Our faculty research broadens the knowledge of kidney disease.

Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Jennifer E. Flythe,Tara I. Chang, Martin P. Gallagher, Elizabeth Lindley, Magdalena Madero, Pantelis A. Sarafidis, Mark L. Unruh, Angela Yee-Moon Wang, Daniel E. Weiner, Michael Cheung, Michel Jadoul, Wolfgang C. Winkelmayer, Kevan R. Polkinghorne, Conference Paticipants including Rajnish Mehrota, Suzanne Watnick, et al...

Blood pressure (BP) and volume control are critical components of dialysis care and have substantial impacts on patient symptoms, quality of life, and cardiovascular complications. Yet, developing consensus best practices for BP and volume control have been challenging, given the absence of objective measures of extracellular volume status and the lack of high-quality evidence for many therapeutic interventions. In February of 2019, Kidney Disease: Improving Global Outcomes (KDIGO) held a Controversies Conference titled Blood Pressure and Volume Management in Dialysis to assess the current state of knowledge related to BP and volume management and identify opportunities to improve clinical and patient-reported outcomes among individuals receiving maintenance dialysis.

Advancing American Kidney Health—New Opportunities for Collaborative Care

Matthew B. Rivara, Richard N. Formica, Rajnish Mehrotra

One of the most ambitious components of the AAKH Initiative is an explicit aim to reduce the number of Americans developing end-stage renal disease by 25% by 2030. Slowing the progression of kidney function decline in patients with chronic kidney disease to the extent necessary to achieve this goal will require an extraordinary effort to maximally implement evidence-based treatments, identify and treat established kidney disease risk factors such as hypertension and diabetes, and improve access to care for those with identified chronic kidney disease.

Spinal Tophi Causing Cord Compression and Mimicking Epidural Abscess in a Young Man With Lesch-Nyhan Variant

Liew, Jean W., Struthers, Sarah A., Cormack, Fionnuala C., Bays, Alison M., Han, Bobby Kwanghoon

A 23-year-old man presented with 3 days of thoracic back pain, leg weakness, paresthesias, urinary incontinence, and fever (38°C). He had a history of autism spectrum disorder, tophaceous gout diagnosed at 20, and chronic kidney disease (CKD).

Differential effects of phosphate binders on vitamin D metabolism in chronic kidney disease.

C. Ginsberg, L.R. Zelnick, G.A. Block, G.M. Chertow, M.Chonchol, A. Hoofnagle, B. Kestenbaum, I.H. de Boer

 

Phosphate binders are commonly used in the treatment of patients with hyperphosphatemia. While phosphate binders are used to lower phosphate, the effects of specific phosphate binder types on vitamin D metabolism are unknown.

Association of Tubular Solute Clearance with Symptom Burden in Incident Peritoneal Dialysis.

Ke Wang, Michelle Nguyen, Yan Chen, Andrew N. Hoofnagle, Jessica O. Becker, Leila R. Zelnick, John Kundzins, Anne Goodling, Jonathan Himmelfarb, Bryan Kestenmbaum

 

Residual kidney function is important to the health and wellbeing of patients with ESKD. We tested whether the kidney clearances of proximal tubular secretory solutes are associated with burden of uremic and heart failure symptoms among patients on peritoneal dialysis with residual kidney function.

Impaired skeletal muscle mitochondrial bioenergetics and physical performance in chronic kidney disease

B. Kestenmaum, J. Gamboa S. Liu, A.S. Ali, E. Shankland, T. Jue, C. Giulivi, L.R. Smith, J. Himmelfarb, I. de Boer, K. Conley, B. Roshanravan

The maintenance of functional independence is the top priority of patients with chronic kidney disease (CKD). Defects in mitochondrial energetics may compromise physical performance and independence. We investigated associations of the presence and severity of kidney disease with in vivo muscle energetics and the association of muscle energetics with physical performance.

Deregulation of Neuro-Developmental Genes and Primary Cilium Cytoskeleton Anomalies in iPSC Retinal Sheets from Human Syndromic Ciliopathies

Barabino, A., Flamier, A., Hanna, R., Héon, E., Freedman, B.S., Bernier, G.

We describe the generation and molecular characterization of human induced pluripotent stem cell (iPSC)-derived retinal sheets (RSs) from controls, and MKS (TMEM67) and BBS (BBS10) cases. MKS and BBS RSs displayed significant common alterations in the expression of hundreds of developmental genes and members of the WNT and BMP pathways.

High levels of dd-cfDNA identify patients with TCMR 1A and borderline allograft rejection at elevated risk of graft injury

Stites, E., Kumar, D., Olaitan, O., John Swanson, S., Leca, N., Weir, M., Bromberg, J., Melancon, J., Agha, I., Fattah, H., Alhamad, T., Qazi, Y., Wiseman, A., Gupta, G.

The clinical importance of subclinical, early T cell–mediated rejection (Banff TCMR 1A and borderline lesions) remains unclear, due, in part to the fact that histologic lesions used to characterize early TCMR can be nonspecific. Donor‐derived cell‐free DNA (dd‐cfDNA) is an important molecular marker of active graft injury. Over a study period from June 2017 to May 2019, we assessed clinical outcomes in 79 patients diagnosed with TCMR 1A/borderline rejection across 11 US centers with a simultaneous measurement of dd‐cfDNA.

Clinician Engagement in Research as a Path Toward the Learning Health System: A Regional Survey Across the Northwestern United States

Elizabeth L Ciemins, Brenda L Mollis, Jeannine M Brant, Laurie A Hassell, Sandra Albritton, Paul Amoroso, Angela Lloyd, Jodi M Smith, Bethann M Pflugeisen, Katherine R Tuttle, Laura-Mae Baldwin 

Increased research engagement of frontline, community-based clinicians could result in greater research relevancy, increased likelihood of implementation into practice, and improved health care for patients. Establishment of learning health systems within health-care organizations may facilitate this process. In 2016, the U.S. Northwest Participant and Clinical Interactions Network conducted a region-wide survey in four community-based health systems to identify barriers to clinician involvement in research and understand clinician interest and levels of engagement.

Web Exclusive. Annals On Call - The Good, the Bad, and the Ugly-the Sequel: GLP1 Agonists

Robert M Centor, Katherine R Tuttle 

Dr. Centor discusses the role of glucagon-like peptide-1 receptor agonists in the treatment of patients with type 2 diabetes with Dr. Tuttle of Providence Health Care and University of Washington School of Medicine.