Our research broadens the knowledge of kidney disease.

Read up-to-date Nephrology faculty research on Pubmed with the link below

University of Washington Nephrology Faculty Research on Pubmed

We are committed to conducting path-breaking research in order to improve the lives of people with kidney diseases. Our faculty consistently publish new research in nationally recognized journals.


A selection of recent papers:

 

Removal of race from estimation of kidney function

Concerns regarding the incorrect use of race as a biological construct and the resulting negative effect on health equity have led to the reconsideration of the inclusion of race in equations for estimating glomerular filtration rate. Now, two studies report that cystatin-C-based equations can accurately estimate glomerular filtration rate independent of race.

Therapeutic Inertia and Racial Differences in Blood Pressure Control-Time to Get Moving

Hypertension is the most common chronic health condition in the United States and is one of the most important modifiable risk factors for the prevention of cardiovascular events among adults worldwide. The results of numerous landmark clinical trials testing many different classes of antihypertensive agents have repeatedly demonstrated that treatment of hypertension dramatically improves clinical outcomes. Despite these data, guideline-adherent achievement of target blood pressure (BP) in individuals treated for hypertension remains frustratingly low.

Risk of Foot Ulcer and Lower-Extremity Amputation Among Participants in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study

Boyko EJ, Zelnick LR, Braffett BH, Pop-Busui R, Cowie CC, Lorenzi GM, Gubitosi-Klug R, Zinman B, de Boer IH

Intensive glycemic control reduces the risk of kidney, retinal, and neurologic complications in type 1 diabetes (T1D), but whether it reduces the risk of lower-extremity complications is unknown. We examined whether former intensive versus conventional glycemic control among Diabetes Control and Complications Trial (DCCT) participants with T1D reduced the long-term risk of diabetic foot ulcers (DFUs) and lower-extremity amputations (LEAs) in the subsequent Epidemiology of Diabetes Interventions and Complications (EDIC) study.

DCRM Multispecialty Practice Recommendations for the management of diabetes, cardiorenal, and metabolic diseases

Handelsman Y, Anderson JE, Bakris GL, Ballantyne CM, Beckman JA, Bhatt DL, Bloomgarden ZT, Bozkurt B, Budoff MJ, Butler J, Dagogo-Jack S, de Boer IH, DeFronzo RA, Eckel RH, Einhorn D, Fonseca VA, Green JB, Grunberger G, Guerin C, Inzucchi SE, Jellinger PS, Kosiborod MN, Kushner P, Lepor N, Mende CW, Michos ED, Plutzky J, Taub PR, Umpierrez GE, Vaduganathan M, Weir MR.

Type 2 diabetes (T2D), chronic kidney disease (CKD), atherosclerotic cardiovascular disease (ASCVD), and heart failure (HF)—along with their associated risk factors—have overlapping etiologies, and two or more of these conditions frequently occur in the same patient. Many recent cardiovascular outcome trials (CVOTs) have demonstrated the benefits of agents originally developed to control T2D, ASCVD, or CKD risk factors, and these agents have transcended their primary indications to confer benefits across a range of conditions. This evolution in CVOT evidence calls for practice recommendations that are not constrained by a single discipline to help clinicians manage patients with complex conditions involving diabetes, cardiorenal, and/or metabolic (DCRM) diseases.

Validation of the 24,25-dihydroxyvitamin D 3 to 25-hydroxyvitamin D 3 ratio as a biomarker of 25-hydroxyvitamin D 3 clearance

Hsu S, Zelnick LR, Lin YS, Best CM, Kestenbaum BR, Thummel KE, Hoofnagle AN, de Boer IH

The formation of 24,25-dihydroxyvitamin D (24,25(OH)2D) from 25-hydroxyvitamin D (25(OH)D) is the primary mechanism for the metabolic clearance of 25(OH)D, and is regulated by tissue-level vitamin D activity. The ratio of 24,25(OH)2D3 to 25(OH)D3 in blood (vitamin D metabolite ratio, VDMR) is postulated to be a marker of 25(OH)D3 clearance, however this has never been tested. We measured baseline 24,25(OH)2D3 and 25(OH)D3 concentrations in 87 participants by liquid chromatography-tandem mass spectrometry.

Outpatient Hemodialysis for Acute Kidney Injury Post-Medicare Coverage: How Are We Doing?

Struthers SA, Bieber SD

In January 2017, the Centers for Medicare and Medicaid Services (CMS) implemented a new policy allowing outpatient end-stage renal disease (ESRD) facilities to furnish care for Medicare beneficiaries with acute kidney injury (AKI) requiring dialysis (AKI-D).1 This change reversed a 2012 CMS rule clarification that prohibited ESRD facilities from providing dialysis for AKI. The impetus for the legislation resulting in this policy change related, in part, to a desire to expand access to outpatient dialysis care for patients with AKI-D and reduce costs associated with prolonged hospital stays necessitated only by the need for an ongoing dialysis.

Ten-Year Risk-Prediction Equations for Incident Heart Failure Hospitalizations in Chronic Kidney Disease: Findings from the Chronic Renal Insufficiency Cohort Study and the Multi-Ethnic Study of Atherosclerosis

Rupal Mehta, Hongyan Ning, Nisha Bansal, Jordana Cohen, Anand Srivastava, Mirela Dobre, Erin D Michos, Mahboob Rahman, Raymond Townsend, Stephen Seliger, James P Lash, Tamara Isakova, Donald M Lloyd-Jones, Sadiya S Khan

Background: Heart failure (HF) is a leading contributor to cardiovascular morbidity and mortality in the population with chronic kidney disease (CKD). HF risk prediction tools that use readily available clinical parameters to risk-stratify individuals with CKD are needed. Methods: We included Black and White participants aged 30–79 years with CKD stages 2–4 who were enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study and were without self-reported cardiovascular disease. We assessed model performance of the Pooled Cohort Equations to Prevent Heart Failure (PCP-HF) to predict incident hospitalizations due to HF and refit the PCP-HF in the population with CKD by using CRIC data-derived coefficients and survival from CRIC study participants in the CKD population (PCP-HFCKD).

Prescriptive analytics determining which patients undergoing simultaneous liver-kidney transplant may benefit from high-risk organs

Mohini Dasari, James D. Perkins, James B. Hendele, Nicolae Leca, Scott W. Biggins, Lena Sibulesky

Objectives: Simultaneous liver-kidney transplant is a treatment option for patients with end-stage liver disease and concomitant irreversible kidney injury. We developed a decision tool to aid transplant programs to advise their candidates for simultaneous liver-kidney transplant on accepting high-risk grafts versus waiting for lower-risk grafts. Materials and Methods: To find the critical decision factors, we used the prescriptive analytic technique of microsimulation. All probabilities used in the simulation model were calculated from Organ Procurement and Transplantation Network data collected from February 27, 2002 to June 30, 2018. Results: The simulated patient population results revealed, on average, that...

Management of Adults with Newly Diagnosed Atrial Fibrillation With and Without Chronic Kidney Disease

Bansal N, Zelnick L, Reynolds K, Harrison T, Lee MS, Singer D, Sung SH, Fan D, Go A

Atrial fibrillation (AF) is highly prevalent in chronic kidney disease (CKD) and is associated with worse cardiovascular and kidney outcomes. Limited data exist on use of AF pharmacotherapies and AF-related procedures by CKD status. We examined a large "real-world" contemporary population of incident AF to study the association of CKD with management of AF. We identified patients with newly diagnosed AF between 2010-2017 from two large, integrated healthcare delivery systems.

Cyclosporine Induces Fenestra-Associated Injury in Human Renal Microvessels In Vitro

Nagao RJ, Marcu R, Shin YJ, Lih D, Xue J, Arang N, Wei L, Akilesh S, Kaushansky A, Himmelfarb J, Zheng Y

The use of cyclosporine A (CsA) in transplantation is frequently associated with nephrotoxicity, characterized by renal vascular injury, thrombotic microangiopathy, and striped interstitial fibrosis. Here, using human kidney-specific microvascular endothelial cells (HKMECs), we showed that CsA inhibited NFAT1 activation and impaired VEGF signaling in these ECs in a dose- and time-dependent manner. Integrated genome regulatory analyses identified key distinctions in the landscapes of HKMECs compared to human umbilical vein endothelial cells, particularly around genes related to the formation and maintenance of fenestrae. Using a bioengineered flow-directed 3D kidney microphysiological system, we revealed that CsA-induced kidney microvascular injury was associated with fenestrae and cell adhesion impairment, membrane swelling, and erythrocyte adhesion and extravasation into the interstitial space.