Author Interviews, Clots - Coagulation, Heart Disease, Karolinski Institute, Kidney Disease / 06.10.2022

MedicalResearch.com Interview with: Juan Jesus Carrero Pharm PhD Professor of Epidemiology Cardio-renal Department of Medical Epidemiology and Biostatistics Karolinska Institutet, Stockholm MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Concerns on the possibility of (direct oral anticoagulants)  DOAC-related nephropathy may limit its use. In this cohort study of non-valvular AF patients from routine clinical practice, initiation of DOAC vs (vitamin K antagonists) VKA was associated with more favorable kidney outcomes, i.e., a lower risk of the composite of kidney failure and sustained 30% eGFR decline, as well as a lower risk of AKI occurrence. In agreement with trial evidence, we also showed that DOAC vs VKA treatment was associated with a lower risk of major bleeding, but a similar risk of the composite of stroke, systemic embolism or death. (more…)
Author Interviews, Diabetes, Kidney Disease / 08.06.2022

MedicalResearch.com Interview with: prof. dr. H.J. (Hiddo) Lambers Heerspink Clinical Pharmacologist Department Clinical Pharmacy and Pharmacology University Medical Center Groningen Groningen  MedicalResearch.com:  What is the background for this study?    Response: Tirzepatide is a novel GIP-GLP1 receptor agonist recently FDA approved for the treatment of type 2 diabetes. The SURPASS_4 trial demonstrated that in patients with type 2 diabetes at high cardiovascular risk tirzepatide compared to insulin glargine markedly reduces Hba1c and body weight. About 1 out of 3 patients with type 2 diabetes and CV disease has kidney disease and these patients are at high risk of kidney failure. The aim of this study was to assess whether tirzepatide could slow CKD progression in high risk individuals with type 2 diabetes participating in the SURPASS 4 trial.  (more…)
Author Interviews, Gout, JAMA, Kidney Disease / 06.06.2022

MedicalResearch.com Interview with: Csaba P Kovesdy MD FASN Fred Hatch Professor of Medicine Director, Clinical Outcomes and Clinical Trials Program Division of Nephrology, University of Tennessee Health Science Center Nephrology Section Chief, Memphis VA Medical Center Memphis TN, 38163 MedicalResearch.com:  What is the background for this study?  What are the main findings?  Response: Hyperuricemia has unfavorable metabolic effects and has been associated with higher risk of progressive kidney disease and mortality. Despite this, earlier clinical trials have failed to prove a beneficial impact on kidney disease progression from uric acid lowering therapy in patients with preexisting CKD. The effect of uric acid lowering therapy on the development of new onset CKD in patients with normal kidney function has not been well studied. In our large observational study we did not find a beneficial association between newly initiated uric acid lowering therapy (the majority of which was in the form of allopurinol). On the contrary, uric acid lowering therapy was associated with a slightly higher risk of new onset low eGFR and new onset albuminuria, especially in patients with less elevated baseline serum acid levels. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, JAMA, Kidney Disease / 15.03.2022

MedicalResearch.com Interview with: Susan P. Y. Wong, MD MS Assistant Professor Division of Nephrology University of Washington VA Puget Sound Health Care System  MedicalResearch.com:  What is the background for this study?  What are the main findings? Response: Very little is known about the care and outcomes of patients who reach the end stages of kidney disease and do not pursue dialysis. We conducted a systematic review of longitudinal studies on patients with advanced kidney disease who forgo dialysis to determine their long-term outcomes. We found that many patients survived several years and experienced sustained quality of life until late in the illness course. However, use of acute care services was common and there was a high degree of variability in access to supportive care services near the end of life. (more…)
Author Interviews, Kidney Disease, Rheumatology / 24.01.2022

Stephen Connelly, PhD Co-founder & Chief Scientific Officer Equillium, Inc. San Diego, California MedicalResearch.com:  What is the background for this study?    Response: Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease that predominantly affects women in the reproductive age range. Approximately 50% of SLE patients experience lupus nephritis (LN), a serious complication that is accompanied by significant morbidity and mortality. Progression of LN to chronic kidney disease is common, with 10% of patients with LN developing end-stage kidney disease. T cells, play a central role in the pathogenesis of both SLE and LN by mediating tissue damage and enhancing the production of autoantibodies by promoting B cell differentiation, proliferation, and maturation. These T cells express CD6, a costimulatory receptor that through its binding to activated leukocyte cell adhesion molecule (ALCAM), expressed on immune cells and tissues, modulates both the activity and trafficking of effector T cells (Teff). The expression of both CD6 and ALCAM (CD6-ALCAM pathway) have been associated with pathogenic effector T cell activity and trafficking in multiple autoimmune and inflammatory diseases. Based on a comprehensive screen of more than 1100 urine proteins, soluble urinary ALCAM (uALCAM) was identified as one of only a few molecules that were elevated in the urine of patients with SLE with active renal involvement compared with patients with quiescent or no prior nephritis. However, no studies had been conducted to characterize the cellular sources of the soluble ALCAM and questions remained about the relevance of this protein and whether it was associated with the pathology of the disease. (more…)
Author Interviews, Kidney Disease, Race/Ethnic Diversity / 13.01.2022

MedicalResearch.com Interview with: Joshua D. Bundy, PhD, MPH Department of Epidemiology Tulane University School of Public Health and Tropical Medicine and Tulane University Translational Science Institute New Orleans Louisiana MedicalResearch.com: What is the background for this study? What is included in the KFRE score? Response: Kidney function is quantified using estimated glomerular filtration rate (eGFR), which is often calculated in clinical practice using filtration markers like serum creatinine and/or cystatin C, and patient characteristics like age, sex, and race. Recently, new eGFR equations were created that remove race adjustment because of concerns that using a patient’s race may perpetuate racial inequities in healthcare delivery. The Kidney Failure Risk Equation (KFRE) is the most commonly-used tool to predict end-stage kidney disease (ESKD) risk and includes age, sex, eGFR, and urinary albumin-creatinine ratio. We sought to evaluate the impact of removing race from eGFR on prediction of ESKD.  (more…)
Annals Internal Medicine, Author Interviews, COVID -19 Coronavirus, Kidney Disease, Vaccine Studies / 16.12.2021

MedicalResearch.com Interview with: Shuchi Anand, MD MS (she/her) Assistant Professor in Medicine Director, Center for Tubulointerstitial Kidney Disease Stanford University School of Medicine  MedicalResearch.com: What is the background for this study? What are the main findings? Response: A majority of  people on dialysis who completed vaccination as of September 2021 have had a decline in antibody response to levels that would render them vulnerable to infection. Antibody response immediately after vaccination and circulating antibody response is strongly associated with risk for breakthrough after the initial vaccination series. (more…)
Author Interviews, Cost of Health Care, JAMA, Kidney Disease, Social Issues, Transplantation / 14.12.2021

MedicalResearch.com Interview with: Rebecca Thorsness, PhD Research Associate Department of Health Services, Policy, and Practice Brown University School of Public Health  MedicalResearch.com: What is the background for this study? What are the main findings? Response: In 2019, the President signed the Advancing American Kidney Health executive order, which included provisions to increase the use of home dialysis and kidney transplant for Americans living with kidney failure. To carry out this vision, the Centers for Medicare & Medicaid Services (CMS) developed the ESRD Treatment Choices (ETC) payment model, which uses financial incentives and penalties to incentivize dialysis facilities to pursue home dialysis or kidney transplant for their patients. Transplant and home dialysis are optimal care for people with kidney failure, but there are social and clinical reasons that patients with high social risk (such as those exposed to racism, poverty, or housing instability) may not be candidates for these treatments. This means that facilities which serve a large number of patients with high social risk might be disproportionately penalized by this new payment model. Using data immediately prior to the implementation of the ETC model, we found that dialysis facilities that serve high proportions of patients with high social risk have lower rates of home dialysis and kidney transplantation than facilities that care for lower proportions of such patients. (more…)
Author Interviews, Kidney Disease / 08.11.2021

MedicalResearch.com Interview with: Csaba P Kovesdy MD FASN Fred Hatch Professor of Medicine Director, Clinical Outcomes and Clinical Trials Program Division of Nephrology, University of Tennessee Health Science Center Nephrology Section Chief, Memphis VA Medical Center Memphis TN, 38163  MedicalResearch.com: What is the background for this study? Response: Microinflammation may be a mechanism contributing to adverse outcomes in patients with chronic kidney disease (CKD). Low dose aspirin (ASA) is usually used as an antiplatelet agent for cardiovascular indications, but may also have beneficial effects on kidney function by reducing microinflammation.  (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Kidney Disease, Transplantation / 27.09.2021

MedicalResearch.com Interview with: Joel T. Adler, MD, MPH Department of Surgery, Brigham and Women’s Hospital Center for Surgery and Public Health Brigham and Women’s Hospital Boston, Massachusetts  MedicalResearch.com: What is the background for this study? Response: For patients who require renal replacement therapy for failed kidneys, kidney transplantation increased length of life and improves quality of life.  For many of these patients, their dialysis centers are the source of referral for evaluation for transplantation.  These dialysis centers have a number of publicly-reported quality measures, but they largely focus on the provision of dialysis care and not how often the centers’ patients undergo a kidney transplant.  Because these higher-rated facilities provide better dialysis care, we wanted to know if that benefit also spilled over into higher transplant listing rates. (more…)
Author Interviews, Brigham & Women's - Harvard, Cancer Research, Immunotherapy, Kidney Disease, NEJM / 18.08.2021

MedicalResearch.com Interview with: Toni K. Choueiri, MD Director, Lank Center for Genitourinary Oncology Director, Kidney Cancer Center Jerome and Nancy Kohlberg Chai Professor of Medicine, Harvard Medical School  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The standard of care for patients diagnosed with locoregional RCC is partial or total nephrectomy. Nearly half of patients will eventually experience disease recurrence following nephrectomy and no standard, globally approved adjuvant therapy options are currently available for this population. The phase 3 KEYNOTE-564 study met its primary objective of demonstrating a statistically significant and clinically meaningful improvement in disease-free survival with pembrolizumab vs placebo as adjuvant therapy for patients with RCC post nephrectomy, supporting pembrolizumab as a potential new standard of care for patients at high risk of disease recurrence following surgery. (more…)
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Kidney Disease / 04.08.2021

MedicalResearch.com Interview with: Maria Luisa S. Sequeira Lopez, MD, FAHA Harrison Distinguished Professor in Pediatrics and Biology University of Virginia Charlottesville, VA 22908 MedicalResearch.com: What is the background for this study? Response: The renin-angiotensin system (RAS) is crucial in the regulation of the blood pressure (BP). Synthesis and secretion of renin is the key regulated event in the operation of the RAS. One of the main mechanisms that control renin synthesis and release is the baroreceptor mechanism whereby a decrease in blood pressure results in increased release of renin by juxtaglomerular (JG) cells. In spite of its enormous importance, the nature and location of the renal baroreceptor was still unknown. This was due in great part to the lack of appropriate in vitro and in vivo models to confidently allow tracking of the fate and isolation of renin cells, and the lack of tools to study the chromatin in scarce cells. (more…)
Author Interviews, JAMA, Kidney Disease, Race/Ethnic Diversity, UCSF / 17.07.2021

MedicalResearch.com Interview with: Chi-yuan Hsu, MD, MSc (he/him/his) Professor and Division Chief Division of Nephrology University of California, San Francisco San Francisco, CA 94143-0532 MedicalResearch.com: What is the background for this study? Response: There has been a great deal of controversy recently about how race should be considered in medicine, including its use in estimating kidney function (e.g. https://jamanetwork.com/journals/jama/fullarticle/2769035).  A recent paper published in JAMA Network Open by Zelnick et al suggested that removing the race coefficient improves the accuracy of estimating kidney function (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2775076) in the Chronic Renal Insufficiency Cohort, a NIH-funded study (www.cristudy.org). We are core investigators of the Chronic Renal Insufficiency Cohort Study and were not involved in the Zelnick’s study that was based on a public use dataset.  Because we were surprised by the methodological approach they took and the conclusion they came to, we implemented our own analysis of the data. (more…)
Author Interviews, Brigham & Women's - Harvard, Kidney Disease, Transplantation / 12.03.2021

MedicalResearch.com Interview with: Jamil R. Azzi MD Associate Professor of Medicine, Harvard Medical School Medical Director, Vascularized Composite Allotransplantation Associate Director, Kidney and Pancreas Transplantation Director, Kidney Transplant Fellowship Engineering in Medicine, Brigham and Women’s Hospital Renal Division, Brigham and Women's Hospital MedicalResearch.com: What is the background for this study? Would you explain what is meant by an exosome?  Response: Kidney transplant recipients are always at risk of developing rejection where the immune system recognizes the transplanted kidney as “foreign body” and attacks it. The risk is up to 20% the first year after transplant and many more develop chronic rejection which ultimately leads to kidney failure. Currently, most clinicians monitor for kidney rejection by measuring serum creatinine and urine protein. However, creatinine is neither sensitive nor specific for rejection. On the other hand, performing kidney biopsies to make accurate diagnosis of rejection is invasive and has many complications. In our study, when clinicians decided on performing biopsies based on the clinical informations they have including changes in serum creatinine, the biopsies did not show rejection in almost 70% of the cases. Furthermore, serum creatinine can remain stable while the patient may be undergoing a rejection (subclinical rejection). In fact, some centers currently perform routine biopsies at different time points for all their patients regardless of creatinine despite the high risks, costs and inconveniences of doing biopsies. Out of this frustration with the current tools, we have been working on novel technologies to diagnose rejection through the urine. The idea started from the bench as we were studying exosomes, those are tiny vesicles (less than 100 nm in size) released by all cells. We were interested on how immune cells communicate via those vesicles so we developed assays to identify them. We then showed that if immune cells are invading the kidney during rejection, vesicles derived from those immune cells are found in the urine. This gave us the idea of developing a urine test based on these findings. (more…)
Author Interviews, COVID -19 Coronavirus, JAMA, Kidney Disease, Yale / 11.03.2021

MedicalResearch.com Interview with: Jim Nugent, MD MPH Pediatric Nephrology Fellow Yale University School of Medicine MedicalResearch.com: What is the background for this study? Response: It is now well-established that acute kidney injury is common in patients hospitalized with COVID-19. In addition, patients with COVID-19 tend to have more severe acute kidney injury than patients who have acute kidney injury due to other causes. However, the intermediate and longer-term kidney outcomes after COVID-19-associated acute kidney injury have not yet been described. Our study compares the rate of change in estimated glomerular filtration rate after hospital discharge between patients with and without COVID-19 who experienced in-hospital acute kidney injury. Due to their more severe acute kidney injury in the hospital, we hypothesized that patients with COVID-19-associated acute kidney injury would have greater decline in kidney function after discharge compared to patients with acute kidney injury who tested negative for COVID-19. In order to answer this question, we reviewed the medical records of adult patients at 5 hospitals in Connecticut and Rhode Island admitted between March and August 2020 who had developed acute kidney injury during their hospitalization, survived until discharge, and were discharged off dialysis. For our study, we included patients who had at least one outpatient serum creatinine measurement after discharge. (more…)
Author Interviews, Blood Pressure - Hypertension, Kidney Disease / 24.02.2021

MedicalResearch.com Interview with: Dr. FotiKathryn Foti, PhD, MPH Postdoctoral fellow Department of Epidemiology Johns Hopkins Bloomberg School of Public Health MedicalResearch.com: What is the background for this study? Response: The Kidney Disease: Improving Global Outcomes (KDIGO) 2021 Clinical Practice Guideline for the Management of Blood Pressure (BP) in Chronic Kidney Disease (CKD) provides recommendations for the management of BP in individuals with nondialysis CKD, incorporating new evidence since the publication of its previous guideline in 2012. The 2021 KDIGO guideline recommends a target systolic BP <120 mmHg based on standardized office BP measurement. This BP goal is largely informed by the findings of the SPRINT trial which found targeting SBP <120 mmHg compared with <140 mmHg reduced the risk of cardiovascular disease by 25% and all-cause mortality by 27%. The benefits were similar for participants with and without CKD. In our study, we sought to examine the potential implications of the 2021 KDIGO guideline for BP lowering among US adults with CKD compared to the 2012 KDIGO guideline (target BP ≤130/80 mmHg in adults with albuminuria or ≤140/90 mmHg or under without albuminuria) and the 2017 American College of Cardiology/American Heart Association (target BP <130/80 mmHg) guideline. Additionally, we determined implications of the 2021 KDIGO guideline for angiotensin converting enzyme inhibitor (ACEi) or angiotensin II-receptor blocker (ARB) use for those with albuminuria (recommended at systolic BP ≥120 mmHg) compared to the 2012 KDIGO guideline (recommended at BP >130/80 mmHg).  (more…)
Author Interviews, CMAJ, COVID -19 Coronavirus, Kidney Disease / 05.02.2021

MedicalResearch.com Interview with: Peter G. Blake MD, FRCPC, FRCPI,MSc MB Professor of Medicine in the Division of Nephrology Ontario Renal Network University of Western Ontario and London Health Sciences Centre London, Ontario  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Covid-19 pandemic has been very difficult for people on dialysis with reports of high infection rates and high mortality. We prospectively collected data on SARS-CoV-2 infection every week from all renal programs in the province of Ontario, Canada from the start of the pandemic. Between March and August 2020, 187 people on dialysis, equivalent to 1.5% of all those in the province, were infected with the SARS-CoV-2 virus. Over 60% were hospitalized, 20% required ICU and the mortality rate was very high at over 28%. Risk factors for infection included center hemodialysis versus home dialysis, residing in long term care, black, south Asian and other non-white ethnicity, and low neighbourhood income. (more…)
Author Interviews, Hepatitis - Liver Disease, Kidney Disease / 14.12.2020

MedicalResearch.com Interview with: Kevin Moore, MD UCL Institute of Liver and Digestive Health Royal Free Hospital, University College London MedicalResearch.com: What is hepatorenal syndrome – acute kidney injury (HRS-AKI) and how does terlipressin fit into the treatment landscape?  Response: HRS-AKI, also known as hepatorenal syndrome type 1 (HRS-1), is an acute and life-threatening syndrome involving acute kidney failure in people with cirrhosis.[i] HRS-1 can progress to life-threatening renal failure within daysi and has a median survival time of approximately two weeks and greater than 80 percent mortality within three months if left untreated.[ii],[iii] Terlipressin, a potent vasopressin analogue selective for V1 receptors, is an investigational agent, and its safety and effectiveness have not yet been established by the U.S. Food and Drug Administration. In the U.S., there are currently no approved pharmacologic treatments for HRS-1; however, terlipressin is approved in most other countries, where it has been a standard of care for the last 20 years in the treatment of patients with HRS-1.[iv],[v] The current standard of care for HRS-1 in the U.S. includes other vasoconstrictors such as midodrine (a drug which can increase blood pressure and potentially improve blood flow into the kidneys) along with concomitant albumin and frequent monitoring, but current data do not support good efficacy.2 Dialysis (a type of renal replacement therapy) is sometimes used in hepatorenal syndrome, but dialysis is not curative and it can be costly.  (more…)
Author Interviews, Kidney Disease / 03.12.2020

MedicalResearch.com Interview with: Khurram Jamil, MD Vice President, Clinical Research in Hepatology Critical Care Division, Mallinckrodt MedicalResearch.com: What is the background for the new data of terlipressin presented during Kidney Week 2020 Reimagined? Would you briefly describe hepatorenal syndrome type 1? Whom does it affect and how frequently does it progress to ESRD? Response:  Results from two post-hoc analyses of terlipressin, an investigational agent in the U.S. for adults with hepatorenal syndrome type 1 (HRS-1), were presented at Kidney Week 2020 Reimagined, the annual meeting of the American Society of Nephrology. The first was an oral presentation titled, “Terlipressin Improves Renal Replacement Therapy–Free Survival in Hepatorenal Syndrome Type 1” and included a pooled post-hoc analysis to assess the incidence of renal replacement therapy (RRT) and its impact on survival among patients from three Phase 3 trials. The second was a poster presentation titled, “Treatment of Hepatorenal Syndrome Type 1 with Terlipressin Reduces Need for Renal Replacement Therapy After Liver Transplantation,” which focused on a post-hoc analysis of the CONFIRM study and evaluated the need for RRT among patients who had liver transplantation within 90 days of HRS treatment. HRS-1 is an acute and life-threatening syndrome involving acute kidney failure in people with cirrhosis.[i] HRS-1 can progress to life-threatening renal failure within days,i and has a median survival time of approximately two weeks and greater than 80 percent mortality within three months if left untreated.[ii],[iii] It is often a challenge to effectively diagnose in a timely manner due to its diagnosis of exclusion.iii In general, the average patient with hepatorenal syndrome (HRS type 1 or type 2) is in their 50s,[iv] and up to 73 percent of HRS patients are men.[v]  HRS-1 is estimated to affect between 30,000 and 40,000 patients in the U.S. annually.[vi],[vii] (more…)
Annals Internal Medicine, Author Interviews, Kidney Disease, Pediatrics / 12.11.2020

MedicalResearch.com Interview with: Prof. Dr. Hans Pottel PhD Professeur Invité (titre honorifique) Faculté de Médecine Université de Liège KULeuven-KULAK, Kortrijk, Belgium  MedicalResearch.com: What is the background for this study? Why do we need a new GFR? Response: The currently recommended equations have flaws, mainly because there is one equation (CKiD) recommended for children, and one recommended (CKD-EPI) for adults (by KDIGO). When transitioning from pediatric nephrology care to adult nephrology care, the switch from CKiD to CKD-EPI causes implausible jumps (of more than 50%), mainly because CKD-EPI largely overestimates GFR in young adults (18-30 years). The new equation overcomes this problem as it applies for all ages (for children and adults) and overcomes the known flaws of the currently most used equations. The new equation is less biased and more precise across the full age spectrum and for the full range of serum creatinine concentrations. The equation was developed in 11 251 participants from 7 cohorts (development and internal validation datasets) and validated in 8 378 participants from 6 cohorts (external validation dataset). Data were coming from European and American nephrology centers. No patients of African-American ancestry were included. Actually, the previously published FAS-equation served as the basic mathematical form for the equation, but we adjusted the power coefficients for serum creatinine (very much like it was done in the CKD-EPI equation). You could say that we used properties of both the FAS and CKD-EPI equation to come to an improved equation to estimate GFR. (more…)
Author Interviews, Kidney Disease / 16.10.2020

MedicalResearch.com Interview with: Mallika Mendu, MD, MBA MedicalDirector of Clinical Operations Brigham and Women’s Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: African-Americans with chronic kidney disease have poorer outcomes with respect to hypertension control, timely nephrology referral, progression to end stage renal disease, placement of vascular access and transplantation compared to other racial groups. For the past two decades a race multiplier has been applied in equations that estimate glomerular filtration rate (a proxy for kidney function) for African-Americans. We sought to determine whether what the impact of the race multiplier term was on care delivered to African-Americans, by using our health system-wide CKD registry. We were particularly focused on advanced CKD patient outcomes, knowing that there are health disparities that could be potentially exacerbated.

The original CKD-EPI and MDRD studies showed an association between African-American race with higher measured GFR at the same blood creatinine concentration. However, there have been concerns raised about the application of the race multiplier to all African-American patients. First, there is no clear biological explanation for the association, the identification of Black race was unclear in some of the cohorts used in these studies, and there is vast genetic and ancestral heterogeneity among those who self-identify as black. The use of the race multiplier also ignores the fact that race is a social, not biological construct.

We found that with the removal of the race multiplier, up to one in every three African-American patients would be reclassified as having a more severe stage of CKD, with one-quarter of African-American patients going from stage 3 to stage 4. We also found that with the removal of the race multiplier, 64 patients would have had an eGFR <20, the threshold for referral for kidney transplant, and none of these patients were referred, evaluated or waitlisted for transplant. This is in contrast, to those African-American patients with an eGFR <20 with the race multiplier applied, who had a higher odds of being referred, evaluated or waitlisted for transplant compared to other racial groups (Odds ratio of 2.28, compared to White cohort).

(more…)
Author Interviews, Kidney Disease, Transplantation / 09.10.2020

MedicalResearch.com Interview with: Jim Gleason, National President of Transplant Recipients International Organization (TRIO), discusses what organ transplant patients are experiencing during the pandemic, and some tips they ought to consider to help ease some of the burden. Mr. Gleason also discusses his role in the development of the recently released AlloCare app is in the AppStore -- https://apps.apple.com/us/app/allocare-transplant-health/id1497962881?ign-mpt=uo%3D2 – to help post-transplant recipients navigate their day-to-day health. MedicalResearch.com: Would you describe your journey with organ transplantation? Mr. Gleason: I was diagnosed with heart failure at the age of 49, 2 years later listed with Penn Medicine in Philadelphia in September of 1994, and received my donor heart on October 19, 1994. After I received my transplant, I was home from the hospital 7 days later and able to return to work in 3 months as a computer manager with Unisys Corp in Blue Bell, PA, where I worked for the next dozen years before my retirement. Once retired, I dedicated my time to raising awareness of the need for organ donation and the success of transplants ever since. Today, 26 active and fulfilled years with my new heart and gift of life, I am able to live life to its fullest at age 77. I am now also coincidentally married to an organ donor of 15 years, who donated her 13-year-old son’s organs when he was hit by a car on his bike back in 1997.  (more…)
Author Interviews, Kidney Disease, Transplantation / 20.07.2020

MedicalResearch.com Interview with: Giacomo Pasini, PhD Professor of Econometrics - Professore ordinario Economics PhD program Director - Coordinatore dottorato in Economia Rector's delegate for Cooperation and Development - Delegato alla Cooperzione per lo sviluppo Economics Department - Dipartimento di Economia Universita' Ca' Foscari - Venezia MedicalResearch.com: What is the background for this study? Response: Kidney transplantation carries several advantages over dialysis treatment for patients with end-stage renal dis-ease (ESRD). Nevertheless, the disparity between the large number of transplant candidates and the scarcity of organs available continues to increase. In order to close this gap selection criteria for donor appropriateness have been widened significantly in recent years to include older persons and those with co-morbidities that could potentially increase the risk of infectious disease transmission (the so-called Expanded Criteria Donors, ECD). The result of kidney transplantation from marginal donors is one of the most topical issues in the transplant literature. (more…)
Author Interviews, Columbia, COVID -19 Coronavirus, Kidney Disease, Transplantation / 09.07.2020

MedicalResearch.com Interview with: Syed Ali Husain, MD, MPH Assistant Professor of Medicine Division of Nephrology, Department of Medicine Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital The Columbia University Renal Epidemiology Group New York, New York  MedicalResearch.com: What is the background for this study? Response: One group of patients thought to be at a high risk of severe COVID-19 manifestations is kidney transplant recipients, since they take medications that suppress their immune system and they often have other medical problems that have been associated with severe infection. We wanted to understand whether it is safe to manage kidney transplant recipients who develop COVID-19 as outpatients, without admitting them to the hospital. (more…)
Author Interviews, Gout, Kidney Disease, NEJM / 24.06.2020

MedicalResearch.com Interview with: Sunil Badve MBBS, MD, DNB, FRACP, PhD, FASN Staff specialist nephrologist | St George Hospital Conjoint Associate Professor | University of New South Wales Senior Research Fellow, Acute Kidney Injury and Trials The George Institute for Global Health Australia  MedicalResearch.com: What is the background for this study? Response: Elevated serum urate levels are associated with progression of chronic kidney disease (CKD). CKD patients often have elevated serum urate levels due to decreased excretion. We conducted this placebo-controlled randomized trial to evaluate if urate-lowering treatment with allopurinol would attenuate decline in estimated glomerular filtration rate (eGFR) over 2 years in patients with CKD. We enrolled 369 CKD patients with high progression risk and no prior history of gout. (more…)
Author Interviews, Dermatology, Kidney Disease / 22.06.2020

MedicalResearch.com Interview with: Gil Yosipovitch, MD, Professor Miami Itch Center Lennar Medical Foundation South Miami Clinic in Coral Gables University of Miami Health System MedicalResearch.com: What is the background for this study? Response: Chronic Pruritus is a common and burdensome condition in patients with end stage chronic kidney disease (CKD). It is Present at all stages of CKD, not only in patients undergoing hemodialysis (including stage 3-5 CKD). There are no approved treatments for this condition in US and Europe. CKD pruritus   has significant impact on quality of life of patients with higher mortality rates due to its effect on sleep. Studies in the last 2 decades have shown that in patients with CKD pruritus there is an imbalance between endogenous mu opioids that are over expressed to Kappa Opioids that are down regulated.   Difelikefalin (DFK) is a novel peripherally selective kappa opioid receptor (KOR) agonist.   Study of IV DFK administration  in hemodialysis patients has  recently  been published and showed significant anti Pruritic effect ( NEJM Fishbane et al. 382: 289-290, 2020). (more…)
Author Interviews, Clots - Coagulation, JAMA, Kidney Disease / 09.06.2020

MedicalResearch.com Interview with: Manish M Sood MD FRCPC MSc Jindal Research Chair for the Prevention of Kidney Disease Associate Professor of Medicine, Dept. of Medicine and the School of Epidemiology and Public Health University of Ottawa Scientist, Ottawa Hospital Research Institute Nephrologist, The Ottawa Hospital Ottawa, Ontario, Canada  MedicalResearch.com: What is the background for this study? Response: Early work has suggested a very commonly used antibiotic, clarithromycin, may interfere with the metabolism of the most widely used type of blood thinning medication (called direct oral anticoagulants or DOACs) such that the blood level of the DOAC increases and may place the patient at a higher risk for bleeding.  In our study we looked at patients of advanced age (>66 years old) who were given clarithromycin while on a DOAC in Ontario, Canada. We compared patients on clairthromycin-DOAC to patients given a very similar antibiotic, azithromycin, that does not interfere with the metabolism of DOAC. (more…)
Author Interviews, JAMA, Kidney Disease, Medicare / 10.04.2020

MedicalResearch.com Interview with: Lead and Senior coauthors contributing to this interview: Abby Hoffman, BA is a Pre-Doctoral Fellow in Population Health Sciences at Duke University and a PhD Candidate in Health Policy and Management University of North Carolina at Chapel Hill. Virginia Wang, PhD, MSPH is an Associate Professor in the Department of Population Health Sciences, Associate Director of the Center for Health Innovation and Outcomes Research, and Core Faculty in the Margolis Center for Health Policy at Duke University and Investigator at the Durham VA HSR&D Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT).   MedicalResearch.com: What is the background for this study? Response: It is well established that healthcare providers are sensitive to changes in price, though their behavioral response varies. Dialysis facilities are particularly responsive to changes in Medicare reimbursement. Many dialysis patients are eligible for Medicare regardless of age, but dialysis facilities generally receive significantly higher reimbursement from private insurers than from Medicare. In 2011, Medicare implemented a new prospective bundled payment for dialysis that was expected to decrease Medicare payment and reduce overall revenues flowing into facilities. Then the Affordable Care Act (ACA) rules against refusing to insure patients for preexisting conditions and the 2014 ACA Marketplace provided an additional avenue for patients to purchase private insurance. As a result of these policies, dialysis facilities had a strong motivation and opportunity to increase the share of patients with private insurance coverage. We were interested in understanding whether dialysis facilities were shifting their payer mix away from Medicare, possibly in response to these policy changes.  (more…)
Author Interviews, Diabetes, Kidney Disease, OBGYNE, Race/Ethnic Diversity / 30.03.2020

MedicalResearch.com Interview with: Silvi Shah, MD, MS, FACP, FNKF, FASN Assistant Professor Division of Nephrology University of Cincinnati Cincinnati, OH-45267 MedicalResearch.com: What is the background for this study? Response: The study identified 42,190,790 pregnancy related hospitalizations between Jan. 1, 2006 and Dec. 31, 2015, using data from the from the Nationwide Inpatient Sample. (more…)
Author Interviews, Kidney Disease, Stem Cells / 27.01.2020

MedicalResearch.com Interview with: Dr. Orit Harari-Steinberg Dr. Dorit Omer Dr. Oren Pleniceanu Prof. Benjamin Dekel The Pediatric Stem Cell Research Institute Sheba Medical Center Tel Hashomer, Israel MedicalResearch.com: What is the background for this study? Response: The motivation behind this study is the rising epidemic of chronic kidney disease (CKD). With a prevalence in some reports of up to 17.3%  and very expensive treatments, especially in its advanced stages, CKD is more common than most people think, and it keeps growing at a very fast rate, due to the increasing number of patients suffering from diabetes and hypertension. At the same time, medicine doesn’t offer good solutions to these patients, with dialysis creating high morbidity and mortality. From the fact that 70,000 cells are shed in the urine each hour, we deduce that the kidney has the ability to form new cells to make up for this loss. In a previous work, we used a mouse model to show that cell clones form and proliferate in the adult kidney, so we know that cells of the adult kidney, or at least a portion thereof, have the ability to multiply in-vivo. It has been possible for quite a while to isolate proliferating cells from human kidneys and grow them in a dish. The problem, however, is that in order to achieve a large enough number of cells capable of regenerating the kidneys, massive expansion is needed ex-vivo, and that's the real obstacle. The reason is that following several passages, the cells lose their phenotype and become senescent, and therefore useless for regenerative purposes. In this study, we developed a unique 3D culturing method, growing the kidney cells in structures which we termed 'nephrospheres'. This culturing method rejuvenated the cells and allowed massive expansion for long periods of time. The positive effect on the cells was evident when we analyzed their transcriptome and found activation of molecular pathways associated with renal epithelial identity and renal tissue-forming capacity. What's even more striking, is that the same effect was seen when we used cells from the kidneys of CKD patients. We were then interested in determining whether these cells might also have a therapeutic effect. Indeed, when we injected these cells into mice with CKD (which was generated by resecting 5/6 of their kidneys), we saw a functional improvement in GFR. When we analyzed the treated kidneys, we found that the injected cell both formed renal tubule-like structures and integrated into existing host tubules, which resulted in a therapeutic effect. So, altogether, this study showed that our culturing method can serve as an effective means of establishing large numbers of autologous cells with regenerative capacity. (more…)