Blood pressure can fluctuate a great deal from one day to the next (a phenomenon known as visit-to-visit blood pressure variability), and this variability may be a risk factor for heart disease, stroke, death, and other important clinical outcomes. Currently, not much is known about visit-to-visit blood pressure variability, particularly in persons with kidney disease, who are at very high risk of cardiovascular disease and other adverse outcomes. The project aims to shed some light on this important topic by evaluating the determinants and consequences of visit-to-visit blood pressure variability in persons with kidney disease using data from several large administrative databases and electronic health records.
This project uses previously collected data from the African American Study of Kidney Diseases and Hypertension (AASK) Trial and Cohort Study to examine the relation among sodium intake, blood pressure and clinical outcomes in African Americans with kidney disease. High blood pressure is one of the leading causes of chronic kidney disease and end-stage renal disease in the United States, and affects African Americans to a disproportionate degree. We will also examine how sodium intake is related to other important outcomes such as heart disease and death. Understanding how a potentially modifiable risk factor like sodium intake can affect blood pressure control and risks for adverse outcomes will help to clarify strategies to reduce its incidence in this high-risk population.
PI: Wolfgang Winkelmayer Co-I: Tara Chang Type: Obs Population: CKD and ESRD
The kidneys of more than 575,000 Americans have irreversibly stopped working, which renders these patients dependent on receiving regular kidney dialysis. Atrial fibrillation is a common type of irregular heartbeat, but patients receiving kidney dialysis are particularly often affected. Atrial fibrillation may lead to stroke or death in a large proportion of these patients and therapies to reverse it or to prevent bad outcomes do not appear to work in dialysis patients. This project aims to identify possibly preventable factors that make patients on dialysis develop atrial fibrillation in the first place. This information will help identify high-risk patients in whom preventive measures can then be tested.
PI: Michelle O'Shaghnessy Co-I: Wolfgang Winkelmayer, Richard Lafayette Type: Obs Population: Glomerulonephritis
Kidney transplantation is the optimal treatment for end-stage renal disease. Whether a patient’s cause of kidney failure influences their chance of receiving a kidney transplant has not been established. This project aims to uncover disease-specific barriers to kidney transplantation that, if targeted, might result in more equitable organ allocation systems and improved patient outcomes.
PI: Michelle O'Shaughnessy Co-I: Wolfgang Winkelmayer, Richard Lafayette Type: Obs Population: Glomerulonephritis
Mortality rates after starting dialysis depend, in part, upon a patient’s cause of kidney failure, although the relative contributions from specific causes of death to this finding remain poorly understood. This project aims to compare rates of fatal and non-fatal cardiovascular events and infections across common subtypes of glomerular disease, in order to determine disease-specific risks. The high-risk groups identified in this study can, in turn, become the focus of future observational and interventional studies aiming to better understand, prevent and treat these potentially catastrophic outcomes, thus improving patient outcomes.
There is little information on hospital and nursing facility stays during the transition from pre-dialysis kidney disease to end-stage renal disease (ESRD) treated with dialysis. This project looks at older ESRD patients (aged≥67 years) with Medicare Part A/B coverage for 1 year pre-dialysis initiation to examine hospital and nursing facility stays in the year pre- and post-dialysis initiation. We developed a visual representation of facility day patterns that we refer to as “heat maps”, which can be found by following the Box link below. For additional plots please contact Tara Chang (email@example.com).