Our research broadens the knowledge of kidney disease.
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.
Body Composition Changes Following Dialysis Initiation and Cardiovascular and Mortality Outcomes in CRIC (Chronic Renal Insufficiency Cohort): A Bioimpedance Analysis Substudy
Bioelectrical impedance analysis (BIA) provides a noninvasive assessment of body composition. BIA measures of nutritional (phase angle) and hydration (vector length) status are associated with survival among individuals with chronic kidney disease (CKD), including those receiving maintenance dialysis. However, little is known regarding changes in these parameters with CKD following the high-risk transition to maintenance dialysis. Study Design: Observational study. Settings & Participants: 427 adults enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study, with BIA measurements performed within 1 year before and after initiation of maintenance dialysis.
Medicaid Expansion and Incidence of Kidney Failure among Nonelderly Adults
Prior work suggests that uniform access to health insurance coverage and health care services reduces disparities in treatment and outcomes of patients with CKD. This study assessed whether expansions of Medicaid coverage to low-income adults in the United States under the Affordable Care Act (ACA) were associated with changes in the incidence rate of kidney failure. The authors found that, in the entire adult population aged 19–64 years, the ACA’s Medicaid expansions were associated with a statistically significant 3% relative reduction in kidney failure incidence in the early period (years 2 and 3) after expansion. However, this decline was not sustained in the later period (years 4 and 5) after expansion. Further research is needed to understand the relationship between expanding health insurance coverage and the incidence of kidney failure.
Retinal Capillary Nonperfusion on OCT-Angiography and Its Relationship to Kidney Function in Patients with Diabetes
Background. Diabetic retinopathy and kidney disease share underlying mechanisms of microvascular damage and are often comorbid in people with diabetes. We evaluated whether there is a relationship between retinal capillary perfusion as measured by swept-source optical coherence tomography angiography and estimated glomerular filtration rate (eGFR) and albuminuria in patients with diabetes and chronic kidney disease (CKD). Method. A cross-sectional pilot study was conducted at the University of Washington among a subset of participants with diabetes and CKD participating in a larger cohort study. Participants were excluded if they were known to have kidney disease from conditions other than diabetes. Ten participants (11 eyes) were included. Retinal nonperfusion (RNP) and vessel density (VD) were measured by swept-source optical coherence tomography angiography in 30° and 60° field of view (FOV) regions centered at the fovea.
KDOQI US Commentary on the KDIGO Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation
There is considerable variability among transplant centers in their approach to evaluation and decision-making regarding transplant candidacy. The 2020 KDIGO (Kidney Disease: Improving Guidelines Outcome) clinical practice guideline on the evaluation and management of candidates for kidney transplantation provides practice recommendations that can serve as a useful reference guide to transplant professionals. The guideline, covering a broad range of topics, was developed by an international group of experts from transplant and nephrology through a review of literature published until May 2019. A work group of US transplant nephrologists convened by NKF-KDOQI (National Kidney Foundation–Kidney Disease Quality Initiative) chose key topics for this commentary with a goal of presenting a broad discussion to the US transplant community. Each section of this article has a summary of the key KDIGO guideline recommendations, followed by a brief commentary on the recommendations, their clinical utility, and potential implementation challenges.
Development and Content Validity of a Patient-Reported Experience Measure for Home Dialysis
The population of patients with kidney failure in the United States using home dialysis modalities is growing rapidly. Unlike for in-center hemodialysis, there is no patient-reported experience measure for assessment of patient experience of care for peritoneal dialysis or home hemodialysis. We sought to develop and establish content validity of a patient-reported experience measure for patients undergoing home dialysis using a mixed methods multiple stakeholder approach.
Professional roles and relationships during the COVID-19 pandemic: a qualitative study among US clinicians
Objective: The COVID-19 pandemic has transformed healthcare delivery in the USA, but there has been little empirical work describing the impact of these changes on clinicians. We conducted a study to address the following question: how has the pandemic impacted US clinicians' professional roles and relationships? Design: Inductive thematic analysis of semi-structured interviews. Setting: Clinical settings across the USA in April and May of 2020. Participants: Clinicians with leadership and/or clinical roles during the COVID-19 pandemic. Measures: Emergent themes related to professional roles and relationships.
Prevention of Urinary Stones With Hydration (PUSH): Design and Rationale of a Clinical Trial
Rationale & objective: Although maintaining high fluid intake is an effective low-risk intervention for the secondary prevention of urinary stone disease, many patients with stones do not increase their fluid intake. Study design: We describe the rationale and design of the Prevention of Urinary Stones With Hydration (PUSH) Study, a randomized trial of a multicomponent behavioral intervention program to increase and maintain high fluid intake. Participants are randomly assigned (1:1 ratio) to the intervention or control arm. The target sample size is 1,642 participants. Setting & participants: Adults and adolescents 12 years and older with a symptomatic stone history and low urine volume are eligible. Exclusion criteria include infectious or monogenic causes of urinary stone disease and comorbid conditions precluding increased fluid intake.
Association of Obesity with Cardiovascular Risk Factors and Kidney Disease Outcomes in Primary Proteinuric Glomerulopathies
Obesity is a known risk factor for cardiovascular disease and contributes to the development and progression of kidney disease. However, the specific influence of obesity on outcomes in primary glomerular disease has not been well characterized. In this prospective cohort study, data were from 541 participants enrolled in the Nephrotic Syndrome Study Network (NEPTUNE), between 2010 and 2019, at 23 sites across North America. Blood pressure, lipids, and kidney disease outcomes including complete proteinuria remission, kidney failure, and chronic kidney disease progression were evaluated. Data were analyzed using linear and logistic regression with generalized estimating equations and time-varying Cox regression with Kaplan-Meier plots.