Department of Medicine Research
Major themes in the nephrology and hypertension research program include:
- Hypertension, chronic kidney disease, and cardiovascular outcomes. The division has provided major leadership for key National Institutes of Health (NIH)-sponsored multicenter trials, including the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) (Wright and Rahman), the African American Study of Kidney Disease and Hypertension (AASK) (Wright, Rahman, Smith), and the Chronic Renal Insufficiency Cohort (CRIC) (Rahman, Wright, Smith). The CRIC Study is now in its third five-year cycle of funding. The division plays a lead role in the NIH-sponsored SPRINT Trial (Wright, Rahman). Enrollment of patients into this major multicenter trial began in 2011.
- Immune monitoring of kidney transplant recipients. The division is a leading participant in a multicenter (U01) consortium enrolling patients into the NIH's Clinical Trial in Organ Transplant (CTOT) initiative. CTOT1 is an observational study designed to evaluate an array of noninvasive immune monitoring tests as surrogates for long-term outcomes of kidney allografts. Preliminary results from this study were presented by Donald Hricik, MD, in the plenary session of the 2010 American Transplantation Congress. This U01 grant was recently renewed as CTOT-09 for an additional five years. Dr. Hricik serves as the Protocol Chair of CTOT-09 which is being carried out at eight transplant centers in the U.S. and Canada. Enrollment of patients in the CTOT-09 trial began in the Spring of 2011.
- Metabolic Abnormalities in Chronic Kidney Disease. Dialysis only partially corrects the abnormal metabolic milieu collectively referred as "the uremic syndrome". Thomas Hostetter, MD, is spearheading two projects that 1) explore the importance of uremic toxins that persist in patients receiving dialysis and 2) study the effects of correcting metabolic acidosis in patients with chronic kidney disease. The latter study is supported by Dr. Hostetter's R01 NIH grant.
- Biomarkers of Diabetic Nephropathy. To improve prognosis for chronic kidney disease, the Division of Endocrinology is investigating novel biomarkers of diabetic nephropathy in the ACCORD trial of patients with type 2 diabetes. The goal is to confirm candidate urinary biomarkers from Dr. Simonson's recent comparative study of diabetic kidney disease in mice and humans with type 2 diabetes. This multicenter translational research project involves investigators from Case Western Reserve University and Yale and is funded by an RO1 from NIH-NHLBI. Dr. Simonson also participated in multicenter study of NGAL as a biomarker of progressive renal disease in the CRIC cohort. Ongoing studies focus on the development of biomarker panels for testing in pilot studies and a new collaboration with members of Pediatric Nephrology (Rupesh Raina, MD, Michael Dell, MD, and Beth Vogt, MD) to discover biomarkers of progression in patients in autosomal dominant polycystic kidney disease, the fourth-leading cause of end-stage renal failure.