Fluid Management and Bioimpedance
Body Composition and Nutrition
Epidemiology and MONDO
Neurobiomarkers and Environmental Factors
in CKD and HD
by Abby Johnson, BS, Hassan A. N. El-Fawal, MS, PhD,
Darius Mason, PharmD, BCPS
A neglected area in the management of chronic kidney disease (CKD) and hemodialysis (HD) is the early detection and amelior- ation of cognitive decline. A survey of the literature indicates that in patients with CKD, there is a high prevalence of cognitive and neurological impairments, where approximately 70% of HD patients age 55 and older suffer from moderate to severe chronic cognitive dysfunction (1,2). This
|Also in this issue|
Periodontal Disease in Hemodialysis Patients
Saving Lives in sub-Sahara Africa
RRI 2014 Conference Program
XIX World Transplant Games 2013
Sustainable Kidney Care Foundation
Advanced Renal Education Program
16th International Conference on Dialysis
impairment may manifest as difficulty in recall, confusion and dementia (2).
Although the exact cause for the decline is unknown, several factors such as vascular disease and inflammation, progression of CKD, hemodialysis, and increase stroke prevalence could contribute to its development (3). Furthermore, uremic neurotoxins, such as creatinine and guanidine, accumulate during CKD progression (4-7). With the largely growing incidence of neurological deficits in HD patients, there is a compelling need for high-throughput screening biomarkers to diagnose, monitor, and evaluate protective measures aimed at ameliorating cognitive decline. One area that has shown promising results is the capitalization on the immune system to indicate nervous system (NS) damage in the form of neuro- auto- antibodies, or neuroantibodies.
Capitalizing on the Immune System to Detect Nervous System Damage
The identification of autoantibodies as potential biomarkers of NS insult arose based upon the premise that neurodegeneration results in the loss of NS-specific proteins.
To these proteins, the immune system mounts a humoral immune response which can be detected in blood (8).The loss of NS proteins to the periphery has been reported in numerous neurodegenerative conditions such as Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, and depression (9-11). Whereas these proteins have limited half-lives in cerebral spinal fluid and serum, the Furthermore, uremic neurotoxins, such as creatinine and guanidine, accumulate during CKD progression (4-7). With the largely growing incidence of neurological deficits in HD patients, there is a compelling need for high-throughput screening biomarkers to diagnose, monitor, and evaluate protective measures aimed at ameliorating cognitive decline. One area that has shown promising results is the capitalization on the immune system to indicate nervous system (NS) damage in the form of neuro-autoantibodies ...
One of the nation's top academic medical centers, the University of Rochester Medical Center forms the centerpiece of the University's health research, teaching, patient care, and community outreach missions. With more than $145 million in federal research funding, UR School of Medicine research funding ranks in the top one-quarter of U.S. medical centers, while the School of Nursing ranks 12th highest in funding. The University's health care delivery network is anchored by Strong Memorial Hospital—a 739-bed, University-owned teaching hospital—which boasts programs that consistently rank among "America's Best Hospitals," according to U.S. News & World Report. Our patients benefit from the Medical Center's robust teaching and biomedical research programs. Our mission is to use education, science, and technology to improve health—transforming the patient experience with fresh ideas and approaches steeped in disciplined science, and delivered by health care professionals who innovate, take intelligent risks, and care about the lives they touch.
The University of Massachusetts Lowell is a division of the University of Massachusetts system. We enroll 10,000 undergraduates and 8000 graduates in a diverse set of programs that include natural sciences, liberal arts, business,and engineering, with 600 full-time and 300 part-time faculty. We have professional programs in nursing, medical technology and physical therapy, and award the PhD in 26 areas, include Biomedical Engineering, Physics, Chemistry, Mathematics, and Polymer Technology.
The UNC Health Care System is a not-for-profit integrated health care system, owned by the State of North Carolina and based in Chapel Hill. It exists to further the teaching mission of the University of North Carolina and to provide state-of-the-art patient care. A distinguishing characteristic of UNC Health Care is its association with the UNC-Chapel Hill School of Medicine, a nationally eminent research institution. This relationship gives UNC Health Care a powerful pathway for moving the results of biomedical research from medical school laboratories to patient care settings. UNC Health Care has been granted broad powers by the North Carolina General Assembly to assure its management flexibility and competitiveness in a rapidly changing health care business environment. The enterprise is governed by a board of directors appointed by the University of North Carolina.
The Mount Sinai Health System is an integrated health care system providing exceptional medical care to our local and global communities. Encompassing the Icahn School of Medicine at Mount Sinai and seven hospital campuses in the New York metropolitan area, as well as a large, regional ambulatory footprint, Mount Sinai is acclaimed internationally for its excellence in research, patient care, and education across a range of specialties. The Mount Sinai Health System was created from the combination of The Mount Sinai Medical Center and Continuum Health Partners, which both agreed unanimously to combine the two entities in July 2013.
The Health System is designed to increase efficiencies and economies of scale, improve quality and outcomes, and expand access to advanced primary, specialty, and ambulatory care services throughout a wide clinical network. The System includes 2,784 full- and part-time physicians, 3,783 voluntary physicians, and 12 free-standing ambulatory surgery centers. With more than 430 full- and part-time primary care physicians, clinical teams are able to manage large populations of patients in the lowest-cost, most-effective settings. The System also features a robust and continually expanding network of multispecialty services, including more than 45 ambulatory practices throughout the five boroughs of New York City, Westchester, and Long Island. It has more than 40 clinical and academic relationships with other local health care organizations, and Mount Sinai physicians are located in more than 200 community locations throughout the New York metropolitan area. With an extraordinary array of resources for the provision of compassionate, state-of-the-art care, the Mount Sinai Health System is poised to identify and respond to the health-related needs of the diverse populations we serve.
We are a different kind of renal therapy provider. As part of the Renal Research Institute, our affiliation with leading academic institutions is dedicated to developing and improving therapies and best practices for patients with kidney disease. Ideas take flight through research and testing, and our Avantus Renal Therapy clinics offer our dialysis patients the opportunity to participate in clinical trials and evaluation of new devices to make dialysis more comfortable and more efficient. We’re proud to say that the Renal Research Institute has led to many new developments for dialysis patients, and freely shares these research findings with everyone interested. From home therapies to private renal suites, Avantus Renal Therapy is committed to providing progressive therapy options and environmental solutions to ensure high quality, cost effective healthcare for our patients. We provide the program and service support for our patients and physicians as they evolve the medical approach throughout the continuum of care.
The Division of Nephrology at Vanderbilt University Medical Center has a long and notable history of the study, treatment, causes and potential therapies of kidney disease. With leading researchers, clinicians, and instructors working in state-of-the-art facilities our contributions are significant and validated through the many publications, honors, and grant funding received as we help to advance cures for kidney disease through scientific discoveries, cutting-edge treatments, and renal transplants.
The mission of Nephrology is to; Inspire Interest in the Prevention of Disease, Promote Human Health, Cultivate Biomedical Discovery, Provide Compassionate Care, and Educate Tomorrow's Leaders Vanderbilt Nephrology is ranked in the top 10 by US News and World Reports, investigators received over 12.86 million dollars in grant awards for the fiscal year 2011. Our Division Chief, Ray Harris, MD, is an ASN Councilor and many of our faculty have been elected to advisory boards, steering committees, and leadership positions for NKF, ASN, and other medical associations. Our goal is to provide excellence in patient care, train physicians and researchers, lead in scientific research and discoveries in understanding and treating acute and chronic renal disease, and promote collaborations within the scientific domain.
Taipei Medical University (TMU), formerly known as Taipei Medical College (TMC), was founded on June 1, 1960 by Dr. Shui-Wang Hu, Dr. Cheng-Tien Hsu and other medical professionals and devoted educators. TMU is located on Wuxing Street in eastern Taipei.
Most of more than 30,000 TMU graduates serve in medical institutions and clinics, while many others are prominent figures in the fields of research, politics, and business. TMU has 7 colleges, 12 undergraduate schools and 14 graduate institutes as well as three affiliated hospitals - TMU Hospital, Wan Fang Hospital, and Shuangho Hospital. With approximately 3,000 beds, TMU is one of the largest health care systems and offers top-quality teaching, research and clinical services in the Taipei metropolitan area. We work continuously to improve the quality of teaching, research and clinical services with the goal of becoming a fully internationalized university that ranks in the top tier worldwide.
Maastricht University Medical Centre+ (‘Maastricht UMC+’) is known both nationally and internationally for its focus on prevention The promotion and maintenance of good health are just as important to us as helping patients recover their health. Key tasks are - besides clinical and highly specialized patient - scientific research and education / training. The Maastricht UMC + characterizes itself by the multidisciplinary and problem-based approach. The Maastricht university hospital, which has 715 beds, employs approximately 7,000 people, and educates 4,000 students, is a member of the NFU, the Netherlands Federation of University Medical Centres.
The School of Medicine, Pontificia Universidade Católica do Paraná, is a 52 year old school based in Curitiba, Paraná, Brazil. The Renal Medicine Division is part of the Department of Internal Medicine based at the Cajuru and Santa Casa University Hospitals, where the residency program in Nephrology is based. The Renal Medicine Division has strong activities in translational and clinical research, particularly in the area of chronic kidney disease and dialysis, and offers opportunities for Master and PhD students at the Graduate Program in Health Sciences. The Renal Medicine Division is an ISN Sister Renal Center of the University of Nottingham, UK, and has been an academic partner of RRI since 2011.
The University of Michigan Division of Nephrology is dedicated to serving people with kidney disease. Faculty in the division practice and teach optimal care for patients with a broad spectrum of kidney diseases at all stages. In addition, faculty members are actively involved in high-quality research aimed at better treatment as well as prevention of kidney-related health issues.
Samer completed his PhD degree in October 2007 at the Medical Faculty of the Technical University of Aachen (RWTH Aachen). He has worked as a scientific fellow on different projects at the Institute of Applied Nephrology, Interneph, and at the Dialysis Centre, KFH, in Aachen, Germany from 2003 to 2008. The aim of these projects was to improve dialysis dose, adequacy and inta-dialytic parenteral nutrition in hemodialysis patients. He currently works on applications of bioimpedance techniques that include body composition, the estimation and maintenance of normal hydration status in PD and HD patients.
Ingrid studied Hospitality and Tourism Management in Vienna prior to working in the United States. She has experience in managing both domestic and international scientific meetings from all aspects including Continuing Medical Education (CME) compliance as well as organizing social and corporate events. She is a co-applicant on a NIH grant for the annual CKD conference for which she is responsible. Furthermore she has been involved in the MONDO Initiatives since 2013 as the administrative contact and manages the inter-group communication as well as the MONDO meetings.
John has been with RRI since February of 2003 where he began as Controller of New York Dialysis Services before coming into this role in 2007. His duties include budget preparation, analysis and grant submissions. He is also a founder of the Sustainable Kidney Care Foundation (SKCF) which provides dialysis in developing nations currently with programs operating in sub-Saharan Africa.
Cassandra serves as a Co-Investigator for the Bioimpedance Analysis in the General Population study as well as editor for the Dialysis Times and The Research Insider Newsletter. Subsequently she also assists with the Sustainable Kidney Care Foundation, whether it be trying to find fundraising opportunities, charitable donations or updating the website with current programs or conferences dedicated to the mission statement.
Mary is responsible for the overall strategic management of the research program with a focus on team building and collaborative research in an international setting. She has been with RRI for 15 years leading the program from inception to its current level of international recognition for innovation, swift decision making and excellence in clinical trial execution. Her oversight includes the annual CKD conference and Dialysis Times. Her leadership in the global arena is exemplified by her work with the Sustainable Kidney Care Foundation, bringing kidney treatment where none exists, where she is the founder and director. With a background in molecular biology, physiology, business and public health, she has the skills to lead this team into future success.
Christine studied premedical sciences at Columbia University, and has several years of clinical research experience and experience working with postdoctoral research fellows. Currently, she is responsible for the documentation for all research projects, and she works closely with investigators and IRBs to ensure ICH and GCP compliance. She also works with RRI clinics on GCP training, and helps to prepare the clinics for future research studies.
Doris has finished her doctoral studies in mathematics at the Karl-Franzens University, Graz, Austria. She specializes in mathematical modeling in physiology and numerical mathematics. Prior working at RRI, Doris was involved in projects about erythropoiesis, cardiovascular response to ergometric workload, orthostatic stress and low body negative pressure (a model of hypotension). Her research interests include: anemia management, change of blood volume intra- and interdialytically, the connection between EPO and prolonged red cell survival and cardiovascular modeling.
Peter Kotanko, MD as the Research Director is responsible for the overall direction of RRI’s research whose work spans bench science to clinical research to epidemiology to mathematical modeling, protocol design, manuscript preparation and teaching. After spending three years at RRI, Dr. Kotanko was recruited to take over the strategic leadership role of RRI’s research in 2010. His background and expertise in physiology, internal medicine and nephrology and 20 years of clinical experience enable him to be the intellectual leader for our scientists and fellows who come to train in clinical research. He is a member of the Editorial Board of Blood Purification, and Kidney and Blood Pressure Research and co-author of over 190 peer-reviewed publications and book chapters and holds several patents in the dialysis field.
Prior to joining RRI, he was the Vice Chair of a Department of Internal Medicine in Graz, Austria, from 1997 to 2007. From 1982 to 1989, he worked as an Assistant Professor, first in the Department of Physiology, and subsequently at the University Clinic of Internal Medicine, Innsbruck, Austria. From 1995-1996 Dr. Kotanko worked at the Hammersmith Hospital in London, UK. Dr. Kotanko’s current teaching appointments are with the Albert Einstein College of Medicine, New York, and the Medical University in Innsbruck. He has lectured internationally on topics in nephrology, physiology, and mathematical modeling.
Nathan is a Professor of Clinical Medicine at Albert Einstein College of Medicine and Chair of RRI’s Research Board. He is the founder and former Medical and Research Director of RRI under whose scientific leadership the Institute gained global recognition. He was a Professor of Medicine at Mount Sinai School of Medicine and at the University of Michigan. He is the founder and was the co-Chair of KDOQI and a member of the Executive Committee of KDIGO. Dr. Levin was responsible for nephrology programs at Northwestern University, VA Research Hospital, Henry Ford Hospital, and Beth Israel Medical Center in New York. He serves on the Steering Committee of DOPPS, is currently co-Chair of ISN’s GO Committee and is a past ISN Council Member. He is the Chair of the Selection Committee for the Lillian Jean Kaplan International Prize for Advancement in the Understanding of Polycystic Kidney Disease. He was President of the Renal Physicians Association (RPA), President of New York Dialysis Services (NYDS) and Chairman of Roche Foundation for Anemia Research (RoFAR).
In April 2007 Jochen received his Medical degree, after approval of his doctoral thesis, from the Medical University Graz, Austria, and is certified by the Educational Commission for Foreign Medical Graduates (ECFMG) since January 2009. His research activities and interests include glucose and insulin kinetics and metabolism, dry weight, the determination of body composition and body volumes, bioelectrical impedance, cardiovascular pathology in dialysis patients (blood pressure, heart rate variability), citrate anticoagulation, calcium kinetics during dialysis, dietary and dialytic restriction, and the clinical application of saliva urea nitrogen as measured by a dipstick method. Dr. Raimann has first- and co-authored several peer-reviewed papers, abstracts and book chapters, is a member of the Editorial Board of Dialysis Times and has been Peer-Reviewer for various international journals.
Research Fellow. In January of 2006 Joselyn received her M.D from San Martin de Porres University in Lima Peru. In May of 2011 Joselyn obtained her nephrology certification from Puigvert Foundation in Barcelona Spain where she worked until she came to RRI. Her research interest include sodium restriction, sodium alignment and blood volume in hemodialysis patients.
Laura started her clinical research as a research fellow for Beth Israel Medical Center in partnership with RRI. Laura obtained her MD degree from the Central University in Quito, Ecuador and did her residency training in nephrology at the Armed Forces Hospital N1 in Quito. She has been working in clinical research for more than 13 years and has presented her work worldwide. She has authored and co-authored numerous publications in peer reviewed journals. She has collaborated actively with prestigious institutions such as the University of California at Davis, the Medical University of Graz, Austria and the Maastricht University Hospital, Netherlands. She is a member of the American Society of Nephrology and the New York Academy of Sciences.
Prior to RRI Penny was employed by Bear Stearns, Inc. as a Registered Sales Assistant where she was licensed and registered to trade. She holds her B.A. in Health Science. Penny maintains a unique position as she is both part of the Operations team as well as a published member of the Research team.
Prior to coming to New York, Stephan worked in the Nephrology Department of the University Hospital Homburg, Germany. In 2005, Dr. Thijssen joined the Renal Research team as a Research Fellow and later became the Institute's Associate Research Laboratory Director in late 2007 and then Research Laboratory Director in 2010. Dr. Thijssen brings seven years of research experience to the RRI team. He is author and co-author of five book chapters and co-inventor on five pending patents related to his field of research. Dr. Thijssen's primary responsibility is comprehensive study project management, from study design to oversight of study execution to biostatistical guidance and supervision of manuscript preparation.
Len Usvyat, PhD started working with Renal Research Institute in 2001 analyzing patient quality data to assure the best and most efficient use of data in improving patient outcomes. He also works closely with the RRI’s Research division on a variety of projects resulting in over one hundred abstracts and 30 manuscripts published in high ranking professional journals. Len holds a Master’s Degree from the University of Pennsylvania and PhD from University of Maastricht. Prior to working at RRI, Len had over 10 years of experience in information technology and data analysis. In August 2012, Len started working as a Director of Integrated Care Analytics with Fresenius Medical Care North America although he still maintains very close ongoing collaboration with RRI.
While currently working on the Sodium Intervention Study, Caroline had worked on the “Hemo Study” from 1999 to 2002. She has worked as a renal dietitian for St. Johns Queens Hospital from 1990-1998 and has been an active member of the Council on Renal Nutrition since 1991 and acted as its Chair from 2001-2003.
Michelle recently completed her clinical training in nephrology at the University of British Columbia in 2012. She received her MD and Masters in Pharmacology from the University of British Columbia, and did her internal medicine training at the University of Alberta. She has been actively involved in producing systematic reviews with the Cochrane Collaboration and worked with its Hypertension Group in Vancouver, Canada and Renal Group in Westmead, Australia. Her research interests include: volume assessment, hypertension management and salt and fluid adherence in dialysis patients. Currently she is involved in the Absolute Blood Volume Estimation Study, and MONitoring Dialysis Outcomes (MONDO) data analyses.
Leslie received her MS in Statistics from Cornell University and joined RRI in 2012. She works closely with the database group to assure the best and most efficient use of the database as well as the analysis of data. She is also working with the research division to help build statistical models on a variety of projects.
Fansan studied biomedical signal processing as well as design of biomedical instrumentation at the Department of Bioengineering, Huazhong University of Science & Technology, Wuhan, China from 1992-1996. He was Vice President in Wuhan Miyou Medical Instrument Co., Ltd. Wuhan, China from 1981 to 1989. His research interests are body fluid dynamics and body composition, modeling of electrical properties in tissue and the application of bioimpedance technique for estimating normal hydration in dialysis patients. He is the author of over forty peer-reviewed papers in highly ranked professional journals and is an inventor on six U.S. patents.
Mingli received his MD from The Second Military Medical University in 1998 in Shanghai, China. He has been working in the renal division of Renji Hospital in Shanghai Jiaotong University School of Medicine for more than 10 years. His research work focuses on water supply system and chronic inflammation in hemodialysis patients, thrombotic microangiopahty in chronic hemodialysis patients and palliative care in Shanghai ESRD patients.
Rina Rogov joined RRI in August as an Executive Assistant to Dr. Peter Kotanko. She has a degree in Computer Science / Information Technology. The first 10 years of her career she spent at a Financial Firm on Wall Street where she started as a Systems Analyst and became a Project Leader on one of the largest and more important systems in the company. After the company was bought out in 2002, she changed her profile when an opportunity arose to join a start-up company as a co-shareholder. She spent the next 10 years as an Executive Assistant to the President and General Office Administrator. She helped run the company while supporting its Executive Founder. Rina is very excited about this new opportunity presented to her at RRI. She hopes to be an asset to this organization and is looking forward to learning about this new and exciting field of research.