Browse Ideas with tag 'ckd':

• Recent Ideas (33)
• Popular Ideas (33)
• Hot Ideas (0)

• I agree

  2 votes

  I disagree
  This idea is active.
  HYPERTENSION »

  Hypertension--Scourge of CKD/CVD?

  Hypertension appears to be the scourge of CKD and CVD. Is it any wonder that CVD events are elevated in the CKD (including post-transplant) population when its a battle to control blood pressure? How much of the problem is medication compliance, drug interaction, or sub-optimal BP-lowering regimen? Does aggressive BP-control result in long-term benefit? Can anyone develop a BP-lowering med (or patch) that only needs ...more »

  Hypertension appears to be the scourge of CKD and CVD. Is it any wonder that CVD events are elevated in the CKD (including post-transplant) population when its a battle to control blood pressure? How much of the problem is medication compliance, drug interaction, or sub-optimal BP-lowering regimen? Does aggressive BP-control result in long-term benefit? Can anyone develop a BP-lowering med (or patch) that only needs to be used weekly or monthly?

  « less full details »

  2 comments for Idea: Hypertension--Scourge of CKD/CVD?

  Submitted by Myra Carpenter 2 years ago

• I agree

  2 votes

  I disagree
  This idea is active.
  NKDEP-Translation »

  Multifactorial intervention to stop progressive CKD

  Patients with progressive CKD (diabetic and non-diabetic) benefit from aggressive treatment that improves control of its antecedents, such as poor control of blood pressure, blood glucose, lipid profiles, etc. Some multifactorial interventions have been effective (most notably, the Steno2 Study) but none have been widely translated to populations or conducted in a diverse US population. Telehealth approaches may help ...more »

  Patients with progressive CKD (diabetic and non-diabetic) benefit from aggressive treatment that improves control of its antecedents, such as poor control of blood pressure, blood glucose, lipid profiles, etc. Some multifactorial interventions have been effective (most notably, the Steno2 Study) but none have been widely translated to populations or conducted in a diverse US population. Telehealth approaches may help overcome barriers to implementing efficacy studies in the US while allowing a scalable solution for translation to large populations (T2) if results are favorable.

  « less full details »

  1 comment for Idea: Multifactorial intervention to stop progressive CKD

  Submitted by Uptal Patel 2 years ago

• I agree

  0 votes

  I disagree
  This idea is active.
  CKD »

  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.

  « less full details »

  1 comment for Idea: Direct renin inhibitors vs. ACEI/ARB for CKD

  Submitted by Bruce Carter 2 years ago

• I agree

  1 vote

  I disagree
  This idea is active.
  ESRD/DIALYSIS »

  Quality or Life

  The Rand KDQOL-SF currently used in dialysis units is onerous to use. It comprises 78 questions, is difficult to administer and to take. Furthermore, there seems to be differences in what populations gauge as quality of life changes and what patients actually report in clinical settings. Herein lies an opportunity to update and modify patient reporting and quality of life metrics.

  2 comments for Idea: Quality or Life

  Submitted by Stephen Fadem 2 years ago

• I agree

  3 votes

  I disagree
  This idea is active.
  CKD »

  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.

  « less full details »

  Add your comment for Idea: Pain management in CKD

  Submitted by Witty Kidney 2 years ago

• I agree

  1 vote

  I disagree
  This idea is in review.
  HYPERTENSION »

  CKD, hypertension, and autonomic neuropathy

  CKD, elevated nighttime BP, and autonomic neuropathy are all associated with increased morbidity and mortality (both cardiovascular and renal). The bivariate relationships between each of these "risk factors" has been well documented. The interaction between the three variables is not as well studied. A better understanding of this interaction could lead to novel therapies that significantly reduce cardiovascular and ...more »

  CKD, elevated nighttime BP, and autonomic neuropathy are all associated with increased morbidity and mortality (both cardiovascular and renal). The bivariate relationships between each of these "risk factors" has been well documented. The interaction between the three variables is not as well studied. A better understanding of this interaction could lead to novel therapies that significantly reduce cardiovascular and renal morbidity and mortality.

  « less full details »

  1 comment for Idea: CKD, hypertension, and autonomic neuropathy

  Submitted by Paul Drawz 2 years ago

• I agree

  2 votes

  I disagree
  This idea is active.
  ESRD/DIALYSIS »

  Sudden cardiac death in renal dialysis patients

  Many pts on dialysis have CAD, heart failure or arrythmias. Do automatic implantable defibrillators decrease the risk of sudden cardiac death in these patients?

  2 comments for Idea: Sudden cardiac death in renal dialysis patients

  Submitted by Flora Sam 2 years ago

• I agree

  0 votes

  I disagree
  This idea is active.
  CKD »

  Optimal statin therapy to slow or halt CKD progression

  CKD sub-analysis from the large TNT and more recent JUPITER trials suggest that more intensive statin therapy, can help slow and even reverse CKD progression. It remains to be determined which statins and at what doses will be most effective, and how statin therapy should be adjusted over the course of CKD. Targeted head-to-head trials and varying-dose trials are needed to answer these questions. http://www.renalandurologynews.com/high-dose-statin-therapy-has-expanded-benefits/article/175689/ ...more »

  CKD sub-analysis from the large TNT and more recent JUPITER trials suggest that more intensive statin therapy, can help slow and even reverse CKD progression.

  It remains to be determined which statins and at what doses will be most effective, and how statin therapy should be adjusted over the course of CKD. Targeted head-to-head trials and varying-dose trials are needed to answer these questions.

  http://www.renalandurologynews.com/high-dose-statin-therapy-has-expanded-benefits/article/175689/

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

  « less full details »

  3 comments for Idea: Optimal statin therapy to slow or halt CKD progression

  Submitted by Bruce Carter 2 years ago

• I agree

  7 votes

  I disagree
  This idea is active.
  CKD »

  Reducing uric acid levels to slow CKD progression.

  Recent single-center randomized trials suggest reducing uric acid levels to be simultaneously renoprotective and cardioprotective, even without the presence of gout. Risk reductions on the order of 50% have been reported.

  These results need validation in larger, multi-center trials, as well as determining optimal targets and treatment guidelines.

  3 comments for Idea: Reducing uric acid levels to slow CKD progression.

  Submitted by Bruce Carter 2 years ago

• I agree

  7 votes

  I disagree
  This idea is active.
  AKI »

  miRNAs and Renal Disease

  It is becoming clear that miRNAs regulate all aspects of renal disease, and they are 'druggable' targets: the first antagomir human trial is underway in heart. We need to understand which miRNAs are specific to kidney, in what to kidney cell type they are expressed and how they regulate renal disease. This effort should be systematic - with data made available publicly to avoid duplicative effort and funding.

  5 comments for Idea: miRNAs and Renal Disease

  Submitted by Ben Humphreys 2 years ago

• I agree

  6 votes

  I disagree
  This idea is active.
  DIABETIC NEPHROPATHY »

  Large scale collection of CKD patient samples from dialysis unit

  Identifying robust association between genetic variation and severe human CKD phenotypes has been hindered by lack of collections of patient sample collection of sufficient size to use effectively in GWAS. The community could address this issue by developing reproducible but simple clinical phenotyping criteria and collecting samples from ESRD patients in dialysis units. Contrast can be made to publicly available datasets ...more »

  Identifying robust association between genetic variation and severe human CKD phenotypes has been hindered by lack of collections of patient sample collection of sufficient size to use effectively in GWAS. The community could address this issue by developing reproducible but simple clinical phenotyping criteria and collecting samples from ESRD patients in dialysis units. Contrast can be made to publicly available datasets of healthy volunteers with GWAS data. I am assuming, for example, that patients with diabetic nephropathy can be compared to healthy non-diabetic patients since the genetic architecture of type 2 diabetes common variants has been characterized.

  « less full details »

  3 comments for Idea: Large scale collection of CKD patient samples from dialysis unit

  Submitted by John Sedor 2 years ago

• I agree

  5 votes

  I disagree
  This idea is active.
  DIABETIC NEPHROPATHY »

  Non-mammalian model systems

  Non-mammalian model organisms have been underutilized to understand diabetic nephropathy pathogenesis. These simple model organism systems that permit ease of genetic manipulation, rapid throughput and precise measurement of phenotypes. Work published earlier this year (PNAS 107: 775, 2010) demonstrated that type 2 DM risk loci could be characterized in zebrafish. Interestingly, this study demonstrated this study shows ...more »

  Non-mammalian model organisms have been underutilized to understand diabetic nephropathy pathogenesis. These simple model organism systems that permit ease of genetic manipulation, rapid throughput and precise measurement of phenotypes. Work published earlier this year (PNAS 107: 775, 2010) demonstrated that type 2 DM risk loci could be characterized in zebrafish. Interestingly, this study demonstrated this study shows that zebrafish embryo can respond to human regulatory elements [even if not highly conserved in teleosts] in a time- and tissue-restricted manner.

  « less full details »

  2 comments for Idea: Non-mammalian model systems

  Submitted by John Sedor 2 years ago

• I agree

  7 votes

  I disagree
  This idea is active.
  DIABETIC NEPHROPATHY »

  Mouse models

  While the mouse has many advantages, the human diabetic nephropathy phenotype has been difficult to faithfully replicate in the mouse using candidate gene approaches. Future work should focus on developing "humanized mice," in which loci associated with human diabetic complications are knock-in to the mouse. This animals could then be used to study mechanisms and therapeutics using systems biology approaches.

  3 comments for Idea: Mouse models

  Submitted by John Sedor 2 years ago

• I agree

  9 votes

  I disagree
  This idea is active.
  GN/INFLAMMATION »

  Glomerular biomarkers based on podocyte products

  Podocyte injury and depletion drive glomerulosclerosis and progression in glomerular diseases. The podocyte is on the urinary space side of the GBM so that urine is the logical place to look for markers of podocyte injury and the urine pellet is well known to contain valuable information. Several investigators have demonstrated that podocytes and their products can be detected in urine and are altered in a major way in ...more »

  Podocyte injury and depletion drive glomerulosclerosis and progression in glomerular diseases. The podocyte is on the urinary space side of the GBM so that urine is the logical place to look for markers of podocyte injury and the urine pellet is well known to contain valuable information. Several investigators have demonstrated that podocytes and their products can be detected in urine and are altered in a major way in association with progression in model systems and in man. Development and validation of biomarkers is a complex process that NIDDK has experience with for AKI. It is time to bring together groups working on glomerular disease urine biomarkers and define how they should be evaluated and validated in the clinic. We can thereby accelerate introduction of potentially game-changing technology to our clinics that can reduce the costs/morbidity of ESKD.

  « less full details »

  Add your comment for Idea: Glomerular biomarkers based on podocyte products

  Submitted by Roger Wiggins 2 years ago

• I agree

  1 vote

  I disagree
  This idea is active.
  ESRD/DIALYSIS »

  Syndrome of rapid onset ESRD

  We recently described the previously unrecognized syndrome of rapid-onset end-stage renal disease (SORO-ESRD) in a high-risk 100-CKD patient cohort in the September 2010 issue of the journal, Renal Failure. This is the unanticipated and unpredictable accelerated progression from CKD to ESRD following acute medical and surgical events. The majority of the patients who exhibited this syndrome were aged >65 years old. The ...more »

  We recently described the previously unrecognized syndrome of rapid-onset end-stage renal disease (SORO-ESRD) in a high-risk 100-CKD patient cohort in the September 2010 issue of the journal, Renal Failure. This is the unanticipated and unpredictable accelerated progression from CKD to ESRD following acute medical and surgical events. The majority of the patients who exhibited this syndrome were aged >65 years old. The US population is an aging one. The prevalence of this new unrecognized syndrome in the general US ESRD population and the predilection of the aging US population calls for further study. The impact of the findings on AV Fistula First programs, on reno-protection strategies in general and the whole neglected area of preventative nephrology especially as it pertains to the aging baby boomers may be most significant and could call for paradigm shifts in current standards of practice and care of older (>65 year old) CKD patients.

  « less full details »

  Add your comment for Idea: Syndrome of rapid onset ESRD

  Submitted by MACAULAY ONUIGBO 2 years ago

• I agree

  2 votes

  I disagree
  This idea is active.
  CKD »

  What is the optimum dietary sodium intake in CKD?

  A lower Na diet has been suggested for CKD patients, and may help reduce proteinuria, but impact on progression has not been proven, and in heart failure, the role of a low sodium diet is being questioned (see Rothberg et al, J Gen Intern Med 25(10):1136–7, 2010). Proposed would be a randomized study in proteinuric diabetic CKD patients with target dietary Na of 1.5 vs. 3.0 g/day, with endpoints being 50% reduction in ...more »

  A lower Na diet has been suggested for CKD patients, and may help reduce proteinuria, but impact on progression has not been proven, and in heart failure, the role of a low sodium diet is being questioned (see Rothberg et al, J Gen Intern Med 25(10):1136–7, 2010).

  Proposed would be a randomized study in proteinuric diabetic CKD patients with target dietary Na of 1.5 vs. 3.0 g/day, with endpoints being 50% reduction in estimated cystatin GFR or dialysis/transplantation.

  « less full details »

  Add your comment for Idea: What is the optimum dietary sodium intake in CKD?

  Submitted by John Daugirdas 2 years ago

• I agree

  2 votes

  I disagree
  This idea is active.
  DIABETIC NEPHROPATHY »

  It is easier to find genes in Type 1 diabetes DN than type 2

  It has been difficult to identify SNPs with even modest effects in studies of type 2 diabetic nephropathy. One possible explanation is that patients with kidney disease who have type 2 diabetes may not have a single disease. Indeed the old biopsy data suggest that there is a diversity of diseases in this population. Should gene finding efforts focus exclusively on type 1 diabetic nephropathy for the short term?

  5 comments for Idea: It is easier to find genes in Type 1 diabetes DN than type 2

  Submitted by rebekah rasooly 2 years ago

• I agree

  3 votes

  I disagree
  This idea is active.
  NKDEP-Translation »

  CKD and social networks

  Diseases like obesity and alcoholism have been shown to be clustered in social groups. The distribution of CKD in social groups (families, churches, neighborhoods, friend networks, etc) should be explored with the intent of introducing interventions into such networks to improve outcomes.

  2 comments for Idea: CKD and social networks

  Submitted by Jeffrey Fink 2 years ago

• I agree

  3 votes

  I disagree
  This idea is active.
  AKI »

  Carediorenal Syndrome: is it all about volume?

  Heart failure accounts for over 1 million hospital admissions annually in the United States, and is a leading cause of disability and healthcare costs. Cardiorenal syndrome occurs when cardiac and kidney dysfunction coexists, with each accelerating the progression of the other through a combination of renal hypoperfusion, venous congestion, and neurohormonal dysregulation. In patients with cardiorenal syndrome, attempts ...more »

  Heart failure accounts for over 1 million hospital admissions annually in the United States, and is a leading cause of disability and healthcare costs. Cardiorenal syndrome occurs when cardiac and kidney dysfunction coexists, with each accelerating the progression of the other through a combination of renal hypoperfusion, venous congestion, and neurohormonal dysregulation. In patients with cardiorenal syndrome, attempts at diuresis often exacerbate underlying renal dysfunction. Venous congestion may play an important role in worsening renal function due to increased renal interstitial pressure. Therefore, volume removal may potentially prevent or abolish the development of worsening renal function in cardiorenal syndrome. Clinicians caring for cardiorenal failure patients are limited in medical therapies to effectively remove fluid. When medical therapies fail to alleviate congestion, ultrafiltration may be used for mechanical fluid removal and is endorsed by current heart failure treatment guidelines. What is the timing, type and mode of volume removal? Is volume overload the bad actor or is it simply these are patients with mulitple organ failure. Can we preven CHF patients from developing renal dysfunction? What is the mechanism of renal dysfunction in cardiorenal?

  « less full details »

  1 comment for Idea: Carediorenal Syndrome: is it all about volume?

  Submitted by Mark Unruh 2 years ago

• I agree

  4 votes

  I disagree
  This idea is active.
  NKDEP-Translation »

  Health services in CKD: The need for Type 2 Translation

  Although many in this dialogue are neprologists, primary care physicians care for the majority of pre-dialysis CKD patients; however, PCPs often do not recognize the presence of CKD based on serum creatinine levels. Prior studies suggest that both PCPs and nephrologists deliver suboptimal CKD care. There are many strategies to improve the care of patients with CKD using novel systems base approaches. One strategy to ...more »

  Although many in this dialogue are neprologists, primary care physicians care for the majority of pre-dialysis CKD patients; however, PCPs often do not recognize the presence of CKD based on serum creatinine levels. Prior studies suggest that both PCPs and nephrologists deliver suboptimal CKD care. There are many strategies to improve the care of patients with CKD using novel systems base approaches. One strategy to improve disease awareness and treatment has been estimated glomerular filtration rate (eGFR) reporting and routine screening of patients at risk for proteinuria. There are large health care systems where either providers or even regions could be randomized to either screening, or testing national guidelines in the care of patients with CKD. I would think that it is important for the NIDDK to take on this type of translational research.

  « less full details »

  2 comments for Idea: Health services in CKD: The need for Type 2 Translation

  Submitted by Mark Unruh 2 years ago

• I agree

  4 votes

  I disagree
  This idea is active.
  CKD »

  Cell therapy

  Adult progenitor cells reduce proteinuria and improve GFR in animal models of CKD. Results fro human studies in cardiac disease are looking cautiously optimistic. Time to start planning early phase studies in patients with CKD.

  1 comment for Idea: Cell therapy

  Submitted by Richard Gilbert 2 years ago

• I agree

  3 votes

  I disagree
  This idea is active.
  CKD »

  BURNT-OUT DIABETES IN CKD

  Treatment of early diabetes mellitus, the most common cause of chronic kidney disease (CKD), may prevent or slow the progression of diabetic nephropathy and lower mortality and the incidence of cardiovascular disease in the general population and in patients with early stages of CKD. It is unclear if glycemic control in patients with advanced CKD, including those with end-stage renal disease (ESRD) who undergo maintenance ...more »

  Treatment of early diabetes mellitus, the most common cause of chronic kidney disease (CKD), may prevent or slow the progression of diabetic nephropathy and lower mortality and the incidence of cardiovascular disease in the general population and in patients with early stages of CKD. It is unclear if glycemic control in patients with advanced CKD, including those with end-stage renal disease (ESRD) who undergo maintenance dialysis treatment is beneficial. Aside from the uncertain benefits of treatment in ESRD, hypoglycemic interventions in this population are also complicated by the complex changes in glucose homeostasis related to decreased kidney function and to dialytic therapies, which may occasionally lead to spontaneous resolution of hyperglycemia and normalization of hemoglobin A1c levels, with a resultant picture of “burnt-out diabetes”. Further difficulties in ESRD are posed by the complicated pharmacokinetics of antidiabetic medications and the serious flaws in our available diagnostic tools used for monitoring long term glycemic control. Studies are needed ti examine the physiology and pathophysiology of glucose homeostasis in advanced CKD and ESRD, the available antidiabetic medications and their specifics related to kidney function, and the diagnostic tools used to monitor the severity of hyperglycemia and the therapeutic effects of available treatments, along with their deficiencies in ESRD. Studies need to investigate the concept of burnt-out diabetes and summarize the findings of studies that examined outcomes related to glycemic control in diabetic ESRD patients

  « less full details »

  Add your comment for Idea: BURNT-OUT DIABETES IN CKD

  Submitted by Kamyar Kalantar-Zadeh 2 years ago

• I agree

  4 votes

  I disagree
  This idea is active.
  ESRD/DIALYSIS »

  Racial Survival Disparities within Dialysis Populations

  There are counterintuitive but consistent observations that African Americans maintenance dialysis patients have greater survival despite their less favorable socioeconomic status, high burden of cardiovascular risks including hypertension and diabetes, and excessively high chronic kidney disease prevalence. The fact that such individuals have a number of risk factors for lower survival and yet live longer when undergoing ...more »

  There are counterintuitive but consistent observations that African Americans maintenance dialysis patients have greater survival despite their less favorable socioeconomic status, high burden of cardiovascular risks including hypertension and diabetes, and excessively high chronic kidney disease prevalence. The fact that such individuals have a number of risk factors for lower survival and yet live longer when undergoing dialysis treatment is puzzling. Similar findings have been made among Israeli maintenance dialysis patients, in that those who are ethnically Arab have higher end-stage renal disease but exhibit greater survival than Jewish Israelis. The juxtaposition of these two situations may provide valuable insights into racial/ethnic based mechanisms of survival in chronic diseases. Survival advantages of African American dialysis patients may be explained by differences in nutritional status, inflammatory profile, dietary intake habits, body composition, bone and mineral disorders, mental health and coping status, dialysis treatment differences, and genetic differences among other factors. Prospective studies are needed to examine similar models in other countries and to investigate the potential causes of these paradoxes in these societies. Better understanding the roots of racial/ethnic survival differences may help improve outcomes in both chronic kidney disease patients and other individuals with chronic disease states

  « less full details »

  Add your comment for Idea: Racial Survival Disparities within Dialysis Populations

  Submitted by Kamyar Kalantar-Zadeh 2 years ago

• I agree

  18 votes

  I disagree
  This idea is active.
  NORMAL BIOLOGY/DEVELOPMENT »

  Mouse Tool Development

  Do we need a set of validated tools for mouse models of kidney disease (and development), available to all, for example Cre/CreER drivers for the major relevant differentiated cell types in adult kidney (endothelial, nephron epithelia by segment, fibroblast, macrophage etc...)?

  3 comments for Idea: Mouse Tool Development

  Submitted by Ben Humphreys 2 years ago

• I agree

  1 vote

  I disagree
  This idea is active.
  CKD »

  Mitochondrial genetics

  Is it time to explore the role of mitochondrial genetics in the pathogenesis of CVD in CKD

  1 comment for Idea: Mitochondrial genetics

  Submitted by Dominic Raj 2 years ago

Displaying 1 - 25 of 33 Ideas

• 1
• 2
• Next »