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  Bardoxolone

  Bardoxolone methyl was associated with improvement in the estimated GFR in patients with advanced CKD and type 2 diabetes at 24 weeks. The improvement persisted at 52 weeks, suggesting that bardoxolone methyl may have promise for the treatment of CKD. (N Engl J Med. 2011 Jun 24) Is this GFR improvement due to hyperfiltration? related to weight loss? effect on degree of proteinuria/ microalbuminuria? As Phase III commences, ...more »

  Bardoxolone methyl was associated with improvement in the estimated GFR in

  patients with advanced CKD and type 2 diabetes at 24 weeks. The improvement

  persisted at 52 weeks, suggesting that bardoxolone methyl may have promise for

  the treatment of CKD. (N Engl J Med. 2011 Jun 24)

  Is this GFR improvement due to hyperfiltration? related to weight loss? effect on degree of proteinuria/ microalbuminuria?

  As Phase III commences, what other measures of renal function should be evaluated?

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  7 comments for Idea: Bardoxolone

  Submitted by Edgar Lerma 1 year ago

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  The pathogenesis of sickle cell nephropathy

  Renal complications occur commonly in sickle cell disease and contribute to the morbidity and mortality that occur in this patient population. A better understanding of the pathogenesis of this major complication of this disease may offer new therapeutic insights.

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  Submitted by Karl Nath 2 years ago

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  What are the genetics for the congenital anomalies of the kidney

  Congenital anomalies of the kidney and the urinary tract (CAKUT) represent a major source of morbidity and mortality in children. Understanding the pathways involved in these anomalies is essential for prevention and has broad implications in patients with kidney and urinary tract malformations.

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  Submitted by Augusto Cesar S S Jr 2 years ago

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  Obesity and resistance to diuretics.

  We encounter more obese people with fluid retention, resistant to diuretics. This is not explained clearly. There are "causes" to be discovered.

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  Submitted by Sinasi Salman 2 years ago

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  New tools to reverse glomerular fibrosis and sclerosis

  The development of CKD and its progression may have few clinical symptoms, this will lead to delayed CKD diagnosis when kidney damage is advanced and glomerular fibrosis and sclerosis are already established. The development of new therapeutic tools aimed to reverse chronic kidney lesions as glomerular fibrosis and sclerosis may be very helpful.

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  Submitted by Maria Jose Soler 2 years ago

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  Sequella of chronic renal disease

  I think the future of renal research will be to broadly define our areas of interest as a community. Chronic renal disease touches hypertension, cardiovascular disease, metabolic diseases etc. I believe NIDDK has to support cutting edge research in all these areas, whether or not the work strictly focuses on the kidney

  1 comment for Idea: Sequella of chronic renal disease

  Submitted by ken bernstein 2 years ago

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  Direct renin inhibitors vs. ACEI/ARB for CKD

  Theoretical grounds suggest that direct renin inhibitors (Aliskiren) may be superior at slowing CKD progression compared to ACE-inhibitors or ARB, and is supported by some animal studies. Renoprotective effect in humans has been demonstrated, but whether this represents "superiority" remains an unanswered question. Larger trials, including head-to-head comparisons are needed to determine whether direct renin inhibition ...more »

  Theoretical grounds suggest that direct renin inhibitors (Aliskiren) may be superior at slowing CKD progression compared to ACE-inhibitors or ARB, and is supported by some animal studies. Renoprotective effect in humans has been demonstrated, but whether this represents "superiority" remains an unanswered question.

  Larger trials, including head-to-head comparisons are needed to determine whether direct renin inhibition provides superior protection against CKD progression, or might replace or supplant ACE/ARB as the standard of care.

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  Submitted by Bruce Carter 2 years ago

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  Approaching mineral disorders after parathyroidectomy

  Often parathyroidectomy results in unsuccessful treatment. The recurrence of hyperparathyroidism or (on the opposite side) the apearance of the hypoparathyroidism have critical long term consequences to the chronic renal patient. New approaches and investigations are needed.

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  Submitted by Augusto Cesar S S Jr 2 years ago

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  validation of eGFR formulae

  Various formulae for estimating GFR and defining CKD are available; but when it comes to screening for CKD in developing countries, it gets hampered due to lack of validation in native population. Large scaled multicentric studies need to be carried out to set up local correction factors to account for racial differences.

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  Submitted by Anupama Janardhana 2 years ago

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  CKD in South Asian populations

  Several studies have shown that persons of South Asian descent are at high risk of cardiovascular disease. Less is known about the prevalence and progression of CKD in south asians. Studies that validate measurement of GFR, evaluate risk factors for progression of CKD, CVD and other outcomes will important in this growing segment of the population

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  Submitted by Mahboob Rahman 2 years ago

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  Progression in Non Diabetic, Non Hypertensive CKD

  Once we calculate eGFR through any equation What is the progress in Non Diabetic non Hypertensive pts?

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  Submitted by DR NARINDER PAL SINGH 2 years ago

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  Kidney function in aging

  Renal function is thought to inevitably decline with chronological age, however the rate and even the existence of reduced renal function varies widely in the general public. Clearly more data is needed to dissect the underlying causes and consequences of declining renal function, and new thoughts about how to determine whether it represents a significant risk to the individual person. Finally, the means to interfere ...more »

  Renal function is thought to inevitably decline with chronological age, however the rate and even the existence of reduced renal function varies widely in the general public. Clearly more data is needed to dissect the underlying causes and consequences of declining renal function, and new thoughts about how to determine whether it represents a significant risk to the individual person. Finally, the means to interfere with the "inevitability" remains as an open question.

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  Submitted by Gary Striker 2 years ago

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  the care needs of young and emerging adults with CKD

  Transitioning from pediatric to adult care is talked about at every peds-related conference. We need to move beyond struggling with institutional transitioning programs and focus on the needs, outcomes, and experience of young adults who have grown up and survived with kidney disease. Adult-oriented nephrology and primary care practices needs to be ready to provide developmentally appropriate care to young and emerging ...more »

  Transitioning from pediatric to adult care is talked about at every peds-related conference. We need to move beyond struggling with institutional transitioning programs and focus on the needs, outcomes, and experience of young adults who have grown up and survived with kidney disease. Adult-oriented nephrology and primary care practices needs to be ready to provide developmentally appropriate care to young and emerging adults. While understanding outcomes for patients is vital, new initiatives in training adult nephrology fellows (along with primary care and family medicine)to care for those with congenital and childhood-acquired kidney disease are equally so.

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  Submitted by Maya Doyle 2 years ago

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  Optimizing functioning and health through physical activity

  Patients with CKD, regardless of stage, have low functioning and physical activity. How can we effectively and efficiently incorporate physical activity into the routine care of these patients to optimize physical function, overall health and quality of life?

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  Submitted by Patricia Painter 2 years ago

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  Bone Disease in CKD

  Study toxins impeding bone integrity. One of more common exposures: Fluoride in CKD.

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  Submitted by Emmy Bell 2 years ago

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  Pain management in CKD

  Pain is common and is underrecognized and under-treated in chronic kidney disease (CKD). Often these patients with various co-morbidities undergo operative procedures and require analgesics. The most-responsible physician providing the care to these individuals during their hospitalization is often a non-nephrologist. Opioids are commonly used in the management of both acute and chronic pain, and often a standard dose ...more »

  Pain is common and is underrecognized and under-treated in chronic kidney disease (CKD). Often these patients with various co-morbidities undergo operative procedures and require analgesics. The most-responsible physician providing the care to these individuals during their hospitalization is often a non-nephrologist. Opioids are commonly used in the management of both acute and chronic pain, and often a standard dose is used by the health-care providers without taking into consideration the kidney function. Prolonged narcotic effects and ventilatory depression due to morphine and other opioids have been known for over a century in patients with kidney failure. The exact incidence is not known but it occurs in over half of the patients with chronic kidney disease. Despite the increased potential for respiratory depression, especially in patients with chronic kidney disease, life-threatening cases of opiate toxicity continue to occur not only in patients with kidney disease but also in patients without kidney disease. It is important to evaluate and highlight the issue of central nervous system (CNS) and respiratory depression with opioid analgesics in patients with chronic kidney disease and then formulate strategies to prevent these complications, while providing effective pain relief.

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  Submitted by Witty Kidney 2 years ago

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  Management of Osteoporosis in CKD

  What is the ideal regimen for managing osteoporosis in patients with CKD/ ESRD?

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  Submitted by Edgar Lerma 2 years ago

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  Anemia management in sickle cell nephropathy

  Sickle Cell Nephropathy patients frequently present as management challenges in terms of anemia. Certainly, the recent updated NKF/ KDOQI Guidelines on Anemia Management in CKD cannot be applied to this unique population. Is there any evidence-based guideline or recommendation that will solve this dilemma?

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  Submitted by Edgar Lerma 2 years ago

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  Intensive vs. Standard Therapy for slowing CKD

  Researchers affiliated with the Mario Negri Institute and other institutions in Italy have developed a "Remission Clinic" intervention protocol and have reported achieving substantial (on the order of 90%) reductions in GFR decline, observed ESRD, and projected ESRD, with delays ranging from 12 (all subjects) to 21 years (nondiabetics). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2396935/ http://clinicalweb.marionegri.it/remission/letteratura.php ...more »

  Researchers affiliated with the Mario Negri Institute and other institutions in Italy have developed a "Remission Clinic" intervention protocol and have reported achieving substantial (on the order of 90%) reductions in GFR decline, observed ESRD, and projected ESRD, with delays ranging from 12 (all subjects) to 21 years (nondiabetics).

  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2396935/

  http://clinicalweb.marionegri.it/remission/letteratura.php

  A more recent randomized trial again found substantial slowing (greater than 50%) of CKD progression:

  http://www.ncbi.nlm.nih.gov/pubmed/20097461

  Such findings warrant validation through larger multi-center trials, as such remarkable results would represent a significant improvement in prognosis.

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  1 comment for Idea: Intensive vs. Standard Therapy for slowing CKD

  Submitted by Bruce Carter 2 years ago

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  Progression of CKD from Stage II/IIIa

  Studies of large cohorts of CKD (AASK, CRIC, MDRD) have shown that some individuals seem not to progress while others follow an inexorable path toward ESRD (or earlier cardiovascular demise). More research on the prediction and determinants of progression within the population with early stages of kidney disease will potentially provide greater opportunity to intervene before advanced and irreversible complications of ...more »

  Studies of large cohorts of CKD (AASK, CRIC, MDRD) have shown that some individuals seem not to progress while others follow an inexorable path toward ESRD (or earlier cardiovascular demise). More research on the prediction and determinants of progression within the population with early stages of kidney disease will potentially provide greater opportunity to intervene before advanced and irreversible complications of CKD have occurred.

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  Submitted by Harold Feldman 2 years ago

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  CKD and Cognitive Decline

  Early findings from the CRIC Study indicate an important relationship between level of kidney function and cognitive function. Additional study is needed understand the mechanisms for these associations as well as the subpopulations at greatest risk.

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  Submitted by Harold Feldman 2 years ago

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  Non-CVD Morbidity in CKD

  Increasingly, studies like the Chronic Renal Insufficiency Cohort (CRIC) Study are making us aware of the large burden of morbidity associated with chronic kidney disease that appears in forms other than classical CVD morbidity or progressive reductions of GFR. Research initiatives are need to characterize and quantify this morbidity, seeking better primary and secondary preventive strategies. Failing to do so may represent ...more »

  Increasingly, studies like the Chronic Renal Insufficiency Cohort (CRIC) Study are making us aware of the large burden of morbidity associated with chronic kidney disease that appears in forms other than classical CVD morbidity or progressive reductions of GFR. Research initiatives are need to characterize and quantify this morbidity, seeking better primary and secondary preventive strategies. Failing to do so may represent missed opportunities to reduce cost and morbidity if we continue to focus principally on the CKD-CVD relationship.

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  Submitted by Harold Feldman 2 years ago

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  Diastolic heart failure

  Diastolic heart failure comprises up to 50% of heart failure presentations. The majority of these patients have abnormal renal function. Despite the incidence increasing there are no therapies and an unclear understanding of the mechanisms involved. What is the role of increasing renal blood flow in diastolic HF? Is there more to this than "volume" or is this congestive "renal" failure?

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  Submitted by Flora Sam 2 years ago

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  CKD:genetics vs environment-epigenomic

  In early CKD progressing to ESRD with/without complications, accompanying oxidative / inflammatory stress, triggers a persistent, self-reinforcing reprogramming of cellular function and gene expression that culminates in progression to a pathological state. Recent studies suggest that gene-environment interactions relevant for CKD are at least partly regulated by epigenomic mechanisms and may contribute to the progression ...more »

  In early CKD progressing to ESRD with/without complications, accompanying oxidative / inflammatory stress, triggers a persistent, self-reinforcing reprogramming of cellular function and gene expression that culminates in progression to a pathological state. Recent studies suggest that gene-environment interactions relevant for CKD are at least partly regulated by epigenomic mechanisms and may contribute to the progression of CKD. Aberrant expression patterns that develop in response to diet, increased body weight and environmental factors in CKD are likely to become “locked” by DNA methylation if they occur over a longer period of time. In this model, production of ROS by mitochondria is central to the change in DNA methylation patterns that contribute to the progression of CKD / CVD.

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  1 comment for Idea: CKD:genetics vs environment-epigenomic

  Submitted by Vallabh (Raj) Shah 2 years ago

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  Chronic Infections and CKD

  What is the association of hepatitis C virus with CKD?

  How does HCV and its treatment modify CKD

  How do HIV and its treatment modify CKD?

  1 comment for Idea: Chronic Infections and CKD

  Submitted by Adeel Butt 2 years ago

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