Chronic kidney disease is estimated to affect at least 37 million (or 1 in 7) Americans and is associated with excess risks of requiring kidney replacement therapy (dialysis or kidney transplant), heart failure, atherosclerotic cardiovascular events, arrhythmias, cardiovascular death, and all-cause mortality.
Sentinel kidney study: In a sentinel study of more than 1.1 million Kaiser Permanente Northern California members, Division of Research (DOR) investigators showed that a reduced estimated glomerular filtration rate of under 60 ml/min/1.73 m2 (and particularly under 45 ml/min/1.73 m2) as well as excess urine protein excretion are independent predictors of cardiovascular events, being hospitalized for any reason, and all-cause death.
CRIC study: DOR researchers are also co-leading the multicenter prospective Chronic Renal Insufficiency Cohort (CRIC) Study, sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), which is following patients with chronic kidney disease long term to delineate mechanisms underlying the excess risks for adverse renal, cardiovascular, and patient-centered outcomes. More accurate risk-prediction models based on the Kaiser Permanente Northern California population and information from their clinically rich electronic health records has also been developed to promote more personalized prevention and treatment strategies.
Acute kidney injury: Acute kidney injury, defined as an acute reduction in kidney function, is a frequent complication of hospitalized patients and is linked to higher risks of in-hospital complications and death. DOR researchers have shown that among Kaiser Permanente Northern California members, an episode of hospitalized acute kidney injury increases the subsequent risk of being hospitalized for heart failure, experiencing a recurrent episode of acute kidney injury, and progression of chronic kidney disease. Kaiser Permanente Northern California co-led the NIDDK-sponsored, multicenter, prospective Assessment, Serial Evaluation, and Subsequent Sequelae of Acute Kidney Injury (ASSESS-AKI) Study, which has followed a matched cohort of hospital survivors who did or didn’t experience acute kidney injury for long-term kidney, cardiovascular, and other outcomes, as well as studying possible explanatory mechanisms. Ongoing studies within Kaiser Permanente Northern California are also improving the prediction of developing acute kidney injury in members receiving care in the emergency department or being hospitalized, as well as risk-stratifying members who suffer from acute kidney injury.
End-stage kidney disease: Patients with end-stage kidney disease requiring chronic dialysis therapy or kidney transplant are at particularly high risk for premature death as well as other clinical complications and negative impacts on their quality of life and functional status. In eligible patients who are not yet able to receive kidney transplantation, Kaiser Permanente Northern California has been a national leader in expanding the large-scale use of recommended peritoneal dialysis instead of hemodialysis as the initial type of dialysis, and ongoing studies are examining the implications of this and related management strategies on health care delivery systems, patients, and families. Efforts are also focused on how to reduce the high cardiovascular burden in patients with end-stage kidney disease.
Personalized medicine: DOR investigators are leading studies to more accurately identify different forms of kidney disease, including rarer types of kidney disorders (e.g., glomerular diseases) from electronic health records based on advanced machine learning and artificial intelligence methods, including natural language processing algorithms. These efforts will support future interventions and more personalized medicine approaches tailored to the specific causes of kidney disease.
