Our faculty research broadens the knowledge of kidney disease.

International variation in dialysis discontinuation in patients with advanced kidney disease

Sarbjit V. Jassal, Maria Larkina, Kitty J. Jager, Fliss E.M. Murtagh, Ann M. O’Hare, Norio Hanafusa, Hal Morgenstern, Friedrich K. Port, Keith McCullough, Ronald Pisoni, Francesca Tentori, Rachel Perlman and Richard D. Swartz

Decisions about dialysis for advanced kidney disease are often strongly shaped by sociocultural and system-level factors rather than the priorities and values of individual patients. We examined international variation in the uptake of conservative approaches to the care of patients with advanced kidney disease, in particular discontinuation of dialysis.

Construct validity, ecological validity and acceptance of self-administered online neuropsychological assessment in adults

Chaytor, N.S., Barbosa-Leiker, C., Germine, L.T., Fonseca, L.M., McPherson, S.M., Tuttle, K.R.

The goal of this project was to explore the initial psychometric properties (construct and ecological validity) of self-administered online (SAO) neuropsychological assessment (using the www.testmybrain.org platform), compared to traditional testing, in a clinical sample, as well as to evaluate participant acceptance. SAO assessment has the potential to expand the reach of in-person neuropsychological assessment approaches.

Race, Ancestry and Vitamin D Metabolism: The Multi-Ethnic Study of Atherosclerosis

Simon Hsu, Andrew N Hoofnagle, Deepak K Gupta, Orlando M Gutierrez, Carmen A Peralta, Steven Shea, Norrina B Allen, Gregory Burke, Erin D Michos, Joachim H Ix, David Siscovick, Bruce M Psaty, Karol E Watson, Bryan Kestenbaum, Ian H de Boer, Cassianne Robinson-Cohen

Context: A comprehensive characterization of racial/ethnic variations in vitamin D metabolism markers may improve our understanding of differences in bone and mineral homeostasis and the risk of vitamin D-related diseases. Objective: Describe racial/ethnic differences in vitamin D metabolism markers and their associations with genetic ancestry

Tubular Secretory Clearance is Associated with Whole-Body Insulin Clearance

Matthew P Huber, Leila R Zelnick, Kristina M Utzschneider, Steven E Kahn, Ian H de Boer, Bryan R Kestenbaum

The kidneys eliminate insulin via glomerular and peritubular mechanisms; consequently, the kidney contribution to insulin clearance may be underestimated by the glomerular filtration rate (GFR) alone. Objective: To determine associations of tubular secretory clearance with whole-body insulin clearance and sensitivity in a dedicated study of glucose and insulin metabolism.

Continuous Glucose Monitoring and Use of Alternative Markers To Assess Glycemia in Chronic Kidney Disease

Leila R Zelnick, Zona O Batacchi, Iram Ahmad, Ashveena Dighe, Randie R Little, Dace L Trence, Irl B Hirsch, Ian H de Boer

In chronic kidney disease, glycated albumin and fructosamine have been postulated to be better biomarkers of glycemic control than HbA1c. We evaluated the accuracy, variability, and covariate bias of three biomarkers (HbA1c, glycated albumin, and fructosamine) compared with continuous glucose monitoring (CGM)–derived measurement of glycemia across estimated glomerular filtration rate (eGFR) in type 2 diabetes.

Parietal epithelial cell differentiation to a podocyte fate in the aged mouse kidney

Natalya V. Kaverina, Diana G. Eng, Jeffrey H. Miner, Jeffrey W. Pippin, Stuart J. Shankland

Healthy aging is typified by a progressive and absolute loss of podocytes over the lifespan of animals and humans. To test the hypothesis that a subset of glomerular parietal epithelial cell (PEC) progenitors transition to a podocyte fate with aging, dual reporter PEC-rtTA|LC1|tdTomato|Nphs1-FLPo|FRT-EGFP mice were generated. PECs were inducibly labeled with a tdTomato reporter, and podocytes were constitutively labeled with an EGFP reporter. With advancing age (14 and 24 months) glomeruli in the juxta-medullary cortex (JMC) were more severely injured than those in the outer cortex (OC). In aged mice (24m), injured glomeruli with lower podocyte number (41% decrease), showed more PEC migration and differentiation to a podocyte fate than mildly injured or healthy glomeruli.

Cardiopulmonary Resuscitation Preferences of People Receiving Dialysis

Bernacki, G.M., Engelberg, R.A., Curtis, J.R., Kurella Tamura, M., Brumback, L.C., Lavallee, D.C, Vig, E.K., O'Hare, A.M.

Importance: Whether the cardiopulmonary resuscitation (CPR) preferences of patients receiving dialysis align with their values and other aspects of end-of-life care is not known. Objective: To describe the CPR preferences of patients receiving dialysis and how these preferences are associated with their responses to questions about other aspects of end-of-life care.

Treating Home Versus Predialysis Blood Pressure Among In-Center Hemodialysis Patients: A Pilot Randomized Trial

Nisha Bansal, David V Glidden, Rajnish Mehrotra, Raymond R Townsend, Jordana Cohen, Lori Linke, Farshad Palad, Hannah Larson, Chi-Yuan Hsu

Observational studies have reported a U-shaped association between pre-dialysis blood pressure (BP) and death. In contrast, a linear association between out-of-dialysis unit BP has been reported. Home BP may be a better target for treatment. To test the feasibility of this approach, we conducted a pilot trial of treating home vs. pre-dialysis BP in hemodialysis patients. Study design: A 4-month parallel, randomized controlled trial.

Establishing Core Cardiovascular Outcome Measures for Trials in Hemodialysis: Report of an International Consensus Workshop

O'Lone, E., Viecelli, A.K., Craig, J.C., Tong, A., Sautenet, B., Herrington, W.G., Herzog, C.A., Jafar, T.H., Jardine, M.,, Krane, V., Levin, A., Malyszko, J., Rocco, M.V., Strippoli, G., Tonelli, M., Wang, A.Y.M., Wanner, C., Zannad, F., Winkelmayer, W.C., Wheeler, D.C., Manns, B., Pecoits-Filho, R., Harris, T., Winkelmayer, W., Herzog, C.A., Kleinpeter, M., Ju, A., Cho, Y., Gutman, T., Bernier-Jean, A., James, L., Hamiwka, L., Jardine, A., Bello, A., Stengel, B., Schiller, B., Johnson, D., Bavlovlenkov, E., Caskey, F., Gillespie, B., Block, G., Phan, H.A., Heerspink, H.L., Madero, M., Ruospo, M., Unruh, M., Laville, M., Bansal, N., Mark, P., Blankestijn, P.J., Roy-Chaudhury, P., Perlman, R., Agarwal, R., Mehrotra, R., Seliger, S., Shafi, T., Hiemstra, T., Jassal, V., Perkovic, V., Simplice, A., White, D., Eilers, D., Alexander, H., Landry, Y., Landry, G., Wilkie, C., SONG-HD CVD Consensus Workshop Investigators

Cardiovascular disease (CVD) affects more than two-thirds of patients receiving hemodialysis and is the leading cause of death in this population, yet CVD outcomes are infrequently and inconsistently reported in trials in patients receiving hemodialysis. As part of the Standardised Outcomes in Nephrology-Haemodialysis (SONG-HD) initiative, we convened a consensus workshop to discuss the potential use of myocardial infarction and sudden cardiac death as core outcome measures for CVD for use in all trials in people receiving hemodialysis.

Nephrology Provider Surprise Question Response and Hospitalizations in Older Adults with Advanced CKD

Ramer S.J.Baddour N.A.Siew E.D., Salat H.Bian A.Stewart T.G.Wong S.P.Y.Jhamb M.Abdel-Kader K.

Older adults with advanced non-dialysis-dependent chronic kidney disease (NDD-CKD) face a high risk of hospitalization and related adverse events. This prospective cohort study followed nephrology clinic patients ≥60 years old with NDD-CKD stages 4-5. After an eligible patient’s office visit, study staff asked the patient’s provider to rate the patient’s risk of death within the next year using the surprise question (“Would you be surprised if this patient died in the next 12 months?”) with a 5-point Likert scale response (1, “definitely not surprised” to 5, “very surprised”). We used a statewide database to ascertain hospitalization during follow-up.