Their findings shed light on why U.S. blacks are far more likely than whites to suffer from kidney disease and could potentially lead to new treatments or even preventive measures.

Read abstract
Read news releases
View podcast

 
Dr. Andrew Levey, a leading nephrologist at Tufts University in Boston, has thoroughly described for hundreds of patients what to expect following a kidney transplant operation. These days, however, Levey speaks with a different authority–the expertise of one who’s walked in their shoes himself. Read Article.

According to a study published in the Journal of the American Medical Association (JAMA) by Dr. Brenda Hemmelgarn and colleagues of the Alberta Kidney Disease Network, the reporting of estimated Glomerular Filtration Rate (eGFR) – a measurement of the kidney’s ability to filter waste products -  increased first time visits to kidney specialists, especially for middle aged to elderly patients, patients with more severe kidney dysfunction and those with co-morbidities, such as hypertension and diabetes.

This news is notable because Chronic Kidney Disease (CKD) is an important and increasing public health problem that could be more effectively addressed and treated by early patient and physician awareness. In fact, early detection and appropriate interventions could stem chronic kidney disease progression - or even reverse it.

“An extremely important measurement of kidney function is estimated GFR”, says Paul Shay, National Executive Director, The Kidney Foundation of Canada. “ People at risk for kidney disease should know their GFR just as people at risk for cardiovascular disease know their blood pressure.”

A low GFR is an indication of reduced kidney function. Estimated GFR is calculated using a formula based on age, gender and the result of a blood test (serum creatinine) to estimate kidney function. Creatinine is a natural waste product of body muscle. High levels in the blood or serum tests coupled with other risk factors, is an important indicator of an individual’s kidney health or possible kidney damage.

This Canadian study, funded by the Kidney Foundation of Canada and the KRESCENT Program and published in March 2010, is based on information of more than 1,000,000 adults in a province-wide (Alberta) database. The same research group published an earlier study, showed that a lower eGFR is associated with an increased risk of negative outcomes (see story “Reduced kidney function with proteinuria associated with increased risk of kidney failure) Together these studies underscore that CKD is common and requires referral to a specialist.

The Kidney Research Scientist Core Education National Training (KRESCENT) Program focuses on the training of world class scientists.
It was created in 2005 through a special contribution of The Kidney Foundation of Canada, the Canadian Society of Nephrology and the Canadian Institutes of Health Research. A unique program, KRESCENT is characterized by: the recruitment of trainees from multiple disciplines, for involvement in a national curriculum; career development support at the (post-) doctoral level including the first Faculty appointment and ongoing mentorship; and the development of collaborative research and knowledge translation across research themes.
 
For more information on the KRESCENT Program or The Kidney Foundation of Canada, contact Wim Wolfs, National Director Research (514) 531-2212 (cell.) or wim.wolfs@kidney.ca

View the article in Journal of American Medical Association

Patients with high levels of  protein in the urine (proteinuria) coupled with at least one other marker of reduced kidney function had a higher risk of death, heart attack and progression to kidney failure according to a recent study published in the Journal of the American Medical Association (JAMA) co-authored by Dr. Matthew James. Dr. James is a Post-Doctoral Fellowship recipient of the landmark Kidney Research Scientist Core Education and National Training (KRESCENT) Program made possible by The Kidney Foundation and a team of collaborators.

This Canadian study, published in February 2010, is based on information from nearly a million (902,985) adults in a province-wide (Alberta) database and proves significant for both its size and findings. Current guidelines for the classification and staging of chronic kidney disease (CKD) are based on estimated glomerular filtration rate or eGFR (a measure of the severity of kidney damage) without explicit consideration of the severity of coexistent proteinuria. The authors note: ''our findings do suggest that risk stratification performed in terms of eGFR alone is relatively insensitive to clinically relevant gradients in risk.''

Presently, chronic kidney disease is classified in five (5) different stages based on eGFR. This classification scheme has been very helpful in educating both medical professionals and the general public on CKD incidence and the implications of CKD in terms of early identification and management of persons with the disease.

The five stage classification, however, has been questioned for not including the presence and severity of proteinuria, a condition in which urine contains an abnormal amount of protein. Proteinuria is an important indicator of CKD associated with negative outcomes.

Not everyone progresses from stage 1 to stage 5. Research is ongoing to better understand the factors that cause kidney failure and to identify individuals who are at particular risk for it.

“This is an important study,” says Paul Shay, National Executive Director of The Kidney Foundation of Canada. “The Kidney Foundation is interested in a better understanding of chronic kidney disease. The study demonstrates the importance of proteinuria. The Kidney Foundation is proud to support relevant research and those who perform it. These kinds of findings contribute in a significant way to a pool of knowledge that cumulatively has practical implications for both clinical care and research.”

The KRESCENT Program was created through a special collaboration of The Kidney Foundation of Canada, the Canadian Society of Nephrology and the Canadian Institutes of Health Research. The KRESCENT Program focuses on the training of world class scientists. It is a unique program characterized by: the recruitment of trainees from multiple disciplines, for involvement in a national curriculum, supports the career development at the (post-) doctoral level and the first Faculty appointment, with ongoing mentorship support, and fostering the development of collaborative research and knowledge translation across research themes.

For more information on the KRESCENT Program or The Kidney Foundation of Canada, contact Wim Wolfs, National Director Research (514) 531-2212 (cell.) or wim.wolfs@kidney.ca

View the article in Journal of American Medical Association

Patients with sudden loss of kidney function, called acute kidney injury (AKI), are more likely to die prematurely after leaving the hospital—even if their kidney function has apparently recovered, according to a study published in Journal of the American Society of Nephrology (JASN).and conducted by Dr. Jean-Philippe Lafrance, recipient of a KRESCENT Post Doctoral Fellowship recipient "Our study found that risk of death remains elevated long after the acute kidney injury," comments Dr. Lafrance, who has returned to the Maisonneuve-Rosemont Hospital in Montreal after finishing his Fellowship at the Boston University School of Public Health.

Dr. Lafrance, along with Dr. Donald R. Miller (also of Boston University School of Public Health), used a Veterans Affairs health database to analyze long-term outcomes in about 83,000 veterans with AKI. Patients with AKI have rapid deterioration in kidney function, resulting from many possible causes. More than half of patients with AKI need dialysis at least temporarily, and many die prior to leaving the hospital. The new study focused on AKI patients who did not need dialysis and who survived at least three months after leaving the hospital.

During an average two year follow-up, 30 percent of the AKI patients died compared to 16 percent of a group of patients without AKI. Researchers determined risk of death to be about 40 percent higher in the AKI group, even after adjusting for other factors including impaired kidney function following hospital discharge.   

The risk was even higher for patients with more severe AKI, as defined by severe declines in kidney function. Mortality risk was elevated even for patients whose kidney function returned to normal after AKI, as it did in more than half of cases. "Impaired kidney function following hospital discharge explained only part of the increased long-term mortality risk associated with AKI," said Lafrance.  

The study had several limitations: it used data collected for another purpose, did not include complete information on the serum creatinine test used to diagnose AKI, was mostly limited to men, and did not include information on causes of death. It also lacked data on the long-term risk of chronic kidney disease, a potential late complication of AKI.  

“The Foundation’s KRESCENT Program is a cutting edge initiative which focuses on the training of world class scientists,” says Paul Shay, National Executive Director of The Kidney Foundation of Canada. “Dr. Lafrance’s study is an excellent example of the kind of relevant clinical research our program supports that could have significant implications for medical practice and patient treatment.”

The KRESCENT Program was created through a special collaboration of The Kidney Foundation of Canada, the Canadian Society of Nephrology and the Canadian Institutes of Health Research. The KRESCENT Program focuses on the training of world class scientists. It is an unique program characterized by: the recruitment of trainees from multiple disciplines, for involvement in a national curriculum, support the career development at the (post-) doctoral level and the first Faculty appointment, with ongoing mentorship support, and fostering the development of collaborative research and knowledge translation across research themes.

For more information on the KRESCENT Program or The Kidney Foundation, call Wim Wolfs, Director National Research Program (514) 531-2212 (cell.) or wim.wolfs@kidney.ca

View Dr. Lafrance’s article in Journal of the American Society of Nephrology.

KRESCENT trainees to present at the 42nd Annual Meeting & Scientific Exposition of the American Society of Nephrology (ASN) view list of presentations

Klotho is a recently described hormone, which has been implicated in ageing. Two common characteristics of aging are decreased bone mineral density (thin bones) and the potential to develop kidney stones. Both of these processes are linked to alterations in calcium homeostasis, state of equilibrium, in individuals with advanced age. In a laboratory model, the lack of Klotho demonstrates many characteristics of human ageing including both thinner bones and kidney calcium deposits, suggesting a role for Klotho in calcium homeostasis. Our model demonstrated that Klotho is necessary to prevent the loss of calcium in urine. Evidence showed that renal loss of calcium contributes to increased vitamin D synthesis and contributes to thin bones. However, the kidney calcium deposits appear to be directly attributable to the lack of Klotho.

The methodology and rationale behind these studies provide the basis for further studies currently funded by The Kidney Foundation of Canada and being carried out in the laboratory of Dr. Alexander at the University of Alberta. This new project “the molecular determinants of proximal tubular calcium absorption” seeks to unravel how the majority of calcium filtered by the glomerulus, is (re)absorbed by the first section of the renal tubule. This is the part of the kidney that appears to be abnormal in most individuals who demonstrate altered calcium handling.  View Abstract