Satellite Dialysis Clinical Investigator Grant
Translational Characterization of Blood Pressure Changes Following the Dash Diet – From Nutrition Through Electrolytes to Exosomes in African American with Stage 1 Hypertension
Dana Bielopolski, Rockefeller University; New York, NY
Hypertension is a leading cause of morbidity and mortality in the industrialized world, attributed mostly to modifiable lifestyle factors. African Americans suffer from increased rates of hypertension, and worse cardiovascular outcomes. The Dietary Approach to Stop Hypertension (DASH) diet is a proven effective intervention to lower blood pressure; its mechanism is unknown. We hypothesize that the relative abundance of proteins in urine will elucidate the role of the kidney in the response to DASH and the basis for difference in potassium homeostasis between Caucasians and African Americans. In this study, African American in-patient volunteers with untreated Stage I hypertension (130 - 139/80 – 89mm Hg), will receive DASH meals for 14 days. We will collect clinical measures, blood, and urine, to characterize urine electrolytes and urine exosome protein patterns. We anticipate these changes to occur during the shift from a "westernized diet" to a DASH diet, and blood pressure reduction.
NKF Young Investigator Grant
Increasing Physician Utilization of Genetic Testing to Personalize Nephrology Care
Jordan Nestor, Columbia University; New York, NY
Genetic testing in nephrology is opening the door to opportunities to make kidney care more personalized for a subset of patients with genetic forms of kidney disease, leading to more tailored treatment, prevention strategies, genetic counseling on family planning, etc. However, it is a new technology that most physicians lack familiarity with. Physicians' lack of expertise is inhibiting full use of genetic sequencing tests and genetic results in clinical nephrology. First, we must identify what nephrologists know about genomics, and their attitudes and beliefs towards using it in nephrology. We also have to develop tools that physicians can use during the patient visit that supports their interpretation of the genetic results and see if it makes them feel confident acting on those genetic findings. This proposed study will achieve both these goals.
Pilot Randomized Controlled Trial of Integrated Palliative Care and Nephrology Care versus Usual Nephrology Care
Jennifer Scherer, New York University School of Medicine; New York, NY
Patients with advanced kidney disease have many palliative care needs, including symptom control, assistance with treatment decision-making and advance care planning. Despite an evidence base documenting these needs, palliative care remains limited in standard nephrology care. Barriers to integration include a lack of research to support clinical recommendations. We will test the impact of integrated palliative and nephrology care versus usual nephrology care on patient-centered outcomes including symptom burden, health related quality of life, and documentation of advance directives. Our proposal is innovative as one of the only studies to address this documented void in nephrology care. It has the potential to improve the patient experience for those with serious kidney disease. Our proposal also aims to measure the feasibility of palliative care research inclusive of patients with kidney disease. Addressing kidney palliative care research and identifying its challenges can assist other researchers working in this arena.
New Drug Adoption in Kidney Disease: Sodium-Glucose Cotransporter-2 Inhibitors
Sri Lekha Tummalapalli, Joan & Sanford I. Weill Medical College of Cornell University; New York, NY
Sodium-glucose cotransporter-2 (SGLT2) inhibitors are the first therapeutic drug class in decades shown to decrease the risk of kidney failure in diabetic kidney disease (DKD), and new guidelines recommend their use in individuals with Type 2 diabetes and chronic kidney disease. Yet, SGLT2 prescribing remains very low for those with kidney disease. To improve care for people with DKD and reduce progression to kidney failure, it is crucial for nephrologists to adopt and prescribe SGLT2 inhibitors. This proposal seeks to characterize physician prescribing patterns of SGLT2 inhibitors among individuals with DKD using electronic health record data, and investigate novel channels influencing new drug prescribing. We will then assess nephrologist knowledge, attitudes, and barriers to SGLT2 inhibitor prescribing by conducting a local and national survey. The findings generated from this research will inform strategies to improve the use of SGLT2 inhibitors and other novel therapeutics in nephrology.
Chastain Research Grant of Arkansas
Identifying Barriers and Impacting Care in Chronic Kidney Disease (CKD) Awareness
Manisha Singh, University of Arkansas for Medical Sciences; Little Rock, AR
Of about 450,000 Arkansans with chronic kidney disease (CKD), only 10% are aware that they have it. Primary-care providers (PCPs) are powerful partners for positive changes to protect kidney function and slow CKD progression since they encounter patients long before the nephrologists. However, CKD detection by PCPs is low, as also their awareness of the steps required to adequately manage CKD. In this study, we will assess the ability of checklists to create short and long-term knowledge gains in PCPs. We will also explore barriers that prevent optimized CKD care, including nephrology referrals. A 10 step checklist of CKD guidelines will be used to support PCP awareness and provide an outline for care.
This study is one facet of the overall goal to improve CKD awareness in Arkansas. The results of this study will inform the development of further study addressing an interactive CKD checklist to improve outpatient CKD care.