Our faculty research broadens the knowledge of kidney disease.

SGLT2 inhibitor and incretin mimetic therapy for type 2 diabetes and chronic kidney disease

The pandemic of diabetes has become a global emergency. Despite increasing knowledge about diabetes prevention, this knowledge has not translated into action that effectively reduces diabetes prevalence in communities. The global picture projects an increase in people living with diabetes, from 425 million in 2017 to nearly 630 million by 2045, 1 and such an increase also means more people with diabetes complications. Chronic kidney disease develops in almost half of people with type 2 diabetes and is the leading cause of end-stage kidney disease worldwide.

Burden and Outcomes of Heart Failure Hospitalizations in Adults With Chronic Kidney Disease

Nisha Bansal, Leila Zelnick, Zeenat Bhat, Mirela Dobre, Jiang He, James Lash, Bernard Jaar, Rupal Mehta, Dominic Raj, Hernan Rincon-Choles, Milda Saunders, Sarah Schrauben, Matthew Weir, Julie Wright, Alan S. Go, for the CRIC Study Investigators, Lawrence J. Appel, Harold I. Feldman, Alan S. Go, Jiang He, James P. Lash, Panduranga S. Rao, Mahboob Rahman and Raymond R. Townsend

Data on rates of heart failure (HF) hospitalizations, recurrent hospitalizations, and outcomes related to HF hospitalizations in chronic kidney disease (CKD) are limited. This study examined rates of HF hospitalizations and re-hospitalizations within a large CKD population and evaluated the burden of HF hospitalizations with the risk of subsequent CKD progression and death.

A turning point for chronic kidney disease in diabetes

The Study Of Diabetic Nephropathy with Atrasentan (SONAR) in The Lancet demonstrates a turning point in trial innovation.12 This double-blind, randomised, placebo-controlled trial tested the endothelin A receptor antagonist atrasentan in patients with chronic kidney disease and type 2 diabetes using an enrichment design to select participants on the basis of drug tolerance for safety and responder status for efficacy.

Comparative Safety of Phosphate Binders Without Proven Efficacy-How Did We Get Here?

Consistent associations of a circulating marker with disease, supportive mechanistic evidence, and available drugs to modify the marker constitute a reasonable starting point for conducting randomized trials of clinical outcomes. Yet, clinical trials based on such evidence often fail to demonstrate clinical benefit from modifying the marker of interest. Initial studies of hyperphosphatemia in kidney disease did not engender informative trials of clinical outcomes, and to our knowledge, there are no randomized clinical trial data of clinical benefits of any phosphate binder in patients with ESRD compared with no treatment with phosphate binders.

Biomarkers of mineral metabolism and progression of aortic valve and mitral annular calcification: The Multi-Ethnic Study of Atherosclerosis

Bortnick AE, Xu S, Kim RS, Kestenbaum B, Ix JH, Jenny NS, de Boer IH, Michos ED, Thanassoulis G, Siscovick DS, Budoff MJ, Kizer JR

Previous research has implicated dysregulation of phosphate metabolism and calcium-phosphate solubilization in cardiovascular calcification, but epidemiologic studies evaluating longitudinal associations with valvular or annular calcification by computed tomography (CT), a highly sensitive imaging modality, are lacking. Our primary aim was to investigate the associations of mineral biomarkers with incidence and progression of aortic valve calcification (AVC) and mitral annular calcification (MAC).

CJASN and Disclosure of Conflicts of Interest

Although recognizing the primacy of authors in fully reporting conflicts of interest, journals also have the responsibility of clearly articulating their policy on conflicts of interest and possible consequences for failure to adhere to such policy. CJASN is very mindful of its responsibility in ensuring the disclosure of conflicts of interest by authors for the work that we publish.

Listing practices and graft utilization of hepatitis C–positive deceased donors in liver and kidney transplant

 
Kling, C.E.,  Perkins, J.D.,  Biggins, S.W.,  Johnson, C.K.,  Limaye, A.P.,  Sibulesky, L.

The opioid epidemic has resulted in increasing the incidence of hepatitis C virus in the general population and more deceased organ donors with hepatitis C in the United States. We aim to describe how the changing donor landscape affects patterns of liver and kidney transplantation among donors, waitlist candidates, and transplanted recipients.

Mineral Metabolism Disturbances and Arteriovenous Fistula Maturation

Kubiak RW, Zelnick LR, Hoofnagle AN, Alpers CE, Terry CM, Shiu YT, Cheung AK, de Boer IH, Robinson-Cohen C, Allon M, Dember LM, Feldman HI, Himmelfarb J, Huber TS, Roy-Chaudhury P, Vazquez MA, Kusek JW, Beck GJ, Imrey PB, Kestenbaum B; Hemodialysis Fistula Maturation Study Group.

The arteriovenous fistula (AVF) is central to haemodialysis treatment, but up to half of surgically created AVF fail to mature. Chronic kidney disease often leads to mineral metabolism disturbances that may interfere with AVF maturation through adverse vascular effects. This study tested associations between mineral metabolism markers and vein histology at AVF creation and unassisted and overall clinical AVF maturation.

One-Year Mortality After Dialysis Initiation Among Older Adults

Wachterman, M.W.,  O'Hare, A.M.,  Rahman, O.-K.,  Lorenz, K.A.,  Marcantonio, E.R.,  Alicante, G.K.,  Kelley, A.S. 

Shared decision making about dialysis, a potentially burdensome or harmful treatment for older adults, requires accurate estimates of prognosis.1 More than 120 000 people in the United States initiated chronic dialysis in 2015, half of whom were older than 65 years.2 The 1-year mortality rate after dialysis initiation for these older adults, based on the United States Renal Data System (USRDS) registry, is currently approximately 30%.2 However, the USRDS does not include all patients who start dialysis—most notably omitting those who die before an outpatient dialysis provider enters them into the registry.

Achieving a person-centered approach to dialysis discontinuation: An historical perspective

O'Hare, A.M., Murphy, E.,  Butler, C.R.,  Richards, C.A.

In this essay, we describe the evolution of attitudes toward dialysis discontinuation in historical context, beginning with the birth of outpatient dialysis in the 1960s and continuing through the present. From the start, attitudes toward dialysis discontinuation have reflected the clinical context in which dialysis is initiated. In the 1960s and 1970s, dialysis was only available to select patients and concerns about distributive justice weighed heavily. Because there was strong enthusiasm for new technology and dialysis was regarded as a precious resource not to be wasted, stopping treatment had negative moral connotations and was generally viewed as something to be discouraged.