Our faculty research broadens the knowledge of kidney disease.

Hemodialysis and COVID-19: An Achilles’ Heel in the Pandemic Health Care Response in the United States

Weiner, D.E., Watnick, S.G.

Health care is a major exception to social distancing. Although many routine outpatient encounters have been cancelled or converted to telehealth,3 hemodialysis continues largely unchanged. There are nearly 500,000 in-center hemodialysis patients in the United States in 20204 and likely as many as 200,000 health care workers directly engaged in the delivery of hemodialysis care. These 700,000 individuals are unable to practice social distancing while continuing lifesaving dialysis care.

Association Between Early Recovery of Kidney Function After Acute Kidney Injury and Long-term Clinical Outcomes

Bhatraju, P.K., Zelnick, L.R., Chinchilli, V.M., Moledina, D.G., Coca, S.G., Parikh, C.R., Garg, A.X., Hsu, C.-Y.j, Go, A.S., Liu, K.D.,l, Ikizler, T.A., Siew, E.D., Kaufman, J.S., Kimmel, P.L., Himmelfarb, J., Wurfel, M.M.

Is the trajectory of kidney function within 72 hours after acute kidney injury associated with 5-year clinical outcomes, such as chronic kidney disease, dialysis, and death? Among 1538 participants in this prospective multicenter cohort study, the early recovery pattern after acute kidney injury was associated with long-term outcomes. In adjusted analyses, patients with a non-resolving recovery pattern after acute kidney injury had a 51% greater risk for the composite kidney-specific clinical outcome compared with patients with a resolving acute kidney injury recovery pattern, independent of traditional criteria to risk stratify patients with acute kidney injury. This study’s finding suggest that the acute recovery pattern after development of acute kidney injury should be considered in evaluating the risk of long-term clinical outcomes.

On the Frontline of the COVID-19 Outbreak

Suzanne Watnick, Elizabeth McNamara

We received a call at 9:00 pm on Friday evening, February 28th that our patient had died of coronavirus disease 2019 (COVID-19) disease. This would be the first reported death from COVID-19 in the nation. After suspending disbelief, we began our approach following three guiding principles: provide outpatient dialysis; follow the science; and provide leadership to our community through assurance, transparency, communication, and support.

Liraglutide for the Treatment of Type 2 Diabetes and Safety in Diabetic Kidney Disease: Liraglutide and Diabetic Kidney Disease

Cherney, D.Z., Tuttle, K.R.

Diabetes is a global emergency with projection for growth to nearly 700 million people by 2045. The number of people with diabetes complications, including diabetic kidney disease, will also multiply.

ACE Inhibitor/Angiotensin Receptor Blocker Use Patterns in Advanced CKD and Risk of Kidney Failure and Death

Nayan Arora, Ronit Katz, Nisha Bansal

The use of renin-angiotensin system (RAS) inhibitors is standard of care in people with early to moderate chronic kidney disease (CKD). Less is known regarding the efficacy of RAS inhibitors in very advanced CKD. In this study, we describe patterns of use of RAS inhibitors and associations of these patterns of use with risk for CKD progression and mortality in patients with advanced CKD.

Ambulatory Blood Pressure Phenotypes in Adults Taking Antihypertensive Medication with and without CKD

Stanford E. MwasongweRikki M. TannerBharat PoudelDaniel N. PuglieseBessie A. YoungMarwah AbdallaSolomon K. MusaniOrlando M. GutiérrezAdolfo CorreaDaichi Shimbo and Paul Muntner

Recent guidelines recommend out-of-clinic BP measurements.We compared the prevalence of BP phenotypes between 561 black patients, with and without CKD, taking antihypertensive medication who underwent ambulatory BP monitoring at baseline (between 2000 and 2004) in the Jackson Heart Study.

Kidney Clearance of Secretory Solutes Is Associated with Progression of CKD: The CRIC Study

Yan Chen, Leila R. Zelnick, Ke Wang, Andrew N. Hoofnagle, Jessica O. Becker, Chi-yuan Hsu, Harold I. Feldman, Rupal C. Mehta, James P. Lash, Sushrut S. Waikar, Tariq Shafi, Stephen L. Seliger, Michael G. Shlipak, Mahboob Rahman, Bryan R. Kestenbaum and the CRIC Study Investigators

The secretion of organic solutes by the proximal tubules is an essential intrinsic kidney function. However, the clinical significance of the kidney clearance of tubular secretory solutes is uncertain. In this prospective cohort study of 3416 participants with CKD, the authors found that lower kidney clearances of six endogenous secretory solutes are associated with significantly greater risk of CKD progression (defined as a ≥50% decline in eGFR from baseline, initiation of maintenance dialysis, or kidney transplantation) and that lower clearances of four solutes are associated with all-cause mortality after adjustment for eGFR, albuminuria, and other confounding characteristics. These findings suggest that kidney clearances of secretory solutes may provide complementary information to existing measurements of GFR and albuminuria for the assessment of kidney health.

Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Jennifer E. Flythe,Tara I. Chang, Martin P. Gallagher, Elizabeth Lindley, Magdalena Madero, Pantelis A. Sarafidis, Mark L. Unruh, Angela Yee-Moon Wang, Daniel E. Weiner, Michael Cheung, Michel Jadoul, Wolfgang C. Winkelmayer, Kevan R. Polkinghorne, Conference Paticipants including Rajnish Mehrota, Suzanne Watnick, et al...

Blood pressure (BP) and volume control are critical components of dialysis care and have substantial impacts on patient symptoms, quality of life, and cardiovascular complications. Yet, developing consensus best practices for BP and volume control have been challenging, given the absence of objective measures of extracellular volume status and the lack of high-quality evidence for many therapeutic interventions. In February of 2019, Kidney Disease: Improving Global Outcomes (KDIGO) held a Controversies Conference titled Blood Pressure and Volume Management in Dialysis to assess the current state of knowledge related to BP and volume management and identify opportunities to improve clinical and patient-reported outcomes among individuals receiving maintenance dialysis.

Advancing American Kidney Health—New Opportunities for Collaborative Care

Matthew B. Rivara, Richard N. Formica, Rajnish Mehrotra

One of the most ambitious components of the AAKH Initiative is an explicit aim to reduce the number of Americans developing end-stage renal disease by 25% by 2030. Slowing the progression of kidney function decline in patients with chronic kidney disease to the extent necessary to achieve this goal will require an extraordinary effort to maximally implement evidence-based treatments, identify and treat established kidney disease risk factors such as hypertension and diabetes, and improve access to care for those with identified chronic kidney disease.

Spinal Tophi Causing Cord Compression and Mimicking Epidural Abscess in a Young Man With Lesch-Nyhan Variant

Liew, Jean W., Struthers, Sarah A., Cormack, Fionnuala C., Bays, Alison M., Han, Bobby Kwanghoon

A 23-year-old man presented with 3 days of thoracic back pain, leg weakness, paresthesias, urinary incontinence, and fever (38°C). He had a history of autism spectrum disorder, tophaceous gout diagnosed at 20, and chronic kidney disease (CKD).