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174 results on '"Parikh, Chirag R."'

1. Protein N-Glycans in Healthy and Sclerotic Glomeruli in Diabetic Kidney Disease

Author

Veličković, Dušan, Shapiro, John P., Parikh, Samir V., Rovin, Brad, Toto, Robert D., Vazquez, Miguel A., Poggio, Emilio D., O'Toole, John F., Sedor, John R., Alexandrov, Theodore, Jain, Sanjay, Bitzer, Markus, Hodgin, Jeffrey, Veličković, Marija, Sharma, Kumar, Anderton, Christopher R., Adeyi, Oyedele A., Alakwaa, Fadhl, Alexandrov, Theodore, Allen, Jamie L., Alpers, Charles E., Alvear, Alison Bunio, Ambekar, Akhil, Ancheta, Joed, Anderton, Christopher R., Angus, Sophia A., Anjani, Kavya, Appelbaum, Paul S., Ardayfio, Joseph, Arora, Tanima, Ascani, Heather K., Asghari, Mahla, El-Achkar, Tarek M., Athar, Humra, Atta, Mohamed G., Aulisio, Mark P., Aw, Stephanie J., Azeloglu, Evren U., Bagne, Cathy A., Balderes, Olivia, Balis, Ulysses G.J., Barasch, Jonathan, Barisoni, Laura, Barwinska, Daria, Basta, Jeannine, Bebiak, Jack, Beck, Laurence H., Berge, Jerica M., Berglund, Ashley C., Bernard, Lauren, Berry, Brooke, Beyda, David H., Bhanushali, Jini Ashok, Bitzer, Markus, Bjornstad, Petter, Blanc, Victoria M., Blank, Kristina N., Bledsoe, Sharon B., Bogen, Steve, Bomback, Andrew S., Bonevich, Nikole, Border, Samuel, Börner, Katy, Bowen, William S., Boys, Charlotte, Bracamonte, Erika R., Bream, Peter R., Brosius, Frank C., Brown, Keith D., Budiman, Tifanny, Bueckle, Andreas, Bui, J.T., James, T., Burg, Ashley R., Burgess, Adam, Bush, Lakeshia, Bush, William S., Cai, Qi, Calixte, Marie Florence, Cameron-Wheeler, Tashas, Campbell, Kirk N, Campbell, Taneisha, Campbell, Catherine, Campos, Baltazar, Canetta, Pietro A., Cantley, Lloyd G, Caramori, M. Luiza, Carmona-Powell, Eunice, Carson, Jonas M, Chan, Lili, Chen, Sarah W, Chen, Yijiang, Cheng, Ying-Hua, Bejarano, Maria Chilo, Choe, Kisurb, Cimino, James G., Coca, Steven G., Coleman, Alyson, Colley, Madeline E., Collie, Mary M., Colona, Mia R., Commander, Clayton W., Conlon, Kristine, Conser, Ninive, Cooperman, Leslie, Corona-Villalobos, Celia P., Crawford, Dana C., Creger, Nathan, Cuevas-Rios, Yarieli, D'Agati, Vivette ., Dagher, Pierre c., de Boer, Ian H., de Caestecker, M.P, de Cos, Marina, Gonçalves, Joana P., Dekker, Matthew, Demeke, Dawit, Dighe, Ashveena L, Ding, Yanli, Djambazova, Katerina V., Donohoe, Isabel, Dowd, Frederick, Drawz, P.E., Dufresne, Martin, Dull, Rachel, Dunn, Kenneth W., Duran, Daniel Damian, Eadon, Michael T, Eddy, Sean, Elder, Michele M, Fallegger, Robin, Farrow, Melissa A, Ferkowicz, Michael, Fine, Derek M., Flanagan, Siobhan M., Fogo, Agnes B., Fox, Monica L., Frey, Renee, Froment, Anne, Gaba, Ron C., Gadegbeku, Crystal A, Gaut, Joseph P., Gehlenborg, Nils, Geraghty, Molly C, Ghag, Reetika, Gilliam, Matthew, Ginley, Brandon, Gisch, Debora, Gordon, Ronald E., Gorman, Brittney L., Greka, Anna, Grewenow, Stephanie M., Gurung, Bhupendra Kumar, Guthrie, Leah, Hacohen, Nir, Haddad, Samuel, Hall, Daniel E., Hansen, Jens, Harindhanavudhi, Tasma, Hartman, John, Hayashi, Lynda, Haydak, Jonathan, He, John Cijiang, He, Yongqun, Hedayati, S. Susan, Henderson, Dori, Henderson, Joel M, Hendricks, Allen R, Henshaw, Asari, Herlitz, Leal, Hernandez, Jeanine, Herr, Bruce W., Himmelfarb, Jonathan, Hodgin, Jeffrey B., Hoofnagle, Andrew N, Horowitz, Carol R., Hsieh, E.W.Y., Huynh, Courtney, Iyengar, Ravi, Jain, Sanjay, Janowczyk, Andrew, Jeffers, Vivian, Jefferson, Nichole M., Jennette, J Charles, Johansen, Camille, Jolly, Stacey, Jones, Christopher J., Jones, Jennifer L., Jones, Kiasha, Joyeux, Cienn N., Ju, Wenjun, Judd, Audra M., Kakade, Vijayakumar R, Kakarla, Dhatri, Kaspari, Rachel R., Kaushal, Madhurima, Keefe, Nicole, Keller, Mark S., Kelley, Sara S., Kellum, John A., Kelly, K. J., Kelly, Tanika N., Kermani, Asra, Kiryluk, Krzysztof, Klett, Susan, Knight, Richard A., Knoten, Amanda, Koch, Gina, Koewler, Robert, Kretzler, Matthias, Kruse, Angela R.S., Küchenhoff, Leonie, Lake, Blue B., Lardenoije, Roy, Larson, Astrid, Larson, Brandon G, Lash, James P., Laszik, Zoltan G., Lecker, Stewart H., Lee, Simon C., Lee, Sora, Lefferts, Sean, Li, Xiang, Lienczewski, Chrysta C, Limonte, Christine P, Lucarelli, Nicholas, Lukowski, Jessica, Lutnick, Brendon, Ma, Shihong, Ma, Sisi, Madabhushi, Anant, Maikhor, Shana, Mao, Weiguang, Mariani, Laura H., Markovic, Marina, Marquez, Nicole, Marshall, Jamie L., McAdams, Meredith C, McClelland, Robyn L., McCown, Phillip J., McMahon, Gearoid Michael, McMurray, Amy, Mehl, Karla, Meliambro, Kristin, Ferreira, Ricardo Melo, Mendoza, Katherine, Menez, Steven, Menon, Rajasree, Meza, Natalie, Migas, Lukasz G., Miller, R. Tyler, Mimar, Sayat, Minor, Brittany C, Mody, Priya, Moeckel, Gilbert W., Moledina, D.G., Molina-Guzman, Jenny, Monroy-Trujillo, Jose M, Morales, Alexander, Moreno, Vanessa, Mottl, Amy K., Mukatash, Tariq, Munar, Dane, Murugan, Raghavan, Nachman, Patrick H., Nadkarni, Girish N, Naglah, Ahmed, Nair, Viji, Nam, Yunbi, Narasimhan, R., Nwanne, Gerald, O'Malley, Charles, O'Toole, John F., Toro, Fernanda Ochoa, Oliver, George (Holt), Onul, Ingrid F, Otto, Edgar A., Palevsky, Paul M., Palmer, Ellen, Pamreddy, Annapurna, Parikh, Chirag R., Parikh, Samir V, Park, Christopher, Park, Harold, Paša-Tolić, Ljiljana, Patel, Jiten, Patel, Marissa, Patlis, Boris S., Paul, Anindya S., Phuong, Jimmy, Pillai, Anil, Pinkeney, Roy, Plisiewicz, Alexa, Poggio, Emilio D, Pollack, Ari, Prasad, Pottumarthi V, Pyle, Laura, Quardokus, Ellen M., Quiroga, Arabela, Ragi, Nagarjunachary, Randhawa, Parmjeet, Randle, Teresa, Rao, Via, Rauchman, Michael, Rauwolf, Nicolas J, Reamy, Rebecca, Record, Elizabeth G., Redmond, Devona, Rennke, Helmut, Renteria, Amada, Rezaei, Kasra A, Rhodes, Rosamond, Ricardo, Ana C., Rice, Samuel, Rivera, Marcelino, Roberts, Glenda V., Rosas, R., Sylvia, E., Rose, Michael P., Rosen, Seymour, Rosenberg, Avi Z., Rosenberg, Michael S., Rosengart, Matthew R., Rovin, Brad H., Roy, Neil, Roy-Chaudhury, Prabir, Rubinsky, Melissa D., Sabo, Angela R., Saez-Rodriguez, Julio, Safadi, Sami, Samari, Imane H., Sanora, Ana Celina, Sarder, Pinaki, Sarkisova, Natalya, Sarwal, Minnie M, Saul, John, Saunders, Milda R., Schaub, Jennifer A., Schmidt, IM, Scott, Raymond, Scroggins, Aaron, Sealfon, Rachel S. G., Sedor, John R., Sendrey, Dianna, Setty, Suman, Shah, Sonya, Shariff, Saad Mohammed, Sharma, Kumar, Shaw, Melissa M., Sigdel, Tara K, Silva, Paolo S., Snyder, Jaime, Snyder, Michelle L., Spates-Harden, Kassandra, Sperati, C. John, Spraggins, Jeffrey M., Srivastava, Anand, Stashevsky, Jennifer, Steck, Becky, Stillman, Isaac E, Stutzke, Christy, Subramanian, Lalita, Sun, Jennifer K., Rajan, Sandhya Sundar, Sutton, Timothy A., Taliercio, Jonathan J, Tan, Roderick, Tanevski, Jovan, Thajudeen, Bijin, Thurman, Joshua M., Tokita, Joji, Torrealba, Jose R., Toto, Robert D, Tout, Haneen, Troyanskaya, Olga G, Tsosie, Rebecca, Turner, Jeffrey M, Tuttle, Katherine R., Ugwuowo, Ugochukwu, Upadhyay, Ashish, Valerius, M. Todd, Van de Plas, Raf, Varela, German, Vazquez, Miguel A., Velickovic, Dusan, Venkatachalam, Manjeri, Verdoes, Abraham, Verma, Ashish, Victoria-Castro, Angela M., Vijayan, Anitha, Villalobos, Alexander, Viloria, Noralinda B., Vinovskis, Carissa, Vita, Tina, Waikar, Sushrut S., Wang, Ashley R., Wang, Bangchen, Wang, Nancy, Wang, Ruikang, Wangperawong, Artit, Ward, Stephen C, Warfield, Curtis, Weins, Astrid, Wen, Natasha, Wen, Yumeng, Wilcox, Adam, Williams, James C., Williams, Kayleen, Williams, Mark E., Wilson, F. Perry, Winfree, Seth, Winters, James, Wofford, Stephanie, Wolf, Susan M., Wong, Aaron, Woodhead, Gregory, Wright, Devin M., Wright, Zach, Wright, Zoe, Wrobel, Julia, Xing, Fuyong, Xu, Alan, Yadati, Pranav, Ye, Hongping, Young, Bessie A., Yu, Guanghao, Mon-Wei Yu, Samuel, Zeinoun, Gabriel, Zeitler, Evan M., Zhang, Bo, Zhang, Guanshi, and Zhang, Yi

Published
2024
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4. Effect of methylprednisolone on acute kidney injury in patients undergoing cardiac surgery with a cardiopulmonary bypass pump: a randomized controlled trial

Author

Garg, Amit X., Chan, Matthew T.V., Cuerden, Meaghan S., Devereaux, P.J., Abbasi, Seyed Hesameddin, Hildebrand, Ainslie, Lamontagne, Francois, Lamy, Andre, Noiseux, Nicolas, Parikh, Chirag R., Perkovic, Vlado, Quantz, Mackenzie, Rochon, Antoine, Royse, Alistair, Sessler, Daniel I., Shah, Pallav J., Sontrop, Jessica M., Tagarakis, Georgios I., Teoh, Kevin H., Vincent, Jessica, Walsh, Michael, Yared, Jean-Pierre, Yusuf, Salim, and Whitlock, Richard P.

Subjects
Acute kidney failure -- Care and treatment, Cardiac patients -- Health aspects, Heart surgery -- Complications and side effects -- Health aspects, Heart-lung machines -- Usage, Methylprednisolone -- Health aspects -- Usage -- Complications and side effects, Aprotinin, Death, Risk assessment, Corticosteroid drugs, Coronary artery bypass, Glucocorticoids, Central nervous system agents, Surgery, Kidney diseases, Steroids (Organic compounds), Caregivers, Chronic kidney failure, Health
Abstract

BACKGROUND: Perioperative corticosteroid use may reduce acute kidney injury. We sought to test whether methylprednisolone reduces the risk of acute kidney injury after cardiac surgery. METHODS: We conducted a prespecified substudy of a randomized controlled trial involving patients undergoing cardiac surgery with cardiopulmonary bypass (2007-2014); patients were recruited from 79 centres in 18 countries. Eligibility criteria included a moderate-to-high risk of perioperative death based on a preoperative score of 6 or greater on the European System for Cardiac Operative Risk Evaluation I. Patients (n = 7286) were randomly assigned (1:1) to receive intravenous methylprednisolone (250 mg at anesthetic induction and 250 mg at initiation of cardiopulmonary bypass) or placebo. Patients, caregivers, data collectors and outcome adjudicators were unaware of the assigned intervention. The primary outcome was postoperative acute kidney injury, defined as an increase in the serum creatinine concentration (from the preoperative value) of 0.3 mg/dL or greater ([greater than or equal to] 26.5 [micro]mol/L) or 50% or greater in the 14-day period after surgery, or use of dialysis within 30 days after surgery. RESULTS: Acute kidney injury occurred in 1479/3647 patients (40.6%) in the methylprednisolone group and in 1426/3639 patients (39.2%) in the placebo group (adjusted relative risk 1.04, 95% confidence interval 0.96 to 1.11). Results were consistent across several definitions of acute kidney injury and in patients with preoperative chronic kidney disease. INTERPRETATION: Intraoperative corticosteroid use did not reduce the risk of acute kidney injury in patients with a moderate-to-high risk of perioperative death who had cardiac surgery with cardiopulmonary bypass. Our results do not support the prophylactic use of steroids during cardiopulmonary bypass surgery. Trial registration: ClinicalTrials.gov, no. NCT00427388, About 20% of the 4 million cardiopulmonary bypass surgeries performed worldwide each year are complicated by acute kidney injury, defined as a sudden reduction in kidney function. (1) Acute kidney [...]

Published
2019
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5. Associations of Baseline and Longitudinal Serum Uromodulin With Kidney Failure and Mortality: Results From the African American Study of Kidney Disease and Hypertension (AASK) Trial

Author

Chen, Teresa K., Estrella, Michelle M., Appel, Lawrence J., Surapaneni, Aditya L., Köttgen, Anna, Obeid, Wassim, Parikh, Chirag R., and Grams, Morgan E.

Abstract

Uromodulin (UMOD) is the most abundant protein found in urine and has emerged as a promising biomarker of tubule health. Circulating UMOD is also detectable, but at lower levels. We evaluated whether serum UMOD levels were associated with the risks of incident kidney failure with replacement therapy (KFRT) and mortality.

Published
2024
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6. The ASSESS-AKI Study found urinary epidermal growth factor is associated with reduced risk of major adverse kidney events

Author

Menez, Steven, Wen, Yumeng, Xu, Leyuan, Moledina, Dennis G., Thiessen-Philbrook, Heather, Hu, David, Obeid, Wassim, Bhatraju, Pavan K., Ikizler, T. Alp, Siew, Edward D., Chinchilli, Vernon M., Garg, Amit X., Go, Alan S., Liu, Kathleen D., Kaufman, James S., Kimmel, Paul L., Himmelfarb, Jonathan, Coca, Steven G., Cantley, Lloyd G., and Parikh, Chirag R.

Abstract

Biomarkers of tubular function such as epidermal growth factor (EGF) may improve prognostication of participants at highest risk for chronic kidney disease (CKD) after hospitalization. To examine this, we measured urinary EGF (uEGF) from samples collected in the Assessment, Serial Evaluation, and Subsequent Sequelae of Acute Kidney Injury (ASSESS-AKI) Study, a multi-center, prospective, observational cohort of hospitalized participants with and without AKI. Cox proportional hazards regression was used to investigate the association of uEGF/Cr at hospitalization, three months post-discharge, and the change between these time points with major adverse kidney events (MAKE): CKD incidence, progression, or development of kidney failure. Clinical findings were paired with mechanistic studies comparing relative Egfexpression in mouse models of kidney atrophy or repair after ischemia-reperfusion injury. MAKE was observed in 20% of 1,509 participants over 4.3 years of follow-up. Each 2-fold higher level of uEGF/Cr at three months was associated with decreased risk of MAKE (adjusted hazards ratio 0.46, 95% confidence interval: 0.39-0.55). Participants with the highest increase in uEGF/Cr from hospitalization to three-month follow-up had a lower risk of MAKE (adjusted hazards ratio 0.52; 95% confidence interval: 0.36-0.74) compared to those with the least change in uEGF/Cr. A model using uEGF/Cr at three months combined with clinical variables yielded moderate discrimination for MAKE (area under the curve 0.73; 95% confidence interval: 0.69-0.77) and strong discrimination for kidney failure at four years (area under the curve 0.96; 95% confidence interval: 0.92-1.00). Accelerated restoration of Egfexpression in mice was seen in the model of adaptive repair after injury, compared to a model of progressive atrophy. Thus, urinary EGF/Cr may be a biomarker of distal tubular health, with higher concentrations and increased uEGF/Cr post-discharge independently associated with reduced risk of MAKE in hospitalized patients.

Published
2023
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7. Oral curcumin in elective abdominal aortic aneurysm repair: a multicentre randomized controlled trial

Author

Garg, Amit X., Devereaux, P.J., Hill, Andrew, Sood, Manish, Aggarwal, Bharat, Dubois, Luc, Hiremath, Swapnil, Guzman, Randolph, Iyer, Vikram, James, Matthew, McArthur, Eric, Moist, Louise, Ouellet, George, Parikh, Chirag R., Schumann, Virginia, Sharan, Sumit, Thiessen-Philbrook, Heather, Tobe, Sheldon, Wald, Ron, Walsh, Michael, Weir, Matthew, and Pannu, Neesh

Subjects
Curcumin -- Health aspects, Aneurysmectomy -- Methods -- Patient outcomes, Abdominal aortic aneurysm -- Development and progression -- Care and treatment, Health
Abstract

BACKGROUND: Curcumin, a popular herbal supplement from the plant turmeric, has prevented ischemic reperfusion and toxin-induced injury in many animal studies and a single-centre randomized human trial. We sought to test whether perioperative oral curcumin (compared with placebo) affects the inflammatory response and risk of postrepair complications after elective abdominal aortic aneurysm repair in humans. METHODS: We conducted a parallel-group, randomized, placebo-controlled trial of patients from 10 hospitals in Canada who were scheduled to undergo elective repair of an unruptured abdominal aortic aneurysm (November 2011 to November 2014). Patients in the treatment group received perioperative oral curcumin (2000-mg doses 8 times over 4 d). Patients, health care providers and local research staff were unaware of the treatment assignment. The primary outcomes were median concentrations of 4 biomarkers indicating injury and inflammation (postoperative urine interleukin-18 and perioperative rise in serum creatinine, plasma W-terminal pro-B-type natriuretic peptide and plasma high-sensitivity C-reactive protein). RESULTS: Baseline characteristics were similar in the 2 groups (606 patients overall; median age 76 yr). More than 85% of patients in each group took more than 80% of their scheduled capsules. Neither curcumin nor placebo significantly affected any of the 4 biomarkers (p > 0.05 for all comparisons). Regarding the secondary outcomes, there was a higher risk of acute kidney injury with curcumin than with placebo (17% v. 10%, p = 0.01), but no between-group difference in the median length of hospital stay (5 v. 5 days, p > 0.9) or the risk of clinical events (9% v. 9%, p = 0.9). INTERPRETATION: Curcumin had no beneficial effects when used in elective abdominal aortic aneurysm repair. These findings emphasize the importance of testing turmeric and curcumin before espousing their health benefits, as is currently done in the popular media. Trial registration: ClinicalTrials.gov, no. NCT01225094., Many modern medicines come from plants. (1,2) Turmeric, a plant in the ginger family that is native to South Asia, has been used for centuries as a spice and traditional [...]

Published
2018
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9. An atlas of healthy and injured cell states and niches in the human kidney

Author

Lake, Blue B., Menon, Rajasree, Winfree, Seth, Hu, Qiwen, Melo Ferreira, Ricardo, Kalhor, Kian, Barwinska, Daria, Otto, Edgar A., Ferkowicz, Michael, Diep, Dinh, Plongthongkum, Nongluk, Knoten, Amanda, Urata, Sarah, Mariani, Laura H., Naik, Abhijit S., Eddy, Sean, Zhang, Bo, Wu, Yan, Salamon, Diane, Williams, James C., Wang, Xin, Balderrama, Karol S., Hoover, Paul J., Murray, Evan, Marshall, Jamie L., Noel, Teia, Vijayan, Anitha, Hartman, Austin, Chen, Fei, Waikar, Sushrut S., Rosas, Sylvia E., Wilson, Francis P., Palevsky, Paul M., Kiryluk, Krzysztof, Sedor, John R., Toto, Robert D., Parikh, Chirag R., Kim, Eric H., Satija, Rahul, Greka, Anna, Macosko, Evan Z., Kharchenko, Peter V., Gaut, Joseph P., Hodgin, Jeffrey B., Eadon, Michael T., Dagher, Pierre C., El-Achkar, Tarek M., Zhang, Kun, Kretzler, Matthias, and Jain, Sanjay

Abstract

Understanding kidney disease relies on defining the complexity of cell types and states, their associated molecular profiles and interactions within tissue neighbourhoods1. Here we applied multiple single-cell and single-nucleus assays (>400,000 nuclei or cells) and spatial imaging technologies to a broad spectrum of healthy reference kidneys (45 donors) and diseased kidneys (48 patients). This has provided a high-resolution cellular atlas of 51 main cell types, which include rare and previously undescribed cell populations. The multi-omic approach provides detailed transcriptomic profiles, regulatory factors and spatial localizations spanning the entire kidney. We also define 28 cellular states across nephron segments and interstitium that were altered in kidney injury, encompassing cycling, adaptive (successful or maladaptive repair), transitioning and degenerative states. Molecular signatures permitted the localization of these states within injury neighbourhoods using spatial transcriptomics, while large-scale 3D imaging analysis (around 1.2 million neighbourhoods) provided corresponding linkages to active immune responses. These analyses defined biological pathways that are relevant to injury time-course and niches, including signatures underlying epithelial repair that predicted maladaptive states associated with a decline in kidney function. This integrated multimodal spatial cell atlas of healthy and diseased human kidneys represents a comprehensive benchmark of cellular states, neighbourhoods, outcome-associated signatures and publicly available interactive visualizations.

Published
2023
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10. Joint Modeling of Clinical and Biomarker Data in Acute Kidney Injury Defines Unique Subphenotypes with Differing Outcomes

Author

Vasquez-Rios, George, Oh, Wonsuk, Lee, Samuel, Bhatraju, Pavan, Mansour, Sherry G., Moledina, Dennis G., Gulamali, Faris F., Siew, Edward D., Garg, Amit X., Sarder, Pinaki, Chinchilli, Vernon M., Kaufman, James S., Hsu, Chi-yuan, Liu, Kathleen D., Kimmel, Paul L., Go, Alan S., Wurfel, Mark M., Himmelfarb, Jonathan, Parikh, Chirag R., Coca, Steven G., and Nadkarni, Girish N.

Published
2023
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11. Characterization of Glomerular and Tubulointerstitial Proteomes in a Case of Nonsteroidal Anti-Inflammatory Drug–Attributed Acute Kidney Injury

Author

Parikh, Samir V., Madhavan, Sethu, Shapiro, John, Knight, Richard, Rosenberg, Avi Z., Parikh, Chirag R., Rovin, Brad, and Menez, Steven

Abstract

The major goals of the Kidney Precision Medicine Project (KPMPP) are to establish a molecular atlas of the kidney in health and disease and improve our understanding of the molecular drivers of CKD and AKI. In this clinical-pathologic-molecular correlation, we describe the case of a 38-year-old woman without any history of CKD who underwent a research kidney biopsy in the setting of AKI suspected to be due to nonsteroidal anti-inflammatory use after cesarean section delivery. The participant's histopathology was consistent with mild acute tubular injury, without significant interstitial fibrosis or tubular atrophy. This diagnosis was supported by analysis of the glomerular and tubulointerstitial proteomes. The proteomic interrogation revealed a molecular landscape that demonstrated differences in kidney prostaglandin synthesis that may be in response to nonsteroidal anti-inflammatory drugs and signs of intrarenal inflammation and fibrosis that were not evident by histopathology alone.

Published
2023
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12. Plasma Soluble Tumor Necrosis Factor Receptor Concentrations and Clinical Events After Hospitalization: Findings From the ASSESS-AKI and ARID Studies

Author

Coca, Steven G., Vasquez-Rios, George, Mansour, Sherry G., Moledina, Dennis G., Thiessen-Philbrook, Heather, Wurfel, Mark M., Bhatraju, Pavan, Himmelfarb, Jonathan, Siew, Eddie, Garg, Amit X., Hsu, Chi-yuan, Liu, Kathleen D., Kimmel, Paul L., Chinchilli, Vernon M., Kaufman, James S., Wilson, Michelle, Banks, Rosamonde E., Packington, Rebecca, McCole, Eibhlin, Kurth, Mary Jo, Richardson, Ciaran, Go, Alan S., Selby, Nicholas M., and Parikh, Chirag R.

Abstract

The role of plasma soluble tumor necrosis factor receptor 1 (sTNFR1) and sTNFR2 in the prognosis of clinical events after hospitalization with or without acute kidney injury (AKI) is unknown.

Published
2023
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13. The Society of Thoracic Surgeons/Society of Cardiovascular Anesthesiologists/American Society for Extracorporeal Technology Clinical Practice Guidelines for the Prevention of Adult Cardiac Surgery–Associated Acute Kidney Injury

Author

Brown, Jeremiah R., Baker, Robert A., Shore-Lesserson, Linda, Fox, Amanda A., Mongero, Linda B., Lobdell, Kevin W., LeMaire, Scott A., De Somer, Filip M. J. J., Wyler von Ballmoos, Moritz, Barodka, Viachaslau, Arora, Rakesh C., Firestone, Scott, Solomon, Richard, Parikh, Chirag R., Shann, Kenneth G., and Hammon, John

Published
2023
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14. The Relationship between Rate and Volume of Intravenous Fluid Administration and Kidney Outcomes after Angiography

Author

Soomro, Qandeel H., Anand, Sonia T., Weisbord, Steven D., Gallagher, Martin P., Ferguson, Ryan E., Palevsky, Paul M., Bhatt, Deepak L., Parikh, Chirag R., Kaufman, James S., Brophy, Mary, Chertow, Glenn, Conner, Todd, Ferguson, Ryan, Fine, M., Kaufman, James, Lew, Robert, McCullough, Peter, Palevsky, Paul, Parikh, Chirag, Ringer, Robert, Shunk, Kendrick, Soliva, Susan, Weisbord, Steven, Bhatt, Deepak, Cass, Alan, Gallagher, Martin, McFalls, Edward, Pirakh, Chirag, Wu, Hongsheng, Ratliff, Michelle, Ketteler, Erika, Goff, James, Snider, Richard, Jones, Debra, Kreuch, Jeannie, Duvernoy, Claire, Thomas, Michael, Willatt, Jonathan, Gurm, Hitinder, Krishnamurthy, Venkat, Nallamothu, Brahmajee, Szymanski, Kendra, Grossman, P. Michael, Menees, Daniel, Rose, Patricia, Mavromatis, Kreton, Kumar, Gautam, Raghavan, Sumati, Dow, Jeanne, Mandawat, Mahendra, Noe, Susan, Alavi, Hossain, Calkins, Joe, McNear, Jennifer, Beals, Donald, Cavalieri, Stuart, Sierzega, Renata, Pearson, Laura, Afaq, Mazhar, Vaitkus, Paul, Kudryk, Bruce, Hall, Dennis, Nadella, Neelima, Corin, William, Woklu, Nina, Inting-Toothman, Stella, Wescott, Lea, Ventura, Nicole, Kinlay, Scott, Croce, Kevin, Faxon, David, Vokonas, Pantel, Raffetto, Joseph, McPhee, James, Gupta, Naren, Nava, Adrianna, Ly, Samantha, My-Do, Jacquelyn, Ostrowski, Simon, Bundy, Mariah, Quinn, Margot, Chin, Melissa, Corbelli, John, Dosluoglu, Hasan, Lohr, James, Rivero, Mariel, Cooke, Beth, Galla, Ann, Cloen, Denise, Fernandes, Valerian, DiBona, Alexander, Nielsen, Christopher, Idleman, Lois, Lee, Bertha, Vidovich, Mladen, Kibbe, Melina, Griza, Decebal, Raicu, Mihai, Rothenberg, Florence, Thakar, Charuhas, Madabhushi, Aditi, Arif, Imran, Bath, Jonathan, Helmy, Tarek, Unterbrink, Kendra, Ross, Stephanie, Bailey, Cathy, Hailes, Myrtle, Goldberg, Jonathan, Jozic, Joseph, Kang, Preet, Kalman, Jeaniene, Rosenthal, Noah, Catania, Deborah, Marlow, Jeanne, Kumaran, Vinay, Krupka, Angela, Zappernick, Taissa, Brilakis, Emmanouil, Tsai, Shirling, Banerjee, Subhash, Modrall, J. Gregory, Roesle, Michele, Hamilton, Marcie, Lusk, Cassie, Compton, Jennifer, Willis, Cyenthia, Atwell, Amy, Soto-Gonzalez, Marilisa, Agarwal, Ajay, Saklayen, Mohammad, Woerner, Donna, Ross, Jeffrey, Turner, Karen, Zheng-Phelan, Ling, Rider, Kamia, Rao, Sunil, Jones, W. Schuyler, Povsic, Thomas, Krucoff, Mitchell, Brennan, James, Miller, Michael, Mureebe, Leila, Aristy, Kathy, Powell, Marilyn, Bavry, Anthony, Choi, Calvin, Park, Ki, Curry, Tempa, Robertson, Debra, Wright, Cila, Jneid, Hani, Paniagua, David, Denktas, Ali, Lara-Smalling, Agueda, Palmer, Leah, Malarchick, Jo Ann, Broussard, Emily, Bolad, Islam, Breall, Jeffrey, Motaganahalli, Raghunandan, English, Beth, Ramkaransingh, Jeffrey, Mukerji, Rita, Subbarao, Roopa, Williams, Vicki, Henson, Sharon, Krier, Connie, Parashara, Deepak, Ciniglio, Ricardo, Barua, Rajat, Roys, Michael, Surineni, Kamalakar, Mendes, Kimberley, Oni, Olurinde, Uretsky, Barry, Ahmed, Zubair, Yousaf, Muhammad, Hakeem, Abdul, Chung, Hui Yong, Miller, Kristin, Dishongh, Katherine, Ramanathan, Kodangudi, Shah, Rahman, McGee, Jesse, Qualls, Zoe, Armstrong, Ashley, Johnson, Lillie, Garcia, Santiago, Adabag, Selcuk, Vakil, Kairav, Nguyen, Jennifer, Berg, Matthew, Herrmann, Rebekah, Condon, Debra, Meyeraan, Tacy, Sedlis, Steven, Lorin, Jeffrey, Keary, Mary, Shah, Binita, Maranan, Leandro, Latif, Faisal, Thadani, Udho, Abu-Fadel, Mazen, Exaire, Jose, Rousan, Talla, Ramirez-Jimenez, Arleen, Pham, Trang, Giacomini, John, Lit, Yiming, Massaband, Payam, Yong, Celina, Fearon, William, Zhou, Wei, Aalami, Oliver, Peters, Theresa, Bratcher, Karen, Monteverde, Edgardo, Rahman, Aref, Bandi, Rupal, Garbelotti, Kelly, Mulukutla, Suresh, Overberger, Pamela, Watnick, Suzanne, Davies, Crispin, Larsen, Greg, Atkinson, Tamara, Walczyk, Jacqueline, Kenworthy-Heinige, Tawni, Guenther, Stephanie, Pitts, Alexandra, Jovin, Ion, Minisi, Anthony, Sumption, Kevin, Feldman, George, Ha, Jonathan, Hendrix, Mack, Maldonado, Maureen, Jeter, Deborah, Klein, Andrew, Forsberg, Michael, Rowe, Caroline, Nasir, Ammar, Mani, Kartik, Vercher, Paul, Waidmann, Kristi, Vargo, Kristin, Chilakapati, Venkata, Jarmukli, Nabil, Tan, Shen-Li, Sherigar, Rathnakara, Bottomley, Sharon, Capuno, Maribeth, Henley, Katherine, Dev, Devasmita, Mathew, Jacob, Ochalek, Tracy, Lui, Charles, Smith, Brigham, Huo, Eugene, Frodsham, Aaron, Eskelson, Noni, Velarde, Kandi, Dulin, Heather, Martinez, Lillian, Zimmet, Jeffrey, Sawhney, Rajiv, Malik, Fady, Chou, Tony, Huynh, Cynthia, Stanley, Kathleen, Garcia, Epifanio, Lehmann, Kenneth, Stadius, Michael, Beatty, Alexis, Naria, Sohilkumar, Galvin, Georgia, Chilton, Robert, Pham, Son, Oliveros, Rene, Hecht, Joan, Thai, Hoang, Truong, Huu Tam, Goldman, Steven, Thal, Sergio, Juneman, Elizabeth, Kapoor, Divya, Tsuda, Ryan, Kipps, Juliana, Mikhail, Amani, Sandoval, Michael, Currier, Jesse, Lee, Hsin-Yi, Chang, Donald, Walsworth, Matthew, Warner, Alberta, Chen, Alice, Lendvai, Dora, Johnson, Janet, Lee, Joanne, Coggan, Sarah, Kumar, Namrata Nath, Dempsey, Erika, Kotwal, Sradha, Smyth, Brendan, Yianni, Alexia, Lee, Li Hui, Cheong, Siew Yan, Yates, Casey, James, Earl, Talaulikar, Girish, Farshid, Ahmad, Johnson, Patricia, Taverner, Pearle, Chadwick, Heather, Stewart, Ralph, Benatar, Jocelyne, Stone, Louise, Howell, Leah, Anderson, Sue, Lehnhard, Siobhan, Patten, Cathrine, Farouque, Omar, Bellomo, Rinaldo, Horrigan, Mark, Scott, Peter, Jones, Nicolas, Yudi, Matias, Huq, Rafi, Al-Fiadh, Ali, Brown, Louise, Brieger, David, Hillis, Graham, Cherry, Jonathan, Aitken, Sarah, Anastasius, Malcom, Lau, Jerrett, Lowe, Harry, Ayoub, Chadi, Jardine, Meg, O?Connor, Jody, Wong, Christopher, Wu, June, Xu, Kitty, Webster, Julie, Mwaijele, Liliang, Hand, Samantha, Chew, Derek, Alyward, Philip, Balakrishnan, Deepu, Prakash, Roshan, Pathik, Bhupesh, Kinatra, Vineet, Jones, Dylan, Singh, Arun, Ratib, Karim, Hammad, Nassser Al, Gunton, James, Mazhar, Jawad, Musameh, Muntaser, O?Shea, Catherine, Judd, Jo, Raman, Betty, Wollaston, Fiona, Felice, Kerri Ann, Hincks, Christine, Harrison, Timothy, Fawcett, Malcolm, Wright, Therese, Horsfall, Lee-Anne, Kissajukian, Francis, Murphy, Diedre, Bartlett, Pamela, Stockle, Paul, William, Maged, Elsokkari, Ihab, Rangasamy, Karthikeyan, Roy, Probal, Tran, David, Hayat, Muhammed Umair, May, Austin, Nyakudarika, Elijah, Phang, Calvin, Conway, Bets, O?Donoghue, Michelle, Ellis, Katrina, Kanna, Rajesh, Hendriks, Randall, Forrest, Nicole, Tulloch, Gill, Greenwell, Della, Ghapar, Abd Kahar, Ghani, Abdul Raqib Abd, Sundaralingam, Shamini, Fuah, K., Habizal, Nor Halwani, Daud, Siti Rohaya, Haq, Hafsah Begum binti Abdul, Mohammad, Masliza Binti, Hassan, Faizah Che, Hashim, Hanani, Ismail, Omar, Kong, Poi Keong, Ma, Soot Keng, Wahab, Mohamed Jahangir Abdul, Abdulla, Zarina Banu, Kader, Mohamad Ali Sheikh Abdul, Goh, Chong Aik, Ahmadsha, Shahul Hamid, Naser, Mohamad Nazrulhisham Mad, Yusuf, Azizah, Govindasamy, Paramesveri, Ibrahim, Nur Azliati Binti, Yahaya, Normilah, Juergens, Craig, French, John, Mussap, C., Lo, Sidney, Burgess, S., Mallard, Trevor, Huang, Justin, Kumar, Manish, Lee, Adam, Leung, Dominic, Badie, Tamar, Xu, James, Terluk, Andrew, Croucher, Alexandria, O?Brien, Kelsey, Raynes, Suzanne, Plotz, Maria, Hallani, Hisham, Fernandes, Clyne, Fitzpatrick, Drew, Parikh, Devang, Coulshed, David, Pathan, Faraz, Ganda, Prashil, Chandrala, Pavan, Barry, Lisa, Mackenzie, Michele, VanGaal, William, Hyat, Umair, Tsay, It Men, Subiakto, Ivan, Cresp, Damian, Nelson, Gregory, Mau, James, Shaw, Elizabeth, Yan, Warren, Arena, Frank, Danson, Edward, Vernon, S., Ward, Michael, Allahwala, U., Reid, Emma, Straiton, Nicola, Whitley, Alexandra, Loxton, Annie, Erickson, Royal Perth Hospital: Matthew, Ihdayid, Abdul-Rhman, Dias, Peter, Atique, Syed, Bonner, Michelle, Venn-Edmonds, Clare, Prasan, Ananth, Sader, Mark, Ramsay, David, Ford, Tom, Weaver, James, Binnekamp, Maurits, Barrett, David, Roy, James, Ng, Ben, Youssef, George, Shrestha, Prakriti, Vrachas, Deborah, Dobinson, Kate, Ternouth, Ian, Lumb, Nicky, Sebastian, Jeffrey, Jackson, Carolyn, Vickers, Cathy, Prideaux, Jan, Ahmad, Wan Azman Wan, Abidin, Imran Zainal, Zuhdi, Ahmad Syadi Mahmood, Ismail, Muhammad Dzafir, Sridhar, Ganiga Srinivasaiah, Lim, Soo Kun, Hadi, Moud Firdaus, Adnan, Wan Ahmad Hafiz Wan Md, Kassim, Zainab Abu, Mansor, Syed Mukhtar Syed, Lee, Vin-Zhen, Harding, Scott, Ranchord, Anil, Matsis, Philip, Aitken, Andrew, Simmonds, Mark Bernard, Fairley, Sarah, Wolbinski, Mariusz, Plunkett, Susan, Sinan, Ali Al, Ferrier, Katherine, O?Meeghan, Tim, Wilkins, Ben, Anscomise, Russell, Sasse, Alexander, Kirby, Alyssa, Ershad, Shakiya, Smyth, Duncan, Lim, Ren Yik, Middleditch, Diane, and Davies, Bronwyn

Published
2022
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16. Systematic Review and Meta-Analysis of Plasma and Urine Biomarkers for CKD Outcomes

Author

Liu, Caroline, Debnath, Neha, Mosoyan, Gohar, Chauhan, Kinsuk, Vasquez-Rios, George, Soudant, Celine, Menez, Steve, Parikh, Chirag R., and Coca, Steven G.

Abstract

Biomarker studies in the setting of CKD have increased considerably within the past 15 years, but vary significantly by design and clinical context. The authors conducted a systematic review and meta-analysis to summarize the prognostic value of preclinical plasma and urine biomarkers for CKD outcomes (incident CKD, CKD progression, or incident ESKD), including 129 studies in the meta-analysis. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) among some of the most studied CKD biomarkers were 2.17 (95% CI, 1.91 to 2.47) for plasma TNFR1, 1.21 (95% CI, 1.15 to 1.28) for plasma FGF23, 2.07 (95% CI, 1.82 to 2.34) for plasma TNFR2, 1.10 (95% CI, 1.05 to 1.16) for urine KIM-1, and 1.12 (95% CI, 1.06 to 1.19) for urine NGAL. The study?s findings suggest these biomarkers merit assessment of their performance in clinical practice.

Published
2022
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17. Secular trends in acute dialysis after elective major surgery--1995 to 2009

Author

Siddiqui, Nausheen F., Coca, Steven G., Devereaux, Philip J., Jain, Arsh K., Li, Lihua, Luo, Jin, Parikh, Chirag R., Paterson, Michael, Philbrook, Heather Thiessen, Wald, Ron, Walsh, Michael, Whitlock, Richard, and Garg, Amit X.

Subjects
Urinary organs -- Surgery, Acute renal failure -- Care and treatment -- Demographic aspects, Hemodialysis -- Forecasts and trends -- Methods, Market trend/market analysis, Health
Abstract

Background: Acute kidney injury is a serious complication of elective major surgery. Acute dialysis is used to support life in the most severe cases. We examined whether rates and outcomes of acute dialysis after elective major surgery have changed over time. Methods: We used data from Ontario's universal health care databases to study all consecutive patients who had elective major surgery at 118 hospitals between 1995 and 2009. Our primary outcomes were acute dialysis within 14 days of surgery, death within 90 days of surgery and chronic dialysis for patients who did not recover kidney function. Results: A total of 552 672 patients underwent elective major surgery during the study period, 2231 of whom received acute dialysis. The incidence of acute dialysis increased steadily from 0.2% in 1995 (95% confidence interval [CI] 0.15-0.2) to 0.6% in 2009 (95% CI 0.6-0.7). This increase was primarily in cardiac and vascular surgeries. Among patients who received acute dialysis, 937 died within 90 days of surgery (42.0%, 95% CI 40.0-44.1), with no change in 90day survival over time. Among the 1294 patients who received acute dialysis and survived beyond 90 days, 352 required chronic dialysis (27.2%, 95% CI 24.8-29.7), with no change over time. Interpretation: The use of acute dialysis after cardiac and vascular surgery has increased substantially since 1995. Studies focusing on interventions to better prevent and treat perioperative acute kidney injury are needed., More than 230 million elective major surgeries are done annually worldwide. (1) Acute kidney injury is a serious complication of major surgery. It represents a sudden loss of kidney function [...]

Published
2012
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18. Renal ultrasonography in the evaluation of acute kidney injury: developing a risk stratification framework

Author

Licurse, Adam, Kim, Michael C., Dziura, James, Forman, Howard P., Formica, Richard N., Makarov, Danil V., Parikh, Chirag R., and Gross, Cary P.

Subjects
Acute renal failure -- Diagnosis, Acute renal failure -- Risk factors, Acute renal failure -- Research, Health risk assessment -- Methods, Health risk assessment -- Research, Diagnosis, Ultrasonic -- Usage, Diagnosis, Ultrasonic -- Research, Health
Published
2010

19. Acute Kidney Injury Associates with Long-Term Increases in Plasma TNFR1, TNFR2, and KIM-1: Findings from the CRIC Study

Author

McCoy, Ian E., Hsu, Jesse Y., Bonventre, Joseph V., Parikh, Chirag R., Go, Alan S., Liu, Kathleen D., Ricardo, Ana C., Srivastava, Anand, Cohen, Debbie L., He, Jiang, Chen, Jing, Rao, Panduranga S., Hsu, Chi-yuan, Appel, Lawrence J., Feldman, Harold J., Lash, James P., Nelson, Robert G., Rahman, Mahboob, Shah, Vallabh O., and Unruh, Mark L.

Abstract

Levels of TNF receptors 1 and 2 (TNFR1 and TNFR2) and kidney injury molecule 1 (KIM-1) vary considerably among patients with CKD; those with higher levels have faster subsequent disease progression. The reasons why some individuals have higher levels of biomarkers of inflammation and injury are unknown. In this observational cohort study, the authors investigated whether these higher biomarker levels reflect effects of prior episodes of AKI. They found that levels of TNFR1, TNFR2, and KIM-1 in banked plasma samples increased after AKI, and these elevations persist for months, a longer timeframe than examined in prior studies. These findings may provide insight into the pathophysiology of kidney disease progression and the potential role of AKI episodes punctuating the course of CKD.

Published
2022
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20. Longitudinal TNFR1 and TNFR2 and Kidney Outcomes: Results from AASK and VA NEPHRON-D

Author

Chen, Teresa K., Coca, Steven G., Estrella, Michelle M., Appel, Lawrence J., Coresh, Josef, Thiessen Philbrook, Heather, Obeid, Wassim, Fried, Linda F., Heerspink, Hiddo J.L., Ix, Joachim H., Shlipak, Michael G., Kimmel, Paul L., Parikh, Chirag R., Grams, Morgan E., Ramachandran, Vasan S., Massaro, Joseph, Clish, Clary, Schelling, Jeffrey, Denburg, Michelle, Furth, Susan, Warady, Bradley, Bonventre, Joseph, Waikar, Sushrut, McMahon, Gearoid, Sabbisetti, Venkata, Coresh, Josef, Grams, Morgan, Rebholz, Casey, Abraham, Alison, Tin, Adrienne, Parikh, Chirag, Klein, Jon, Coca, Steven, Ferket, Bart S, Nadkarni, Girish N., Rhee, Eugene, Kimmel, Paul L., Gossett, Daniel, Rovin, Brad, Shlipak, Michael G., Sarnak, M, Levey, Andrew S., Inker, Lesley A., Foster, Meredith, Guti?rrez, Orlando M., Ix, Joachim, Dubin, Ruth, Seegmiller, Jesse, Hostetter, Tom, Deo, Rajat, Feldman, Harold I., Anderson, Amanda, Mifflin, Theodore, Xie, Dawei, Shou, Haochang, Ballard, Shawn, Whitehead, Krista, Collins, Heather, Greenberg, Jason, and Ganz, Peter

Abstract

Recent research suggests that biomarkers of the TNF pathway (TNFR1 and TNFR2) are associated with worse kidney outcomes. Most of these studies, however, evaluated baseline levels rather than longitudinal changes. In two cohorts (AASK, which enrolled Black people with CKD attributed to hypertension, and VA NEPHRON-D, which enrolled veterans with albuminuric CKD and type 2 diabetes), greater longitudinal increases in serum or plasma TNFR1 and TNFR2 were associated with higher risks of ESKD in AASK and subsequent kidney function decline in VA NEPHRON-D. These associations were independent of baseline biomarker level and kidney function. Longitudinal trajectories in TNFR1 and TNFR2 may ultimately allow improved risk assessment for kidney failure in persons with CKD.

Published
2022
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21. Long-term prognosis of acute kidney injury after acute myocardial infarction

Author

Parikh, Chirag R., Coca, Steven G., Wang, Yongfei, Masoudi, Frederick A., and Krumholz, Harlan M.

Subjects
Acute renal failure -- Prognosis, Acute renal failure -- Research, Heart attack -- Complications and side effects, Heart attack -- Patient outcomes, Heart attack -- Research, Mortality -- United States, Mortality -- Research, Health
Published
2008

24. Cardiovascular outcomes in the irbesartan diabetic nephropathy trial of patients with type 2 diabetes and overt nephropathy

Author

Berl, Tomas, Hunsicker, Lawrence G., Lewis, Julia B., Pfeffer, Marc A., Porush, Jerome G., Rouleau, Jean-Lucien, Drury, Paul L., Esmatjes, Enric, Hricik, Donald, Parikh, Chirag R., Raz, Itamar, Vanhille, Philippe, Wiegmann, Thomas B., Wolfe, Bernard M., Locatelli, Francesco, Goldhaber, Samuel Z., and Lewis, Edmund J.

Subjects
Diabetic nephropathies -- Drug therapy, Type 2 diabetes -- Drug therapy, Type 2 diabetes -- Complications, Cardiovascular diseases -- Patient outcomes, Health
Abstract

Background: Patients with diabetes have increased risk for adverse cardiovascular events. Angiotensin-converting enzyme inhibitors are protective in type 1 diabetes. However, no definitive studies have examined the use of angiotensin-receptor blockers in patients with type 2 diabetes and overt nephropathy. The primary outcomes of the Irbesartan Diabetic Nephropathy Trial were doubling of serum creatinine levels, end-stage renal disease, and death from any cause. Objective: To compare rates of cardiovascular events among patients with type 2 diabetic nephropathy who received conventional antihypertensive therapy with an angiotensin-receptor blocker (irbesartan) or a calcium-channel blocker (amlodipine), or placebo. Design: Randomized double-blind, placebo-controlled trial with a median follow-up of 2.6 years. A time event analysis was used. Setting: 209 centers in the Americas, Europe, Israel, and Australasia. Participants: 1715 adults with type 2 diabetic nephropathy and hypertension; serum creatinine levels of 89 micromol/L (1.0 mg/dL) to 266 micromol/L (3.0 mg/dL) in women and 106 micromol/L (1.2 mg/dL) to 266 micromol/L (3.0 mg/dL) in men; and urinary protein excretion rates of at least 900 mg/d. Intervention: Treatment with irbesartan, amlodipine, or placebo. Measurements: Time to cardiovascular death, myocardial infarction, congestive heart failure, strokes, and coronary revascularization. Results: The three groups were not statistically different in the composite of cardiovascular events. Among the components of the composite, there was a trend toward a decrease in strokes in patients receiving amlodipine versus those receiving placebo (hazard ratio, 0.65 [95% CI, 0.35 to 1.22]; P=0.18). Likewise, patients receiving amlodipine had a significantly lower rate of myocardial infarction when compared with placebo recipients (hazard ratio, 0.58 [CI, 0.37 to 0.92]; P=0.02). In contrast, patients receiving irbesartan had a significantly lower incidence of congestive heart failure when compared with placebo recipients (hazard ratio, 0.72 [CI, 0.52 to 1.00]; P=0.048) or amlodipine recipients (hazard ratio, 0.65 [CI, 0.48 to 0.87]; P=0.004). Conclusion: The composite cardiovascular event rate did not differ in patients with type 2 diabetes and overt nephropathy treated with irbesartan, amlodipine, or placebo in addition to conventional antihypertensive therapy.

Published
2003

25. Trends in the procurement and discard of kidneys from deceased donors with acute kidney injury

Author

Liu, Caroline, Alasfar, Sami, Reese, Peter P., Mohan, Sumit, Doshi, Mona D., Hall, Isaac E., Thiessen Philbrook, Heather, Jia, Yaqi, Stewart, Darren, and Parikh, Chirag R.

Abstract

Kidney allocation trends from deceased donors with acute kidney injury (AKI) have not been characterized since initial Kidney Donor Profile Index reporting in 2012 and its use under the revised Kidney Allocation System (KAS) in 2014. We conducted a retrospective analysis of US registry data to characterize kidney procurement and discard trends in deceased donors with AKI, defined by ≥50% or ≥0.3 mg/dl (≥4.0 mg/dl or ≥200% for stage 3) increase in terminal serum creatinine from admission. From 2010 to 2020, 172 410 kidneys were procured from 93 341 deceased donors 16 years or older; 34 984 kidneys were discarded (17 559 from AKI donors). The proportion of stage 3 AKI donors doubled from 6% (412/6841) in 2010 to 12% (1365/11493) in 2020. Procurement of stage 3 AKI kidneys increased from 51% (423/824) to 80% (2183/2730). While discard of stage 3 AKI kidneys increased from 41% (175/423) in 2010 to 44% (960/2183) in 2020, this increase was not statistically significant in interrupted time-series analysis following KAS implementation (slope difference −0.41 [−3.22, 2.4], and level change 3.09 [−6.4, 12.6]). In conclusion, the absolute number of stage 3 AKI kidneys transplanted has increased. Ongoing high discard rates of these kidneys suggest opportunities for improved utilization.

Published
2022
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27. Angiopoietins as Prognostic Markers for Future Kidney Disease and Heart Failure Events after Acute Kidney Injury

Author

Mansour, Sherry G., Bhatraju, Pavan K., Coca, Steven G., Obeid, Wassim, Wilson, Francis P., Stanaway, Ian B., Jia, Yaqi, Thiessen-Philbrook, Heather, Go, Alan S., Ikizler, T. Alp, Siew, Edward D., Chinchilli, Vernon M., Hsu, Chi-yuan, Garg, Amit X., Reeves, W. Brian, Liu, Kathleen D., Kimmel, Paul L., Kaufman, James S., Wurfel, Mark M., Himmelfarb, Jonathan, Parikh, Samir M., and Parikh, Chirag R.

Abstract

Mechanisms underlying long-term effects after AKI remain unclear. Because vessel instability is an early response to endothelial injury, the authors studied markers of blood vessel homeostasis (the plasma angiopoietins angiopoietin-1 and angiopoietin-2) in a multicenter prospective cohort that included 1503 adults, half of whom had AKI. Three months after hospitalization, the highest quartile of plasma angiopoietin-1:angiopoietin-2 ratio compared with the lowest quartile associated with 72% less risk of CKD progression, 94% less risk of heart failure, and 82% less risk of death among those with AKI; those without AKI exhibited similar but less pronounced reductions in risk of heart failure and mortality. Angiopoietins may serve as a common pathway to explain the progression of kidney and heart disease after AKI and may point to potential future interventions.

Published
2022
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29. The Association between Cytokines and 365-Day Readmission or Mortality in Adult Cardiac Surgery

Author

Everett, Allen D., Alam, Shama S., Owens, Sherry L., Parker, Devin M., Goodrich, Christine, Likosky, Donald S., Thiessen-Philbrook, Heather, Wyler von Ballmoos, Moritz, Lobdell, Kevin, MacKenzie, Todd A., Jacobs, Jeffrey, Parikh, Chirag R., DiScipio, Anthony W., Malenka, David J., Brown, Jeremiah R., Everett, Allen D., Alam, Shama S., Owens, Sherry L., Parker, Devin M., Goodrich, Christine, Likosky, Donald S., Thiessen-Philbrook, Heather, Wyler von Ballmoos, Moritz, Lobdell, Kevin, MacKenzie, Todd A., Jacobs, Jeffrey, Parikh, Chirag R., DiScipio, Anthony W., Malenka, David J., and Brown, Jeremiah R.

Abstract

Cardiac surgery results in a multifactorial systemic inflammatory response with inflammatory cytokines, such as interleukin-10 and 6 (IL-10 and IL-6), shown to have potential in the prediction of adverse outcomes including readmission or mortality. This study sought to measure the association between IL-6 and IL-10 levels and 1-year hospital readmission or mortality following cardiac surgery. Plasma biomarkers IL-6 and IL-10 were measured in 1,047 patients discharged alive after isolated coronary artery bypass graft surgery from eight medical centers participating in the Northern New England Cardiovascular Disease Study Group between 2004 and 2007. Readmission status and mortality were ascertained using Medicare, state all-payer claims, and the National Death Index. We evaluated the association between preoperative and postoperative cytokines and 1-year readmission or mortality using Kaplan–Meier estimates and Cox’s proportional hazards modeling, adjusting for covariates used in the Society of Thoracic Surgeons 30-day readmission model. The median follow-up time was 1 year. After adjustment, patients in the highest tertile of postoperative IL-6 values had a significantly increased risk of readmission or death within 1 year (HR: 1.38; 95% CI: 1.03–1.85), and an increased risk of death within 1 year of discharge (HR: 4.88; 95% CI: 1.26–18.85) compared with patients in the lowest tertile. However, postoperative IL-10 levels, although increasing through tertiles, were not found to be significantly associated independently with 1-year readmission or mortality (HR: 1.25; 95% CI: .93–1.69). Pro-inflammatory cytokine IL-6 and anti-inflammatory cytokine IL-10 may be postoperative markers of cardiac injury, and IL-6, specifically, shows promise in predicting readmission and mortality following cardiac surgery.

Published
2019
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35. Urine Biomarkers of Kidney Tubule Health, Injury, and Inflammation are Associated with Progression of CKD in Children

Author

Greenberg, Jason H., Abraham, Alison G., Xu, Yunwen, Schelling, Jeffrey R., Feldman, Harold I., Sabbisetti, Venkata S., Ix, Joachim H., Jogalekar, Manasi P., Coca, Steven, Waikar, Sushrut S., Shlipak, Michael G., Warady, Bradley A., Vasan, Ramachandran S., Kimmel, Paul L., Bonventre, Joseph V., Denburg, Michelle, Parikh, Chirag R., Furth, Susan, Ramachandran, Vasan S., Schelling, Jeffrey, Denburg, Michelle, Furth, Susan, Warady, Bradley, Bonventre, Joseph, Waikar, Sushrut, Sabbisetti, Venkata, Coresh, Josef, Grams, Morgan, Rebholz, Casey, Abraham, Alison, Parikh, Chirag, Coca, Steven, Rhee, Eugene, Kimmel, Paul L., Kusek, John W., Rovin, Brad, Shlipak, Michael G., Sarnak, Mark, Gutiérrez, Orlando M., Ix, Joachim, Dubin, Ruth, Hostetter, Tom, Deo, Rajat, Feldman, Harold I., Xie, Dawei, Shou, Haochang, Ballard, Shawn, Whitehead, Krista, Collins, Heather, Greenberg, Jason H., and Ganz, Peter

Published
2021
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36. Identification of Distinct Clinical Subphenotypes in Critically Ill Patients With COVID-19

Author

Vasquez, Charles R., Gupta, Shruti, Miano, Todd A., Roche, Meaghan, Hsu, Jesse, Yang, Wei, Holena, Daniel N., Reilly, John P., Schrauben, Sarah J., Leaf, David E., Shashaty, Michael G.S., Walther, Carl P., Anumudu, Samaya J., Arunthamakun, Justin, Kopecky, Kathleen F., Milligan, Gregory P., McCullough, Peter A., Nguyen, Thuy-Duyen, Shaefi, Shahzad, Krajewski, Megan L., Shankar, Sidharth, Pannu, Ameeka, Valencia, Juan D., Waikar, Sushrut S., Kibbelaar, Zoe A., Athavale, Ambarish M., Hart, Peter, Upadhyay, Shristi, Vohra, Ishaan, Oyintayo, Ajiboye, Green, Adam, Rachoin, Jean-Sebastien, Schorr, Christa A., Shea, Lisa, Edmonston, Daniel L., Mosher, Christopher L., Shehata, Alexandre M., Cohen, Zaza, Allusson, Valerie, Bambrick-Santoyo, Gabriela, Bhatti, Noor ul aain, Mehta, Bijal, Williams, Aquino, Brenner, Samantha K., Walters, Patricia, Go, Ronaldo C., Rose, Keith M., Chan, Lili, Mathews, Kusum S., Coca, Steven G., Altman, Deena R., Saha, Aparna, Soh, Howard, Wen, Huei Hsun, Bose, Sonali, Leven, Emily A., Wang, Jing G., Mosoyan, Gohar, Nadkarni, Girish N., Pattharanitima, Pattharawin, Gallagher, Emily J., Friedman, Allon N., Guirguis, John, Kapoor, Rajat, Meshberger, Christopher, Kelly, Katherine J., Parikh, Chirag R., Garibaldi, Brian T., Corona-Villalobos, Celia P., Wen, Yumeng, Menez, Steven, Malik, Rubab F., Cervantes, Carmen Elena, Gautam, Samir C., Mallappallil, Mary C., Ouyang, Jie, John, Sabu, Yap, Ernie, Melaku, Yohannes, Mohamed, Ibrahim, Bajracharya, Siddhartha, Puri, Isha, Thaxton, Mariah, Bhattacharya, Jyotsna, Wagner, John, Boudourakis, Leon, Nguyen, H. Bryant, Ahoubim, Afshin, Kashani, Kianoush, Tehranian, Shahrzad, Thomas, Leslie F., Sirganagari, Dheeraj Reddy, Guru, Pramod K., Zhou, Yan, Bergl, Paul A., Rodriguez, Jesus, Shah, Jatan A., Gupta, Mrigank S., Kumar, Princy N., Lazarous, Deepa G., Kassaye, Seble G., Melamed, Michal L., Johns, Tanya S., Mocerino, Ryan, Prudhvi, Kalyan, Zhu, Denzel, Levy, Rebecca V., Azzi, Yorg, Fisher, Molly, Yunes, Milagros, Sedaliu, Kaltrina, Golestaneh, Ladan, Brogan, Maureen, Kumar, Neelja, Chang, Michael, Thakkar, Jyotsana, Raichoudhury, Ritesh, Athreya, Akshay, Farag, Mohamed, Schenck, Edward J., Cho, Soo Jung, Plataki, Maria, Alvarez-Mulett, Sergio L., Gomez-Escobar, Luis G., Pan, Di, Lee, Stefi, Krishnan, Jamuna, Whalen, William, Charytan, David, Macina, Ashley, Chaudhry, Sobaata, Wu, Benjamin, Modersitzki, Frank, Srivastava, Anand, Leidner, Alexander S., Martinez, Carlos, Kruser, Jacqueline M., Wunderink, Richard G., Hodakowski, Alexander J., Velez, Juan Carlos Q., Price-Haywood, Eboni G., Matute-Trochez, Luis A., Hasty, Anna E., Mohamed, Muner M.B., Avasare, Rupali S., Zonies, David, Leaf, David E., Gupta, Shruti, Sise, Meghan E., Newman, Erik T., Omar, Samah Abu, Pokharel, Kapil K., Sharma, Shreyak, Singh, Harkarandeep, Correa, Simon, Shaukat, Tanveer, Kamal, Omer, Wang, Wei, Yang, Heather, Boateng, Jeffery O., Lee, Meghan, Strohbehn, Ian A., Li, Jiahua, Mueller, Ariel L., Redfern, Roberta E., Cairl, Nicholas S., Naimy, Gabriel, Abu-Saif, Abeer, Hall, Danyell, Bickley, Laura, Rowan, Chris, Madhani-Lovely, Farah, Peev, Vasil, Reiser, Jochen, Byun, John J., Vissing, Andrew, Kapania, Esha M., Post, Zoe, Patel, Nilam P., Hermes, Joy-Marie, Sutherland, Anne K., Patrawalla, Amee, Finkel, Diana G., Danek, Barbara A., Arikapudi, Sowminya, Paer, Jeffrey M., Cangialosi, Peter, Liotta, Mark, Radbel, Jared, Puri, Sonika, Sunderram, Jag, Scharf, Matthew T., Ahmed, Ayesha, Berim, Ilya, Vatson, Jayanth S., Anand, Shuchi, Levitt, Joseph E., Garcia, Pablo, Boyle, Suzanne M., Song, Rui, Zhang, Jingjing, Woo, Sang Hoon, Deng, Xiaoying, Katz-Greenberg, Goni, Senter, Katharine, Sharshir, Moh’d A., Rusnak, Vadym V., Ali, Muhammad Imran, Bansal, Anip, Podoll, Amber S., Chonchol, Michel, Sharma, Sunita, Burnham, Ellen L., Rashidi, Arash, Hejal, Rana, Judd, Eric, Latta, Laura, Tolwani, Ashita, Albertson, Timothy E., Adams, Jason Y., Chang, Steven Y., Beutler, Rebecca M., Schulze, Carl E., Macedo, Etienne, Rhee, Harin, Liu, Kathleen D., Jotwani, Vasantha K., Koyner, Jay L., Kunczt, Alissa, Shah, Chintan V., Jaikaransingh, Vishal, Toth-Manikowski, Stephanie M., Joo, Min J., Lash, James P., Neyra, Javier A., Chaaban, Nourhan, Ahmad, Yahya, Elias, Madona, Dy, Rajany, Iardino, Alfredo, Au, Elizabeth H., Sharma, Jill H., Sosa, Marie Anne, Taldone, Sabrina, Contreras, Gabriel, De La Zerda, David, Gershengorn, Hayley B., Hayek, Salim S., Blakely, Pennelope, Berlin, Hanna, Azam, Tariq U., Shadid, Husam, Pan, Michael, Hayer, Patrick O’, Meloche, Chelsea, Feroze, Rafey, Kaakati, Rayan, Perry, Danny, Bitar, Abbas, Anderson, Elizabeth, Padalia, Kishan J., Donnelly, John P., Admon, Andrew J., Flythe, Jennifer E., Tugman, Matthew J., Chang, Emily H., Brown, Brent R., Leonberg-Yoo, Amanda K., Spiardi, Ryan C., Miano, Todd A., Roche, Meaghan S., Vasquez, Charles R., Bansal, Amar D., Ernecoff, Natalie C., Kapoor, Sanjana, Verma, Siddharth, Chen, Huiwen, Kovesdy, Csaba P., Molnar, Miklos Z., Azhar, Ambreen, Hedayati, S. Susan, Nadamuni, Mridula V., Shastri, Shani, Willett, Duwayne L., Short, Samuel A.P., Renaghan, Amanda D., Enfield, Kyle B., Bhatraju, Pavan K., Malik, A. Bilal, Semler, Matthew W., Vijayan, Anitha, Joy, Christina Mariyam, Li, Tingting, Goldberg, Seth, Kao, Patricia F., Schumaker, Greg L., Goyal, Nitender, Faugno, Anthony J., Schumaker, Greg L., Hsu, Caroline M., Tariq, Asma, Meyer, Leah, Kshirsagar, Ravi K., Weiner, Daniel E., Jose, Aju, Christov, Marta, Griffiths, Jennifer, Gupta, Sanjeev, Kapoor, Aromma, Chugh, Savneek, Wilson, Perry, Arora, Tanima, and Ugwuowo, Ugochukwu

Abstract

Subphenotypes have been identified in patients with sepsis and ARDS and are associated with different outcomes and responses to therapies.

Published
2021
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40. Rationale and design of the Kidney Precision Medicine Project

Author

de Boer, Ian H., Alpers, Charles E., Azeloglu, Evren U., Balis, Ulysses G.J., Barasch, Jonathan M., Barisoni, Laura, Blank, Kristina N., Bomback, Andrew S., Brown, Keith, Dagher, Pierre C., Dighe, Ashveena L., Eadon, Michael T., El-Achkar, Tarek M., Gaut, Joseph P., Hacohen, Nir, He, Yongqun, Hodgin, Jeffrey B., Jain, Sanjay, Kellum, John A., Kiryluk, Krzysztof, Knight, Richard, Laszik, Zoltan G., Lienczewski, Chrysta, Mariani, Laura H., McClelland, Robyn L., Menez, Steven, Moledina, Dennis G., Mooney, Sean D., O’Toole, John F., Palevsky, Paul M., Parikh, Chirag R., Poggio, Emilio D., Rosas, Sylvia E., Rosengart, Matthew R., Sarwal, Minnie M., Schaub, Jennifer A., Sedor, John R., Sharma, Kumar, Steck, Becky, Toto, Robert D., Troyanskaya, Olga G., Tuttle, Katherine R., Vazquez, Miguel A., Waikar, Sushrut S., Williams, Kayleen, Wilson, Francis Perry, Zhang, Kun, Iyengar, Ravi, Kretzler, Matthias, Himmelfarb, Jonathan, Knight, Richard, Lecker, Stewart, Stillman, Isaac, Waikar, Sushrut, Mcmahon, Gearoid, Weins, Astrid, Short, Samuel, Hacohen, Nir, Hoover, Paul, Aulisio, Mark, Cooperman, Leslie, Herlitz, Leal, O’Toole, John, Poggio, Emilio, Sedor, John, Jolly, Stacey, Appelbaum, Paul, Balderes, Olivia, Barasch, Jonathan, Bomback, Andrew, Canetta, Pietro A., d’Agati, Vivette D., Kiryluk, Krzysztof, Kudose, Satoru, Mehl, Karla, Radhakrishnan, Jai, Weng, Chenhua, Barisoni, Laura, Alexandrov, Theodore, Ashkar, Tarek, Barwinska, Daria, Dagher, Pierre, Dunn, Kenneth, Eadon, Michael, Ferkowicz, Michael, Kelly, Katherine, Sutton, Timothy, Winfree, Seth, Menez, Steven, Parikh, Chirag, Rosenberg, Avi, Villalobos, Pam, Malik, Rubab, Fine, Derek, Atta, Mohammed, Monroy Trujillo, Jose Manuel, Slack, Alison, Rosas, Sylvia, Williams, Mark, Azeloglu, Evren, He, Cijang (John), Iyengar, Ravi, Hansen, Jens, Parikh, Samir, Rovin, Brad, Anderton, Chris, Pasa-Tolic, Ljiljana, Velickovic, Dusan, Lukowski, Jessica, Oliver, George (Holt), Ardayfio, Joseph, Bebiak, Jack, Brown, Keith, Campbell, Taneisha, Campbell, Catherine, Hayashi, Lynda, Jefferson, Nichole, Koewler, Robert, Roberts, Glenda, Saul, John, Shpigel, Anna, Stutzke, Edith Christine, Wright, Lorenda, Miegs, Leslie, Pinkeney, Roy, Sealfon, Rachel, Troyanskaya, Olga, Tuttle, Katherine, Dobi, Dejan, Goltsev, Yury, Lake, Blue, Zhang, Kun, Joanes, Maria, Laszik, Zoltan, Schroeder, Andrew, Sarwal, Minnie, Sigdel, Tara, Balis, Ulysses, Blanc, Victoria, He, Oliver, Hodgin, Jeffrey, Kretzler, Matthias, Mariani, Laura, Menon, Rajasree, Otto, Edgar, Schaub, Jennifer, Steck, Becky, Lienczewski, Chrysta, Eddy, Sean, Elder, Michele, Hall, Daniel, Kellum, John, Kruth, Mary, Murugan, Raghav, Palevsky, Paul, Randhawa, Parmjeet, Rosengart, Matthew, Sims-Lucas, Sunny, Stefanick, Mary, Stull, Stacy, Tublin, Mitchell, Alpers, Charles, de Boer, Ian, Dighe, Ashveena, Himmelfarb, Jonathan, Mcclelland, Robyn, Mooney, Sean, Shankland, Stuart, Williams, Kayleen, Blank, Kristina, Carson, Jonas, Dowd, Frederick, Drager, Zach, Park, Christopher, Sharma, Kumar, Zhang, Guanshi, Bansal, Shweta, Venkatachalam, Manjeri, Kermani, Asra, Lee, Simon, Lu, Christopher, Miller, Tyler, Moe, Orson, Park, Harold, Sambandam, Kamalanathan, Sanchez, Francisco, Torrealba, Jose, Robert, Toto, Vazquez, Miguel, Wang, Nancy, Gaut, Joe, Jain, Sanjay, Vijayan, Anitha, Luciano, Randy, Moledina, Dennis, Ugochukwu, Ugwuowo, Wilson, Francis Perry, and Alfano, Sandy

Abstract

Chronic kidney disease (CKD) and acute kidney injury (AKI) are common, heterogeneous, and morbid diseases. Mechanistic characterization of CKD and AKI in patients may facilitate a precision-medicine approach to prevention, diagnosis, and treatment. The Kidney Precision Medicine Project aims to ethically and safely obtain kidney biopsies from participants with CKD or AKI, create a reference kidney atlas, and characterize disease subgroups to stratify patients based on molecular features of disease, clinical characteristics, and associated outcomes. An additional aim is to identify critical cells, pathways, and targets for novel therapies and preventive strategies. This project is a multicenter prospective cohort study of adults with CKD or AKI who undergo a protocol kidney biopsy for research purposes. This investigation focuses on kidney diseases that are most prevalent and therefore substantially burden the public health, including CKD attributed to diabetes or hypertension and AKI attributed to ischemic and toxic injuries. Reference kidney tissues (for example, living-donor kidney biopsies) will also be evaluated. Traditional and digital pathology will be combined with transcriptomic, proteomic, and metabolomic analysis of the kidney tissue as well as deep clinical phenotyping for supervised and unsupervised subgroup analysis and systems biology analysis. Participants will be followed prospectively for 10 years to ascertain clinical outcomes. Cell types, locations, and functions will be characterized in health and disease in an open, searchable, online kidney tissue atlas. All data from the Kidney Precision Medicine Project will be made readily available for broad use by scientists, clinicians, and patients.

Published
2021
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41. Association Between Early Treatment With Tocilizumab and Mortality Among Critically Ill Patients With COVID-19

Author

Gupta, Shruti, Wang, Wei, Hayek, Salim S., Chan, Lili, Mathews, Kusum S., Melamed, Michal L., Brenner, Samantha K., Leonberg-Yoo, Amanda, Schenck, Edward J., Radbel, Jared, Reiser, Jochen, Bansal, Anip, Srivastava, Anand, Zhou, Yan, Finkel, Diana, Green, Adam, Mallappallil, Mary, Faugno, Anthony J., Zhang, Jingjing, Velez, Juan Carlos Q., Shaefi, Shahzad, Parikh, Chirag R., Charytan, David M., Athavale, Ambarish M., Friedman, Allon N., Redfern, Roberta E., Short, Samuel A. P., Correa, Simon, Pokharel, Kapil K., Admon, Andrew J., Donnelly, John P., Gershengorn, Hayley B., Douin, David J., Semler, Matthew W., Hernán, Miguel A., and Leaf, David E.

Abstract

IMPORTANCE: Therapies that improve survival in critically ill patients with coronavirus disease 2019 (COVID-19) are needed. Tocilizumab, a monoclonal antibody against the interleukin 6 receptor, may counteract the inflammatory cytokine release syndrome in patients with severe COVID-19 illness. OBJECTIVE: To test whether tocilizumab decreases mortality in this population. DESIGN, SETTING, AND PARTICIPANTS: The data for this study were derived from a multicenter cohort study of 4485 adults with COVID-19 admitted to participating intensive care units (ICUs) at 68 hospitals across the US from March 4 to May 10, 2020. Critically ill adults with COVID-19 were categorized according to whether they received or did not receive tocilizumab in the first 2 days of admission to the ICU. Data were collected retrospectively until June 12, 2020. A Cox regression model with inverse probability weighting was used to adjust for confounding. EXPOSURES: Treatment with tocilizumab in the first 2 days of ICU admission. MAIN OUTCOMES AND MEASURES: Time to death, compared via hazard ratios (HRs), and 30-day mortality, compared via risk differences. RESULTS: Among the 3924 patients included in the analysis (2464 male [62.8%]; median age, 62 [interquartile range {IQR}, 52-71] years), 433 (11.0%) received tocilizumab in the first 2 days of ICU admission. Patients treated with tocilizumab were younger (median age, 58 [IQR, 48-65] vs 63 [IQR, 52-72] years) and had a higher prevalence of hypoxemia on ICU admission (205 of 433 [47.3%] vs 1322 of 3491 [37.9%] with mechanical ventilation and a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen of <200 mm Hg) than patients not treated with tocilizumab. After applying inverse probability weighting, baseline and severity-of-illness characteristics were well balanced between groups. A total of 1544 patients (39.3%) died, including 125 (28.9%) treated with tocilizumab and 1419 (40.6%) not treated with tocilizumab. In the primary analysis, during a median follow-up of 27 (IQR, 14-37) days, patients treated with tocilizumab had a lower risk of death compared with those not treated with tocilizumab (HR, 0.71; 95% CI, 0.56-0.92). The estimated 30-day mortality was 27.5% (95% CI, 21.2%-33.8%) in the tocilizumab-treated patients and 37.1% (95% CI, 35.5%-38.7%) in the non-tocilizumab–treated patients (risk difference, 9.6%; 95% CI, 3.1%-16.0%). CONCLUSIONS AND RELEVANCE: Among critically ill patients with COVID-19 in this cohort study, the risk of in-hospital mortality in this study was lower in patients treated with tocilizumab in the first 2 days of ICU admission compared with patients whose treatment did not include early use of tocilizumab. However, the findings may be susceptible to unmeasured confounding, and further research from randomized clinical trials is needed.

Published
2021
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42. The association of acute kidney injury with hospital readmission and death after pediatric cardiac surgery

Author

Nunes, Sophia, Brown, Jeremiah, Parikh, Chirag R., Greenberg, Jason H., Devarajan, Prasad, Philbrook, Heather Theissen, Pizzi, Michael, Palijan, Ana, and Zappitelli, Michael

Abstract

Acute kidney injury (AKI) in children undergoing cardiac surgery (CS) is strongly associated with increased hospital mortality and length of stay. The association of AKI with postdischarge outcomes is unclear. We evaluated the association of AKI with all-cause readmissions and death within 30 days and 1 year of CS discharge.

Published
2020
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43. Kidney nonprocurement in solid organ donors in the United States

Author

Yu, Kathleen, King, Kristen, Husain, Syed A., Dube, Geoffrey K., Stevens, Jacob S., Ratner, Lloyd E., Cooper, Matthew, Parikh, Chirag R., and Mohan, Sumit

Abstract

There are limited data on the nonprocurement of kidneys from solid organ donors. Analysis of Standard Transplant Analysis and Research files was undertaken on all deceased donors in the United States with at least 1 solid organ recovered. From 2000 to 2018, 21 731 deceased donor kidneys (averaging 1144 kidneys per year) were not procured. No kidneys were procured from 8% of liver donors, 3% of heart donors, and 3% of lung donors. Compared to donors with all kidneys procured, those with none procured were older and more likely obese, black, hypertensive, diabetic, hepatitis C positive, smokers, Public Health Service – Increased Risk designated, deceased after cardiac death, or deceased after cerebrovascular accident. Although these donors had lower quality kidneys (median Kidney Donor Risk Index (interquartile range) 1.9 (1.0) vs 1.2 (0.7)), there was substantial overlap in quality between nonprocured and procured kidneys. Nearly one third of nonprocurements were attributed to donor history. Donors with elevated terminal creatinine likely resulting from acute kidney injury (AKI) had higher odds of kidney nonprocurement. Nonprocurement odds varied widely across Organ Procurement and Transplantation Network regions, with a positive correlation between donor kidney nonprocurements and kidney discards at the donation service area level. These findings suggest current discard rates underestimate the underutilization of deceased donor kidneys and more research is needed to optimize safe procurement and utilization of kidneys from donors with AKI. In this analysis of deceased donors in the United States between 2000–2018, the authors show that kidney nonprocurement, despite procurement of a lung, heart, or liver, was associated with donor history and elevated terminal creatinine that likely reflect donor acute kidney injury.

Published
2020
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44. Factors Associated With Death in Critically Ill Patients With Coronavirus Disease 2019 in the US

Author

Gupta, Shruti, Hayek, Salim S., Wang, Wei, Chan, Lili, Mathews, Kusum S., Melamed, Michal L., Brenner, Samantha K., Leonberg-Yoo, Amanda, Schenck, Edward J., Radbel, Jared, Reiser, Jochen, Bansal, Anip, Srivastava, Anand, Zhou, Yan, Sutherland, Anne, Green, Adam, Shehata, Alexandre M., Goyal, Nitender, Vijayan, Anitha, Velez, Juan Carlos Q., Shaefi, Shahzad, Parikh, Chirag R., Arunthamakun, Justin, Athavale, Ambarish M., Friedman, Allon N., Short, Samuel A. P., Kibbelaar, Zoe A., Abu Omar, Samah, Admon, Andrew J., Donnelly, John P., Gershengorn, Hayley B., Hernán, Miguel A., Semler, Matthew W., and Leaf, David E.

Abstract

IMPORTANCE: The US is currently an epicenter of the coronavirus disease 2019 (COVID-19) pandemic, yet few national data are available on patient characteristics, treatment, and outcomes of critical illness from COVID-19. OBJECTIVES: To assess factors associated with death and to examine interhospital variation in treatment and outcomes for patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTS: This multicenter cohort study assessed 2215 adults with laboratory-confirmed COVID-19 who were admitted to intensive care units (ICUs) at 65 hospitals across the US from March 4 to April 4, 2020. EXPOSURES: Patient-level data, including demographics, comorbidities, and organ dysfunction, and hospital characteristics, including number of ICU beds. MAIN OUTCOMES AND MEASURES: The primary outcome was 28-day in-hospital mortality. Multilevel logistic regression was used to evaluate factors associated with death and to examine interhospital variation in treatment and outcomes. RESULTS: A total of 2215 patients (mean [SD] age, 60.5 [14.5] years; 1436 [64.8%] male; 1738 [78.5%] with at least 1 chronic comorbidity) were included in the study. At 28 days after ICU admission, 784 patients (35.4%) had died, 824 (37.2%) were discharged, and 607 (27.4%) remained hospitalized. At the end of study follow-up (median, 16 days; interquartile range, 8-28 days), 875 patients (39.5%) had died, 1203 (54.3%) were discharged, and 137 (6.2%) remained hospitalized. Factors independently associated with death included older age (≥80 vs <40 years of age: odds ratio [OR], 11.15; 95% CI, 6.19-20.06), male sex (OR, 1.50; 95% CI, 1.19-1.90), higher body mass index (≥40 vs <25: OR, 1.51; 95% CI, 1.01-2.25), coronary artery disease (OR, 1.47; 95% CI, 1.07-2.02), active cancer (OR, 2.15; 95% CI, 1.35-3.43), and the presence of hypoxemia (Pao2:Fio2<100 vs ≥300 mm Hg: OR, 2.94; 95% CI, 2.11-4.08), liver dysfunction (liver Sequential Organ Failure Assessment score of 2-4 vs 0: OR, 2.61; 95% CI, 1.30–5.25), and kidney dysfunction (renal Sequential Organ Failure Assessment score of 4 vs 0: OR, 2.43; 95% CI, 1.46–4.05) at ICU admission. Patients admitted to hospitals with fewer ICU beds had a higher risk of death (<50 vs ≥100 ICU beds: OR, 3.28; 95% CI, 2.16-4.99). Hospitals varied considerably in the risk-adjusted proportion of patients who died (range, 6.6%-80.8%) and in the percentage of patients who received hydroxychloroquine, tocilizumab, and other treatments and supportive therapies. CONCLUSIONS AND RELEVANCE: This study identified demographic, clinical, and hospital-level risk factors that may be associated with death in critically ill patients with COVID-19 and can facilitate the identification of medications and supportive therapies to improve outcomes.

Published
2020
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45. Early Prediction of Acute Kidney Injury in the Emergency Department With Machine-Learning Methods Applied to Electronic Health Record Data

Author

Martinez, Diego A., Levin, Scott R., Klein, Eili Y., Parikh, Chirag R., Menez, Steven, Taylor, Richard A., and Hinson, Jeremiah S.

Abstract

Acute kidney injury occurs commonly and is a leading cause of prolonged hospitalization, development and progression of chronic kidney disease, and death. Early acute kidney injury treatment can improve outcomes. However, current decision support is not able to detect patients at the highest risk of developing acute kidney injury. We analyzed routinely collected emergency department (ED) data and developed prediction models with capacity for early identification of ED patients at high risk for acute kidney injury.

Published
2020
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46. A Review of Donor Acute Kidney Injury and Posttransplant Outcomes

Author

Koyawala, Neel and Parikh, Chirag R.

Abstract

Although over 90 000 people are on the kidney transplant waitlist in the United States, some kidneys that are viable for transplantation are discarded. Transplant surgeons are more likely to discard deceased donors with acute kidney injury (AKI) versus without AKI (30% versus 18%). AKI is defined using changes in creatinine from baseline. Transplant surgeons can use DonorNet data, including admission, peak, and terminal serum creatinine, and biopsy data when available to differentiate kidneys with AKI from those with chronic injury. Although chronic kidney disease is associated with reduced graft survival, an abundance of literature has demonstrated similar graft survival for deceased donors with AKI versus donors without AKI. Donors with AKI are more likely to undergo delayed graft function but have similar long-term outcomes as donors without AKI. The mechanism for similar graft survival is unclear. Some hypothesized mechanisms include (1) ischemic preconditioning; (2) posttransplant and host factors playing a greater role in long-term survival than donor factors; and (3) selection bias of transplanting only relatively healthy donor kidneys with AKI. Existing literature suggests transplanting more donor kidneys with stage 1 and 2 AKI, and cautious utilization of stage 3 AKI donors, may increase the pool of viable kidneys. Doing so can reduce the number of people who die on the waitlist by over 500 every year.

Published
2020
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47. Urine Injury Biomarkers Are Not Associated With Kidney Transplant Failure

Author

Koyawala, Neel, Reese, Peter P., Hall, Isaac E., Jia, Yaqi, Thiessen-Philbrook, Heather R., Mansour, Sherry G., Doshi, Mona D., Akalin, Enver, Bromberg, Jonathan S., Harhay, Meera N., Mohan, Sumit, Muthukumar, Thangamani, Schröppel, Bernd, Singh, Pooja, Weng, Francis L., and Parikh, Chirag R.

Abstract

Supplemental Digital Content is available in the text.

Published
2020
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48. Outcomes From Right Versus Left Deceased-Donor Kidney Transplants: A US National Cohort Study

Author

Kulkarni, Sanjay, Wei, Guo, Jiang, Wei, Lopez, Licia A., Parikh, Chirag R., and Hall, Isaac E.

Abstract

There may be important transplant-related differences between right and left kidneys, including logistical/surgical considerations about vessel length for the right compared to the left kidney from the same donor. Because US centers choose between the right and left kidney when their recipient is ranked higher on a “match-run,” we sought to determine whether deceased-donor right kidneys have had worse posttransplantation outcomes than left kidneys.

Published
2020
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49. Post–Acute Kidney Injury Proteinuria and Subsequent Kidney Disease Progression: The Assessment, Serial Evaluation, and Subsequent Sequelae in Acute Kidney Injury (ASSESS-AKI) Study

Author

Hsu, Chi-yuan, Chinchilli, Vernon M., Coca, Steven, Devarajan, Prasad, Ghahramani, Nasrollah, Go, Alan S., Hsu, Raymond K., Ikizler, T. Alp, Kaufman, James, Liu, Kathleen D., Parikh, Chirag R., Reeves, W. Brian, Wurfel, Mark, Zappitelli, Michael, Kimmel, Paul L., and Siew, Edward D.

Abstract

IMPORTANCE: Among patients who had acute kidney injury (AKI) during hospitalization, there is a need to improve risk prediction such that those at highest risk for subsequent loss of kidney function are identified for appropriate follow-up. OBJECTIVE: To evaluate the association of post-AKI proteinuria with increased risk of future loss of renal function. DESIGN, SETTING, AND PARTICIPANTS: The Assessment, Serial Evaluation, and Subsequent Sequelae in Acute Kidney Injury (ASSESS-AKI) Study was a multicenter prospective cohort study including 4 clinical centers in North America included 1538 patients enrolled 3 months after hospital discharge between December 2009 and February 2015. EXPOSURES: Urine albumin-to-creatinine ratio (ACR) quantified 3 months after hospital discharge. MAIN OUTCOMES AND MEASURES: Kidney disease progression defined as halving of estimated glomerular filtration rate (eGFR) or end-stage renal disease. RESULTS: Of the 1538 participants, 769 (50%) had AKI durring hospitalization. The baseline study visit took place at a mean (SD) 91 (23) days after discharge. The mean (SD) age was 65 (13) years; the median eGFR was 68 mL/min/1.73 m2; and the median urine ACR was 15 mg/g. Overall, 547 (37%) study participants were women and 195 (13%) were black. After a median follow-up of 4.7 years, 138 (9%) participants had kidney disease progression. Higher post-AKI urine ACR level was associated with increased risk of kidney disease progression (hazard ratio [HR], 1.53 for each doubling; 95% CI, 1.45-1.62), and urine ACR measurement was a strong discriminator for future kidney disease progression (C statistic, 0.82). The performance of urine ACR was stronger in patients who had had AKI than in those who had not (C statistic, 0.70). A comprehensive model of clinical risk factors (eGFR, blood pressure, and demographics) including ACR provided better discrimination for predicting kidney disease progression after hospital discharge among those who had had AKI (C statistic, 0.85) vs those who had not (C statistic, 0.76). In the entire matched cohort, after taking into account urine ACR, eGFR, demographics, and traditional chronic kidney risk factors determined 3 months after discharge, AKI (HR, 1.46; 95% CI, 0.51-4.13 for AKI vs non-AKI) or severity of AKI (HR, 1.54; 95% CI, 0.50-4.72 for AKI stage 1 vs non-AKI; HR, 0.56; 95% CI, 0.07-4.84 for AKI stage 2 vs non-AKI; HR, 2.24; 95% CI, 0.33-15.29 for AKI stage 3 vs non-AKI) was not independently associated with more rapid kidney disease progression. CONCLUSIONS AND RELEVANCE: Proteinuria level is a valuable risk-stratification tool in the post-AKI period. These results suggest there should be more widespread and routine quantification of proteinuria after hospitalized AKI.

Published
2020
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50. Kidney Biomarkers of Injury and Repair as Predictors of Contrast-Associated AKI: A Substudy of the PRESERVE Trial

Author

Parikh, Chirag R., Liu, Caroline, Mor, Maria K., Palevsky, Paul M., Kaufman, James S., Thiessen Philbrook, Heather, and Weisbord, Steven D.

Abstract

The PRESERVE trial used a 2 × 2 factorial design to compare intravenous saline solution with intravenous sodium bicarbonate solution and oral N-acetylcysteine with placebo for the prevention of 90-day major adverse kidney events and death (MAKE-D) and contrast-associated acute kidney injury (CA-AKI) among patients with chronic kidney disease undergoing angiography. In this ancillary study, we evaluated the predictive capacities of preangiography injury and repair proteins in urine and plasma for MAKE-D, CA-AKI, and their impact on trial design.

Published
2020
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