Our research broadens the knowledge of kidney disease.
What Is the “Maintenance” in Maintenance Dialysis?
It is time that we adopt a more patient-centered mindset when caring for patients on dialysis. Other studies indicate that while staying alive is important to patients, their independence and how they spend their time when they are not on dialysis may be of greater value to most. However, nephrologists are more attuned to addressing patients’ biomedical markers of disease activity and risk factors for mortality than patients’ personal goals and function.
Comparison of host endothelial, epithelial and inflammatory response in ICU patients with and without COVID-19: a prospective observational cohort study
Analyses of blood biomarkers involved in the host response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral infection can reveal distinct biological pathways and inform development and testing of therapeutics for COVID-19. Our objective was to evaluate host endothelial, epithelial and inflammatory biomarkers in COVID-19.
Magnesium and Cardiovascular Disease in CKD: The Mysteries of a Humble Divalent Cation
Despite its abundance, magnesium is an enigmatic electrolyte. Within the intracellular compartment, magnesium is the most abundant cation second only to potassium. Numerous biochemical processes, many of them essential for life, require magnesium as a cofactor. However, magnesium remains underappreciated clinically, particularly in nephrology, because concentrations are monitored and treated only in specific disease states such as torsades de pointes or preeclampsia. However, there has been an increase in epidemiologic research investigating the relationship between serum magnesium levels and outcomes (specifically cardiovascular outcomes), bringing renewed attention to this often “forgotten” electrolyte.
Lessons Learned: Nephrology Training Program Adaptation in the Time of COVID
The COVID-19 pandemic has prompted rapid changes to medical education. Across the U.S., graduate medical education programs have had to navigate abrupt declines in outpatient medical care, marked fluctuations in inpatient volume and acuity, and a rapid shift to online education. Through our shared experiences across nephrology fellowship programs in three different U.S. regions, we identified three domains in which we faced the greatest challenges: changes in care delivery models, curricular adaptation, and fellow wellbeing. Here, we outline the specific challenges in these areas and highlight opportunities for innovation in nephrology fellowship training, stimulated by the COVID-19 disruption.
Assessment of kidney proximal tubular secretion in critical illness
Serum creatinine concentrations (SCr) are used to determine the presence and severity of acute kidney injury (AKI). SCr is primarily eliminated by glomerular filtration; however, most mechanisms of AKI in critical illness involve kidney proximal tubules, where tubular secretion occurs. Proximal tubular secretory clearance is not currently estimated in the ICU. Our objective was to estimate the kidney clearance of secretory solutes in critically ill adults.
Kidney recipients with allograft failure, transition of kidney care (KRAFT): A survey of contemporary practices of transplant providers
Despite improvement of long‐term kidney allograft survival, allograft failure with return to dialysis is common. It is estimated that 12% of patients on the current kidney transplant waiting list have had a prior failed transplant. Returning to dialysis remains a major challenge for patients and providers. Patients face a higher risk of morbidity and mortality in addition to depression and social challenges during the transition period when immunosuppresion is not well monitored. The estimated mortality rate in patients with failed allograft is 16% in the first year following allograft failure with persistently increased risk compared to those starting dialysis without a prior failed transplant. Two major causes of mortality after returning to dialysis are infections and cardiovascular disease
The NIH Somatic Cell Genome Editing program
The United States National Institutes of Health (NIH) Somatic Cell Genome Editing (SCGE) Consortium aims to accelerate the development of safer and more-effective methods to edit the genomes of disease-relevant somatic cells in patients, even in tissues that are difficult to reach. Here we discuss the consortium’s plans to develop and benchmark approaches to induce and measure genome modifications, and to define downstream functional consequences of genome editing within human cells.
Microvascular Benefits of New Antidiabetic Agents: A Systematic Review and Network Meta-Analysis of Kidney Outcomes
Diabetic kidney disease affects nearly one-third of US adults with prevalent type 2 diabetes mellitus (T2DM). The use of new antidiabetic medications in the prevention and treatment of diabetic kidney disease is a growing area of research interest. Objective: We sought to characterize the risk of developing a composite kidney outcome among patients receiving a new antidiabetic medication of the SGLT-2i, GLP-1ra, and DPP-4i drug classes.
Development of COVIDVax Model to Estimate the Risk of SARS-CoV-2-Related Death among 7.6 Million US Veterans for Use in Vaccination Prioritization
Question: How can the risk of SARS-CoV-2–related death be estimated in the general population to be used for vaccination prioritization? Findings: In this prognostic study of more than 7.6 million individuals enrolled in the Veterans Affairs health care system, a logistic regression model (COVIDVax) was developed to estimate risk of SARS-CoV-2–related death using the following 10 characteristics: sex, age, race, ethnicity, body mass index, Charlson Comorbidity Index, diabetes, chronic kidney disease, congestive heart failure, and the Care Assessment Need score. The model was estimated to save more lives than prioritizing vaccination based on age or on the US Centers for Disease Control and Prevention vaccination allocation. Meaning: These findings suggest that prioritizing vaccination based on the model developed in this study could prevent a substantial number of SARS-CoV-2–related deaths during vaccine rollout.
Ambulatory and Home Blood Pressure Monitoring in Hemodialysis Patients: A Mixed-Methods Study Evaluating Comparability and Tolerability of Blood Pressure Monitoring
Out-of-dialysis unit blood pressure (BP) measurement is a better predictor of adverse outcomes compared with traditional dialysis unit BP measurement among patients receiving thrice-weekly in-center hemodialysis. Forty-four–hour ambulatory BP monitoring in maintenance hemodialysis patients provides valuable prognostic information but is often not practical in clinical practice. Home BP monitoring may be better suited for longitudinal BP monitoring to guide hypertension management. However, limited evidence exists regarding the tolerability of ambulatory versus home BP in hemodialysis patients. We evaluated data from the Blood Pressure Lowering in Dialysis (BOLD) Trial (NCT03459807), a pilot randomized trial in which participants were randomly assigned to targeting a home systolic BP (SBP) versus predialysis SBP < 140 mm Hg.10 Fifty hemodialysis patients were recruited, of whom 31 (N = 16 in the home BP arm, N = 15 in the dialysis-unit BP arm) agreed to optional 44-hour ambulatory BP monitoring.