Our research broadens the knowledge of kidney disease.

Association between goal-striving stress and rapid kidney function decline among African Americans: The Jackson Heart Study

Loretta Cain-Shields, LáShauntá Glover, Bessie Young, Mario Sims

African Americans (AAs) are disproportionately affected by kidney disease and also report higher psychosocial stressors than other racial groups. Goal-striving stress (GSS) is an understudied psychosocial stressor related to attempting to accomplish one's life goals. Given the numerous social determinants that contribute to health inequities among AAs, stress from goal striving may also disproportionately affect the health of AAs and in particular kidney disease outcomes. The objective of this study was to explore the association between GSS and rapid kidney function decline (RKFD) in an AA cohort.

Effects of the Soluble Guanylate Cyclase Stimulator Praliciguat in Diabetic Kidney Disease: A Randomized Placebo-Controlled Clinical Trial

John P. Hanrahan, Ian H. de Boer, George L. Bakris, Phebe J. Wilson, James D. Wakefield, Jelena P. Seferovic, Jennifer G. Chickering, Yueh-tyng Chien, Kenneth Carlson, Michael D. Cressman, Mark G. Currie, G. Todd Milne and Albert T. Profy

Background and objectives: Impaired nitric oxide signaling through soluble guanylate cyclase has been implicated in the pathophysiology of diabetic kidney disease. Praliciguat, a soluble guanylate cyclase stimulator that amplifies nitric oxide signaling, inhibited kidney inflammation and fibrosis in animal models. Design, setting, participants, & measurement: In a phase 2 trial, 156 adults with type 2 diabetes, eGFR 30–75 ml/min per 1.73 m2, and urine albumin-creatinine ratio 200–5000 mg/g treated with renin-angiotensin system inhibitors were randomly allocated 1:1:1 to placebo, 20 mg praliciguat, or 40 mg praliciguat daily for 12 weeks. The primary efficacy and safety outcomes were change from baseline to weeks 8 and 12 in urine albumin-creatinine ratio and treatment-emergent adverse events, respectively. Other outcomes assessed were 24-hour ambulatory BP and metabolic parameters.

Change in Cardiac Biomarkers and Risk of Incident Heart Failure and Atrial Fibrillation in CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study

Nisha Bansal, Leila R Zelnick, Elsayed Soliman, Amanda Anderson, Robert Christenson, Christopher DeFilippi, Rajat Deo, Harold I Feldman, Jiang He, Bonnie Ky, John Kusek, James Lash, Stephen Seliger, Tariq Shafi, Myles Wolf, Alan S Go, Michael G Shlipak, CRIC Study Investigators

Circulating cardiac biomarkers may signal potential mechanistic pathways involved in heart failure (HF) and atrial fibrillation (AF). Single measures of circulating cardiac biomarkers are strongly associated with incident HF and AF in chronic kidney disease (CKD). We tested the associations of longitudinal changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP), high sensitivity troponin T (hsTnT), galectin-3, growth differentiation factor-15 (GDF-15), and soluble ST-2 (sST-2) with incident HF and AF in patients with CKD.

Association of circulating cardiac biomarkers with electrocardiographic abnormalities in chronic kidney disease

Alexander J Kula, Ronit Katz, Leila R Zelnick, Elsayed Soliman, Alan Go, Michael Shlipak, Rajat Deo, Bonnie Ky, Ian DeBoer, Amanda Anderson, Rob Christenson, Stephen L Seliger, Chris Defilippi, Harold I Feldman, Myles Wolf, John Kusek, Tariq Shafi, Jiang He, Nisha Bansal

Among patients with chronic kidney disease (CKD), the circulating cardiac biomarkers soluble ST2 (SST2), galectin-3, growth differentiation factor-15 (GDF-15), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin-T (hsTnT) possibly reflect pathophysiologic processes and are associated with clinical cardiovascular disease. Whether these biomarkers are associated with electrocardiographic findings is not known. The aim of this study was to test the association between serum cardiac biomarkers and the presence of electrocardiographic changes potentially indicative of subclinical myocardial disease in patients with CKD.

SGLT2 inhibition and chronic kidney disease outcomes: in diabetes and beyond

Chronic kidney disease (CKD) is a pressing public health concern. CKD attributed to diabetes, known as diabetic kidney disease (DKD), is the most common cause of kidney failure, accounting for half of all cases. As the number of people with diabetes dramatically rises around the world, the burden of diabetic complications will concurrently swell. Occurring in about 30% of patients with type 1 diabetes and 40% of those with type 2 diabetes, DKD is one of most incapacitating and lethal complications of diabetes. Additionally, about a quarter of cases of kidney failure in CKD are attributed to hypertension, followed by various forms of glomerular diseases. It is crucial to recognise that the risks of CKD include a high risk of death that outcompetes risk of progression to kidney failure, particularly in patients with diabetes. Indeed, most people with CKD die before progressing to kidney failure. The largest number of deaths in people with CKD are due to cardiovascular diseases, especially heart failure. In order to meaningfully improve patient outcomes—survival without kidney failure or heart failure—better CKD care is urgently needed.

Perspectives on Conservative Care in Advanced Kidney Disease: A Qualitative Study of US Patients and Family Members

Oestreich, T., Sayre, G., O'Hare, A.M., Curtis, J.R., Wong, S.P.Y.

Rationale & Objective: Little is known about perceptions of conservative care among patients with advanced kidney disease in the United States. Study Design: Qualitative study using cognitive interviewing about attitudes regarding conservative care using decision aids on treatments for advanced kidney disease developed outside the United States. Setting & Participants: 14 patients 75 years or older with advanced kidney disease, defined as estimated glomerular filtration rate ≤ 20 mL/min/1.73 m2 and not receiving maintenance dialysis, and 6 of their family members. Analytical Approach: Thematic analysis of participants’ reactions to descriptions of conservative care taken from various clinical care decision aids.

A multi-center study on safety and efficacy of immune checkpoint inhibitors in cancer patients with kidney transplant

Naoka Murakami, Patrick Mulvaney, Melissa Danesh, Ala Abudayyeh, Adi Diab, Noha Abdel-Wahab, Maen Abdelrahim, Pascale Khairallah, Shayan Shirazian, Aleksandra Kukla, Itunu O. Owoyemi, Tarek Alhamad, Samir Husami, Madhav Menon, Andrew Santeusanio, Christopher Blosser, Sandra Carias Zuniga, Maria Jose Soler, Francesc Moreso, Zain Mithani, David Ortiz-Melo, Edgar A. Jaimes, Victoria Gutgarts, Erik Lum, Gabriel M. Danovitch, Francesca Cardarelli, Reed E. Drews, Claude Bassil, Jennifer L. Swank, Scott Westphal, Roslyn B. Mannon,Keisuke Shirai, Abhijat Kitchlu, Song Ong, Shana M. Machado, Suraj S. Mothi, Patrick A. Ott, Osama Rahma, F. Stephen Hodi, Meghan E. Sise, Shruti Gupta, David E. Leaf, Craig E. Devoe, Rimda Wanchoo, Vinay V. Nair, Chrysalyne D. Schmults, Glenn J. Hanna, Ben Sprangers, Leonardo V. Riella, Kenar D. Jhaveri, On behalf ofImmune Checkpoint Inhibitors in Solid Organ Transplant Consortium

Immune checkpoint inhibitors (ICIs) are widely used for various malignancies. However, their safety and efficacy in patients with a kidney transplant have not been defined. To delineate this, we conducted a multicenter retrospective study of 69 patients with a kidney transplant receiving ICIs between January 2010 and May 2020. For safety, we assessed the incidence, timing, and risk factors of acute graft rejection. For efficacy, objective response rate and overall survival were assessed in cutaneous squamous cell carcinoma and melanoma, the most common cancers in our cohort, and compared with stage-matched 23 patients with squamous cell carcinoma and 14 with melanoma with a kidney transplant not receiving ICIs.

Defining the roles and responsibilities of the kidney transplant medical director: A necessary step for future training, mentoring, and professional development

Alexander C. Wiseman, Enver Akalin, Darshana M. Dadhania, Angelo DeMattos, Mona Doshi, John Friedewald, Christina Klein, Nicolae Leca, Kim Nicoll, Todd Pesavento, Luke Preczewski, Millie Samaniego, Neeraj Singh, Roy Bloom 

The management of a kidney transplant program has evolved significantly in the last decades to become a highly specialized, multidisciplinary standard of care for end‐stage kidney disease. Transplant center job descriptions have similarly morphed with increasing responsibilities to address a more complex patient mix, increasing medical and surgical therapeutic options, and increasing regulatory burden in the face of an ever‐increasing organ shortage. Within this evolution, the role of the Kidney Transplant Medical Director (KTMD) has expanded beyond the basic requirements described in the United Network for Organ Sharing bylaws. Without a clear job description, transplant nephrology trainees may be inadequately trained and practicing transplant nephrologists may face opaque expectations for the roles and responsibilities of Medical Director. To address this gap and clarify the key areas in which the KTMD interfaces with the kidney transplant program, American Society of Transplantation (AST) formed a Task Force of 14 AST KTMDs to review and define the role of the KTMD in key aspects of administrative, regulatory, budgetary, and educational oversight of a kidney transplant program.

Dialysis adequacy reconsidered: The person comes first

Although many nephrologists see value in maximizing clearance and time on dialysis, clinical trials have failed to show a clear and consistent benefit of increasing clearance above the minimum threshold level recommended in clinical practice guidelines or of increasing dialysis session length or frequency. Available evidence suggests that patients and clinicians do not necessarily agree on what matters most when it comes to dialysis care, and that what patients consider to be an adequate dialysis session is highly individual and has little to do with solute clearance. Qualitative studies suggest that patients value spending less time on dialysis, having the dialysis procedure go smoothly, and being treated like an individual by staff members. Because many patients feel that they have little choice but to show up for their dialysis sessions, failing to involve them in decisions about time spent on the machine can contribute to feelings of powerlessness and loss of control, erode their sense of self, and diminish the quality of therapeutic relationships. On the other hand, a flexible and shared approach to decision‐making about time spent on dialysis (and other aspects of care) can help to strengthen relationships, uphold personhood, and align care with what matters most.

Diabetes Management in Chronic Kidney Disease: Synopsis of the 2020 KDIGO Clinical Practice Guideline

Sankar D. Navaneethan, Sophia Zoungas, M. Luiza Caramori, Juliana C. N. Chan, Hiddo J. L. Heerspink, Clint Hurst, Adrian Liew, Erin D. Michos, Wasiu A. Olowu, Tami Sadusky, Nikhil Tandon, Katherine R. Tuttle, Christoph Wanner, Katy G. Wilkens, Lyubov Lytvyn, Jonathan C. Craig, David J. Tunnicliffe, Martin Howell, Marcello Tonelli, Michael Cheung, Amy Earley, Peter Rossing, Ian H. de Boer, Kamlesh Khunti

The Kidney Disease: Improving Global Outcomes (KDIGO) organization developed a clinical practice guideline in 2020 for the management of patients with diabetes and chronic kidney disease (CKD). The KDIGO Work Group (WG) was tasked with developing the guideline for diabetes management in CKD. It defined the scope of the guideline, gathered evidence, determined systematic review topics, and graded evidence that had been summarized by an evidence review team.