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                  2017 RESEARCH GRANT RECIPIENTS

                  Satellite Dialysis Clinical Investigator Grant of the NKF
                   
                  Project: Weight Trajectory and Outcomes in Kidney Disease
                  Elaine Ku, The Regents of the University of California San Francisco; San Francisco, CA
                   
                  Obesity amongst chronic hemodialysis patients has been associated with a survival advantage compared to normal weight in a phenomenon described as the “obesity paradox.” However, obesity in children on dialysis has not been associated with a lower risk of death compared to normal weight. One of the potential reasons for these differing observations in adults versus children may be due to delivery of more aggressive nutritional interventions in children with kidney disease to maintain weight and growth. Thus, I hypothesize that one reason adults who begin dialysis with a normal weight have a higher risk of death may be due to significant weight loss that occurred prior to needing dialysis. The objectives of this proposal are to 1) characterize weight trajectory in adults versus children; 2) examine the association between weight change before dialysis and risk of death after dialysis in adults.
                   
                  NKF Young Investigator Grants
                   
                  Project: Peritoneal Fluid Microbiome Predictive of Peritonitis
                  John Richard Lee, Joan & Sanford I. Weill Medical College of Cornell University; New York, NY
                   
                  Peritoneal dialysis (PD) is a widely used dialysis modality around the world and provides life-saving treatment for patients who have kidney failure. Peritonitis is an infection of the peritoneal fluid and unfortunately leads to significant morbidity and mortality in PD patients. Current methods are unable to
                  predict development of peritonitis. In this application, we propose to utilize a novel sequencing method
                  called cell free DNA sequencing which will provide a comprehensive analysis of the microbiome (i.e.
                  bacteria) in peritoneal fluid. We propose to study the peritoneal fluid microbiome in PD patients serially
                  over time and to determine the microbiome profiles that are predictive of peritonitis. The proposed
                  study will lead to the development of novel diagnostic tests to predict peritonitis and lead to future
                  interventional studies to prevent its devastating complications.
                   
                  Project: AT1R Antibodies in Pediatric Kidney Transplantation
                  Meghan Haley Pearl, The Regents of the University of California, Los Angeles; Los Angeles, CA
                   
                  Maximizing kidney transplant survival is critical in children given most will require multiple transplants in
                  their lifetimes. Antibodies in the blood can attack the kidney transplant causing rejection, injury, or
                  failure. Recently, an antibody called angiotensin II type 1 receptor antibody (AT1R-Ab) has been
                  associated with kidney transplant rejection and failure (2-6) in adults. Little is known about AT1R-Abs in
                  pediatric kidney transplant recipients (KTRs). We will test blood samples from 200 pediatric KTRs for
                  AT1R-Ab to examine the prevalence and risk factors for development of AT1R-Ab. Furthermore, we will
                  determine if AT1R-Ab is associated with blood vessel injury, decline in renal function, rejection, and
                  transplant failure. This study will enrich our understanding of the effects of AT1R-Abs on transplant
                  outcomes in the vulnerable pediatric population. Our long-term objective is to understand how to
                  incorporate AT1R-Ab testing into kidney transplant monitoring and treatment to improve kidney
                  transplant survival in children.

                  Project: Pilot Trial of Thyroid Hormone Replacement in Dialysis
                  Connie Rhee, The Regents of the University of California, Irvine; Irvine, CA
                   

                  Hypothyroidism, defined by elevated thyrotropin (TSH) levels, is a common endocrine complication of
                  chronic kidney disease that has been associated with impaired quality of life and cardiovascular
                  complications. While levothyroxine is one of the most frequently prescribed medications in dialysis
                  patients, little is known about its efficacy and safety in this population. This study will investigate 1)
                  whether levothyroxine adequately lowers thyrotropin (TSH) levels to therapeutic target ranges, and 2) if
                  thyroid hormone replacement improves quality of life and cardiovascular markers, without leading to
                  wasting (i.e., loss of body mass, fat, and/or muscle mass) in dialysis patients.
                   
                  NKF Southeast Texas Research Grant
                   
                  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.
                   
                  NKF Serving the National Capital Area
                  Joseph M. Krainin, MD, Memorial Young Investigator Award

                   
                  Project: APOL1-Related Nephropathies
                  Avi Z. Rosenberg, MD, PhD, DABP, Assistant Professor, Johns Hopkins University, Baltimore, MD
                   
                  This grant will fund Dr. Rosenberg’s research on APOL1-related nephropathies. This proposal will develop an organoid system that will facilitate studies of APOL1 kidney diseases, including testing novel therapies. This genetic variant is exclusively seen in individuals of sub-Saharan African descent and explains much of the health disparity in renal disease among African Americans. An estimated 12% of the African American population carries two APOL1 risk alleles; this represents 6 million individuals, of whom we estimate that 20% will develop kidney disease during their lifetimes. This is particularly important for NKF/NCA as it is located in Washington, DC – the region of the US with the highest rate of kidney disease in the nation, a problem for which APOL1 variants are likely a leading contributor. 
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