Our faculty research broadens the knowledge of kidney disease.

An Investigation of Selection Bias in Estimating Racial Disparity in Stroke Risk Factors: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Long DL, Howard G, Long DM, Judd S, Manly JJ, McClure LA, Wadley VG, Safford MM, Katz R, Glymour MM

Selection due to survival or attrition may bias estimates of racial disparities in health, but few studies quantify the likely magnitude of such bias. In a large national cohort with moderate loss to follow-up, we contrast racial differences in two stroke risk factors, incident hypertension and incident left ventricular hypertrophy estimated by complete case analyses, inverse probability of attrition weighting, and the Survivor Average Causal Effect.

Safety and cardiovascular efficacy of spironolactone in dialysis-dependent ESRD (SPin-D): a randomized, placebo-controlled, multiple dosage trial

Charytan DM, Himmelfarb J, Ikizler TA, Raj DS, Hsu JY, Landis JR, Anderson AH, Hung AM, Mehrotra R, Sharma S, Weiner DE, Williams M, DiCarli M, Skali H, Kimmel PL, Kliger AS, Dember LM

The safety and efficacy of spironolactone is uncertain in end-stage renal disease. We randomized 129 maintenance hemodialysis patients to placebo (n=51) or spironolactone 12.5 mg (n=27), 25 mg (n=26), or 50 mg (n=25) daily for 36 weeks in a double-blind, placebo-controlled, multiple dosage trial to assess safety, tolerability and feasibility and to explore cardiovascular efficacy.

Fostering Innovation in Symptom Management among Hemodialysis Patients: Paths Forward for Insomnia, Muscle Cramps, and Fatigue

Flythe JE, Hilliard T, Lumby E, Castillo G, Orazi J, Abdel-Rahman EM, Pai AB, Rivara MB, St Peter WL, Weisbord SD, Wilkie CM, Mehrotra R

Individuals receiving in-center maintenance hemodialysis bear a high burden of both physical and mood symptoms. More than half of patients on hemodialysis report sleep disturbance, muscle cramps, and fatigue. Patients describe symptoms as having a deleterious effect on their quality of life, suggesting that symptom alleviation may meaningfully improve patient-reported outcomes.

Association of Monoclonal Gammopathy with Progression to ESKD among US Veterans

Burwick N, Adams SV, Todd-Stenberg JA, Burrows NR, Pavkov ME, O'Hare AM

Whether patients with monoclonal protein are at a higher risk for progression of kidney disease is not known. The goal of this study was to measure the association of monoclonal protein with progression to ESKD.

The Kidney Accelerator: Innovation Wanted, Nephrologists Needed

Innovation in nephrology is long overdue. The most impactful innovations in our field arguably arrived half a century ago with the invention of maintenance dialysis and novel federal funding policies, providing life-sustaining therapy to those with kidney failure. In the interim, we saw important advances, including the introduction of erythropoietin and improved immunosuppressants. However, we continue to reward kidney failure with a life on dialysis for many, while thousands die every year on the kidney transplant waitlist. Where are the novel ways to improve life with kidney disease, and where is the hope for a cure?

Long-term exposure to ambient air pollution and renal function in African Americans: the Jackson Heart Study

Weaver AM, Wang Y, Wellenius GA, Young B, Boyle LD, Hickson DA, Diamantidis CJ

Renal dysfunction is prevalent in the US among African Americans. Air pollution is associated with renal dysfunction in mostly white American populations, but has not been studied among African Americans. We evaluated cross-sectional associations between 1-year and 3-year fine particulate matter (PM2.5) and ozone (O3) concentrations, and renal function among 5090 African American participants in the Jackson Heart Study.

Characterization of Glomerular Sox9+ Cells in Anti-Glomerular Basement Membrane Nephritis in the Rat

Prochnicki A, Amann K, Wegner M, Sock E, Pfister E, Shankland S, Pippin J, Daniel C

Mechanisms of glomerular crescent formation and podocyte repair processes are still unclear. Therefore, we investigated the expression of the transcription factor Sox9 as a potential marker of a subpopulation of parietal epithelial cells (PECs) with potential regenerative properties. Glomerular Sox9 expression was characterized in detail in a rat anti-glomerular basement membrane (GBM) nephritis model using immunofluorescence and confocal laser scanning microscopy.

Reconstructing the Human Renal Vascular-Tubular Unit In Vitro

Rayner SG, Phong KT, Xue J, Lih D, Shankland SJ, Kelly EJ, Himmelfarb J, Zheng Y

Engineered human kidney-on-a-chip platforms show tremendous promise for disease modeling and drug screening. Outstanding challenges exist, however, in reconstructing the complex architecture, cellular make-up, and matrix composition necessary for the proper modeling of kidney function. Herein, the first fully tunable human kidney-on-a-chip platform is reported that allows the reconstruction of the native architecture of the renal endothelial-epithelial exchange interface using entirely cell-remodelable matrix and patient-derived kidney cells.

Cardiovascular Events after New-Onset Atrial Fibrillation in Adults with CKD: Results from the Chronic Renal Insufficiency Cohort (CRIC) Study

Nisha Bansal, Dawei Xie, Daohang Sha, Lawrence J. Appel, Rajat Deo, Harold I. Feldman, Jiang He, Kenneth Jamerson, John W. Kusek, Steven Messe, Sankar D. Navaneethan, Mahboob Rahman, Ana Catherine Ricardo, Elsayed Z. Soliman, Raymond Townsend and Alan S. Go

Atrial fibrillation (AF), the most common sustained arrhythmia in CKD, is associated with poor clinical outcomes in both patients without CKD and patients with dialysis-treated ESRD. However, less is known about AF-associated outcomes in patients with CKD who do not require dialysis.

Association of Medicaid Expansion With 1-Year Mortality Among Patients With End-Stage Renal Disease

Shailender Swaminathan, Benjamin D. Sommers, Rebecca Thorsness, Rajnish Mehrotra, Yoojin Lee, Amal N. Trivedi

In this observational study of 236,246 nonelderly patients with end-stage renal disease initiating dialysis comparing mortality between the preexpansion period and the postexpansion period, the change in 1-year mortality among patients in Medicaid expansion states compared with those in nonexpansion states was −0.8% vs −0.2%, a difference that was statistically significant. Among patients with end-stage renal disease initiating dialysis, the ACA Medicaid expansion was associated with significant improvements in 1-year survival.