Our research broadens the knowledge of kidney disease.
Development and Content Validity of a Patient-Reported Experience Measure for Home Dialysis
The population of patients with kidney failure in the United States using home dialysis modalities is growing rapidly. Unlike for in-center hemodialysis, there is no patient-reported experience measure for assessment of patient experience of care for peritoneal dialysis or home hemodialysis. We sought to develop and establish content validity of a patient-reported experience measure for patients undergoing home dialysis using a mixed methods multiple stakeholder approach.
Professional roles and relationships during the COVID-19 pandemic: a qualitative study among US clinicians
Objective: The COVID-19 pandemic has transformed healthcare delivery in the USA, but there has been little empirical work describing the impact of these changes on clinicians. We conducted a study to address the following question: how has the pandemic impacted US clinicians' professional roles and relationships? Design: Inductive thematic analysis of semi-structured interviews. Setting: Clinical settings across the USA in April and May of 2020. Participants: Clinicians with leadership and/or clinical roles during the COVID-19 pandemic. Measures: Emergent themes related to professional roles and relationships.
Prevention of Urinary Stones With Hydration (PUSH): Design and Rationale of a Clinical Trial
Rationale & objective: Although maintaining high fluid intake is an effective low-risk intervention for the secondary prevention of urinary stone disease, many patients with stones do not increase their fluid intake. Study design: We describe the rationale and design of the Prevention of Urinary Stones With Hydration (PUSH) Study, a randomized trial of a multicomponent behavioral intervention program to increase and maintain high fluid intake. Participants are randomly assigned (1:1 ratio) to the intervention or control arm. The target sample size is 1,642 participants. Setting & participants: Adults and adolescents 12 years and older with a symptomatic stone history and low urine volume are eligible. Exclusion criteria include infectious or monogenic causes of urinary stone disease and comorbid conditions precluding increased fluid intake.
Association of Obesity with Cardiovascular Risk Factors and Kidney Disease Outcomes in Primary Proteinuric Glomerulopathies
Obesity is a known risk factor for cardiovascular disease and contributes to the development and progression of kidney disease. However, the specific influence of obesity on outcomes in primary glomerular disease has not been well characterized. In this prospective cohort study, data were from 541 participants enrolled in the Nephrotic Syndrome Study Network (NEPTUNE), between 2010 and 2019, at 23 sites across North America. Blood pressure, lipids, and kidney disease outcomes including complete proteinuria remission, kidney failure, and chronic kidney disease progression were evaluated. Data were analyzed using linear and logistic regression with generalized estimating equations and time-varying Cox regression with Kaplan-Meier plots.
BP in Young Adults with CKD and Associations with Cardiovascular Events and Decline in Kidney Function
Although young adults (aged 18–40 years) with CKD are at risk for poor cardiovascular and renal outcomes, with hypertension an important and potentially modifiable risk factor, they are largely absent from observational studies and clinical trials of BP in patients with CKD. To address this knowledge gap, this observational study provides a description of BP and its relation to outcomes specifically in young adults with CKD. It demonstrates that among young adults with CKD, higher BP is associated with cardiovascular events (particularly heart failure) and CKD progression. The study’s findings may provide a foundation for future work to develop best practices for BP management in young adults with CKD and improve outcomes.
Mixed Methods Research to Advance Nephrology
Mixed methods research combines elements of quantitative and qualitative methodologies in an effort to leverage their unique strengths and counterbalance their respective limitations. This article provides a concise overview of mixed methods research, highlighting the general forms and functions of mixing quantitative and qualitative methodologies, and concludes with an example from the nephrology literature to illustrate its application.
Changes in cancer incidence and outcomes among kidney transplant recipients in the United States over a thirty-year period
Recipients of kidney transplants have elevated cancer risk compared with the general population. Improvements over time in transplant care and cancer treatment may have affected incidence and outcomes of cancer among recipients of kidney transplant. To evaluate this, we used linked United States transplant and cancer registry data to study 101,014 adult recipients of kidney transplants over three decades (1987-1996, 1997-2006, 2007-2016). Poisson regression was used to assess trends in incidence for cancer overall and seven common cancers. Associations of cancer with risk of death-censored graft failure (DCGF) and death with functioning graft (DWFG) were evaluated with Cox regression. We also estimated absolute risks of DCGF and graft failure following cancer for recipients transplanted in 2007-2016. There was no significant change in the incidence of cancer overall or for six common cancers in recipients across the 1987-2016 period.
Integrating Conservative kidney management Options and advance care Planning Education (COPE) into routine CKD care: A protocol for a pilot randomised controlled trial
Predialysis education for patients with advanced chronic kidney disease (CKD) typically focuses narrowly on haemodialysis and peritoneal dialysis as future treatment options. However, patients who are older or seriously ill may not want to pursue dialysis and/or may not benefit from this treatment. Conservative kidney management, a reasonable alternative treatment, and advance care planning (ACP) are often left out of patient education and shared decision-making. In this study, we will pilot an educational intervention (Conservative Kidney Management Options and Advance Care Planning Education—COPE) to improve knowledge of conservative kidney management and ACP among patients with advanced CKD who are older and/or have poor functional status.
The longitudinal relationship between patient-reported outcomes and clinical characteristics among patients with focal segmental glomerulosclerosis in the Nephrotic Syndrome Study Network
Understanding the relationship between clinical and patient-reported outcomes (PROs) will help support clinical care and future clinical trial design of novel therapies for focal segmental glomerulosclerosis (FSGS).
Rationale and design of the Kidney Precision Medicine Project
Chronic kidney disease (CKD) and acute kidney injury (AKI) are common, heterogeneous, and morbid diseases. Mechanistic characterization of CKD and AKI in patients may facilitate a precision-medicine approach to prevention, diagnosis, and treatment. The Kidney Precision Medicine Project aims to ethically and safely obtain kidney biopsies from participants with CKD or AKI, create a reference kidney atlas, and characterize disease subgroups to stratify patients based on molecular features of disease, clinical characteristics, and associated outcomes. An additional aim is to identify critical cells, pathways, and targets for novel therapies and preventive strategies.