Author Interviews, Frailty, Kidney Disease / 04.11.2017

MedicalResearch.com Interview with: [caption id="attachment_37895" align="alignleft" width="116"]Silvi Shah, MD, FACP, FASN Assistant Professor, Division of Nephrology University of Cincinnati Cincinnati, OH Dr. Shah[/caption] Silvi Shah, MD, FACP, FASN Assistant Professor, Division of Nephrology University of Cincinnati Cincinnati, OH MedicalResearch.com: What is the background for this study? What are the main findings? Response: Elderly represent the fastest growing segment of incident dialysis patients in Unites States. The annual mortality in end stage renal disease (ESRD) patients is very high ~ 20%. Since most of the deaths occur in the first year of dialysis, it is possible that health conditions present prior to initiation of dialysis may impact long-term outcomes. In this study, we determined the impact of poor functional status at the time of dialysis initiation and pre-dialysis health status on type of dialysis modality, type of hemodialysis access and one-year mortality in elderly dialysis patients. We evaluated 49,645 adult incident dialysis patients (1/1/2008 to 12/31/2008) from the United Data Renal Data System (USRDS) with linked Medicare data for at least 2 years prior to dialysis initiation. Mean age of our study population was 72 years. At dialysis initiation, 18.7% reported poor functional status, 88.9% has pre-dialysis hospitalization, and 27.8% did not receive pre-dialysis nephrology care. Patients with poor functional status had higher odds of being initiated on hemodialysis than peritoneal dialysis, lower odds of using arteriovenous access as compared to central venous catheter for dialysis and higher risk of one-year mortality.
Author Interviews, Insomnia, Kidney Disease / 04.11.2017

MedicalResearch.com Interview with: Dr. Jun Ling (Lucy) Lu, MD, CCRP Senior Clinical Research Coordinator in the Department of Medicine 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: Around one third of the world’s population suffers from insomnia. Previous studies showed that sleep disorders affect the hypothalamic–pituitary–adrenal axis and the sympatho-adrenal system, which may cause abnormalities in several organ systems and pathways causing metabolic or cardiovascular abnormalities. However, there is inadequate evidence of an association between chronic insomnia and adverse renal outcomes. After examining 938,473 US veterans (4.4% of them had chronic insomnia) with baseline estimated eGFR >60 ml/min/1.73m2, we found that chronic insomnia is associated with a 43% higher risk of all-cause mortality, a 2.5-fold higher incidence of eGFR ≤45ml/min/1.73m2, a 2.3-fold higher ESRD risk, and with rapid loss of kidney function.
Author Interviews, Coffee, Kidney Disease / 01.11.2017

MedicalResearch.com Interview with: [caption id="attachment_37801" align="alignleft" width="150"]Miguel Bigotte Vieira MD Centro Hospitalar Lisboa Norte Lisbon, Portugal Dr. Bigotte Vieira[/caption] Miguel Bigotte Vieira MD Centro Hospitalar Lisboa Norte Lisbon, Portugal  MedicalResearch.com: What is the background for this study? What are the main findings? Response:  An inverse relationship between coffee consumption and mortality has been reported in the general population. However, the association between caffeine consumption and mortality in patients with chronic kidney disease (CKD) remains unclear. We examined the association between varying levels of caffeine consumption and mortality among 2328 patients with CKD in a prospective nationwide cohort, using the continuous National Health and Nutrition Examination Survey (NHANES) 1999-2010. A dose-dependent inverse association between caffeine and all-cause mortality was observed in patients with CKD. This association was independent of influential factors including age, gender, race, annual family income, education level, estimated GFR, albumin/creatinine ratio, hypertension, smoking status, dyslipidemia, body mass index, previous cardiovascular events and diet: consumption of alcohol, carbohydrates, polyunsaturated fatty acids and fibers. Comparing with 1st quartile of caffeine consumption, adjusted HR for death was 0.88 (95% CI, 0.68-1.44) for 2nd quartile, 0.78 (95% CI, 0.60-1.01) for 3rd quartile and 0.76 (95% CI, 0.59-0.97) for 4th quartile (p=0.027 for trend across quartiles)
Author Interviews, Gastrointestinal Disease, Kidney Disease, Microbiome, Supplements / 19.10.2017

MedicalResearch.com Interview with: [caption id="attachment_37590" align="alignleft" width="150"]Ron Walborn Jr. Prebiotin CEO Ron Walborn Jr.[/caption] Ron Walborn Jr. Prebiotin CEO  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The product Prebiotin™ Prebiotic Fiber was brought to market in 2007 by Dr. Frank Jackson, a gastroenterologist out of Harrisburg, PA. He found through 40 years of experience with his patients that a variety of digestive issues benefitted from daily supplementation with a soluble prebiotic fiber, specifically, oligofructose-enriched inulin (OEI) derived from chicory root. In the late summer of 2012, Prebiotin caught the attention of Dr. Dominic Raj at the Internal Medicine Department of George Washington University. Dr. Raj’s laboratory showed that patients with kidney disease may have a higher level of release of endotoxins like p-Cresol sulfate and indole from the bacteria in the gut, which can move into the bloodstream and promote inflammation. This early work was the basis of a successful grant application. Researchers were interested in investigating the therapeutic potential of altering the composition and/or function of the gut microbiome in this patient population, based on the understanding that by building up the levels of healthy bacteria in the gut, undesirable bacteria is eventually crowded out, thereby reducing the release of harmful endotoxins into the system.
Author Interviews, Kidney Stones / 07.10.2017

MedicalResearch.com Interview with: Benjamin Freedman, Ph.D. Assistant Professor | University of Washington Department of Medicine | Division of Nephrology Member, Kidney Research Institute Member, Institute for Stem Cell and Regenerative Medicine Seattle WA 98109  MedicalResearch.com: What is the background for this new technology and study? What are the main findings? Response: Polycystic kidney disease (PKD) is the leading genetic cause of end stage renal disease, affecting approximately twelve million people. The hallmark of the disease is the massive expansion of kidney tubules into large, fluid-filled cysts. Although we know the genes that are mutated in this disease, we do not have a firm grasp on what they do to protect the body from disease. We used a new system, human kidney organoids with gene-edited PKD mutations, to discover how factors outside the cell affect cyst formation. We found that liberating the organoids from plastic dishes into floating cultures greatly increased the number and size of cysts that formed. We also found that PKD organoids had problems in their ability to change the shape of collagen scaffolds surrounding them, compared to control organoids of the same genetic background.
Author Interviews, Cannabis, Kidney Disease, UCSF / 31.08.2017

MedicalResearch.com Interview with: [caption id="attachment_36714" align="alignleft" width="150"]Dr. Julie H. Ishida MD Division of Nephrology, Department of Medicine San Francisco and San Francisco Veterans Affairs Medical Center University of California Dr. Ishida[/caption] Dr. Julie H. Ishida MD Division of Nephrology, Department of Medicine San Francisco and San Francisco Veterans Affairs Medical Center University of California MedicalResearch.com: What is the background for this study? What are the main findings? Response: Marijuana is becoming increasingly accepted in the United States, and animal studies suggest that marijuana could affect kidney function. However, data in humans are limited to case reports of acute kidney injury related to synthetic cannabinoid use and small cohort studies of relatively short duration. Among 3,765 participants with normal kidney function in the Coronary Artery Risk Development in Young Adults or CARDIA study, my colleagues and I found that higher marijuana use was associated with lower kidney function at the start of the our study. However, we did not find that marijuana was associated with change in kidney function or albuminuria, which is a sign of kidney damage, over long-term follow-up.
Author Interviews, Kidney Disease, Transplantation / 07.08.2017

MedicalResearch.com Interview with: [caption id="attachment_36326" align="alignleft" width="92"]Dr. Anne Huml MD Center for Reducing Health Disparities Case Western Reserve University MetroHealth Medical Center Cleveland, Ohio Dr. Huml[/caption] Dr. Anne Huml MD Center for Reducing Health Disparities Case Western Reserve University MetroHealth Medical Center Cleveland, Ohio  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Overall, about 600,000 Americans have end stage renal disease and require chronic dialysis treatment or a kidney transplant to survive. Compared to chronic dialysis, kidney transplantation results in better survival and quality of life and lower health care costs. Approximately 100,000 patients are listed for a kidney transplant. However, only 17,000 transplants occur per year with two-thirds of these coming from deceased donor organs. Annually, over 8,000 patients either die waiting for a kidney transplant or are removed from the waiting list for being too ill. Waiting times vary based on geography, but it is not unusual for patients to wait upwards of 5 years for a kidney transplant. There are sizeable race, gender, and socioeconomic disparities in access to kidney transplantation. In this study, we evaluated the outcomes of deceased donor kidney offers and their association with donor and waitlisted patient characteristics. Differences in kidney offer outcomes to patients at the top of the waiting list may contribute to disparities in transplantation. When a deceased donor organ becomes available, a match run list is created that ranks potential recipients in priority order based upon several characteristics, including waiting time and immunologic criteria. At the discretion of the transplant center, organ offers to patients on their waiting list can be accepted for transplant, or refused for a particular patient. The offers continue down the match run list in sequential order. For each potential recipient in whom the organ is not transplanted, a refusal code is generated and catalogued with the United Network of Organ Sharing, or UNOS. UNOS identifies 37 unique refusal codes and categorizes them into donor-related, transplant center bypassed for pre-specified criteria, recipient-related, histocompatibility-related, program-related, or other reasons for refusal.
Author Interviews, Kidney Stones, Nutrition / 07.08.2017

MedicalResearch.com Interview with: [caption id="attachment_36321" align="alignleft" width="200"]Dr. Nigwekar and Dr. Paunescu Dr. Nigwekar and                 Dr. Paunescu[/caption] Teodor Paunescu, PhD and Sagar Nigwekar, MD Division of Nephrology Massachusetts General Hospital  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Over 25 million people in the U.S. have chronic kidney disease, and the number of deaths caused by this disease has doubled between 1990 and 2010. It is projected that by 2030 more than 1 in 3 adults over 65 years old will be diagnosed with chronic kidney disease. Many patients with kidney disease are also malnourished, which negatively impacts their quality of life, overall health, and even survival. However, no effective treatments are currently available to address malnutrition in these patients. The sense of smell plays an important role in determining food flavor. If a patient’s ability to smell is impaired, this could affect the taste of food, for example, foods that used to appeal to the patient may no longer do so. Given the relation between the sense of smell and appetite, we set out to investigate the loss of smell in patients with kidney disease, and to test an intervention aimed at alleviating their smell deficits. Our first goal was to determine if patients with various degrees of kidney disease suffer smell losses and whether smell issues might affect their nutritional status. We found that, while most kidney disease patients do not perceive a problem with their sense of smell, deficits in the ability to smell are actually common among these patients, and the severity of these deficits increases with the severity of their kidney disease. Moreover, our study found that reductions in several markers of nutrition (such as cholesterol and albumin levels) correlate with the impairment in these patients’ sense of smell.
Author Interviews, Kidney Disease, NEJM, Transplantation / 04.08.2017

MedicalResearch.com Interview with: [caption id="attachment_36307" align="alignleft" width="143"]Stanley C. Jordan, M.D Director, Division of Nephrology Medical Director, Kidney Transplant Program Medical Director, Human Leukocyte Antigen and Transplant Immunology Laboratory Cedars-Sinai, Los Angeles, CA Dr. Jordan[/caption] Stanley C. Jordan, M.D Director, Division of Nephrology Medical Director, Kidney Transplant Program Medical Director, Human Leukocyte Antigen and Transplant Immunology Laboratory Cedars-Sinai, Los Angeles, CA  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The background for this study is as follows: Patients who are highly HLA sensitized have antibodies to transplant targets create an immunologic barrier to transplant. Currently, there are no approved therapies for elimination of these antibodies. Desensitization is available but is not always successful and most desensitized patients are still transplanted with a positive crossmatch. Thus, many patients are not able to receive life-saving kidney transplants unless newer therapies to remove antibodies are found. The findings of our study published in the New England Journal of Medicine revealed that the use of the enzyme from streptococcal pyogenes called IdeS® (IgG endopeptidase) is very effective in eliminating donor specific antibodies and allowing transplantation to occur. Antibodies were eliminated from one week up to two months after one treatment with Ides® allowing a safe environment for the transplant to occur. Rejections episodes did occur in some of the patients but were generally mild and easily treatable. Only one patient of 25 lost his allograft during the study. Thus, the study shows promising results for a new approach for elimination of pathogenic antibodies that did not exist before.
Author Interviews, Depression, Kidney Disease / 06.06.2017

MedicalResearch.com Interview with: Kathy Aebel-Groesch, MSW,LCSW Manager, Social Work Services DaVita Inc. MedicalResearch.com: What is the background for this study? What are the main findings? Response: Chronic pain and depression can impact quality of life and adherence to treatment regimen among patients with end-stage renal disease (ESRD). Previous research has demonstrated that patients with ESRD experience pain and depression more frequently than the general population. From 2016, CMS has required that all eligible ESRD patients are evaluated regularly for pain and depressive symptoms. We assessed pain and depression symptom scores among patients of a large dialysis organization (LDO) over the period Mar-Oct 2016. Pain was assessed monthly by LDO nurses using the Wong-Baker pain scale (0-10). Depression screenings were conducted biannually by LDO social workers using the PHQ-2 (scale 0-6) and excluded patients with existing diagnosis of depression or bipolar disorder, cognitive impairment or language barrier, and those who were hospitalized or refused screening. A total of 688,346 pain responses from 160,626 individual patients and 223,421 depression screening responses from 158,172 patients were considered. A score of 0 (no pain) was reported for 83.5% of pain responses and 65.7% of patients had a 0 score in all pain assessments. A score of 10 (most severe pain) was reported at least once during the study period by 3.0% of patients. Patients with a pain score of 10 were more frequently female (55%) and patients on peritoneal dialysis were less likely to have a pain score of 10 than those on other modalities. A depression score of 0 (patient answered "Not at all" to both “Little interest or pleasure in doing things” and “Feeling down, depressed, or hopeless”) was reported for 69.1% of all responses and 62.6% of patients had a 0 score in all assessments; 1.8% of patients had at least one score of 6 (patient responded “Nearly every day” to both questions) and 9.7% had at least one score of 3 or more. Patients with a score of 0 were more likely to be male vs. female, HHD vs. PD or ICHD, ≥ age 70 years. The majority of ESRD patients did not report pain symptoms and, among those not excluded from screening due to an existing diagnosis of depression or other reason, the majority did not report symptoms of depression. However, routine assessment of pain and depression enables the timely identification of new or increased symptoms, thus allowing earlier implementation of interventions that may improve patient experience. The LDO has since revised its depression screening policy to remove diagnosis of depression from exclusion criteria and to administer the PHQ-9 to patients with a PHQ-2 score ≥ 3.
Author Interviews, Hepatitis - Liver Disease, Kidney Disease, Lancet, Merck / 01.06.2017

MedicalResearch.com Interview with: [caption id="attachment_35005" align="alignleft" width="112"]Annette Bruchfeld MD, PhD Senior Consultant Associate Professor Karolinska Institute Dept of Renal Medicine, M99 Karolinska University Hospital Huddinge Stockholm, Sweden Dr. Bruchfeld[/caption] Annette Bruchfeld MD, PhD Senior Consultant Associate Professor Karolinska Institute Dept of Renal Medicine, M99 Karolinska University Hospital Huddinge Stockholm, Sweden MedicalResearch.com: What is the background for this study? What are the main findings? Response: In patients with stage 4–5 chronic kidney disease(CKD), hepatitis C virus (HCV) infection can accelerate the decline in kidney function, impair health-related quality of life (HRQOL), and decrease survival chances of both patients and grafts in transplantation recipients. In this study additional data from patients with stage 4–5 chronic kidney disease undergoing treatment for HCV infection in the C-SURFER study, including HRQOL and resistance analyses was presented not previously reported for this patient population with gwnotype 1 infection. The final virological analysis of this study indicated a high cure rate with sustained virological response at 12 weeks after the end of treatment (SVR12) in more than 98% of all treated patients. Even in patients with resistance-associated substitutions (RASs) the SVR was high in 11 (84·6%) of 13 patients genotype 1a infection.
Author Interviews, Cost of Health Care, Kidney Disease / 13.05.2017

MedicalResearch.com Interview with: [caption id="attachment_34553" align="alignleft" width="200"]Shaum Kabadi</strong> HEOR Director at AstraZeneca Shaum Kabadi[/caption] Shaum Kabadi HEOR Director at AstraZeneca MedicalResearch.com: What is the background for this study? What are the main findings? Response: More than 20 million adults – roughly 1 in 10 adults – in the US are estimated to have chronic kidney disease (CKD), and this population is expected to grow as the US population ages. Patients with CKD are at high risk for progression to end-stage renal disease (ESRD), a condition requiring dialysis or kidney transplantation to maintain patients’ long-term survival. The cost of treating ESRD patients was over $40 billion in public and private funds in 2009. Prior research shows per-person annual Medicare expenses attributable to CKD were $1,700 for Stage 2, $3,500 for Stage 3, and $12,700 for Stage 4. Additional research is required to understand the economic burden of CKD by stage in a contemporary cohort of commercially insured patients with non-dialysis-dependent (NDD)-CKD. This retrospective cohort study utilized data from the HealthCore Integrated Research Environment, which contained medical and pharmacy administrative claims integrated with laboratory result values from 14 regionally dispersed Anthem health plans in the US. Of 16,030 patients identified with CKD, the mean (SD) estimated glomerular filtration rate (eGFR) (all in mL/min/1.73 m2) in 2014 was 44.3 (±18.7), and the breakdown by eGFR levels was: Stage 1 (≥90) 3%, Stage 2 (60–89) 13%, Stage 3a (45–59) 27%, Stage 3b (30–44) 35%, Stage 4 (15–29) 19%, and Stage 5 (<15) 3%. Mean age across all stages was 67.4 years, and 47% were women. Hospitalization rate (%) and number of outpatient encounters (visits per patient per year) by stage were: Stage 1 (11.6%, 19.8), Stage 2 (14.9%, 22.5), Stage 3a (16.2%, 23.6), Stage 3b (23.7%, 29.5), Stage 4 (30.7%, 36.3), and Stage 5 (30.8%, 61.7) (p-trend).
Author Interviews, Blood Pressure - Hypertension, Kidney Disease / 07.05.2017

MedicalResearch.com Interview with: Tanushree Banerjee, M.S., M.Phil., Ph.D. Research Specialist, Department of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, MedicalResearch.com: What is the background for this study? What are the main findings? Response: Prevalence of chronic kidney disease (CKD) has increased among adults with diagnosed hypertension (HTN), undiagnosed HTN and pre-hypertension as compared to normotension. However, whether CKD prevalence has changed across each of these groups is unknown. The prevalence of CKD decreased over time among persons with diagnosed, undiagnosed, and pre-hypertension while there was not any change in normotensives.
Author Interviews, Heart Disease, JAMA, Kidney Disease, Surgical Research / 04.05.2017

MedicalResearch.com Interview with: [caption id="attachment_34381" align="alignleft" width="133"]Nirat Beohar, MD Vice-Chief of Cardiology Director Cardiac Catheterization Laboratory Director Structural Heart Disease Program Director Interventional Cardiology Fellowship program Cardiac Catheterization Laboratory Columbia University Division of Cardiology, Mount Sinai Medical Center Miami Beach, Miami, FL 33140 Dr. Beohar[/caption] Nirat Beohar, MD Vice-Chief of Cardiology Director Cardiac Catheterization Laboratory Director Structural Heart Disease Program Director Interventional Cardiology Fellowship program Cardiac Catheterization Laboratory Columbia University Division of Cardiology, Mount Sinai Medical Center Miami Beach, Miami, FL 33140 MedicalResearch.com: What is the background for this study? Response: Nirat Beohar MD, Director of the Cardiovascular Catheterization Laboratory and Vice-Chief of Cardiology at the Columbia University Division of Cardiology at the Mount Sinai Medical Center and co-authors report the effect of trans-catheter aortic valve replacement (TAVR) on subsequent renal function and outcomes in high-risk and inoperable patients presenting with baseline renal dysfunction (eGFR < 60 ml/min/1.73 m2). This was a sub-study of patients undergoing TAVR in the PARTNER 1 trial and continued access registry that was conducted in 25 centers in the United States and Canada.
Author Interviews, Kidney Disease, Social Issues / 03.05.2017

MedicalResearch.com Interview with: [caption id="attachment_34299" align="alignleft" width="132"]Wendy Tan Senior Medical Social Worker Medical Social Work The National Kidney Foundation Wendy Tan[/caption] Wendy Tan Senior Medical Social Worker Medical Social Work The National Kidney Foundation MedicalResearch.com: What is the background for this study? Response: End Stage Renal Disease (ESRD) patients experience significant changes to their daily routine and lifestyle. Their time and attention were often centred solely on their sickness whilst receiving treatment accentuating the employment isolation. This study determined the need for extra support to assist patients adjust (e.g. learning about their psychological wellbeing, change of role and mindset, suitable work conditions and employment support) in returning to work. It also sheds light on how individuals perceive the particular situations they are facing, how they are making sense of their health conditions and the society at large in relations to seeking continued employment.
Author Interviews, Cleveland Clinic, Heart Disease, Kidney Disease / 01.05.2017

MedicalResearch.com Interview with: [caption id="attachment_34251" align="alignleft" width="76"]MedicalResearch.com Interview with: Mohamed Khayata, MD Internal Medicine Resident PGY-3 Cleveland Clinic Akron General, Akron, Ohio MedicalResearch.com: What is the background for this study? What are the main findings? Response: Previous studies showed that patients with ST-elevation myocardial infarction (STEMI) who had elevated creatinine and/or impaired creatinine clearance on presentation had higher short- and long-term mortality independent of other cardiovascular risk factors. We used the National Cardiovascular Database Registry to investigate the impact of creatinine levels at the time of presentation on the cardiovascular outcomes in patients who presented with STEMI. Our study showed that elevated creatinine levels correlated with higher incidence of atrial fibrillation, bleeding, heart failure, and cardiogenic shock during hospital stay after the percutaneous intervention. MedicalResearch.com: What should readers take away from your report? Response: Creatinine level is being checked in almost all patients who present with STEMI within few hours of presentation. Based on previous reports and our results, creatinine is a critical marker that correlate not only with mortality, but is also with morbidity during hospital stay. This marker should be used as a predictor of worse outcomes; thus, patients with higher creatinine levels should be provided higher attention. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Response: Based on our study limitations, I would encourage performing similar outcomes analysis in larger group, multi-center registries. I would also suggest extending outcomes to post-discharge status including quality of life besides cardiovascular compilcations. MedicalResearch.com: Is there anything else you would like to add? Response: MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community. Citation: Abstract presented at the 2017 National Kidney Foundation Spring Clinical Meeting https://www.kidney.org/spring-clinical The Impact of Admission Serum Creatinine on Major Adverse Clinical Events in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions. More Medical Research Interviews on MedicalResearch.com Dr. Khayata[/caption] Mohamed Khayata, MD Internal Medicine Resident PGY-3 Cleveland Clinic Akron General Akron, Ohio MedicalResearch.com: What is the background for this study? What are the main findings? Response: Previous studies showed that patients with ST-elevation myocardial infarction (STEMI) who had elevated creatinine and/or impaired creatinine clearance on presentation had higher short- and long-term mortality independent of other cardiovascular risk factors. We used the National Cardiovascular Database Registry to investigate the impact of creatinine levels at the time of presentation on the cardiovascular outcomes in patients who presented with STEMI. Our study showed that elevated creatinine levels correlated with higher incidence of atrial fibrillation, bleeding, heart failure, and cardiogenic shock during hospital stay after the percutaneous intervention.
Author Interviews, Critical Care - Intensive Care - ICUs, Kidney Disease / 29.04.2017

MedicalResearch.com Interview with: Sean Bagshaw MD MSc Director for Research for the Division of Critical Care Medicine School of Public Health University of Alberta, Canada MedicalResearch.com: What is the background for this study? What are the main findings? Response: The rationale for SPARK stemmed from two general observations. First, experimental and pre-clinical data have suggested the timely utilization of loop diuretics in early AKI could provide “kidney protection” largely mediated through reduction in medullary oxygen demand. Yet, this is in apparent paradox with clinical data (largely derived from older observational studies at some risk of bias) suggesting use of loop diuretics in AKI may be associated with increased risk for death and/or non-recovery of kidney function. Second, in AKI, loop diuretics are used exceedingly often. Surveys of healthcare practitioners and observational data suggest more than two-thirds to three-quarters of patients are exposed to diuretics at some point during their course. This represents a significant misalignment between evidence and clinical practice. This would suggest there is need to generate new evidence and knowledge that would ideally help inform best practice in the management of AKI. SPARK was designed as a pilot trial largely aimed at evaluating the feasibility of the approach to use of loop diuretics in early AKI. While SPARK did not find significant differences in risk of worsening AKI, utilization of RRT or mortality, we recognize the trial was underpowered to meaningfully inform about these and other patient-centered outcomes. We did see differences in secondary endpoints (i.e., fluid balance); however, use of loop diuretics in this setting was also associated with greater incidence of electrolyte abnormalities.
Author Interviews, Kidney Disease, Mineral Metabolism, Nutrition, Social Issues, Transplantation / 25.04.2017

MedicalResearch.com Interview with: [caption id="attachment_34207" align="alignleft" width="133"]Ms. Shifra Mincer Medical Student in the class of 2019 SUNY Downstate Medical School Shifra Mincer[/caption] Ms. Shifra Mincer Medical Student in the class of 2019 SUNY Downstate Medical School MedicalResearch.com: What is the background for this study? What are the main findings? Response: Hypophosphatemia is commonly encountered in the post-transplant setting. Early post-transplant hypophosphatemia has been ascribed to excess FGF23 and hyperphosphaturia. Many patients remain hypohosphatemic months or even years after their transplant and the mechanism was assumed to be the same, however, our group recently reported that patients with late post-transplant hypophosphatemia had very little phosphorous in their urine (Wu S, Brar A, Markell, MS. Am J Kidney Dis. 2016,67(5): A18). We hypothesized that they were not eating enough phosphorous to compensate for the acute phosphorous losses they experienced immediately post-transplant. In this study, using both 3-day diet journals and 24-hour diet recall questionnaires, we found that mean intake of phosphorous and protein was barely at the Recommended Daily Allowance, and that despite 70% of the patients using EBT, 30% of those patients still reported concerns regarding food security. Patients who reported that the cost of food influenced their dietary choices ate 43% less protein (average 48,5 gms vs. 85.8 gms) and 29% less phosphorous (average 887 mg vs 1257 mg). When ability to rise from a chair over a 30 second period was evaluated, only patients who expressed food cost concerns were unable to complete the test.
Author Interviews, Kidney Disease / 20.04.2017

MedicalResearch.com Interview with: Francesco Violi MD Department of Internal Medicine and Medical Specialties e Sapienza University Rome, Italy MedicalResearch.com: What is the background for this study? What are the main findings? Response: The paper reports on the protocol of a trial where we will test the effect of aspirin on renal disease progression in diabetic patients. The study will start shortly and will be terminate next year.
Author Interviews, Diabetes, Kidney Disease, Pediatrics / 16.03.2017

MedicalResearch.com Interview with: [caption id="attachment_33007" align="alignleft" width="139"]Constadina Panagiotopoulos, MD, FRCPC Department of Pediatrics, Endocrinology & Diabetes Unit British Columbia Children’s Hospital Vancouver, British Columbia, Canada Dr. Panagiotopoulos[/caption] Constadina Panagiotopoulos, MD, FRCPC Department of Pediatrics, Endocrinology & Diabetes Unit British Columbia Children’s Hospital Vancouver, British Columbia, Canada MedicalResearch.com: What is the background for this study? Response: I decided to conduct this study after observing a few cases of severe acute kidney injury (AKI) in children hospitalized with diabetic ketoacidosis (DKA) (with two patients requiring dialysis) while on call in the 18 months prior to initiating the study. While caring for these patients, I scanned the literature and realized that aside from 2 published case reports, there had been no large-scale systematic studies assessing AKI in children with DKA. It immediately became apparent to me that managing patients with AKI and DKA was more challenging. On presentation to hospital, many of these children with DKA present quite volume depleted but fluid management is conservative because of the risk for cerebral edema. One of the most important management strategies for acute kidney injury in patients with DKA is early detection and correcting volume depletion in a timely manner to prevent further injury. I discussed my observations and these clinical cases with pediatric nephrologist and co-investigator Dr. Cherry Mammen, a pediatric AKI expert, and he confirmed my initial literature review findings. Thus, we decided to conduct this study to better understand the scope of the problem and any associated risk factors.
Author Interviews, Blood Pressure - Hypertension, Heart Disease, Kidney Disease / 13.03.2017

MedicalResearch.com Interview with: Hon-Yen Wu, MD, PhD, on behalf of all authors Attending Physician and Assistant Professor, Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan. Assistant Professor, Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan. Assistant Professor, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan. Assistant Professor, School of Medicine, National Yang-Ming University, Taipei, Taiwan.  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The effect of intensive blood pressure (BP) control in nondiabetic patients with chronic kidney disease (CKD) has long been a topic of debate. We summarized the published information comparing intensive BP control (< 130/80 mmHg) with standard BP control (< 140/90 mmHg) on major renal outcomes in CKD patients without diabetes. We pooled data from 9 randomized clinical trials with more than 8000 patients and over 800 events of kidney disease progression. We found that targeting blood pressure below the current standard did not provide additional benefit for renal outcomes compared with standard BP control, but may benefit nonblack patients or those with heavy proteinuria. MedicalResearch.com: What should readers take away from your report? Response: For the optimal blood pressure target in CKD patients without diabetes, an individually tailored treatment rather than a general rule to control hypertension is suggested.
Author Interviews, Blood Pressure - Hypertension, Genetic Research, Kidney Disease, Nature, Race/Ethnic Diversity, University of Pennsylvania / 07.03.2017

MedicalResearch.com Interview with: [caption id="attachment_32695" align="alignleft" width="148"]Katalin Susztak MD, PhD Associate Professor of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia, PA 19104 Dr. Susztak[/caption] Katalin Susztak MD, PhD Associate Professor of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia, PA 19104 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Previous studies showed an association between genetic variants in the APOL1 gene and kidney disease development, but it has not been confidently shown that this genetic variant is actually causal for kidney disease. For this reason we developed a mouse model that recapitulates the human phenotype.
Anemia, Author Interviews, Kidney Disease, Pharmacology, Stanford / 16.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31275" align="alignleft" width="200"]Dr. Glenn M. Chertow, MD Professor Medicine, Nephrology Stanford University School of Medicine Dr. Glenn M. Chertow[/caption] Dr. Glenn M. Chertow, MD Professor Medicine, Nephrology Stanford University School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Iron deficiency is common in persons with moderate to advanced (non-dialysis-dependent) chronic kidney disease (CKD), for a variety of reasons. Conventional iron supplements tend to be poorly tolerated and of limited effectiveness. In earlier studies of patients treated with ferric citrate for its effect as a phosphate binder, we saw increases in transferrin saturation and ferritin (markers of iron stores) and hemoglobin and hematocrit (the “blood count”). Therefore, we thought we should test the safety and efficacy of ferric citrate specifically for the treatment of iron deficiency anemia (IDA). With respect to the key findings, more than half (52%) of patients treated with ferric citrate experienced a sizeable (>=1 g/dL) increase in hemoglobin over the 16-week study period compared to fewer than one in five (19%) patients treated with placebo. Rates of adverse events (“side effects”) were similar to placebo; diarrhea in some patients and constipation in others were the most common. There were also favorable effects of ferric citrate on laboratory metrics of bone and mineral metabolism.
Alzheimer's - Dementia, Author Interviews, Kidney Disease, Neurology / 19.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30638" align="alignleft" width="133"]Kay Deckers, MSc PhD student School for Mental Health and Neuroscience Department of Psychiatry and Neuropsychology Maastricht University The Netherlands Kay Deckers[/caption] Kay Deckers, MSc PhD student School for Mental Health and Neuroscience Department of Psychiatry and Neuropsychology Maastricht University The Netherlands MedicalResearch.com: What is the background for this study? Response: In an earlier review (https://www.ncbi.nlm.nih.gov/pubmed/25504093), we found that renal dysfunction was one the new candidate risk factors of dementia and needed further investigation. MedicalResearch.com: What are the main findings? Response: Albuminuria is associated with an increased risk of developing cognitive impairment or dementia.
Anemia, Author Interviews, Kidney Disease / 30.11.2016

MedicalResearch.com Interview with: [caption id="attachment_30030" align="alignleft" width="177"]Dorota Drozdz M.D., Ph.D Jagiellonian University Kraków Dr. Dorota Drozdz[/caption] Dorota Drozdz M.D., Ph.D Jagiellonian University Kraków Response: In Poland and Portugal we use EPO beta for anemia treatment. Our interest was to find differences in clinical patterns taking in consideration that both countries are adherent to KDIGO recommendations an guidelines. We found that in both countries the mean hemoglobin (Hb) level and percentage of patients in target Hb level (10-12 g/dl on ESA treatment) are the same, but the approaches were different – in Poland the ESA dose was statistically lower than in Portugal and iron dose was statistically higher than in Portugal. Most other lab tests results were similar. Future secondary outcomes analysis should answer the question, which method is safer.
Author Interviews, Kidney Disease, Lancet, Transplantation / 28.11.2016

MedicalResearch.com Interview with: Prof. Dr. med. Christian Hugo Head, Division of Nephrology Medical Clinic III Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden Dresden MedicalResearch.com: What is the background for this study? Response: At the end of 2007, the harmony trial was designed predominantly based on the one year results of the ELITE-Symphony trial, demonstrating that low dose tacrolimus, mycophenolate mofetile, and steroids together with monoclonal interleukin-2-receptor (CD 25 antigen) antibody induction therapy has superior efficacy in renal transplant patients compared to all other regimens (low or normal dose cyclosporine or sirolimus) tested. While these advantages of the low dose tacrolimus protocol were so convincing to become the new gold standard of immunosuppressive therapy within the next few years (see KDIGO guide lines for renal transplantation in 2009), the low dose tacrolimus treatment arm also demonstrated increased incidence rates regarding post-transplantation diabetes mellitus (PTDM, at that time called new onset of diabetes after transplantation - NODAT) compared to the low cyclosporine treatment arm. Previous studies had also demonstrated a detrimental association between NODAT and cardiovascular events and mortality, the leading cause of death in renal transplant recipients. Corticosteroid-free or rapid withdrawal regimens were relatively encouraging regarding influencing NODAT rates but only at the price of an increased rate of T cell mediated acute rejections.
Author Interviews, Johns Hopkins, Kidney Disease, Nutrition, Race/Ethnic Diversity / 21.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29753" align="alignleft" width="80"]Deidra C. Crews, MD, ScM, FASN, FACP Associate Professor of Medicine, Division of Nephrology Associate Vice Chair for Diversity and Inclusion, Department of Medicine Director, Doctoral Diversity Program Johns Hopkins University School of Medicine Baltimore MD 21224 Dr. Deidra Crews[/caption] Deidra C. Crews, MD, ScM, FASN, FACP Associate Professor of Medicine, Division of Nephrology Associate Vice Chair for Diversity and Inclusion, Department of Medicine Director, Doctoral Diversity Program Johns Hopkins University School of Medicine Baltimore MD 21224 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Studies suggest that dietary patterns influence risk of kidney function decline. Barriers may hinder urban African Americans' following healthful diets that could mitigate their increased risk of kidney function decline. In this study, we characterized contextual barriers to healthful eating among urban African Africans with hypertension and examined the association of these barriers to kidney function decline over 1 year. We examined the presence of healthy foods in neighborhood stores of study participants. We also assessed them for food insecurity (the inability to afford nutritionally adequate and safe foods), directly observed and documented the presence of fruits and vegetables in their homes, and examined their fruit and vegetable intake via questionnaire.
Author Interviews, Kidney Disease, UCSF / 21.11.2016

Tanushree Banerjee, PhD Research Specialist in the Department of Medicine Division of General Internal Medicine UCSFMedicalResearch.com Interview with: Tanushree Banerjee, PhD Research Specialist in the Department of Medicine Division of General Internal Medicine UCSF MedicalResearch.com: What is the background for this study? Response: Acidosis is usually noted in advanced chronic kidney disease (CKD) while it is relatively unexplored whether changes in the undetermined anions, as measured by anion gap occur earlier in the course of CKD. Consumption of animal-sourced protein is acid-inducing and therefore such diet presumably increases undetermined anions. Since higher dietary acid load is associated with progression of CKD, we wanted to explore whether the increase in undetermined anions in moderate CKD is associated with CKD progression.
Author Interviews, Critical Care - Intensive Care - ICUs, Emergency Care, Heart Disease, Kidney Disease / 21.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29537" align="alignleft" width="144"]Paul E Ronksley, PhD Assistant Professor Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary Canada Dr. Paul E Ronksley[/caption] Paul E Ronksley, PhD Assistant Professor Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary Canada MedicalResearch.com: What is the background for this study? Response: Prior studies have observed high resource use among patients with chronic kidney disease (CKD), which is related to the medical complexity of this patient population. However, there has been limited exploration of how patients with CKD use the emergency department (ED) and whether utilization is associated with disease severity. While the ED is essential for providing urgent or emergent care, identifying ways of improving ED efficiency and decreasing wait times has been recognized as a priority in multiple countries. Improving coordination and management of care for patients with multiple chronic conditions (the norm for CKD) in an outpatient setting may meet health care needs and ultimately improve patient experience and outcomes while reducing the burden currently placed on the ED. However, this requires an understanding of ED use among patients with CKD and the proportion of use that is amenable to outpatient care. Using a large population-based cohort we explored how rates of ED use vary by kidney disease severity and the proportion of these events that are potentially preventable by high quality ambulatory care. We identified all adults (≥18 years) with eGFR<60 mL/min/1.73m2 (including dialysis-dependent patients) in Alberta, Canada between April 1, 2010 and March 31, 2011. Patients with CKD were linked to administrative data to capture clinical characteristics and frequency of ED encounters, and followed until death or end of study (March 31, 2013). Within each CKD category we calculated adjusted rates of overall  emergency departmentt use, as well as rates of potentially preventable ED encounters (defined by 4 CKD-specific ambulatory care sensitive conditions (ACSCs); heart failure, hyperkalemia, volume overload, malignant hypertension).