Cha, Yilin Chen, Katherine Fazioli, Matthew B Rivara, Emily Beth Devine

Diabetic kidney disease affects nearly one-third of US adults with prevalent type 2 diabetes mellitus (T2DM). The use of new antidiabetic medications in the prevention and treatment of diabetic kidney disease is a growing area of research interest. Objective: We sought to characterize the risk of developing a composite kidney outcome among patients receiving a new antidiabetic medication of the SGLT-2i, GLP-1ra, and DPP-4i drug classes.

Development of COVIDVax Model to Estimate the Risk of SARS-CoV-2-Related Death among 7.6 Million US Veterans for Use in Vaccination Prioritization

George N. Ioannou, Pamela Green, Vincent S. Fan, Jason A. Dominitz, Ann M. O’Hare, Lisa I. Backus, Emily Locke, McKenna C. Eastment, Thomas F. Osborne, Nikolas G. Ioannou, Kristin Berry

Question: How can the risk of SARS-CoV-2–related death be estimated in the general population to be used for vaccination prioritization? Findings: In this prognostic study of more than 7.6 million individuals enrolled in the Veterans Affairs health care system, a logistic regression model (COVIDVax) was developed to estimate risk of SARS-CoV-2–related death using the following 10 characteristics: sex, age, race, ethnicity, body mass index, Charlson Comorbidity Index, diabetes, chronic kidney disease, congestive heart failure, and the Care Assessment Need score. The model was estimated to save more lives than prioritizing vaccination based on age or on the US Centers for Disease Control and Prevention vaccination allocation. Meaning: These findings suggest that prioritizing vaccination based on the model developed in this study could prevent a substantial number of SARS-CoV-2–related deaths during vaccine rollout.

Ambulatory and Home Blood Pressure Monitoring in Hemodialysis Patients: A Mixed-Methods Study Evaluating Comparability and Tolerability of Blood Pressure Monitoring

Jordana B. Cohen, Chi-yuan Hsu, David Glidden, Lori Linke, Farshad Palad, Hanna L. Larson, Rajnish Mehrotra, Raymond R. Townsend, Nisha Bansal

Out-of-dialysis unit blood pressure (BP) measurement is a better predictor of adverse outcomes compared with traditional dialysis unit BP measurement among patients receiving thrice-weekly in-center hemodialysis. Forty-four–hour ambulatory BP monitoring in maintenance hemodialysis patients provides valuable prognostic information but is often not practical in clinical practice. Home BP monitoring may be better suited for longitudinal BP monitoring to guide hypertension management. However, limited evidence exists regarding the tolerability of ambulatory versus home BP in hemodialysis patients. We evaluated data from the Blood Pressure Lowering in Dialysis (BOLD) Trial (NCT03459807), a pilot randomized trial in which participants were randomly assigned to targeting a home systolic BP (SBP) versus predialysis SBP < 140 mm Hg.10 Fifty hemodialysis patients were recruited, of whom 31 (N = 16 in the home BP arm, N = 15 in the dialysis-unit BP arm) agreed to optional 44-hour ambulatory BP monitoring.

Body Composition Changes Following Dialysis Initiation and Cardiovascular and Mortality Outcomes in CRIC (Chronic Renal Insufficiency Cohort): A Bioimpedance Analysis Substudy

 

Bioelectrical impedance analysis (BIA) provides a noninvasive assessment of body composition. BIA measures of nutritional (phase angle) and hydration (vector length) status are associated with survival among individuals with chronic kidney disease (CKD), including those receiving maintenance dialysis. However, little is known regarding changes in these parameters with CKD following the high-risk transition to maintenance dialysis. Study Design: Observational study. Settings & Participants: 427 adults enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study, with BIA measurements performed within 1 year before and after initiation of maintenance dialysis.

Medicaid Expansion and Incidence of Kidney Failure among Nonelderly Adults

Rebecca Thorsness, Shailender Swaminathan, Yoojin Lee, Benjamin D. Sommers, Rajnish Mehrotra, Kevin H. Nguyen, Daeho Kim, Maricruz Rivera-Hernandez and Amal N. Trivedi

Prior work suggests that uniform access to health insurance coverage and health care services reduces disparities in treatment and outcomes of patients with CKD. This study assessed whether expansions of Medicaid coverage to low-income adults in the United States under the Affordable Care Act (ACA) were associated with changes in the incidence rate of kidney failure. The authors found that, in the entire adult population aged 19–64 years, the ACA’s Medicaid expansions were associated with a statistically significant 3% relative reduction in kidney failure incidence in the early period (years 2 and 3) after expansion. However, this decline was not sustained in the later period (years 4 and 5) after expansion. Further research is needed to understand the relationship between expanding health insurance coverage and the incidence of kidney failure.

Retinal Capillary Nonperfusion on OCT-Angiography and Its Relationship to Kidney Function in Patients with Diabetes

Tom ES, Saraf SS, Wang F, Zhang Q, Vangipuram G, Limonte CP, de Boer IH, Wang RK, Rezaei KA.

Background. Diabetic retinopathy and kidney disease share underlying mechanisms of microvascular damage and are often comorbid in people with diabetes. We evaluated whether there is a relationship between retinal capillary perfusion as measured by swept-source optical coherence tomography angiography and estimated glomerular filtration rate (eGFR) and albuminuria in patients with diabetes and chronic kidney disease (CKD). Method. A cross-sectional pilot study was conducted at the University of Washington among a subset of participants with diabetes and CKD participating in a larger cohort study. Participants were excluded if they were known to have kidney disease from conditions other than diabetes. Ten participants (11 eyes) were included. Retinal nonperfusion (RNP) and vessel density (VD) were measured by swept-source optical coherence tomography angiography in 30° and 60° field of view (FOV) regions centered at the fovea.

KDOQI US Commentary on the KDIGO Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation

Chethan M. Puttarajappa, Carrie A. Schinstock Christine M. Wu, Nicolae Leca, Vineeta Kumar, Brahm S. Vasudev, Sundaram Hariharan
 
 

There is considerable variability among transplant centers in their approach to evaluation and decision-making regarding transplant candidacy. The 2020 KDIGO (Kidney Disease: Improving Guidelines Outcome) clinical practice guideline on the evaluation and management of candidates for kidney transplantation provides practice recommendations that can serve as a useful reference guide to transplant professionals. The guideline, covering a broad range of topics, was developed by an international group of experts from transplant and nephrology through a review of literature published until May 2019. A work group of US transplant nephrologists convened by NKF-KDOQI (National Kidney Foundation–Kidney Disease Quality Initiative) chose key topics for this commentary with a goal of presenting a broad discussion to the US transplant community. Each section of this article has a summary of the key KDIGO guideline recommendations, followed by a brief commentary on the recommendations, their clinical utility, and potential implementation challenges.