Satellite Dialysis Clinical Investigator Grant of the NKF
Project: Weight Trajectory and Outcomes in Kidney Disease
Elaine Ku, The Regents of the University of California San Francisco; San Francisco, CA
Obesity amongst chronic hemodialysis patients has been associated with a survival advantage compared to normal weight in a phenomenon described as the “obesity paradox.” However, obesity in children on dialysis has not been associated with a lower risk of death compared to normal weight. One of the potential reasons for these differing observations in adults versus children may be due to delivery of more aggressive nutritional interventions in children with kidney disease to maintain weight and growth. Thus, I hypothesize that one reason adults who begin dialysis with a normal weight have a higher risk of death may be due to significant weight loss that occurred prior to needing dialysis. The objectives of this proposal are to 1) characterize weight trajectory in adults versus children; 2) examine the association between weight change before dialysis and risk of death after dialysis in adults.
NKF Young Investigator Grants
Project: Peritoneal Fluid Microbiome Predictive of Peritonitis
John Richard Lee, Joan & Sanford I. Weill Medical College of Cornell University; New York, NY
Peritoneal dialysis (PD) is a widely used dialysis modality around the world and provides life-saving treatment for patients who have kidney failure. Peritonitis is an infection of the peritoneal fluid and unfortunately leads to significant morbidity and mortality in PD patients. Current methods are unable to
predict development of peritonitis. In this application, we propose to utilize a novel sequencing method
called cell free DNA sequencing which will provide a comprehensive analysis of the microbiome (i.e.
bacteria) in peritoneal fluid. We propose to study the peritoneal fluid microbiome in PD patients serially
over time and to determine the microbiome profiles that are predictive of peritonitis. The proposed
study will lead to the development of novel diagnostic tests to predict peritonitis and lead to future
interventional studies to prevent its devastating complications.
Project: AT1R Antibodies in Pediatric Kidney Transplantation
Meghan Haley Pearl, The Regents of the University of California, Los Angeles; Los Angeles, CA
Maximizing kidney transplant survival is critical in children given most will require multiple transplants in
their lifetimes. Antibodies in the blood can attack the kidney transplant causing rejection, injury, or
failure. Recently, an antibody called angiotensin II type 1 receptor antibody (AT1R-Ab) has been
associated with kidney transplant rejection and failure (2-6) in adults. Little is known about AT1R-Abs in
pediatric kidney transplant recipients (KTRs). We will test blood samples from 200 pediatric KTRs for
AT1R-Ab to examine the prevalence and risk factors for development of AT1R-Ab. Furthermore, we will
determine if AT1R-Ab is associated with blood vessel injury, decline in renal function, rejection, and
transplant failure. This study will enrich our understanding of the effects of AT1R-Abs on transplant
outcomes in the vulnerable pediatric population. Our long-term objective is to understand how to
incorporate AT1R-Ab testing into kidney transplant monitoring and treatment to improve kidney
transplant survival in children.
Project: Pilot Trial of Thyroid Hormone Replacement in Dialysis
Connie Rhee, The Regents of the University of California, Irvine; Irvine, CA
Hypothyroidism, defined by elevated thyrotropin (TSH) levels, is a common endocrine complication of
chronic kidney disease that has been associated with impaired quality of life and cardiovascular
complications. While levothyroxine is one of the most frequently prescribed medications in dialysis
patients, little is known about its efficacy and safety in this population. This study will investigate 1)
whether levothyroxine adequately lowers thyrotropin (TSH) levels to therapeutic target ranges, and 2) if
thyroid hormone replacement improves quality of life and cardiovascular markers, without leading to
wasting (i.e., loss of body mass, fat, and/or muscle mass) in dialysis patients.
NKF Southeast Texas Research Grant
Project: Nephrology Care and Employment after Starting Dialysis
Kevin Erickson, Baylor College of Medicine, Houston, TX
Approximately 10% of adults in the United States have chronic kidney disease and are at risk for
developing end-stage renal disease (ESRD), which requires lifelong dialysis treatment or kidney
transplantation. There are nearly 500,000 patients with ESRD who receive dialysis in the United States,
20 percent of whom live in California or Texas. Many patients are unable to continue working after they
initiate dialysis, which can lead to a reduced sense of wellbeing, poorer quality of life, and increased
state and federal expenditures.
We will examine whether regular kidney specialist (nephrology) care prior to developing ESRD helps
patients remain employed after their kidneys fail. We will examine this issue among all patients initiating
dialysis in the United States and among socioeconomically disadvantaged populations with Medicaid
insurance in California and Texas. Findings from this study may inform cost-effective/cost-saving policies
designed to improve access to pre-ESRD care.
NKF Serving the National Capital Area
Joseph M. Krainin, MD, Memorial Young Investigator Award
Project: APOL1-Related Nephropathies
Avi Z. Rosenberg, MD, PhD, DABP, Assistant Professor, Johns Hopkins University, Baltimore, MD
This grant will fund Dr. Rosenberg’s research on APOL1-related nephropathies. This proposal will develop an organoid system that will facilitate studies of APOL1 kidney diseases, including testing novel therapies. This genetic variant is exclusively seen in individuals of sub-Saharan African descent and explains much of the health disparity in renal disease among African Americans. An estimated 12% of the African American population carries two APOL1 risk alleles; this represents 6 million individuals, of whom we estimate that 20% will develop kidney disease during their lifetimes. This is particularly important for NKF/NCA as it is located in Washington, DC – the region of the US with the highest rate of kidney disease in the nation, a problem for which APOL1 variants are likely a leading contributor.