Ongoing Projects: Acute Kidney Injury

Identifying Opportunities to Lower Rates of AKI and Improve Outcome

Principal Investigator: Chi-Yuan Hsu

Funding Source: National Institute of Diabetes and Digestive and Kidney Diseases (5R01DK101507)

Project Summary: In the proposed project, we will test the hypotheses that the declining AKI incidence correlates with temporal changes in medical practice such as reduced use of nephrotoxins (Aim 1). We will test the hypothesis that more cases of AKI identified in acute- care settings (e.g., emergency department and urgent care clinic) are being managed in the community setting; we describe these cases as "community-acquired, community managed AKI" (Aim 2). Finally, we will determine medical practices and patient characteristics associated with recurrent AKI, which contributes to both higher disease incidence as well as cumulative detrimental effects (Aim 3).


Enhancing Appreciation of the Clinical Significance of Acute Kidney Injury

Principal Investigator: Raymond Hsu

Funding Source: National Institute of Diabetes and Digestive and Kidney Diseases (5K23DK100468)

Project Summary: The project's three Specific Aims are: Aim 1: To determine the independent association between AKI and incident hypertension. Aim 2: To better delineate the impact of AKI on renal function trajectory by comparing three different methods of assessing renal function over time. Aim 3: To determine the level of patient awareness and physician recognition of AKI, and to determine the association between these and follow-up care.


Biomarkers of Kidney Injury to Predict AKI Onset and Progression in HIV Infection

Principal Investigator: Michelle Estrella

Funding Source: National Institute of Diabetes and Digestive and Kidney Diseases (1R01DK103574-01A1)

Project Summary: In this proposal, we will leverage the extensive resources within the JHHCC to achieve the following Aims: 1) to determine the association of ambulatory kidney damage with incident hospitalized clinical AKI and progressive kidney disease after AKI; 2) to investigate the prevalence of subclinical and clinical AKI among hospitalized HIV-infected individuals and their associations with progressive kidney disease after hospitalization; and 3) to develop and validate a predictive model which integrates a multiplex panel of complementary, informative urine biomarkers and clinical variables that will distinguish risk for incident AKI and subsequent progressive kidney disease. We will measure urine biomarkers of kidney endothelial and tubulointerstitial injury, inflammation and fibrosis at ambulatory visits and serially during hospitalizations in Aims 1 and 2. We will then utilize the observed associations in Aims 1 and 2 to guide the development of a clinically adaptable multiplex panel of urine biomarkers. This panel will be combined with clinical variables to develop a model that distinguishes the risk of AKI and subsequent kidney disease progression among HIV-infected persons.