Author Interviews, Cost of Health Care, JAMA, Kidney Disease, Transplantation / 01.07.2024

MedicalResearch.com Interview with: Amal Trivedi, MD, MPH Professor of Health Services, Policy & Practice Brown University School of Public Health MedicalResearch.com: What is the background for this study? Response: On January 1st, 2021, the Centers for Medicare & Medicaid Services (CMS) launched the mandatory End-Stage Renal Disease Treatment Choices (ETC) Model, which randomly assigned approximately 30% of U.S. dialysis facilities and managing clinicians to financial incentives to increase the use of home dialysis and kidney transplantation. The program is set to run through 2027, with financial incentives and penalties increasing as the model progresses. Our study sought to assess the ETC’s effect on these outcomes of interest in the first two years, as well as to examine outcome changes by race, ethnicity and socioeconomic status. (more…)
Author Interviews, Kidney Disease / 30.05.2024

MedicalResearch.com Interview with: Silvi Shah, MD,MS,FASN,FACP Associate Professor Internal Medicine | College of Medicine University of Cincinnati College of Medicine MedicalResearch.com: What is the background for this study? Response: AKI  (Acute Kidney Injury) is a major contributor to end-stage kidney disease (ESKD). About a third of patients with ESKD recover kidney function due to AKI. The study looked at the health outcomes of 22,922 patients from the U.S. Renal Data System from 2005 to 2014 to construct a clinical scoring system to predict kidney recovery within 90 days and 12 months after the start of dialysis for kidney failure patients due to acute kidney injury (AKI) (more…)
Author Interviews, Health Care Systems, Kidney Disease, NEJM, NIH, UT Southwestern / 04.04.2024

MedicalResearch.com Interview with: Miguel A. Vazquez, MD Professor of Internal Medicine University of Texas Southwestern Medical Center MedicalResearch.com: What is the background for this study? Response: The main reason to conduct our trial was to improve the care of patients with coexistent chronic kidney disease CKD),  type 2 diabetes and hypertension.   Patients with this triad are at high risk for multiple complications, end stage kidney disease and premature death.   There are effective interventions for these conditions.  Unfortunately, detection and awareness of CKD is low and many patients do not receive interventions that could be beneficial In our study in patients with the coexistent triad of chronic kidney disease, type 2 diabetes, and hypertension the use of an electronic algorithm to identify patients from the electronic health record and practice facilitators embedded in four large health systems to assist primary practitioners deliver evidence-based care did not lower hospitalizations when compared to usual care. (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…)
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, Endocrinology, Heart Disease, Kidney Stones / 10.08.2022

MedicalResearch.com Interview with: Ashish Verma, MD Assistant Professor, Nephrology Department of Medicine Boston University MedicalResearch.com: What is the background for this study? Would you tell us a little about aldosterone? Response: “Recent randomized, controlled trials have shown that a drug called finerenone is effective in delaying CKD progression and adverse cardiovascular outcomes in patients with chronic kidney disease and diabetes. However, the role of aldosterone in this process was not directly investigated and levels of the hormone were not measured,” “Since excessive levels of aldosterone is common, yet mostly unrecognized, we hypothesized that one reason why finerenone was effective in lowering the risk of CKD progression was that it was treating unrecognized high concentrations of the hormone.” To study this we investigated the associations between aldosterone concentrations in the blood and kidney disease progression among 3680 participants in the Chronic Renal Insufficiency Cohort study, which ran in seven clinics in the US between 2003 and 2008. The participants were aged between 21 and 74 years old. Aldosterone is a steroid hormone secreted by the adrenal glands, which sit above the kidneys. Its main role is to regulate salt and water in the body, and so it plays a central role in controlling blood pressure. Too much of it can lead to high blood pressure, cardiovascular and kidney diseases. (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, 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, 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, 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, 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, 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, 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, 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, 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…)
Author Interviews, Emory, Health Care Systems, JAMA, Kidney Disease, Transplantation / 11.09.2019

 A retraction and replacement have been issued due to a major coding error that resulted in the reporting of incorrect data in this study surrounding the difference in transplant rates between for-profit and non-profit dialysis centers. Please see link below:

Bauchner H, Flanagin A, Fontanarosa PB. Correcting the Scientific Record—Retraction and Replacement of a Report on Dialysis Ownership and Access to Kidney Transplantation. JAMA. 2020;323(15):1455. doi:10.1001/jama.2020.4368

MedicalResearch.com Interview with: Rachel Patzer, PhD, MPH Associate Professor Director, Health Services Research Center Department of Medicine Department of Surgery Emory University School of Medicine   MedicalResearch.com: What is the background for this study? Response: We know that historically, for-profit dialysis facilities have been shown to have lower rates of kidney transplantation than patients who receive treatment in non-profit dialysis facilities. However, these studies are outdated, and did not examine access to living donor transplantation or include the entirety of the end-stage kidney disease population  (more…)
Author Interviews, JAMA, Kidney Disease, Transplantation / 26.08.2019

MedicalResearch.com Interview with: Alexandre Loupy, MD PhD Nephrologist, Department of Nephrology & Kidney Transplantation Necker Hospital, Paris Head of the Paris Transplant Group (Inserm)  MedicalResearch.com: What is the background for this study? Response: The lack of organs for kidney transplantation is a major public health problem across the world, due to its attributable mortality and excess cost to healthcare systems while waitlisted patients are maintained on chronic dialysis. Nearly 5,000 people in the US and 3,500 people in Europe die each year while waiting for a kidney transplant. Yet in the US, over 3,500 donated kidneys are discarded annually, representing almost 18% of the available organs, while the discard rate in France is only 6,8%, though these countries have similar organ allocation systems and offer the same treatments to patients after transplant. We thus compared the use of donated kidneys in the US to France from 2004-2014 in much more depth, using a new approach based on validated analytic methods and computer simulation.  (more…)
Annals Internal Medicine, Author Interviews, Clots - Coagulation, Heart Disease, Kidney Stones / 16.07.2019

MedicalResearch.com Interview with: Sunil Badve MBBS, MD, DNB, FRACP, PhD, FASN Senior Research Fellow, Renal & Metabolic Division Staff specialist nephrologist | St George Hospital University of New South Wales The George Institute for Global Health Australia MedicalResearch.com: What is the background for this study? Response: Despite the high prevalence of cardiovascular thrombotic events and venous thromboembolism (VTE) in chronic kidney disease (CKD), oral anticoagulant therapy is often underutilized in patients with advanced CKD and dialysis-dependent end-stage kidney disease (ESKD) due to uncertainty of benefit and potential bleeding complications. This comprehensive systematic review was performed to study the benefits and harms of oral anticoagulant therapy in patients with CKD. (more…)
Author Interviews, End of Life Care, JAMA, Kidney Disease / 08.07.2019

MedicalResearch.com Interview with: Dr. Ann M. O’Hare, MD Professor,Division of Nephrology University of Washington Investigator, VA HSR&D Center of Excellence Affiliate Investigator, Group Health Research Institute Seattle, WA  MedicalResearch.com: What is the background for this study? Response: We know that survival for people undergoing dialysis is generally quite limited.  Only a few studies have attempted to elicit how patients undergoing dialysis understand prognosis and how their prognostic awareness might be related to their interest in planning for the future, their preferences for resuscitation and the kind of care they would want if they were seriously ill or dying. (more…)
Author Interviews, Kidney Disease, Pharmaceutical Companies / 26.04.2019

MedicalResearch.com Interview with: Dr. Jay Venkatesan MD President and CEO of Angion Dr. Venkatesan discusses the recent announcement that ANGION, has received DOD funding for the study of ANG-3070, in treatment of CKD caused by focal segmental glomerulosclerosis,  MedicalResearch.com: What is the background for this announcement? Would you tell us a little about focal segmental glomerulosclerosis (FSGS)? How does ANG-3070 work to prevent kidney scarring? Response: Angion has received a follow-on grant from the Department of Defense (DoD) for $4.76 million in support of the development of ANG-3070, our drug candidate for a form of chronic kidney disease known as focal segmental glomerulosclerosis (FSGS). This funding will allow us to expand our proof-of-concept data for ANG-3070 as a potential anti-fibrotic agent for slowing the progression of FSGS. FSGS is a serious kidney disorder characterized by progressive scarring of the glomeruli, the filtering units of the kidney. There are approximately 80,000 cases of FSGS in the U.S. and Europe, involving both children and young adults. If uncontrolled, FSGS can lead to kidney failure, which may lead to the need for dialysis or a kidney transplant. No therapies exist that treat the underlying cause of FSGS. Therapies such as corticosteroids, immunosuppressants or diuretics  are used, but are mainly supportive and a large proportion of patients progress to end-stage renal disease over a 5-10 year period of time. ANG-3070 is an oral small molecule that selectively inhibits molecular pathways associated with scarring or fibrosis in the kidney and other organs. Our current preclinical study in collaboration with NEPTUNE aims to identify the “signalosome,” or human disease and drug response profile based on the genes, networks and pathways that correlate with the therapeutic activity of ANG-3070 in FSGS. Ultimately, this collaboration will allow us to  develop a precision medicine approach to identify and treat patients in whom ANG-3070 is most likely to block the pathways causing FSGS.  (more…)
Author Interviews, Columbia, Genetic Research, Kidney Disease / 03.01.2019

MedicalResearch.com Interview with: Emily E. Groopman, B.A Departments of Medicine Hammer Health Sciences, and the Department of Epidemiology Columbia University, New York MedicalResearch.com: What is the background for this study? Response: Exome sequencing (ES), targeted capture of the protein-coding segments of the human genome, is quickly becoming a first-line diagnostic tool in clinical medicine, particularly for pediatric disorders and cancer. However, the utility of ES has not been investigated for the majority of constitutional disorders in adults, including for chronic kidney disease (CKD), which collectively affects more than 1 in 10 individuals worldwide. Thus, we performed ES in 3,315 patients with CKD drawn from two independent cohorts, and evaluated the diagnostic yield and the clinical implications of genetic findings. The cohort was predominantly adult (91.6% of patients aged >21 years), ethnically diverse, and encompassed the major CKD subtypes, broadly reflective of the demographic and clinical features of United States CKD patient population. (more…)
Author Interviews, Diabetes, Geriatrics, JAMA, Kidney Disease / 01.12.2018

MedicalResearch.com Interview with: Dr. Ziyad Al-Aly, MD Associate Chief of Staff for Research and Education Veterans Affairs St. Louis Health Care System Institute for Public Health Washington University, St. Louis MO MedicalResearch.com: What is the background for this study? Response: A lot has changed in the US over the past 15 years including aging, population growth, and increased exposure to risk factors such as obesity, elevated blood pressure, etc. With all of these changes, we wondered, how did the burden of kidney disease change in the United States over the past 15 years. (more…)
Author Interviews, Cost of Health Care, JAMA, Kidney Disease / 31.10.2018

MedicalResearch.com Interview with: "Plugged into dialysis" by Dan is licensed under CC BY 2.0Amal Trivedi, MD, MPH Associate Professor of Health Services, Policy and Practice Associate Professor of Medicine Brown University MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Affordable Care Act Medicaid expansion gave states the option to expand coverage to low-income adults. Prior research has reported that these expansions have been associated with increased coverage, improved access to care, and in some studies better self-rated health. To date the impact of Medicaid expansion on mortality rates, particularly for persons with serious chronic illness, remains unknown. Our study found an association between Medicaid expansion and lower death rates for patients with end-stage renal disease in the first year after initiating dialysis.  Specifically, we found an absolute reduction in 1-year mortality in expansion states of -0.6 percentage points, which represents a 9% relative reduction in 1-year mortality.      (more…)
Author Interviews, Kidney Disease, Mineral Metabolism, Pharmacology / 29.10.2018

MedicalResearch.com Interview with: Dr Mattias Ivarsson PhD CEO, Inositec, co-author of data MedicalResearch.com: What is the background for this study? Response: When control of factors in the blood that regulate mineral balance in the body is lost, the subsequent build-up of calcium deposits in the arterial walls and cardiac valves lead to an increase in cardiac events, particularly in patients with chronic kidney disease or diabetes, as well as all-cause mortality. There is a significant unmet need for therapeutic agents capable of reducing pathological mineral accumulation regardless of their root cause. To date, there is no approved therapy for treating calcification-dependent cardiovascular disease.  (more…)
Author Interviews, Cannabis, Kidney Disease / 29.10.2018

MedicalResearch.com Interview with: "Big bags of medical #marijuana on Cannabis Culture News LIVE - watch now on www.pot.tv" by Cannabis Culture is licensed under CC BY 2.0Praveen Kumar Potukuchi, B.Pharm, MS The University of Tennessee Health Science Center MedicalResearch.com: What is the background for this study? Response: Several case reports have indicated that synthetic cannabinoid use is associated with acute kidney injury (AKI). However, it is unclear whether similar adverse effects could occur with medicinal or recreational cannabis use. Previous research has shown that the use of medical marijuana /cannabis for an average of two weeks resulted in no serious adverse effects and no incidence of AKI. However, there are no studies which investigated the effects of marijuana/cannabis use on the incidence of AKI in patients with advanced CKD. (more…)
Annals Internal Medicine, Author Interviews, Blood Pressure - Hypertension, Kidney Disease, UCSF / 23.10.2018

MedicalResearch.com Interview with: Michael G. Shlipak, MD, MPH Scientific Director , Kidney Health Research Collaborative (khrc.ucsf.edu) Professor of Medicine, Epidemiology & Biostatistics University of California, San Francisco Associate Chief of Medicine for Research Development San Francisco VA Medical Center MedicalResearch.com: What is the background for this study?
  • Our study represents major advancements in our understanding of whether kidney tissue damage accompanies the diagnosis of chronic kidney disease during hypertension therapy.
  • The Systolic Blood Pressure Intervention Trial (SPRINT) was a landmark clinical trial that demonstrated that more intensive systolic blood pressure management (target <120 mmHg) reduced rates of major cardiovascular events and mortality compared with standard therapy (<140 mmHg). A recent announcement indicated that the lower systolic blood pressure target also slowed the rate of cognitive decline and dementia incidence.
  • The major concern with intensive blood pressure lowering in SPRINT is the 3-fold incidence of chronic kidney disease, as defined using the clinical standard of serum creatinine levels. This detrimental impact on the kidney was surprising because hypertension is a predominant risk factor for kidney disease, and hypertension therapy should reduce CKD risk.
  • Given the lower blood pressure targets in the recently-updated national hypertension guidelines, there has been substantial concern that guideline implementation of blood pressure targets could cause an epidemic of CKD and the attendant suffering from its downstream consequences of cardiovascular disease, heart failure, and kidney failure.
  • In our study, we compared SPRINT participants who developed CKD with matched controls, using a panel of validated urinary biomarkers of kidney damage. These urine tests can measure actual kidney damage, rather than relying on the creatinine which is an indirect reflection of the kidney’s filtering function.
  • In the group undergoing intensive blood pressure lowering in SPRINT, we found that the new cases of CKD had an overall lowering of the kidney damage biomarkers compared with the controls, contrary to what would have been expected if they were developing “real” CKD.
  • In contrast, the new CKD cases that developed in the standard treatment group did have overall elevations in the urinary biomarkers of kidney damage; 5 of the 9 biomarkers significantly increased relative to the CKD cases in the intensive treatment group. 
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