Nephrology Commons^™

Practice Patterns In Transitioning Patients From Chronic Kidney Disease To Dialysis: A Survey Of United States Nephrologists, M. C. Mallappallil, S. Fishbane, R. Wanchoo, E. Lerma, A. Roche-Recinos, M. Salifu

Journal Articles

No abstract provided.

Risk Factors Associated With Post-Kidney Transplant Malignancies: An Article From The Cancer-Kidney International Network, B. Sprangers, V. Nair, V. Launay-Vacher, L. V. Riella, K. D. Jhaveri

Journal Articles

© The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA.. In kidney transplant recipients, cancer is one of the leading causes of death with a functioning graft beyond the first year of kidney transplantation, and malignancies account for 8-10% of all deaths in the USA (2.6 deaths/1000 patient-years) and exceed 30% of deaths in Australia (5/1000 patient-years) in kidney transplant recipients. Patient-, transplant- and medication-related factors contribute to the increased cancer risk following kidney transplantation. While it is well established that the overall immunosuppressive dose is associated with an increased risk for cancer following transplantation, the contributive …

Strongyloides Stercoralis−Associated Tip Variant Focal Segmental Glomerulosclerosis, M. Merzkani, N. N. Uppal, D. W. Ross, P. Gautam-Goyal, P. Malhotra, H. H. Shah, K. D. Jhaveri, V. D. D'Agati

Journal Articles

No abstract provided.

Mortality And Hospitalizations In Intensive Dialysis: A Systematic Review And Meta-Analysis, A. Mathew, J. A. Mcleggon, N. Mehta, S. Leung, V. Barta, T. Mcginn, G. Nesrallah

Journal Articles

© The Author(s) 2018. Background: Survival and hospitalization are critically important outcomes considered when choosing between intensive hemodialysis (HD), conventional HD, and peritoneal dialysis (PD). However, the comparative effectiveness of these modalities is unclear. Objective: We had the following aims: (1) to compare the association of mortality and hospitalization in patients undergoing intensive HD, compared with conventional HD or PD and (2) to appraise the methodological quality of the supporting evidence. Data Sources: MEDLINE, Embase, ISI Web of Science, CENTRAL, and nephrology conference abstracts. Study Eligibility, Participants, and Interventions: We included cohort studies with comparator arm, and randomized controlled trials …

Barriers To Peritoneal Dialysis In Aboriginal Patients, A. T. Mathew, J. Park, M. Sachdeva, M. M. Sood, K. Yeates

Journal Articles

© The Author(s) 2018. Background: Aboriginal people in Canada have an unduly high burden of end-stage kidney disease (ESKD) and many live in rural settings. Peritoneal dialysis (PD) is a home-based dialysis modality that may provide a valuable alternative to in-center hemodialysis which is relatively underutilized by the Aboriginal population. Objective: We aim to assess the barriers to PD utilization in Aboriginal patients with ESKD. Design: This article is a prospective observational cohort study. Setting: The setting involves 3 predialysis clinics in Winnipeg, Kingston, and Moose Factory. Patients: The patients were 99 individuals (67 non-Aboriginal and 32 Aboriginal) who were …

Potentially Avoidable Readmissions In United States Hemodialysis Patients, A. T. Mathew, L. Rosen, R. Pekmezaris, A. Kozikowski, D. W. Ross, T. Mcginn, K. Kalantar-Zadeh, S. Fishbane

Journal Articles

© 2017 International Society of Nephrology Introduction: Patients with end-stage kidney disease have a high risk of 30-day readmission to hospital. These readmissions are financially costly to health care systems and are associated with poor health-related quality of life. The objective of this study was to describe and analyze the frequency, causes, and predictors of 30-day potentially avoidable readmission to hospital in patients on hemodialysis. Methods: We conducted a retrospective cohort study using the US Renal Data System data from January 1, 2008, to December 31, 2008. A total of 107,940 prevalent United States hemodialysis patients with 248,680 index hospital …

Nephropathology Education During Nephrology Fellowship Training In The United States, V. Mechery, T. Hernandez, A. T. Mathew, R. Wanchoo, S. V. Seshan, K. D. Jhaveri, H. H. Shah

Journal Articles

No abstract provided.

Prevalence Of Proteinuria And Albuminuria In An Obese Population And Associated Risk Factors., J. L. Rosenstock, M. Pommier, G. Stoffels, S. Patel, M. F. Michelis

Journal Articles

Obesity has been increasingly recognized as a risk factor for kidney disease and both proteinuria and microalbuminuria have been associated with obesity. The actual prevalence of microalbuminuria and proteinuria in obese patients in the United States (US) has not been clearly described in the literature. Furthermore, obesity is associated with risk factors of kidney disease, such as diabetes and hypertension (HTN), and the prevalence of proteinuria and albuminuria excluding these risk factors is uncertain. In this study, we collected urine albumin/creatinine and urine protein/creatinine ratios on obese patients undergoing bariatric surgery to determine the prevalence of albuminuria and proteinuria in …

Nicotine Enhances Mesangial Cell Proliferation And Fibronectin Production In High Glucose Milieu Via Activation Of Wnt/Beta-Catenin Pathway, X. Lan, H. Wen, R. Aslam, S. S. Shoshtari, A. Mishra, V. Kumar, H. Wang, G. Wu, A. Malhotra, P. C. Singhal, +1 Additional Author

Journal Articles

No abstract provided.

Prevalence Of Proteinuria And Albuminuria In An Obese Population And Associated Risk Factors, J. L. Rosenstock, M. Pommier, G. Stoffels, S. Patel, M. F. Michelis

Journal Articles

©2018 Rosenstock, Pommier, Stoffels, Patel and Michelis. Obesity has been increasingly recognized as a risk factor for kidney disease and both proteinuria and microalbuminuria have been associated with obesity. The actual prevalence of microalbuminuria and proteinuria in obese patients in the United States (US) has not been clearly described in the literature. Furthermore, obesity is associated with risk factors of kidney disease, such as diabetes and hypertension (HTN), and the prevalence of proteinuria and albuminuria excluding these risk factors is uncertain. In this study, we collected urine albumin/creatinine and urine protein/creatinine ratios on obese patients undergoing bariatric surgery to determine …

Modulation Of Apolipoprotein L1-Microrna-193a Axis Prevents Podocyte Dedifferentiation In High-Glucose Milieu, A. Mishra, K. Ayasolla, V. Kumar, X. Lan, H. Vashistha, R. Aslam, A. Hussain, S. Chowdhary, A. Malhotra, P. C. Singhal, +6 Additional Authors

Journal Articles

No abstract provided.

Intravenous Epoetin Alfa-Epbx Versus Epoetin Alfa For Treatment Of Anemia In End-Stage Kidney Disease, S. Fishbane, B. Singh, S. Kumbhat, W. A. Wisemandle, N. E. Martin

Journal Articles

© 2018 by the American Society of Nephrology. Background and objectives This study was conducted to compare the safety and efficacy of intravenous epoetin alfa-epbx, an epoetin alfa biosimilar, to epoetin alfa in patients on hemodialysis with ESKD and anemia. Design, setting, participants, & measurements In this 24-week, multicenter, double-blind comparative efficacy and safety study, 612 patients on hemodialysis with ESKD and anemia who had stable hemoglobin and were receiving stable doses of intravenous epoetin alfa were randomized (1:1) to intravenous epoetin alfa or epoetin alfa-epbx. Dosing was adjusted according to the epoetin alfa prescribing information. The coprimary efficacy endpoints …

Apol1 Risk Variants Cause Podocytes Injury Through Enhancing Endoplasmic Reticulum Stress, H. Wen, V. Kumar, X. Lan, S. S. Shoshtari, J. M. Eng, X. Zhou, F. Wang, H. Wang, A. Malhotra, P. C. Singhal, +4 Additional Authors

Journal Articles

c 2018 The Author(s). Two coding sequence variants (G1 and G2) of Apolipoprotein L1 (APOL1) gene have been implicated as a higher risk factor for chronic kidney diseases (CKD) in African Americans when compared with European Americans. Previous studies have suggested that the APOL1 G1 and G2 variant proteins are more toxic to kidney cells than the wild-type APOL1 G0, but the underlying mechanisms are poorly understood. To determine whether endoplasmic reticulum (ER) stress contributes to podocyte toxicity, we generated human podocytes (HPs) that stably overexpressed APOL1 G0, G1, or G2 (Vec/HPs, G0/HPs, G1/HPs, and G2/HPs). Propidium iodide staining showed …

Relevance Of B-Lines On Lung Ultrasound In Volume Overload And Pulmonary Congestion: Clinical Correlations And Outcomes In Patients On Hemodialysis., Marc M Saad, Jeanne Kamal, E. Moussaly, B. Karam, W. Mansour, Emad Gobran, Saqib Hussen Abbasi, Ahmed Mahgoub, Puja Singh, Ross Hardy, D. Das, C. Brown, M. Kapoor, S. Demissie, M. J. Kleiner, E. El Charabaty, S. E. El Sayegh

Journal Articles

BACKGROUND: Volume overload in patients on hemodialysis (HD) is an independent risk factor for cardiovascular mortality. B-lines detected on lung ultrasound (BLUS) assess extravascular lung water. This raises interest in its utility for assessing volume status and cardiovascular outcomes.

METHODS: End-stage renal disease patients on HD at the Island Rehab Center being older than 18 years were screened. Patients achieving their dry weight (DW) had a lung ultrasound in a supine position. Scores were classified as mild (0-14), moderate (15-30), and severe (>30) for pulmonary congestion. Patients with more than 60 were further classified as very severe. Patients were …

The Social Media Revolution In Nephrology Education, G. B. Colbert, J. Topf, K. D. Jhaveri, T. Oates, M. N. Rheault, S. Shah, S. Hiremath, M. A. Sparks

Journal Articles

© 2018 International Society of Nephrology The past decade has been marked by the increasing use of social media platforms, often on mobile devices. In the nephrology community, this has resulted in the organic and continued growth of individuals interested in using these platforms for education and professional development. Here, we review several social media educational resources used in nephrology education and tools including Twitter, videos, blogs, and visual abstracts. We will also review how these tools are used together in the form of games (NephMadness), online journal clubs (NephJC), interactive learning (GlomCon), and digital mentorship (Nephrology Social Media Collective …

Chimeric Antigen Receptor T Cell Therapy And The Kidney What The Nephrologist Needs To Know, K. D. Jhaveri, M. H. Rosner

Journal Articles

No abstract provided.

Lung Ultrasonography In End-Stage Renal Disease: Moving From Evidence To Practice-A Narrative Review, D. W. Ross, M. M. Abbasi, K. D. Jhaveri, M. Sachdeva, I. Miller, R. Barnett, M. Narasimhan, P. Mayo, M. Merzkani, A. T. Mathew

Journal Articles

© The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. Traditionally, point of care ultrasonography in nephrology has been used for renal biopsies and dialysis line placement. However, there is an emerging literature supporting the value of point of care lung ultrasonography in the assessment of volume status for dialysis patients.We conducted a review and identified 12 studies that examined the utility of lung ultrasonography in assessing volume status in patients with end-stage renal disease.We conclude that lung ultrasonography can be used to determine volume status in chronic dialysis patients by identifying lung congestion using the B-line …

Opportunities For Increasing The Rate Of Preemptive Kidney Transplantation, S. Fishbane, V. Nair

Journal Articles

No abstract provided.

Medication Discrepancies In Late-Stage Chronic Kidney Disease., J. Ibrahim, A. D. Hazzan, A. T. Mathew, V. Sakhiya, M. Zhang, C. Halinski, S. Fishbane

Journal Articles

Background: Late-stage chronic kidney disease (LS-CKD) can be defined by glomerular filtration rate (GFR) 0-30 mL/min. It is a period of risk for medication discrepancies because of frequent hospitalizations, fragmented medical care, inadequate communication and polypharmacy. In this study, we sought to characterize medication discrepancies in LS-CKD.

Methods: We analyzed all patients enrolled in Northwell Health's Healthy Transitions in LS-CKD program. All patients had estimated GFR 0-30 mL/min, not on dialysis. Medications were reviewed by a nurse at a home visit. Patients' medication usage and practice were compared with nephrologists' medication lists, and discrepancies were characterized. Patients were categorized as …

Nephrologists As Educators: Clarifying Roles, Seizing Opportunities, K. D. Jhaveri, M. A. Perazella

Journal Articles

Nephrologists play an important role in providing medical education in a variety of settings, including the medical school classroom, nephrology consult service, outpatient clinic, and dialysis unit. Therefore, nephrologists interact with a variety of learners. In this article the current state of published literature in medical education in nephrology is reviewed. Eight attending roles are identified of the nephrologist as a medical educator in the academic settings: inpatient internal medicine service, nephrology inpatient consult service, inpatient ESRD service, outpatient nephrology clinic, kidney transplantation, dialysis unit, classroom teacher, and research mentor. Defining each of these distinct settings could help to promote …

Angiotensin Ii Down-Regulates Nephrin-Akt Signaling And Induces Podocyte Injury: Roleof C-Abl, Q. Yang, Y. Ma, Y. Liu, W. Liang, X. Chen, Z. Ren, H. Wang, P. C. Singhal, G. Ding

Journal Articles

Recent studies have shown that nephrin plays a vital role in angiotensin II (Ang II)-induced podocyte injury and thus contributes to the onset of proteinuria and the progression of renal diseases, but its specific mechanism remains unclear. c-Abl is an SH2/SH3 domain-containing nonreceptor tyrosine kinase that is involved in cell survival and regulation of the cytoskeleton. Phosphorylated nephrin is able to interact with molecules containing SH2/SH3 domains, suggesting that c-Abl may be a downstream molecule of nephrin signaling. Here we report that Ang II-infused rats developed proteinuria and podocyte damage accompanied by nephrin dephosphorylation and minimal interaction between nephrin and …

Quality Measurement In Wonderland: The Curious Case Of A Dialysis Readmissions Measure, S. Fishbane, J. B. Wish

Journal Articles

The standardized readmission ratio is a new quality measure for dialysis facilities that will affect public reporting and payment beginning in 2017. Like all quality measures affecting public reporting and payment, the standardized readmission ratio was vetted by a process that included a technical expert panel convened by the US Centers for Medicare and Medicaid Services, and, then, the National Quality Forum. Unlike previous measures, standardized readmission ratio followed a tortuous path that exposed problems in the development and endorsement process. Although it is acknowledged that processes in the dialysis facility can be improved to decrease readmissions, multiple objections to …

On The Safety Of Intravenous Iron, Evidence Trumps Conjecture, M. Auerbach, J. Adamson, A. Bircher, C. Breymann, S. Fishbane, A. Gafter-Gvili, C. Gasche, J. Gilreath, G. Grazzini, A. Shander, +7 Additional Authors

Journal Articles

No abstract provided.

Ferric Pyrophosphate Citrate (Triferic) Administration Via The Dialysate Maintains Hemoglobin And Iron Balance In Chronic Hemodialysis Patients, S. N. Fishbane, A. K. Singh, S. H. Cournoyer, K. K. Jindal, P. Fanti, C. D. Guss, V. H. Lin, R. D. Pratt, A. Gupta

Journal Articles

BACKGROUND: Administration of ferric pyrophosphate citrate (FPC, Triferic) via hemodialysate may allow replacement of ongoing uremic and hemodialysis-related iron losses. FPC donates iron directly to transferrin, bypassing the reticuloendothelial system and avoiding iron sequestration. METHODS: Two identical Phase 3, randomized, placebo-controlled trials (CRUISE 1 and 2) were conducted in 599 iron-replete chronic hemodialysis patients. Patients were dialyzed with dialysate containing 2 microM FPC-iron or standard dialysate (placebo) for up to 48 weeks. Oral or intravenous iron supplementation was prohibited, and doses of erythropoiesis-stimulating agents were held constant. The primary efficacy end point was the change in hemoglobin (Hgb) concentration from …

Full-Length Soluble Urokinase Plasminogen Activator Receptor Down-Modulates Nephrin Expression In Podocytes, M. Alfano, P. Cinque, G. Giusti, S. Proietti, M. Nebuloni, S. Danese, S. D'Alessio, M. Genua, P. C. Singhal, J. Mikulak, +5 Additional Authors

Journal Articles

Increased plasma level of soluble urokinase-type plasminogen activator receptor (suPAR) was associated recently with focal segmental glomerulosclerosis (FSGS). In addition, different clinical studies observed increased concentration of suPAR in various glomerular diseases and in other human pathologies with nephrotic syndromes such as HIV and Hantavirus infection, diabetes and cardiovascular disorders. Here, we show that suPAR induces nephrin down-modulation in human podocytes. This phenomenon is mediated only by full-length suPAR, is time-and dose-dependent and is associated with the suppression of Wilms' tumor 1 (WT-1) transcription factor expression. Moreover, an antagonist of alpha v beta 3 integrin RGDfv blocked suPAR-induced suppression of …

Harvest, A Longitudinal Patient Record Summarizer, J. S. Hirsch, J. S. Tanenbaum, S. Lipsky Gorman, C. Liu, E. Schmitz, D. Hashorva, A. Ervits, D. Vawdrey, M. Sturm, N. Elhadad

Journal Articles

OBJECTIVE: To describe HARVEST, a novel point-of-care patient summarization and visualization tool, and to conduct a formative evaluation study to assess its effectiveness and gather feedback for iterative improvements. MATERIALS AND METHODS: HARVEST is a problem-based, interactive, temporal visualization of longitudinal patient records. Using scalable, distributed natural language processing and problem salience computation, the system extracts content from the patient notes and aggregates and presents information from multiple care settings. Clinical usability was assessed with physician participants using a timed, task-based chart review and questionnaire, with performance differences recorded between conditions (standard data review system and HARVEST). RESULTS: HARVEST displays …

Hypersensitivity To Intravenous Iron: Classification, Terminology, Mechanisms And Management, J. Szebeni, S. Fishbane, M. Hedenus, S. Howaldt, F. Locatelli, S. Patni, D. Rampton, G. Weiss, J. Folkersen

Journal Articles

Intravenous (IV) iron therapy is widely used in iron deficiency anemias when oral iron is not tolerated or ineffective. Administration of IV iron is considered a safe procedure, but severe hypersensitivity reactions (HSRs) can occur at a very low frequency. Recently, new guidelines have been published by the European Medicines Agency (EMA) with the intention of making IV-iron therapy safer; however, the current protocols are still non-specific, non-evidence-based empiric measures which neglect the fact that the majority of IV-iron reactions are not Ig-E-mediated anaphylactic reactions. The field would benefit from new specific and effective methods for the prevention and treatment …

Integrating Real Time Data To Improve Outcomes In Acute Kidney Injury, J. S. Hirsch, S. Mohan

Journal Articles

Critically ill patients with acute kidney injury requiring renal replacement therapy have a poor prognosis. Despite well-known factors, which contribute to outcomes, including dose delivery, patients frequently miss the target dose and volume removal. One major barrier to effective care of these patients is the traditional dissociation of dialysis device data from other clinical information systems, notably the electronic health record (EHR). This lack of integration and the resulting manual documentation leads to errors and biases in documentation and missed opportunities to intervene in a timely fashion. This review summarizes the technological advancements facilitating direct connection of dialysis devices to …

Apolipoprotein L1 (Apol1) Variants (Vs) A Possible Link Between Heroin-Associated Nephropathy (Han) And Hiv-Associated Nephropathy (Hivan), X. Lan, T. K. Rao, P. N. Chander, K. Skorecki, P. C. Singhal

Journal Articles

In 1970s, Heroin-associated Nephropathy (HAN), one form of focal and segmental glomerulosclerosis (FSGS), was a predominant cause of End-stage Kidney Disease (ESKD) in African-Americans (AAs). In 1980s, with the surge of Acquired Immune Deficiency Syndrome (AIDS) in AAs, HAN more or less disappeared, and the incidence of Human Immunodeficiency Virus associated Nephropathy (HIVAN) markedly increased. Recent studies in AAs have identified APOL1 variants (Vs) as a major risk factor for the development and progression of non-diabetic kidney diseases including idiopathic FSGS and hypertension-attributed nephrosclerosis. These observations have also offered partial insights into the mechanisms of development, and higher rate of …

Cardiorenal Syndrome And The Role Of The Bone-Mineral Axis And Anemia, D. M. Charytan, S. Fishbane, J. Malyszko, P. A. Mccullough, D. Goldsmith

Journal Articles

The association between chronic kidney disease (CKD) and cardiovascular disease (CVD) is well established, and there is mounting evidence of interorgan cross talk that may accelerate pathologic processes and the progression of organ dysfunction in both systems. This process, termed cardiorenal syndrome (CRS) by the Acute Dialysis Quality Initiative, is considered a major health problem: patients with CKD and CVD are at much higher risk of mortality than patients with either condition alone. To date, the majority of CRS research has focused on neurohormonal mechanisms and hemodynamic alterations. However, mounting evidence suggests that abnormalities in the normal pathophysiology of the …