Our faculty research broadens the knowledge of kidney disease.

Association of serum and urinary uromodulin and their correlates in older adults-The Cardiovascular Health Study

Dominik Steubl, Petra Buzkova, Joachim H. Ix, Prasad Devarajan, Michael R. Bennett, Paolo H. M. Chaves, Michael G. Shlipak, Nisha Bansal, Mark J. Sarnak, Pranav S. Garimella

Uromodulin is released into serum (sUMOD) and urine (uUMOD) exclusively by renal tubular cells. Both sUMOD and uUMOD are correlated with estimated glomerular filtration rate (eGFR), and associated with mortality and cardiovascular disease (CVD). However, no study to our knowledge has measured both sUMOD and uUMOD in the same population, thus the relationship of sUMOD with uUMOD with one another, and their respective correlates have not been evaluated simultaneously.

Clinical Characteristics of and Risk Factors for Chronic Kidney Disease Among Adults and Children: An Analysis of the CURE-CKD Registry

Katherine R. Tuttle, Radica Z. Alicic, O. Kenrik Duru, Cami R. Jones, Kenn B. Daratha, Susanne B. Nicholas, Sterling M. McPherson, Joshua J. Neumiller, Douglas S. Bell, Carol M. Mangione, Keith C. Norris

What are the clinical characteristics of and major risk factors for chronic kidney disease among patients in 2 large US health care systems? In this cohort study of the Center for Kidney Research, Education, and Hope (CURE-CKD) registry, more than 2.6 million adults and children had chronic kidney disease or were at risk. Albuminuria or proteinuria was tested in approximately one-eighth of adults with chronic kidney disease, renin-angiotensin system inhibitors were prescribed to one-fifth, and nonsteroidal anti-inflammatory agents or proton pump inhibitors were prescribed to more than one-third. Despite common occurrence of chronic kidney disease, rates of identification and use of kidney protective agents were low, while use of potential nephrotoxins was widespread.

The landscape of diabetic kidney disease transformed

After nearly two decades, a new therapeutic agent, canagliflozin, received regulatory approval to prevent loss of kidney function, end-stage kidney disease, hospitalization for heart failure and cardiovascular death in patients with diabetic kidney disease. Nonetheless, the residual risk of kidney disease progression and complications remains high, underlining the importance of ongoing therapeutic development.

Utilizing centralized biorepository samples for biomarkers of cystic fibrosis lung disease severity

Scott D. Sagela, Brandie D. Wagner, Assem Ziady, Tom Kelley, John P. Clancy, Monica Narvaez-Rivase, Joseph Pilewski, Elizabeth Joseloff, Wei Shah, Leila Zelnick, Kenneth D.R.Setchelle, Sonya L. Heltshe, Marianne S. Muhlebach

Circulating biomarkers reflective of lung disease activity and severity have the potential to improve patient care and accelerate drug development in CF. The objective of this study was to leverage banked specimens to test the hypothesis that blood-based biomarkers discriminate CF children segregated by lung disease severity.

Fibrillary Glomerulonephritis Clinicopathologic Features and Atypical Cases from a Multi-Institutional Cohort

Nicole K. Andeen, Megan L. Troxell, Maziar Riazy, Rupali S. Avasare, Jessica Lapasia, J. Ashley Jefferson, Shreeram Akilesh, Behzad Najafian, Roberto F. Nicosia, Charles E. Alpers and Kelly D. Smith

Fibrillary GN has been defined as an immune complex-mediated GN with amyloid-like fibrils larger than amyloid which are IgG positive and Congo red negative. With discovery of DNAJB9 as a highly sensitive and specific marker for fibrillary GN, the specificity of the morphologic criteria for establishing the diagnosis of fibrillary GN has come into question. We sought to (1) determine anatomic characteristics that best define fibrillary GN and (2) identify clinical and pathologic features that predict outcomes.

Transforming Care for Patients and Providers - Perspective from Nonprofit Providers

Suzanne Watnick and Jeffrey Silberzweig

As Chief Medical Officers of not-for-profit organizations, we often find ourselves addressing the needs of many stakeholders, focusing on patient care as our central mission and figuring how to achieve this with resources available. Along with our nephrologist colleagues and our dialysis organizations’ leadership and staff, we seek to provide the best possible care for our patients. This discussion will focus on the potential consequences of the AAKH initiative for our patients, nephrologists, and dialysis organizations.

Advancing American Kidney Health: An Introduction

On July 10, 2019, President Trump announced a sweeping set of initiatives collectively called Advancing American Kidney Health, designed to reduce the incidence of kidney failure, make more treatment options for dialysis available to a larger number of patients, and increase the number of available organs for kidney transplantation. With a series of 10 articles, CJASN wishes to communicate to its readers the opinion on the proposal of a wide range of stakeholders.

Trends in Mortality Among Patients Initiating Maintenance Dialysis in Puerto Rico Compared to US States, 2006-2015

Maricruz Rivera-Hernandez, Shailender Swaminathan, Rebecca Thorsness, Yoojin Lee, Rajnish Mehrotra, Benjamin D.Sommers, Amal N.Trived

Although the incidence of end-stage kidney disease is 34% higher in US Hispanics than non-Hispanics, the latter have a lower mortality rate following initiation of dialysis (107 vs 206 per 1,000 patient-years). Outcomes have not been examined in Puerto Rico, a US territory where 4 million Hispanic Americans reside. Puerto Rico outperforms the US states and the District of Columbia on some measures of coverage and access, but substantial problems with quality of care have been documented. In this study, we compared 1-year mortality rates and predialysis nephrology care among Hispanics in Puerto Rico and Hispanics and whites in the states who initiated maintenance hemodialysis or peritoneal dialysis between 2006 and 2015.

Association of High‐Density Lipoprotein Particles and High‐Density Lipoprotein Apolipoprotein C‐III Content With Cardiovascular Disease Risk According to Kidney Function: The Multi‐Ethnic Study of Atherosclerosis

Julio A. Lamprea‐Montealegre, Robyn L. McClelland, James D. Otvos, Samia Mora, Manja Koch, Majken K. Jensen, Ian H. de Boer

Chronic kidney disease is associated with structural and compositional abnormalities in high‐density lipoprotein particles (HDLp). We examined associations of HDLp size, particle subfractions, and apolipoprotein C‐III content with incident cardiovascular disease (CVD) events across categories of estimated glomerular filtration rate (eGFR). Analyses included 6699 participants in MESA (Multi‐Ethnic Study of Atherosclerosis).

Rationale and design of a multicenter Chronic Kidney Disease (CKD) and at-risk for CKD electronic health records-based registry: CURE-CKD

Keith C. Norris, O. Kenrik Duru, Radica Z. Alicic, Kenn B. Daratha, Susanne B. Nicholas, Sterling M. McPherson, Douglas S. Bell, Jenny I. Shen, Cami R. Jones, Tannaz Moin, Amy D. Waterman, Joshua J. Neumiller, Roberto B. Vargas, Alex A. T. Bui, Carol M. Mangione, Katherine R. Tuttle & on behalf of the CURE-CKD investigators

Chronic kidney disease (CKD) is a global public health problem, exhibiting sharp increases in incidence, prevalence, and attributable morbidity and mortality. There is a critical need to better understand the demographics, clinical characteristics, and key risk factors for CKD; and to develop platforms for testing novel interventions to improve modifiable risk factors, particularly for the CKD patients with a rapid decline in kidney function. We describe a novel collaboration between two large healthcare systems (Providence St. Joseph Health and University of California, Los Angeles Health) supported by leadership from both institutions, which was created to develop harmonized cohorts of patients with CKD or those at increased risk for CKD (hypertension/HTN, diabetes/DM, pre-diabetes) from electronic health record data.