Author Interviews, Inflammation, Kidney Disease, Nature, Rheumatology / 08.02.2024

MedicalResearch.com Interview with: A/Prof. Joshua Ooi, PhD Head, Regulatory T-cell Therapies Translational Research Facility Clinical Sciences at Monash Health, Monash University MedicalResearch.com: What is the background for this study? Response: In 2017, we published a landmark Nature paper showing that people who are protected from autoimmune disease have specialized molecules on immune cells. These specific molecules are missing in patients that develop autoimmune disease. (more…)
Author Interviews, Immunotherapy, Kidney Disease, NEJM / 15.01.2024

MedicalResearch.com Interview with: VisterraMohit Mathur MD, FASN, FNKF, FRCP (Glasgow) Clinical fellow in Nephrology at UofT DM (Nephrology), MRCP.UK (SCE in Nephrology). Director, Clinical Development Visterra Waltham, MA 02451 MedicalResearch.com: What is the background for this study? Would you briefly describe the condition of IgA Nephropathy? Response: IgA Nephropathy is the commonest primary glomerular disease in the world. It is an autoimmune kidney disease that typically presents with urinary abnormalities, elevated blood pressure and reduced kidney function. Until recently IgAN was considered to be a benign disease, but recent studies have indicated that a majority of patients will progress to End stage kidney disease in their lifetime. Steroids have been the mainstay of treatment in IgAN, but they come at a very high burden of side effects. Thus, there is an urgent requirement to develop novel and safe treatment options for patients with IgAN. APRIL is considered to be a key cytokine implicated in the pathogenesis of IgAN, hence we decided to target APRIL as a therapeutic modality in IgAN. (more…)
Author Interviews, Cost of Health Care, JAMA, Kidney Disease, Medicare / 11.01.2024

MedicalResearch.com Interview with: Kalli Koukounas, MPH Ph.D. Student, Health Services Research Brown University School of Public Health Providence, RI MedicalResearch.com: What is the background for this study? Response:  On Jan. 1st, 2021, the Centers for Medicare and Medicaid Services (CMS) implemented the End-Stage Renal Disease Treatment Choices (ETC) Model, one of the largest randomized tests of pay-for-performance incentives ever conducted in the US. The goal of the model was to enhance the use of home dialysis and kidney transplant or waitlisting among kidney failure patients in traditional Medicare. The model randomly assigned approximately 30% of US dialysis facilities and nephrologists to receive financial incentives, ranging from bonuses of 4% to penalties of 5%, based on their patients’ use of home dialysis and kidney transplant/waitlisiting. The payment adjustments apply to all Medicare-based reimbursement for dialysis services. Prior research has demonstrated that dialysis facilities that disproportionately serve populations with high social risk have lower use of home dialysis and kidney transplant, raising concerns that these sites may fare poorly in the payment model. Using data released by CMS, we examined the first year of ETC model performance and financial penalties across dialysis facilities, stratified by the measured social risk of the facilities’ incident patients. (more…)
Author Interviews, JAMA, Kidney Disease, Salt-Sodium / 03.01.2024

MedicalResearch.com Interview with: Lu Qi, MD, PhD, FAHA Interim Chair, Department of Epidemiolog HCA Regents Distinguished Chair and Professor Tulane University School of Public Health and Tropical Medicine Director, Tulane University Obesity Research Center Director, Tulane Personalized Health Institute New Orleans, LA 70112 MedicalResearch.com: What is the background for this study? Response: Adding salt to foods is a behavior reflecting long-term preference to salty diets. High sodium intake is a major risk factor for chronic kidney disease. In our previous studies, we have found that adding salt to foods at the table is related to various disorders including cardiovascular diseases, diabetes, and mortality.  (more…)
AHA Journals, Author Interviews, Heart Disease, Kidney Disease, Obstructive Sleep Apnea, Sleep Disorders / 15.11.2023

MedicalResearch.com Interview with: Lead Author: Rupak Desai, MBBS Atlanta Veterans Affairs Medical Center Independent Researcher, Atlanta, GA, Presenter: Vamsikalyan Borra, MD Resident Physician, Internal Medicine University of Texas Rio Grande Valley, Weslaco, TX MedicalResearch.com: What is the background for this study? Response: The relationship between sleep apnea (OSA) and chronic kidney disease (CKD) is quite complex. OSA can cause hypoxia, activation of the sympathetic nervous system, and hypertension, all of which can have negative effects on kidney function. On the other hand, in patients with end-stage renal disease (ESRD), intensifying renal replacement therapy has shown some improvement in sleep apnea severity, suggesting a bi-directional relationship between the two conditions. While there are still uncertainties, recent studies have focused on understanding the interplay between OSA and CKD. The role of CPAP therapy, a common treatment for OSA, in relation to CKD is not yet clear. Observational studies present findings regarding the impact of CPAPs on kidney function. However, researchers are actively investigating its cardiovascular benefits and its influence on the progression of CKD. The objective of this study is to analyze the trends in composite cardiovascular events in hospital encounters among geriatric patients with CKD, comparing those with and without obstructive sleep apnea. Additionally, we are also investigating sex and racial disparities in trends of major adverse cardiovascular and cerebrovascular events (MACCE) among geriatric patients with obstructive sleep apnea (OSA). Furthermore, we are assessing the impact of continuous positive airway pressure (CPAP) treatment and dependence on MACCE outcomes in OSA patients (more…)
Author Interviews, Kidney Disease, Transplantation / 09.11.2023

MedicalResearch.com Interview with: Collective responses from study authors: MedicalResearch.com: What is the background for this study?
  • Patients with advanced chronic kidney disease (CKD) have the best chance for a longer and healthier life if they receive a kidney transplant.
  • However, due to many barriers, many eligible patients today will never receive a kidney transplant.
  • Advanced CKD care is provided by 26 chronic kidney disease (CKD) programs managed by a government funded provincial renal agency (the Ontario Renal Network)
  • Together these 26 programs treat ~ 24,000 patients each year
  • This care is provided by over 3400 nurses and 230 nephrologists
  • To patients approaching the need for dialysis and those receiving dialysis
  • Approximately half are transplant eligible
    • ~ 600 kidney transplants done in Ontario each year across 6 transplant centres
    • with approximately.30% of kidneys coming from living donors
(more…)
Author Interviews, Kidney Disease / 28.08.2023

MedicalResearch.com Interview with: Amira Abdelrasoul, Ph.D., P. Eng.Associate Professor, Chemical and Biomedical EngineeringDepartment of Chemical and Biological EngineeringDivision of Biomedical EngineeringUniversity of Saskatchewan     MedicalResearch.com: What is the background for this study? Response: The background of this study lies in the pursuit of improving the compatibility of dialysis membranes used in hospitals. My team sought to enhance the performance of these membranes by incorporating heparin, a widely recognized anticoagulant. Existing heparin-grafted membranes carried a negative charge, resulting in adverse blood-membrane interactions and complications for dialysis patients. The study aimed to overcome these issues and create a neutralized membrane surface that maintains the benefits of heparin while minimizing undesirable interactions. (more…)
Annals Internal Medicine, Author Interviews, Kidney Disease, UCSF / 21.07.2023

MedicalResearch.com Interview with:   Chi-yuan Hsu, MD, MSc (he/him/his) Professor and Division Chief Robert W. Schrier Distinguished Professor Division of Nephrology University of California, San Francisco     MedicalResearch.com: What is the background for this study? Response: Acute kidney injury (AKI) had previously been considered a reversible short-term medical problem among hospitalized patients without long-term sequalae in that there is recovery of kidney function back to baseline should the patient survive the hospitalization. Then about 15 years ago, the concept began to shift as research by us and others showed that for patients with severe AKI (e.g. AKI severe enough to require acute dialysis in the hospital), there was more rapid subsequent loss of renal function.  Now based largely on additional observational studies in humans (and animal models), many nephrologists and opinion leaders think that even mild to moderate cases of AKI have long-term sequelae.  We are concerned that the paradigm has swung too much in the opposite direction and we questioned the results of many published studies which did not fully account for differences in background kidney function among those who did and did not experience AKI. (more…)
Anemia, Author Interviews, Diabetes, Kidney Disease, NEJM / 30.05.2023

MedicalResearch.com Interview with: Prof. Heerspink Prof. Hiddo Lambers Heerspink, PhD PHARMD Department of Clinical Pharmacy and Pharmacology University Medical Center Groningen Groningen

MedicalResearch.com: What is the background for this study? What is dapagliflozin primarily indicated for?   Response: Dapagliflozin is a sodium glucose cotransporter 2 (SGLT2) inhibitor. The multinational, double-blinded, randomized, placebo-controlled, DAPA-CKD trial demonstrated the kidney and cardiovascular benefits of dapagliflozin in 4304 patients with chronic kidney disease (CKD) with and without type 2 diabetes (T2D). Based on the results of this and other trials, current guidelines recommend use of SGLT2 inhibitors in patients with CKD, T2D, or heart failure. Anemia is common among patients with CKD and is associated with worse clinical outcomes. Previous studies showed that SGLT2 inhibitors increase hemoglobin and hematocrit levels, but data are lacking in patients with CKD with and without T2D. In this post-hoc analysis of DAPA-CKD, we assessed the effect of dapagliflozin versus placebo on the correction and prevention of anemia in this population. (more…)
Author Interviews, Heart Disease, JACC, Kidney Disease, Transplantation / 21.02.2023

MedicalResearch.com Interview with: Shinobu Itagaki, MD, MSc Assistant Professor Cardiovascular Surgery Icahn School of Medicine at Mount Sinai, New York, NY MedicalResearch.com: What is the background for this study? Were the transplants from a single donor? Response: The heart transplantation is the gold standard therapy for end-stage heart failure patients. As the kidney is affected by the heart function, it is common that the heart transplant candidates have some degree of kidney dysfunction as well. In these cases, the candidates are considered for simultaneous heart and kidney transplantation from a same donor. Unlike isolated heart transplantation, where the indication and benefits have been well established, simultaneous heart and kidney transplantation has less clear indication and benefits. This uncertainty is also complicated by the competing interest with isolated kidney transplantation candidates who in general wait longer on the waiting list. (more…)
Author Interviews, Coffee, Genetic Research, JAMA, Kidney Disease / 15.02.2023

MedicalResearch.com Interview with: Dr. Sara Mahdavi, PhD Clinical Scientist and Clinical Instructor Research Appointment in the Faculty of Medicine University of Toronto Toronto, ON MedicalResearch.com: What is the background for this study? Response: This was a long-term study spanning 16 years and began with a population of young adults who were medically assessed on a regular basis. It was remarkable to see just how striking the effects of coffee were in the group that had the susceptible genetic variant, what we termed “slow caffeine metabolizers” yet no effect whatsoever in those who did not were termed “fast metabolizers”. (more…)
Author Interviews, Biomarkers, Gender Differences, Kidney Disease, NEJM, Race/Ethnic Diversity / 26.01.2023

MedicalResearch.com Interview with: Prof. dr. Hans Pottel KU Leuven Kulak Department of Public Health and Primary Care Belgium MedicalResearch.com: What is the background for this study? Response:  The glomerular filtration rate (GFR) is used to diagnose patients with chronic kidney disease and is also used to adjust the dose of drugs that are eliminated by the kidneys. An accurate estimation of GFR is considered of importance in the management of kidney health in patients. In 2021 we published a new serum creatinine based equation, called the European Kidney Function Consortium (EKFC) equation (Pottel H. et al, Development and Validation of a Modified Full Age Spectrum Creatinine-Based Equation to Estimate Glomerular Filtration Rate : A Cross-sectional Analysis of Pooled Data. Ann Intern Med (2021) 174: 183-191): EKFC-eGFR = 107.3 / [Biomarker/Q]a x [0.990(Age – 40) if age > 40 years] With a = 0.322 if Biomarker/Q is less than 1, and a = 1.132 if Biomarker/Q is 1 or more. The equation can easily be interpreted: the leading coefficient equals the glomerular filtration rate (GFR) of 107.3 mL/min/1.73m², which is the average GFR in healthy children (aged > 2 years), adolescents and young adults. The average healthy GFR remains constant until the age of 40 years, and starts decreasing beyond that age. The GFR is inversely related to the ‘rescaled’ biomarker. The rescaling factor (Q) is the average biomarker value for healthy people of a specific population (e.g. children, adult men, adult women, white people, black people, …). Biomarker/Q equals ‘1’ for the average healthy person, corresponding with eGFR = 107.3 mL/min/1.73m² (up to 40 years of age). It should be noted that for serum creatinine, the Q-value depends on sex and race. Our hypothesis was that the above equation is valid for any renal biomarker, on the condition that the biomarker is appropriately scaled. We showed that the same equation was able to estimate GFR from 2 years to oldest ages. In the current study we tested and validated our hypothesis by applying the above formula for appropriately ‘rescaled’ cystatin C. (more…)
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…)