Our faculty research broadens the knowledge of kidney disease.

Early Rapid Decline in Kidney Function in Medically Managed Patients With Atherosclerotic Renal Artery Stenosis

Emily L. Cooper , Yanmei Xie , Hanh Nguyen , Pamela S. Brewster , Haden Sholl , Megan Sharrett , Kaili Ren , Tian Chen , Katherine R. Tuttle , Steven T. Haller , Kenneth Jamerson , Timothy P. Murphy , Ralph B. D'Agostino Sr , Joseph M. Massaro , William Henrich , Christopher J. Cooper , Donald E. Cutlip , Lance D. Dworkin , Joseph I. Shapiro

Early rapid declines of kidney function may occur in patients with atherosclerotic renal artery stenosis with institution of medical therapy. The causes and consequences are not well understood. Patients enrolled in the medical therapy–only arm of the CORAL (Cardiovascular Outcomes With Renal Artery Lesions) study were assessed for a rapid decline (RD) in estimated glomerular filtration rate (eGFR), defined as a ≥30% decrease from baseline to either 3 months, 6 months, or both.

Association of functional and structural social support with chronic kidney disease among African Americans: The Jackson Heart Study

Rasheeda K. Hall, Clemontina A. Davenport, Mario Sims, Cathleen Colón-Emeric, Tiffany Washington, Jennifer St. Clair Russell, Jane Pendergast, Nrupen Bhavsar, Julia Scialla, Crystal C. Tyson, Wei Wang, Yuan-I Min, Bessie Young, L. Ebony Boulware, Clarissa J. Diamantidis 

There is limited evidence on the relationship between social support and renal outcomes in African Americans. We sought to determine the association of social support with prevalent chronic kidney disease (CKD) and kidney function decline in an African American cohort. We also examined whether age modifies the association between social support and kidney function decline.

Differences in proximal tubular solute clearance across common etiologies of chronic kidney disease

Wang K, Zelnick LR, Hoofnagle AN, Chen Y, de Boer IH, Himmelfarb J, Kestenbaum B

Diverse CKD etiologies have distinct pathological mechanisms that may differentially impact the kidney tubules. Little is known regarding how tubular function changes with varying kidney disease types. We used targeted mass spectrometry to quantify paired serum and urine concentration of 11 solutes of proximal tubular secretion in 223 patients from an outpatient CKD cohort.

Attitudes toward Peritoneal Dialysis among Peritoneal Dialysis and Hemodialysis Medical Directors: Are We Preaching to the Right Choir?

Jenny I. Shen, Martin J. Schreiber, Junhui Zhao, Bruce M. Robinson, Ronald L. Pisoni, Rajnish Mehrotra, Matthew J. Oliver, Tadashi Tomo, Kriang Tungsanga, Isaac Teitelbaum, Arshia Ghaffari, Mark Lambie and Jeffrey Perl

Worldwide, only 10% of the approximately 1.7 million patients on dialysis are treated with home-based peritoneal dialysis (PD); the majority receive facility-based hemodialysis (HD), although most patients prefer PD when educated about their options.

Rituximab or cyclosporine in the treatment of membranous nephropathy

Fernando C. Fervenza, Gerald B. Appel, Sean J. Barbour, Brad H. Rovin, Richard A. Lafayette, Nabeel Aslam, Jonathan A. Jefferson, Patrick E. Gipson, Dana V. Rizk, John R. Sedor, James F. Simon, Ellen T. McCarthy, et al., for the MENTOR Investigators

B-cell anomalies play a role in the pathogenesis of membranous nephropathy. B-cell depletion with rituximab may therefore be noninferior to treatment with cyclosporine for inducing and maintaining a complete or partial remission of proteinuria in patients with this condition.

Implementing the European Renal Best Practice Guidelines suggests that prediction equations work well to differentiate risk of end-stage renal disease vs. death in older patients with low estimated glomerular filtration rate

Hallan SI, Rifkin DE, Potok OA, Katz R, Langlo KA, Bansal N, Ix JH

Recent European guidelines suggest using the kidney failure risk equation (KFRE) and mortality risk equation for kidney disease (MREK) to guide decisions on whether elderly patients with chronic kidney disease should be referred early for dialysis preparation. However, the concurrent use of the two risk equations has not been validated. To do so we evaluated 1,188 individuals over five years with estimated glomerular filtration rate (eGFR) under 45ml/min/1.73m2 and age over 65 years from the Norwegian population based HUNT study. Forty-two patients started renal replacement therapy and 462 died as their first clinical event. The KFRE was well calibrated (mean risk estimate 4.9% vs observed 3.5%) with high diagnostic accuracy (C-statistics 0.93).

Assessment of Self-reported Prognostic Expectations of People Undergoing Dialysis United States Renal Data System Study of Treatment Preferences (USTATE)

Ann M. O’Hare, Manjula Kurella Tamura, Danielle C. Lavallee, Elizabeth K. Vig, Janelle S. Taylor, Yoshio N. Hall, Ronit Katz, J. Randall Curtis, Ruth A. Engelberg

What are the prognostic expectations of people undergoing dialysis, and how do these relate to their treatment goals and preferences? In this cross-sectional survey study of 996 patients receiving maintenance dialysis at nonprofit facilities in 2 US metropolitan areas, most of the respondents were either uncertain about prognosis or had a prognostic expectation of more than 10 years. In adjusted analyses, these groups were less likely than those with a prognostic expectation of fewer than 5 years to report having documented their treatment preferences and to value comfort over life extension, and more likely to want cardiopulmonary resuscitation and mechanical ventilation.

The SPRINT trial suggests that markers of tubule cell function in the urine associate with risk of subsequent acute kidney injury while injury markers elevate after the injury

Alexander L. Bullen, Ronit Katz, Alexandra K. Lee, Cheryl A.M. Anderson, Alfred K. Cheung, Pranav S. Garimella, Vasantha Jotwani, William E. Haley, Areef Ishani, James P. Lash, Javier A. Neyra, Henry Punzi, Anjay Rastogi, Erik Riessen, Rakesh Malhotra, Chirag R. Parikh, Michael V. Rocco, Barry M. Wall, Udayan Y. Bhatt, Michael G. Shlipak, Joachim H. Ix, Michelle M. Estrella

AKI, a common clinical syndrome, is associated with more rapid progression of chronic kidney disease (CKD), cardiovascular disease (CVD), and death. The SPRINT trial randomized hypertensive, nondiabetic persons to intensive (<120 mm Hg) versus standard (<140 mm Hg) systolic blood pressure targets and demonstrated lower risks of CVD and death in the intensive arm but higher risk of AKI.

The expanding résumé of SGLT2 inhibitors

As a class, sodium-glucose co-transporter-2 (SGLT2) inhibitors are are building an impressive résumé as preferred agents for the treatment of type 2 diabetes. In landmark cardiovascular outcomes trials, empagliflozin, canagliflozin, and dapagliflozin each reduced the incidence of cardiovascular events compared with placebo. Consistently, large reductions in progression of chronic kidney disease were also reported with SGLT2 inhibitors in these trials. Although assessed as secondary outcomes, the seemingly beneficial effects of SGLT2 inhibitors on chronic kidney disease are important because this complication is particularly common, morbid, and intractable.

Impact of AKI on Urinary Protein Excretion: Analysis of Two Prospective Cohorts

Chi-yuan Hsu, Raymond K. Hsu, Kathleen D. Liu, Jingrong Yang, Amanda Anderson, Jing Chen, Vernon M. Chinchilli, Harold I. Feldman, Amit X. Garg, Lee Hamm, Jonathan Himmelfarb, James S. Kaufman, John W. Kusek, Chirag R. Parikh, Ana C. Ricardo, Sylvia E. Rosas, Georges Saab, Daohang Sha, Edward D. Siew, James Sondheimer, Jonathan J. Taliercio, Wei Yang, Alan S. Go and on behalf of the Chronic Renal Insufficiency Cohort (CRIC) Study Investigators and the Assessment, Serial Evaluation, and Subsequent Sequelae of Acute Kidney Injury (ASSESS-AKI) Study

Prior studies of adverse renal consequences of AKI have almost exclusively focused on eGFR changes. Less is known about potential effects of AKI on proteinuria, although proteinuria is perhaps the strongest risk factor for future loss of renal function.