2018 Research Grant Recipients

 

Project: A Pilot Randomized-Controlled Trial of Integrated Palliative and Nephrology Care versus Standard Nephrology
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.

 

 

Project: Preventing Deceased Donor Kidney Discard by Improving Organ Quality Assessment
Syed Husain, Columbia University Medical Center; New York, NY

 

Kidney transplantation is the best treatment for patients with kidney failure, but a shortage of donated kidneys in the United States means many patients die before getting a transplant. Many kidneys donated after death are never used, so one solution to this problem is to use more of these discarded kidneys. To do so safely we need a better way to tell which kidneys are good enough to use. We can use kidney biopsies to further examine donated kidneys under a microscope, but these biopsies lead to usable kidneys being thrown away when interpreted incorrectly. This project will develop a simplified biopsy scoring system to make it easier to correctly interpret biopsy results, then make a formula to help doctors combine biopsy results with other information to compare the overall quality of kidneys from different donors. This will result in more patients getting transplanted and shorter wait times for transplants.

 

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.

 

 

Project: Super-Resolution Ultrasound for Assessment of Kidney Vasculature
Roderick Tan, University of Pittsburgh, Pittsburgh, PA

 

Accurate assessment of kidney disease is vitally important for optimal patient care and management. The network of small blood vessel in the kidney (i.e. microvasculature) is a key determinant of the overall health of the kidney. Reduction in vessel numbers are predictive of worsening kidney disease. Current ultrasound technology is limited and can give only a rough estimate of vessel numbers, but new breakthroughs in super-resolution ultrasound (SRU) are making it possible to evaluate the microvasculature with greater accuracy and have never before been applied to human kidney disease. We hypothesize that microvascular density determined by SRU will be capable of differentiating individuals with kidney disease from normal individuals, and that SRU can predict which patients will have worsening disease after injury. This would have significant implications for our ability to stage and manage patients, and would additionally provide a measurable marker for future novel therapies.

 

 

Project: Taking Charge of Your Kidney Disease: Longitudinal Patient Education Program
Daphne Knicely, Johns Hopkins University School of Medicine, Baltimore, MD

 

About 23% of patients with chronic kidney disease (CKD) have trouble accessing and understanding basic health information. This low "health literacy" can result in missed appointments, more emergency department/hospital visits, less kidney transplantation, and increased mortality. Health literacy can be modified through educational interventions. National guidelines recommend that patients and family/caregivers be educated about kidney disease and treatment. This pilot study will establish a longitudinal patient education program for patients with CKD stage 4 or higher along with family/caregivers. The program will meet over 12 sessions to cover different components of CKD in an in-depth manner. Sessions will be led by a nephrologist and expert patient moderator, and include a variety of educational strategies to engage multiple learning styles.