Renal Section

Head of Westport, MA, United States

Renal Section

Head of Westport, MA, United States
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Shari M. Ling, MD has been selected to receive the first-ever Public Service Award from NKF, established to honor those who have dedicated their careers to public service and who have helped to shape public policies or government programs that improve outcomes for kidney patients.  Dr. Ling currently serves as the Deputy Chief Medical Officer for the Centers for Medicare and Medicaid Services (CMS) and Medical Officer in the Center for Clinical Standards and Quality (CCSQ).  In her role at CMS, she assists the CMS Chief Medical Officer in the agency's pursuit of better health care, healthier populations and smarter spending. Dr. Ling's committed focus is on the achievement of meaningful health outcomes for patients and families through the delivery of high quality, person-centered care, across all care settings. Her clinical focus and scientific interest is in the care of persons with dementia, multiple chronic conditions and functional limitations. Derek Forfang, a kidney patient and long-time kidney disease advocate, has been selected to receive the first-ever Celeste Castillo Lee Patient Engagement Award, established in honor of Celeste Castillo Lee, a longtime advocate for patient-centered care and empowerment. It is the highest honor given by NKF to a distinguished kidney patient who exemplifies NKF's mission and Celeste's legacy of putting patients at the center of all aspects of healthcare through their involvement with NKF and community partners.  Mr. Forfang, of San Pablo, California, has been an end-stage renal disease (ESRD) patient since 1999.  He received a kidney transplant and has also been on peritoneal dialysis and hemodialysis.  A regional leader of NKF's Kidney Advocacy Committee and a member of the Public Policy Committee, Derek has worked tirelessly to protect and improve care for the kidney community. Merck been selected to receive the 2017 Corporate Innovator Award which recognizes industry partners that advance the field of nephrology by addressing an unmet medical need, or improving upon an existing practice, therapeutic or technology.  Merck's innovative new treatment for hepatitis C, ZEPATIER, is the only direct anti-viral agent specifically tested and approved for use in patients with chronic kidney disease stages four and five. Paul Palevsky, MD has been selected to receive the Dr. J. Michael Lazarus Distinguished Award established to honor Dr. Lazarus for his major contributions to the clinical science and care of dialysis patients, and to recognize individuals whose research has yielded novel insights related to renal replacement therapy.  Dr. Palevsky is Professor of Medicine and Clinical and Translational Science in the Renal-Electrolyte Division at the University of Pittsburgh School of Medicine; and serves as Chief of the Renal Section at the VA Pittsburgh Healthcare System.  Dr. Palevsky's research has primarily focused on acute kidney injury and critical care nephrology. He will be presenting the Lazarus lecture on "We Don't Have to Fail at Acute Renal Failure: A Multidisciplinary Approach to Quality Improvement" on Friday, April 21st at 8:45 a.m. at the NKF Spring Clinical Meetings. Susanne Nicholas, MD, MPH, PhD has been selected to receive the Medical Advisory Board Distinguished Service Award established to recognize an individual for their educational activities and community service in promoting the mission of NKF on a local level.  Dr. Nicholas is a tenured Associate Professor of Medicine at UCLA in the Division of Nephrology where she maintains her clinical responsibilities, and the Division of Endocrinology, Diabetes and Hypertension, where she conducts research.  She is also a Clinical Hypertension Specialist.   Dr. Nicholas' research interests include understanding and identifying key factors that promote the pathogenesis of diabetic kidney disease (DKD); uncovering and validating novel biomarkers that may predict DKD progression; and quantifying renal structural changes associated with DKD in response to novel therapeutics, using stereology principles. Her research over the past 15 years has led to the identification of a novel biomarker of DKD, which is currently being validated in clinical studies. Katherine R. Tuttle, MD, FASN, FACP, FNKF, has been selected to receive the prestigious Garabed Eknoyan Award, created to recognize an individual who has promoted the mission of NKF in Making Lives Better for people with kidney disease through the exceptional contributions to key initiatives of NKF such as the Kidney Disease Outcomes Quality Initiative (KDOQI) or clinical research in the field of kidney disease.  Dr. Tuttle is the Executive Director for Research at Providence Health Care in Spokane, and serves as Co-Principal Investigator of the Institute of Translational Health Sciences, Investigator at Kidney Research Institute, and Clinical Professor of Medicine for the University of Washington.  Dr. Tuttle's major research interests include diabetic kidney disease, hypertension, renal vascular disease, nutrition in chronic kidney disease, and transitional care.  She has chaired numerous workgroups focused on diabetes and kidney disease including NKF's KDOQI Workgroup for Diabetes and Chronic Kidney Disease. Jonathan Himmelfarb, MD has been selected to receive the Donald W. Seldin Award, established to recognize excellence in clinical nephrology in the tradition of one of the foremost teachers and researchers in the field, Dr. Donald W. Seldin.  Dr. Himmelfarb is a Professor of Medicine, Director of the Kidney Research Institute, and holds the Joseph W. Eschbach, M.D. Endowed Chair in Kidney Research at the University of Washington School of Medicine.   He is the author of more than 200 peer-reviewed publications, has served on numerous grant review committees and scientific advisory boards and has held leadership positions in many national and international nephrology societies.  Dr. Himmelfarb has served on expert panels for the U.S. Food and Drug Administration, Veterans Health Administration, and Centers for Medicare & Medicaid Services. He is also a nephrologist who cares for patients with kidney disease, and an internationally recognized educator about kidney disease. Raymond R. Townsend, MD has been selected to receive the Shaul G. Massry Distinguished Lecture Award, established to honor Dr. Massry for his scientific achievements and contribution to the kidney health care community and to NKF.  Dr. Townsend is Professor of Medicine and an Associate Director of the Center for Human Phenomic Studies at the University of Pennsylvania.  He is currently a Principal Investigator evaluating the role of demographic, phenotypic, humoral and genetic factors in the progression of kidney disease and the development and progression of cardiovascular disease in patients with chronic kidney disease.  He was also the Principal Investigator of a multicenter effort evaluating the specific role of pulse wave velocity in the renal and cardiovascular consequences of chronic kidney disease.   Dr. Townsend led the work group that wrote the KDOQI Commentary on the 2012 KDIGO Guideline on this subject, and most recently co-chaired the NKF workshop on Potassium Homeostasis in Disease and Health, the report on which will soon be published in the American Journal of Kidney Disease and Journal of the American Society of Hypertension. Tilakavati Karupaiah, PhD, APD, AN has been selected to receive the Joel D. Kopple Award, an annual award honoring an individual who has made significant contributions to the field of renal nutrition.  Dr. Karupaiah is an Accredited Practicing Dietitian with Dietitian's Association of Australia, a Professor and Head of the Dietetics Program at the National University of Malaysia; and also Adjunct Associate Professor at Wayne State University, Detroit.    Dr. Karupaiah's involvement in renal nutrition began because of a lack of dietitians in this field in Malaysia, and dialysis patients needed patient-friendly information about local diets. At the National University of Malaysia, she encouraged early exposure of dietetic students to renal patient care through community engagement, outpatient counseling and practical skills on patient diet planning. Dr. Karupaiah is now targeting capacity building mentorship for developing renal dietitians in Malaysia through nutrition research. For the past 26 years, nephrology healthcare professionals from across the country have come to NKF's Spring Clinical Meetings to learn about the newest developments related to all aspects of nephrology practice, network with colleagues, and present their research findings. The NKF Spring Clinical Meetings are designed for meaningful change in the multidisciplinary healthcare teams' skills, performance, and patient health outcomes.  It is the only conference of its kind that focuses on translating science into practice for the entire healthcare team. 1 in 3 American adults is at risk for kidney disease.  26 million American adults have kidney disease—and most aren't aware of it.  Risk factors for kidney disease include diabetes, high blood pressure, family history, and age 60+.  People of African American; Hispanic; Native American; Asian; or Pacific Islander descent are at increased risk for developing the disease.  African Americans are 3 ½ times more likely, and Hispanics 1 ½ times more likely, to experience kidney failure. The National Kidney Foundation (NKF) is the largest, most comprehensive and longstanding organization dedicated to the awareness, prevention and treatment of kidney disease.  For more information about NKF visit :  Full press releases on each award recipient, including quotes for attribution, are hyperlinked by recipient's name and can also be found in the Newsroom at To view the original version on PR Newswire, visit:

Barrett Bowling C.,Birmingham Atlanta Geriatric Research | Plantinga L.,Emory University | Hall R.K.,University of Georgia | Hall R.K.,Emory University | And 5 more authors.
Clinical Journal of the American Society of Nephrology | Year: 2016

Background and objectives The majority of older adults who initiate dialysis do so during a hospitalization, and these patients may require post-acute skilled nursing facility (SNF) care. For these patients, a focus on nondiseasespecific problems, including cognitive impairment, depressive symptoms, exhaustion, falls, impairedmobility, and polypharmacy, may be more relevant to outcomes than the traditional disease-oriented approach. However, the association of the burden of nondisease-specific problems with mortality, transition to long-term care (LTC), and functional impairment among older adults receiving SNF care after dialysis initiation has not been studied. Design, setting, participants, & measurements We identified 40,615 Medicare beneficiaries ≥65 years old who received SNF care after dialysis initiation between 2000 and 2006 by linking renal disease registry data with the Minimum Data Set. Nondisease-specific problems were ascertained from the Minimum Data Set. We defined LTC as ≥100 SNF days and functional impairment as dependence in all four essential activities of daily living at SNF discharge. Associations of the number of nondisease-specific problems (≤1, 2, 3, and 4-6) with 6-month mortality, LTC, and functional impairment were examined. Results Overall, 39.2% of patientswho received SNF care after dialysis initiation diedwithin 6 months.Comparedwith those with ≤1 nondisease-specific problems, multivariable adjusted hazard ratios (95% confidence interval) for mortality were 1.26 (1.19 to 1.32), 1.40 (1.33 to 1.48), and 1.66 (1.57 to 1.76) for 2, 3, and 4-6 nondisease-specific problems, respectively.Among thosewho survived, 37.1% required LTC; of those remainingwho did not require LTC, 74.7% had functional impairment. A higher likelihood of transition to LTC (among thosewho survived 6months) and functional impairment (among those who survived and did not require LTC) was seen with a higher number of problems. Conclusions Identifying nondisease-specific problems may help patients and families anticipate LTC needs and functional impairment after dialysis initiation. © 2016 by the American Society of Nephrology.

Odden M.C.,University of California at Berkeley | Odden M.C.,University of California at San Francisco | Tager I.B.,University of California at Berkeley | Gansevoort R.T.,University of Groningen | And 10 more authors.
Nephrology Dialysis Transplantation | Year: 2010

Background. Kidney function declines with age, but a substantial portion of this decline has been attributed to the higher prevalence of risk factors for kidney disease at older ages. The effect of age on kidney function has not been well described in a healthy population across a wide age spectrum.Methods. The authors pooled individual-level cross-sectional data from 18 253 persons aged 28-100 years in four studies: the Cardiovascular Health Study; the Health, Aging and Body Composition Study; the Multi-Ethnic Study of Atherosclerosis and the Prevention of Renal and Vascular End-Stage Disease cohort. Kidney function was measured by cystatin C. Clinical risk factors for kidney disease included diabetes, hypertension, obesity, smoking, coronary heart disease, cerebrovascular disease, peripheral arterial disease and heart failure.Results. Across the age range, there was a strong, non-linear association of age with cystatin C concentration. This association was substantial, even among participants free of clinical risk factors for kidney disease; mean cystatin C levels were 46 higher in participants 80 and older compared with those <40 years (1.06 versus 0.72 mgL, P < 0.001). Participants with one or more risk factors had higher cystatin C concentrations for a given age, and the age association was slightly stronger (P < 0.001 for age and risk factor interaction).Conclusions. There is a strong, non-linear association of age with kidney function, even in healthy individuals. An important area for research will be to investigate the mechanisms that lead to deterioration of kidney function in apparently healthy persons.

Agaba E.I.,University of Jos | Agaba P.A.,University of Jos | Dankyau M.,Bingham University | Akanbi M.O.,University of Jos | And 4 more authors.
African Journal of Primary Health Care and Family Medicine | Year: 2012

Background: Postgraduate training is aimed at equipping the trainee with the necessary skills to practise as an expert. Non-nephrology specialist physicians render the bulk of pre-end-stage renal disease care for patients with chronic kidney disease (CKD). We sought to ascertain the knowledge of CKD amongst non-nephrology specialist physicians who serve as trainers and examiners for a training, accrediting and certifying body in postgraduate medicine in West Africa. We also compared the knowledge of family physicians and non-nephrology internists. Methods: Self-administered questionnaires were distributed to non-nephrology specialist physicians who serve as examiners for the West African College of Physicians. Results: Only 19 (27.5%) of the respondents were aware of the Kidney Disease Outcomes Quality Initiatives guidelines for CKD management. Twenty five (36.2%) of the respondents had adequate knowledge of CKD. There was no significant difference in the proportion of family physicians and non-nephrology internists who had adequate knowledge of CKD (27.3% vs. 40.4% respectively; p = 0.28). Hypertension and diabetes mellitus were identified by all of the physicians as risk factors for CKD. Non-nephrology internists more frequently identified systemic lupus erythematosus as a risk factor for CKD, urinalysis with microscopy as a laboratory test for CKD evaluation, and bone disease as a complication of CKD than family physicians. Conclusion: There is a lack of adequate CKD knowledge amongst non-nephrology specialist physicians, since many of them are unaware of the CKD management guidelines. Educational efforts are needed to improve the knowledge of CKD amongst non-nephrology specialist physicians. Guidelines on CKD need to be widely disseminated amongst these physicians. © 2012. The Authors.

Seiki S.,Aurora University | Chonchol M.,Aurora University | Cheung A.K.,Renal Section | Cheung A.K.,University of Utah | And 7 more authors.
Clinical Nephrology | Year: 2012

Background: Patients with chronic kidney disease (CKD) not requiring dialysis have a high prevalence of 25-hydroxyvitamin D (25(OH)D) deficiency but the relationship between 25(OH)D levels and metabolic syndrome is unknown in this population. Methods: This study analyzed stored plasma samples from 495 non-diabetic subjects with severe kidney disease, not yet on dialysis, who participated in the homocysteine in kidney and end stage renal disease study. Metabolic syndrome was defined as the presence of all three of the following: (1) Serum triglycerides ≥ 150 mg/dl or drug treatment for hypertriglyceridemia; (2) serum high density lipoprotein-cholesterol (HDL-C) < 50 mg/dl for women or < 40 mg/dl for men or drug treatment for dyslipidemia; and (3) blood pressure ≥ 130/85 mmHg or drug treatment for hypertension. Multivariate logistic regression models were used to evaluate the cross-sectional association between plasma 25(OH)D levels and metabolic syndrome. Results: The prevalence of metabolic syndrome increased as 25(OH)D levels declined, with the highest prevalence in participants with 25(OH)D levels < 20 ng/ ml. Participants with 25(OH)D levels < 20 ng/ml had a significantly increased risk of metabolic syndrome compared to subjects with levels > 30 ng/ml after adjustment for multiple confounders (OR 2.25, 95% CI 1.25 - 4.07). Plasma 25(OH)D levels were inversely associated with diastolic blood pressure (R = -0.10, p = 0.029) and serum triglyceride levels (R = -0.14, p = 0.002). Conclusion: 25(OH)D deficiency is strongly associated with an increased risk of metabolic syndrome in non-diabetic patients with severe CKD not yet on dialysis, independent of cardiometabolic risk factors and other important regulators of mineral metabolism. © 2012 Dustri-Verlag Dr. K. Feistle.

Paredes J.,Rangos Research Center | Sims-Lucas S.,Rangos Research Center | Wang H.,Renal Section | Lu W.,Renal Section | And 5 more authors.
American Journal of Physiology - Renal Physiology | Year: 2011

Vesicoureteral reflux (VUR) is a common pediatric anomaly linked to renal scarring and hypertension. Although there are many mouse VUR models, cystograms have previously only been performed in euthanized animals, thus preventing serial assessments for VUR in the same animal and not delineating "live" physiology. Our purpose was to develop a live murine cystogram assay that could be used serially to track reflux. We injected microbubbles via transurethral catheters into bladders of C57BL6/J and C3H/HeJ inbred mouse strains that are known to have low and high VUR rates, respectively. We performed ultrasound to visualize microbubbles in the renal pelvis to determine feasibility of the procedure. We then repeated the microbubble ultrasound using a transducer allowing for visualization of both kidneys and ureters simultaneously and for 3 dimensional (3D) reconstruction. We then performed "euthanized" cystograms on all mice for comparison. C3H/HeJ mice had a strong and persistent microbubble signal in the renal pelvis and ureters bilaterally with low-contrast infusion volumes (<100 μ1) and similarly showed bilateral reflux by euthanized cystograms. With larger infused volumes (≥150 μl), C57BL6/J mice had small volumes of microbubbles in the renal pelvis that cleared quickly and did not show reflux on euthanized cystograms. Thus, using animal models of known VUR, we demonstrate the utility of contrastenhanced ultrasound to visualize reflux in live mice. © 2011 the American Physiological Society.

Srivaths P.,Renal Section | Krishnamurthy R.,Baylor College of Medicine | Brunner L.,Cincinnati Childrens Hospital Medical Center | Logan B.,Cincinnati Childrens Hospital Medical Center | And 4 more authors.
Clinical Nephrology | Year: 2014

Background: Children receiving maintenance dialysis exhibit high cardiovascular (CV) associated mortality. We and others have shown high prevalence of cardiac calcifications (CC) in children with endstage renal disease (ESRD). However, no pediatric study has examined modality difference in CC prevalence. The current study was conducted to assess for a difference in CC prevalence between hemodialysis (HD) and peritoneal dialysis (PD) in children with ESRD. Methods: 38 patients (19 female, 19 male; mean age 15.5 ± 4.1 years) receiving dialysis (21 HD, 17 PD) were included in the study. CC were assessed by ultrafast gated CT and quantified by Agatston score. Patients received thrice weekly HD for 3-3.5 hours or daily continuous cycler PD (CCPD). FGF 23, IL-6, IL-8, and CRP levels were obtained at time of CT. Time-averaged (6 months prior to CT) serum Ca, P, Alb, iPTH, and cholesterol levels were obtained. Patients on aspirin, with evidence of infection, underlying collagen vascular disease were excluded. Results: CC were present in 11/38 patients, but more prevalent in HD vs. PD (9/21 vs. 2/17, p = 0.04). Subjects with CC were older (p = 0.0003), had longer dialysis vintage (p = 0.02) and higher serum phosphorus (p = 0.02) and FGF 23 levels (p = 0.03). HD patients also had significantly higher phosphorus (p = 0.02), FGF 23 (p = 0.009), and IL-8 levels (p = 0.02) when compared to PD patients. Residual renal function was not different between modalities or patients with CC. On a multinomial regression model, modality, and age remained independent associations for CC prevalence. Conclusion: We have shown that pediatric patients receiving CCPD have lower CC prevalence conferring lower CV risk. The better control of mineral imbalance in patients receiving PD may play an important role in lower CC prevalence. © 2014 Dustri-Verlag Dr. K. Feistle.

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