Author Interviews, JAMA, Kidney Disease / 23.08.2016 Interview with: Fan Fan Hou Chief, Division of Nephrology, Nanfang Hospital Professor of Medicine, Southern Medical UniversityFan Fan Hou MD Chief, Division of Nephrology, Nanfang Hospital Professor of Medicine, Southern Medical University What is the background for this study? What are the main findings? Response: Previous trials (HOST and DIVINe) of folic acid therapy in CKD patients were conducted in patients with advanced CKD and treated with super-high dose of vitamin B or with cyanocobalamin that has been shown to be renal toxic. The current study sought to evaluated the efficacy of folic acid therapy without cyanocobalamin on renal outcomes in patients without folic acid fortification and across a spectrum of renal function at baseline from normal to moderate CKD. We found that treatment with enalapril-folic acid, as compared with enalapril alone, reduced the risk of progression of CKD by 21% and the rate of eGFR decline by 10% in hypertensive patients. More importantly, the presence of CKD at baseline was a significant modifier of the treatment effect (p for interaction = 0.01). Patients with CKD benefited most from the folic acid therapy, with a 56% and 44% reduction in the risk for progression of CKD and the rate of eGFR decline, respectively. In contrast, the renal protective effect in those without CKD was nominal. (more…)
Author Interviews, Cost of Health Care, Emergency Care, JAMA, Kidney Disease / 22.08.2016 Interview with: Rachel Patzer, PhD, MPH Director of Health Services Research, Emory Transplant Center Assistant Professor Emory University School of Medicine Department of Surgery Division of Transplantation What is the background for this study? Response: Patients with End Stage Renal Disease (ESRD) make up less than 1% of all Medicare patients, but account for more than 7% of all Medicare expenses. Patients with ESRD have the highest risk of hospitalization of any patient with a chronic disease, and while hospital admissions have decreased over the last several years, emergency department utilization for this patient population has increased by 3% in the last 3 years. The purpose of the study we conducted was to describe the clinical and demographic characteristics associated with emergency department utilization. (more…)
Author Interviews, Diabetes, JAMA, Kidney Disease / 10.08.2016 Interview with: Ian de Boer, MD, MS Associate Professor of Medicine Adjunct Associate Professor of Epidemiology Division of Nephrology and Kidney Research Institute University of Washington, Seattle, WA What is the background for this study? What are the main findings? Response: From the perspective of patients with diabetes, kidney disease can be a devastating complication, leading to end stage renal disease requiring dialysis or kidney transplantation and markedly increasing the risks heart disease, stroke, peripheral vascular disease, and amputation. From a public health perspective, diabetes is the most common cause of end stage renal disease in the US, so understanding, preventing, and treating diabetic kidney disease is critical to reduce the numbers of people needing dialysis and kidney transplants. There have been major changes in the treatment of patients with diabetes over the last 30 years, so we were interested in evaluating how diabetic kidney disease was changing in this context. We observed that the clinical manifestations of kidney disease have indeed changed among US adults with diabetes over the last 30 years. Albuminuria, or elevated levels of albumin in the urine, has traditionally been thought of as the first evidence of kidney damage for people with diabetes. Reduced GFR, or a reduced ability of the kidneys to filter out waster products, has typically been thought of as a late stage of diabetic kidney disease. But from 1988 to 2014, we saw a significant decrease in the prevalence of albuminuria accompanied by a significant increase in reduced GFR. (more…)
Author Interviews, Heart Disease, Kidney Disease, Pharmacology, UCLA / 09.08.2016 Interview with: Jenny Shen, MD, MS Assistant Professor of Medicine David Geffen School of Medicine at UCLA Los Angeles Biomedical Institute at Harbor-UCLA Medical Center What is the background for this study? What are the main findings? Response: With cardiovascular disease being the No. 1 cause of death in end-stage kidney disease patients on peritoneal dialysis, we examined two classes of medications commonly prescribed to prevent cardiovascular events in these patients and found no significant difference in outcomes. The two classes of medications, angiotensin-converting enzyme inhibitors (ACEI) and angiotensin-II receptor blockers (ARB), have slightly different mechanisms and could theoretically have differing outcomes. Previous studies had suggested that ACEI may lead to a kinin-mediated increase in insulin sensitivity not seen with ARB. This could potentially lower the cardiovascular risk in patients on peritoneal dialysis because they are exposed to high glucose loads in their dialysate that may lead to insulin resistance and its associated cardiovascular risk. Using a national database, the U.S. Renal Data System, we surveyed records for all patients enrolled in Medicare Part D who initiated maintenance peritoneal dialysis from 2007 to 2011. Of those, we found 1,892 patients using either drug class. Surveying their medical records, we found no difference in cardiovascular events or deaths between the users for each class of medication. (more…)
Author Interviews, Cognitive Issues, Dental Research, Geriatrics, Kidney Disease / 05.08.2016 Interview with: Danielle Mairead Maire Ni Chroinin, MB BCh BAO BMedSc MD MRCPI FRACP Staff Specialist in Geriatric Medicine Liverpool Hospital and Senior Conjoint Lecturer UNSW What is the background for this study? What are the main findings? Response: Oral disease may have a large impact on older persons’ health and wellbeing, causing pain, impairing speech, adversely affecting nutrition, contributing to systemic infection and harming self-esteem. However, this important issue may be neglected in the acute hospital setting. Our aim was to investigate oral health status and abnormalities in older patients admitted acutely to hospital, exploring the association with medical co-morbidities. We included all individuals aged 70 and older admitted to a geriatric service over 3 months (N=202), and evaluated oral health using a simple bedside tool the Oral Health Assessment Tool (OHAT). Overall, we found that poor oral health was not uncommon, and was associated with dementia and renal impairment. This association persisted even after adjustment for anticholinergic medication and oral pH, highlighting that patients with these conditions may be particularly vulnerable. (more…)
Author Interviews, Kidney Disease, Kidney Stones, Nutrition, Protein, Red Meat / 01.08.2016 Interview with: Pietro Manuel Ferraro, MD MSc PhD Assistant Professor Fondazione Policlinico Universitario A. Gemelli Catholic University of the Sacred Heart Senior Collaborator in the Nurses' Health Study Brigham and Women's Hospital Channing Division of Network Medicine What is the background for this study? What are the main findings? Response: In our study, we looked at the association between dietary intake of different sources of protein (vegetable, dairy and non-dairy animal), potassium (a marker of fruits and vegetables) and their interaction and the risk of forming kidney stones. We looked at their interaction because some protein is a source of acid, whereas fruits and vegetables are a source of alkali, thus their relationship could potentially impact acid-base status and in turn the risk of stones by modifying the metabolism of calcium and other elements such as urine citrate and uric acid. We found that the risk of forming stones depends not only on the amount of protein but also on the source, with no risk associated with intake of vegetable and dairy protein, and a modestly higher risk for excessive non-dairy animal protein; on the other hand, intake of potassium was associated with a markedly lower risk. Interestingly, the interaction between intake of protein and potassium, the so called net acid load, was also associated with higher risk of forming kidney stones, suggesting that the effect of acid intake is modulated by that of alkali and vice versa. (more…)
Author Interviews, Kidney Disease, Nutrition, Red Meat / 17.07.2016 Interview with: Woon-Puay KOH | Professor Office of Clinical Sciences| Duke-NUS Medical School Singapore 169857 What is the background for this study? Response: There is a growing burden of chronic kidney disease worldwide, and many progress to end-stage renal disease (ESRD), which requires dialysis or a kidney transplant. Hence, urgent efforts are needed in risk factor prevention, especially in the general population. Current guidelines recommend restricting dietary protein intake to help manage patients with advanced chronic kidney disease, and slow progression to ESRD. However, there is limited evidence that overall dietary protein restriction or limiting specific food sources of protein intake may slow kidney function decline in the general population. Hence, we embarked on our study to see what dietary advice may be helpful to the general population in order to reduce the risk of ESRD. (more…)
Author Interviews, Heart Disease, Kidney Disease / 15.06.2016 Interview with: Burns C. Blaxall, PhD, FAHA, FACC, FAPS Director of Translational Science, Heart Institute Co-Director, Heart Institute Research Core & Biorepository Professor, UC Department of Pediatrics What is the background for this study? Dr. Blaxall: The development of kidney disease subsequent to chronic heart failure is known clinically as cardiorenal syndrome 2, and is associated with dual organ failure and reduced survival. Furthermore, patients undergoing invasive cardiac procedures that require heart-lung bypass are at significant risk for developing kidney injury. According to the National Kidney Foundation, cardiorenal syndrome 2 presents a considerable economic burden of around $30 billion annually. Previous work has demonstrated the role of G protein-coupled receptor (GPCR) signaling and the activation of G protein βγ (Gβγ) subunits in the development and progression of heart failure, however little is known regarding the role of this signaling pathway in kidney disease. (more…)
Author Interviews, Diabetes, Kidney Disease, Pharmacology / 13.06.2016 Interview with: Doctor Hiddo Lambers Heerspink Department of Clinical Pharmacy and Pharmacology University Medical Center Groningen the Netherlands What is the background for this study? What are the main findings? Response: SGLT2 inhibitors, including canagliflozin, have beneficial effects on multiple cardiovascular and renal risk parameters. This suggests that SGLT2 inhibitors may confer cardiovascular and renal protection. A recent large clinical trial with the SGLT2 inhibitor empagliflozin demonstrated marked reductions in cardiovascular morbidity and mortality and suggested possible renoprotective effects. Whether SGLT2 inhibition slows the progression of kidney function decline independent of its glucose-lowering effect, however, is unknown. We therefore assessed whether canagliflozin slows the progression of kidney function decline by comparing the effects of canagliflozin versus glimepiride on eGFR and albuminuria. (more…)
Author Interviews, Brigham & Women's - Harvard, Genetic Research, Kidney Disease, Surgical Research / 07.06.2016 Interview with: David E. Leaf, MD, MMSc, FASN Instructor in Medicine, Harvard Medical School Associate Physician, Renal Division, Brigham and Women's Hospital What is the background for this study? What are the main findings? Dr. Leaf: Heme oxygenase-1 (HO-1), the rate-limiting enzyme in the degradation of heme, has a central role in the pathophysiology of acute kidney injury (AKI) in animal models, but data on HO-1 in human AKI are sparse. Genetic polymorphisms in the number of guanosine thymidine dinucleotide [(GT)n] repeats in the promoter of the HO-1 gene are inversely associated with HO-1 expression, and longer (GT)n repeats are associated with increased cardiovascular events and mortality in a variety of clinical settings. However, no study has evaluated the association between number of (GT)n repeats and risk of AKI in a large cohort of patients. We analyzed the allelic frequencies of (GT)n repeats in the HO-1 gene promoter in 2377 Caucasian patients who underwent cardiopulmonary bypass surgery to evaluate their association with AKI. We categorized patients as having the short (S) or long (L) allele if they had. (more…)
Author Interviews, Heart Disease, JAMA, Kidney Disease, Salt-Sodium / 25.05.2016 Interview with: Jiang He, M.D., Ph.D. Joseph S. Copes Chair and Professor Department of Epidemiology School of Public Health and Tropical Medicine Tulane University, New Orleans MedicalResearch: What is the background for this study? Dr. Jiang He: Chronic kidney disease is associated with increased risk of end-stage renal disease, cardiovascular disease, and all-cause mortality. A positive association between sodium intake and blood pressure is well established in observational studies and clinical trials. However, the association between sodium intake and clinical cardiovascular disease remains less clear. Positive monotonic, J-shaped, and U-shaped associations have been reported. Methodologic limitations, including inconsistencies in dietary sodium measurement methods, could be contributing to these conflicting findings. Furthermore, no previous studies have examined the association between sodium intake and incident cardiovascular disease among patients with chronic kidney disease. (more…)
Author Interviews, Kidney Disease / 16.05.2016 Interview with: Dr Laura E Niklason, MD PhD Department of Anesthesia & Biomedical Engineering Yale University, New Haven, CT What is the background for this study? What are the main findings? Dr. Niklason:    For end stage renal disease patients who are not candidates for fistula, dialysis access grafts are the best option for chronic hemodialysis. However, polytetrafluoroethylene arteriovenous grafts suffer from high rates of thrombosis, infection and intimal hyperplasia at the venous anastomosis. We are conducting two, single arm Phase II trials where a novel bioengineered human acellular vessel (HAV) was implanted into the arms of patients for hemodialysis access. Primary endpoints were safety (freedom from immune response/infection, aneurysm, or mechanical failure, and incidence of adverse events), and efficacy as assessed by primary, primary assisted and secondary patencies at 6 months. Secondary endpoints included patency and intervention rates at 12, 18 and 24 months, and changes in panel reactive antibodies following implantation. All patients were followed for at least one year, or had a censoring event. Human acellular vessels were implanted into 60 patients at 6 centers in the US and Poland. The average duration of follow-up was 16 months (range 12 to 30); all patients have completed at least 12 months of follow-up (or been censored). (more…)
Author Interviews, Heart Disease, JACC, Kidney Disease / 15.05.2016 Interview with: Ambarish Pandey, MD Cardiology Fellow, PGY5 University of Texas Southwestern Medical Center Dallas, Texas What is the background for this study? What are the main findings? Dr. Pandey: Previous studies have reported an underutilization of guideline based heart failure therapies among patients with heart failure (HF) and end-stage renal diseases. However, it is not known if the proportional use of these evidence-based medical therapies and associated clinical outcomes among these patients has changed over time. In this study, we observed a significant increase in adherence to heart failure process of care measures over time among dialysis patients with no significant change in clinical outcomes over time. (more…)
Author Interviews, Kidney Disease, Urology / 10.05.2016 Interview with: Hiten D. Patel, MD, MPH Resident, Urological Surgery James Buchanan Brady Urological Institute The Johns Hopkins Medical Institutions Baltimore, Maryland 21287 What is the background for this study? Dr. Patel: The study reports results of a systematic review contracted by the Agency for Healthcare Research and Quality based on input from stakeholders. Part of the motivation was due to the American Urological Association's desire to use the results as a basis to update relevant clinical guidelines. There are four major management options for clinically localized small renal masses diagnosed on imaging including active surveillance, thermal ablation, partial nephrectomy, and radical nephrectomy. The body of research evaluating these management options is broad, but many of the studies performing comparative analyses have limitations. Therefore, the systematic review aimed to evaluate a number of outcomes (e.g. overall survival, cancer specific survival, local recurrence, metastasis, renal function, complications, and perioperative outcomes) based on available comparative studies in the literature. (more…)
Author Interviews, Endocrinology, Gender Differences, Kidney Disease / 28.04.2016 Interview with: A.Univ.-Prof. Dr. Judith Lechner Div. Physiology Medical University of Innsbruck Innsbruck Austria What is the background for this study? What are the main findings? Dr. Lechner: Women are not just small men. Sex differences affect most, if not all the organ systems in the body. Over the past decades biomedical researchers have been mainly using male models. Therefore, there is a significant gap in knowledge of female physiology except for organ functions involved in reproduction. While the necessity to fill in these gaps has been advocated, our understanding of sex and gender differences in human physiology and pathophysiology is still limited. This holds especially true for the kidneys, e.g. while international registries show that fewer women than men are in need of renal replacement therapy due to end stage renal disease, the potentially underlying causes are still not known. The aim of our study was to find out, if hormone changes due to the female menstrual cycle would affect normal renal cells. For this purpose, urinary samples of healthy women of reproductive age were collected daily and analyzed for menstrual cycle-associated changes of marker proteins. Specifically, two enzymes (Fructose-1,6-bisphosphatase, Glutathione-S-transferase alpha) were measured, which are intracellular components of proximal tubular cells, a key population of renal cells. Upon cell damage, these enzymes are released into the urine, qualifying them as clinical markers for early detection of tubular injury. Since even in healthy persons low amounts of these enzymes can be detected in the urine, we used these marker proteins to analyze potential effects of the female hormone cycle on normal functioning of this cell population. As a result, we could detect transient increases of Fructose-1,6-bisphosphatase and Glutathione-S-transferase alpha correlating with specific phases of the female hormone cycle, namely ovulation and menses. This finding suggests that cyclical changes of female hormones might affect renal cell homeostasis, potentially providing women with an increased resistance against kidney damages. Thus, recurring changes of sex hormone levels, as during the natural menstrual cycle, might be involved in periodic tissue re-modeling not only in reproductive organs, but to a certain extent in the kidneys as well. (more…)
Author Interviews, Blood Pressure - Hypertension, Kidney Disease / 22.04.2016 Interview with: Csaba P Kovesdy MD 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 What is the background for this study? Dr. Kovesdy: Older patients experience several physiologic changes which could modify their response to blood-pressure lowering. In fact, hypertension treatment guidelines such as JNC8 recommend slightly higher blood pressure targets when treating elderly patients. Patients with chronic kidney disease (CKD) have been excluded from most hypertension treatment trials, hence the blood pressure treatment goals in this group are mainly derived based on extrapolations. Even less is known about the effects of age on the association of blood pressure with mortality and various other clinical outcomes in patients with CKD. (more…)
Author Interviews, Gender Differences, Kidney Disease, Transplantation, University of Pennsylvania / 22.04.2016 Interview with: Matthew Levine, MD, PhD Assistant Professor of Transplant Surgery Perelman School of Medicine University of Pennsylvania What is the background for this study? What are the main findings? Dr. Levine: This work stemmed from a known finding that female mice tolerate kidney injury better than males and this is true of mice that share exactly the same genes.  Therefore, the gender difference was the driving factor.  My basic science laboratory works at the intersection between scientific discovery and clinical application and this led us to question whether the same phenomenon was true in humans and whether we could identify a way in which this could be used to improve injury tolerance above what is seen in untreated subjects.  What we found was that the hormonal environment seems to impact ischemia tolerance, with female environment being protective and the male environment worsening injury tolerance in ischemia models where blood flow is interrupted and then restored.  The kidneys seemed to adapt to take on the injury response of the host after transplantation, indicating that the differences were not forged into the kidney itself and therefore could be altered.  We then found that estrogen therapy improved kidney injury tolerance when given to female mice in advance of injury, but no effect was seen in male mice.  And most importantly, we found that in a large cohort of transplant recipients that female recipients had better injury tolerance after transplant than male recipients, as shown by ability to avoid dialysis in the first week after transplant, otherwise known as delayed graft function (DGF). This is a fairly major finding since it has not been observed in the literature despite several decades of transplant data being carefully studied. (more…)
Author Interviews, Diabetes, Kidney Disease / 17.04.2016 Interview with: Axel C. Carlsson, PhD Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University Uppsala Sweden What is the background for this study? Dr. Carlsson: Circulating endostatin levels has been shown to be associated with duration of hypertension and cardiovascular events. Moreover, endostatin levels were recently shown to parallel kidney function decline, and has been associated with increased mortality risk in different settings. However, less is known of circulating endostatin in patients with type 2 diabetes.  (more…)
Author Interviews, HPV, Kidney Disease, Transplantation, Vaccine Studies / 15.04.2016 Interview with: Dr. Delphine Robotham MD Division of Pediatric Nephrology Johns Hopkins University School of Medicine Baltimore, Maryland Medical Research: What is the background for this study? What are the main findings? Response: Cervical cancer is the second most common cancer in women worldwide and is almost entirely caused by high risk HPV genotypes.  Vaccines to high risk HPV genotypes have shown great success in protecting healthy women from the sequelae of infection, including cervical cancer and genital warts. Young women with a kidney transplant as well as those with chronic kidney disease have abnormal immune systems and as a result have a significantly increased burden of HPV-related disease making the potential health benefits of the HPV vaccine substantial in this particularly vulnerable population.  This study examined the immune response to the HPV vaccine among girls and young women with kidney disease. The goal of this research was to determine if girls and young women with chronic kidney disease (abnormal kidney function, on dialysis, or post kidney transplant) showed evidence of immune response to the quadrivalent HPV vaccine.  Immune response was determined by measuring the amount of antibody made by the patients against each of the 4 HPV genotypes included in the vaccine.  There are established thresholds of antibody above which patients are believed to have protection from infection.  We found that study participants with chronic kidney disease and those on dialysis had antibody levels above the threshold, indicating the vaccine should be effective in protecting them from HPV related disease.  A significant proportion of patients with kidney transplants showed evidence of inadequate antibody response.  This is important information as it means patients with a kidney transplant, whom we know are at increased risk of developing cervical cancer from HPV infection, may not be protected from HPV infections from the HPV genotypes included in the vaccine. (more…)
Author Interviews, Blood Pressure - Hypertension, Kidney Disease, Salt-Sodium / 31.03.2016 Interview with: Matthew Bailey PhD Faculty Principal Investigator British Heart Foundation Centre for Cardiovascular Science The University of Edinburgh, Edinburgh, United Kingdom. What is the background for this study? Dr. Bailey: This study started with our interest in salt homeostasis and long term blood pressure, so it’s firmly rooted in the cardiovascular/renal disease risk factor arena. We were interested in salt-sensitivity- why does blood pressure go up in some people when they eat salt but not in others. I’m a renal physiologist, so we had a number of papers looking at renal salt excretion and blood pressure. We initially used a gene targeting approach to remove a gene (Hsd11b2) which acts as a suppressor of the mineralocorticoid pathway. It’s mainly expressed in the kidney and when we deleted the gene  throughout the body we saw a number of renal abnormalities all associated with high mineralocorticoid activity. This was consistent with the “hypertension follows the kidney” theory of blood pressure control. There is a human disease called “Apparent Mineralocorticoid Excess”- there are people do not have the gene and are thought to have renal hypertension. Our study threw up some anomalies which we couldn’t easily interpret but suggested that the brain was involved. We moved to a more refined technology that allowed us to knockout a gene in one organ system but not another. We knew the gene was in the brain and localized to a very restricted subset of neurons linked to salt-appetite and blood pressure control. Previous studies had shown that these neurons were activated in salt-depleted rats (ie rats that needed to eat salt). We started there but didn’t anticipate that the effect on salt hunger and on blood pressure would be so large because renal function is -as far as we can tell- normal. (more…)
Author Interviews, End of Life Care, Geriatrics, Kidney Disease / 24.03.2016 Interview with: Dr. Wouter R. Verberne Koekoekslaan 1 The Netherlands What is the background for this study? Dr. Verberne: The number of older patients with End Stage Renal Disease (ESRD) is increasing worldwide. When ESRD is approaching, patients need to be advised on the renal replacement therapy (RRT) necessary to remove toxic products and fluid from the body when their own kidneys are no longer able to do so. ESRD can be treated with kidney transplantation, hemodialysis or peritoneal dialysis. With increasing technical possibilities and with the widespread availability of dialysis treatment, age no longer limits dialysis treatment. It has been questioned whether older patients with ESRD, who often have multiple comorbidities, are likely to benefit from renal replacement therapy. Dialysis treatment comes with high treatment burden. Generally patients are treated in a dialysis facility 3 times per week, 3 to 4 hours per time. Patients with an anticipated poor prognosis on RRT may choose to forego dialysis and decide to be treated conservatively instead. Conservative management (CM) entails ongoing care with full medical treatment, including control of fluid and electrolyte balance and correcting anemia, and provision of appropriate palliative and end of life care. Shared decision making has been recommended to come to a joint decision on   renal replacement therapy by considering potential benefits and harms of all treatment options and the patient’s preferences. Data on outcomes, including survival and quality of life, are needed to foster the decision making. However, adequate survival data, specifically on older patients, are limited. A number of studies, predominantly from the United Kingdom, have determined survival of older patients managed conservatively compared with renal replacement therapy. In these studies, the numbers of recruited patients are generally small, the studies are performed in heterogeneous study populations, and there is significant variability in starting points used in survival analyses. We performed the first Dutch study in a large series of older patients slowly approaching ESRD, enabling the use of several starting points in survival analyses. The aims of the study were to compare survival in patients with ESRD ages ≥ 70 years old choosing either conservative management or renal replacement therapy and determine predictors of survival.  (more…)
Author Interviews, Johns Hopkins, Kidney Disease, Race/Ethnic Diversity, Transplantation / 26.02.2016 Interview with: Tanjala S. Purnell, PhD MPH Assistant Professor, Transplant Surgery and Epidemiology Johns Hopkins University School of Medicine  Medical Research: What is the background for this study? Dr. Purnell:  Kidney transplantation (KT) is the best treatment for most patients with end stage renal disease (ESRD), offering longer life expectancy and improved quality of life than dialysis treatment. Despite these benefits, previous reports suggest that black KT recipients experience poorer outcomes, such as higher kidney rejection and patient death, than white KT recipients. Our team wanted to examine whether this disparity has improved in recent decades. We hypothesized that advances in immunosuppression and post- kidney transplantation  management might differentially benefit black KT recipients, who were disproportionately burdened by immunological barriers, and contribute to reduced racial disparities in kidney transplantation outcomes. Medical Research: What are the main findings? Dr. Purnell: 
  1. From 1990 to 2012, 5-year failure rates of the transplanted kidney after Deceased Donor Kidney Transplantation (DDKT) decreased from 51.4% to 30.6% for blacks and from 37.3% to 25.0% for whites; 5-year failure after Living Donor Kidney Transplantation (LDKT) decreased from 37.4% to 22.2% for blacks and from 20.8% to 13.9% for whites.
  2. Among DDKT recipients in the earliest group of patients, blacks were 39% more likely than whites to experience 5-year failure, but this disparity narrowed to 10% in the most recent group.
  3. Among LDKT recipients in the earliest group, blacks were 53% more likely than whites to experience 5-year failure, but this disparity narrowed to 37% in the most recent group.
  4. There were no statistically significant differences in 1-year or 3-year failure rates of transplanted kidneys after LDKT or DDKT in the most recent groups.
Author Interviews, Heart Disease, JAMA, Kidney Disease, Pharmacology / 24.02.2016 Interview with: Frederic T. Billings IV, MD, MSc Assistant Professor of Anesthesiology and Medicine Additional Specialty: Cardiothoracic Anesthesiology Vanderbilt University Medical Research: What is the background for this study? What are the main findings? Dr. Billings: Acute kidney injury (AKI) affects up to 30% of patients following cardiac surgery and is associated with long-term kidney function decline as well as a 5-fold increase in death during hospitalization following surgery. Statins affect several mechanisms of AKI following cardiac surgery including improvement of endothelial function and attenuation of oxidative stress, so we performed a clinical trial to test the hypothesis that high-dose atorvastatin (brand name Lipitor) use prior to and following surgery reduces AKI following cardiac surgery. In 615 patients who completed the study high-dose atorvastatin treatment, compared to placebo administration, did not reduce the risk of AKI overall, among patients naïve to statins, or patients already using a statin. In fact, among patients naïve to statins with baseline chronic kidney disease we found some evidence that atorvastatin may increase risk for kidney injury, although the number of patients was small in this subgroup. (more…)
Anemia, Author Interviews, Kidney Disease, Pharmacology / 22.02.2016 Interview with: Dr. Navdeep Tangri Attending physician and Assistant Professor in the Division of Nephrology Department of Medicine and the Department of Community Health Sciences University of Manitoba and Dr. David Collister  Seven Oaks General Hospital Renal Program Winnipeg, Manitoba Canada.  Medical Research: What is the background for this study? What are the main findings? Response: Anemia is common in chronic kidney disease (CKD) including dialysis and its treatment with erythopoetin stimulating agents (ESAs) reduces the need for blood transfusions and has varying effects on morbidity and mortality. The optimal hemoglobin (HGB) targets for treating anemia in CKD are controversial with safety concerns around the normalization of hemoglobin levels due to an increase in cardiovascular (CV) events. The effects of ESAs on health related quality of life (HRQOL) are unclear with individualization o fhemoglobin targets being controversial as clinicians and patients attempt to balance perceived HRQOL benefits with cardiovascular risk. We performed an updated meta-analysis of randomized controlled trials (RCTs) that evaluated the treatment of anemia in CKD with ESAs that targeted higher versus lower hemoglobin targets using validated HRQOL metrics including SF-36 and KDQ. We included 17 studies and found that higher hemoglobin targets compared to lower HGB targets did result in a statistically significant difference in HRQOL and thus did not improve HRQOL beyond a clinically meaningful threshold. Any change in HRQOL was further attenuated in dialysis subgroups. (more…)
Author Interviews, Genetic Research, Kidney Disease / 10.02.2016 Interview with: Prof. Hirofumi Kai Kumamoto University Japan MedicalResearch: What is the background for this study? Dr. Kai: Alport Syndrome (AS) is a hereditary progressive kidney disease that affects 1 in 5000-10000 individuals in the US. Depending on the specific subtype and genetic mutation, the onset, symptoms and progression vary among patients. Some have earlier onset and severe phenotypes while others have slow progression towards end-stage renal disease (ESRD). The gene affected in  Alport Syndrome is type 4 collagen, which codes for a protein component of the glomerular basement membrane (GBM). This mutation leads to the dysregulated proliferation (or dysplasia) of the GBM, which has an important role in urine filtration. The pathophysiological process of dysplasia indicates a dysfunction of protein/s that control cellular homeostasis. Because the tumor suppressor p53 is critically involved in modulating cell proliferation, we focused our attention on this protein. (more…)
Annals Internal Medicine, Author Interviews, Kidney Disease, Weight Research / 09.02.2016 Interview with: Yoosoo Chang MD PhD Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul, Korea Medical Research: What is the background for this study? What are the main findings? Response: There is substantial controversy and a lot of interest on the health implications of metabolically healthy obesity, that is, subjects who are obese but do not have metabolic abnormalities in spite of their high body mass index. The risk for chronic kidney disease (CKD) among obese patients without metabolic abnormalities is unknown. In this cohort study of South Korean men and women, metabolically healthy overweight and obese participants had increased incidence of Chronic Kidney Disease (CKD) compared with normal-weight participants. (more…)
Author Interviews, Kidney Disease / 12.01.2016 Interview with: Navdeep Tangri, MD, PhD FRCPC Department of Medicine Seven Oaks General Hospital University of Manitoba Winnipeg, Canada Medical Research: What is the background for this study? What are the main findings? Dr. Tangri: Chronic kidney disease is common and its end stage of kidney failure requiring dialysis can be devastating for patients and families. While 26 million North Americans are affected by CKD, the vast majority of them will not experience kidney failure during their lifetime. Predicting the risk of kidney failure for an individual patient can help doctors plan treatment, improve shared decision making, and provide patients with piece of mind. In 2011, we developed equations that accurately predict the risk of dialysis in more than 8,000 Canadian patients with CKD. While these equations are widely used, global implementation has been limited due to a lack of validation in other countries/health systems. The current study addresses all of these concerns by comprehensively validating the risk equations in more than 700,000 participants spanning 30+ countries, and demonstrating its accuracy in predicting the risk of dialysis. (more…)
Author Interviews, Duke, Heart Disease, Kidney Disease / 03.01.2016 Interview with: Renato D. Lopes MD, MHS, PhD Duke University Medical Center Duke Clinical Research Institute Durham, NC 27705   John P. Vavalle, MD, MHS Assistant Professor of Medicine Division of Cardiology UNC Center for Heart & Vascular Care Medical Research: What is the background for this study? What are the main findings?  Dr. Lopes: Patients with varying degrees of underlying renal failure who presented for primary percutaneous coronary intervention (PCI) for the treatment of ST-segment elevation myocardial infarction (STEMI) were studied as part of the APEX-AMI trial. Baseline renal dysfunction portends a worse prognosis in patients undergoing PCI. However, the association between clinical outcomes and angiographic results with baseline renal function in this population of STEMI patients is not clearly defined.  We report the results of a trial population with a full spectrum of underlying renal function (normal to dialysis dependent) and developed a prediction model for the development of acute kidney injury following primary percutaneous coronary intervention. In summary, patients with worse underlying renal function had worse angiographic outcomes, higher mortality, and were less likely to be treated with evidence-based medications.  The rate of acute kidney injury (AKI) after PCI appears to increase with worsening underlying renal function, except for those with Class IV chronic kidney disease where the rate of AKI was lowest.  Our novel prediction model for the development of AKI found that the strongest predictors of AKI were age and presenting in Killip Class III or IV. (more…)