Use of Biomarkers in patients requiring maintenance hemodialysis
Glycemic control in hospitalized patients treated by maintenance hemodialysis
Hyperkalemia in hospitalized patients treated by maintenance hemodialysis
Glomerulonephritis
Amyloidosis and chronic kidney disease
Publications
Reach, Acceptability, and Patient Preferences of a Mobile Health-Based Survey to Assess COVID-19 Vaccine Hesitancy Among Patients Receiving Dialysis
Sri Lekha Tummalapalli, Natalie C Benda, Daniel Cukor, Daniel M Levine, Jeffrey Silberzweig, Meghan Reading Turchioe...
Kidney Med. 2024 May 22;6(7):100847. doi: 10.1016/j.xkme.2024.100847. eCollection 2024 Jul.
ABSTRACT
RATIONALE & OBJECTIVE: The majority of patients with kidney failure receiving dialysis own mobile devices, but the use of mobile health (mHealth) technologies to conduct surveys in this population is limited. We assessed the reach and acceptability of a short message service (SMS) text message-based survey that assessed coronavirus disease 2019 (COVID-19) vaccine hesitancy among patients receiving dialysis.
STUDY DESIGN & EXPOSURE: A cross-sectional SMS-based survey conducted in January 2021.
SETTING & PARTICIPANTS: Patients receiving in-center hemodialysis, peritoneal dialysis, or home hemodialysis in a nonprofit dialysis organization in New York City.
OUTCOMES: (1) Reach of the SMS survey, (2) Acceptability using the 4-item Acceptability of Intervention Measure, and (3) Patient preferences for modes of survey administration.
ANALYTICAL APPROACH: We used Fisher exact tests and multivariable logistic regression to assess sociodemographic and clinical predictors of SMS survey response. Qualitative methods were used to analyze open-ended responses capturing patient preferences.
RESULTS: Among 1,008 patients, 310 responded to the SMS survey (response rate 31%). In multivariable adjusted analyses, participants who were age 80 years and above (aOR, 0.49; 95% CI, 0.25-0.96) were less likely to respond to the SMS survey compared with those aged 18 to 44 years. Non-Hispanic Black (aOR, 0.58; 95% CI, 0.39-0.86), Hispanic (aOR, 0.31; 95% CI, 0.19-0.51), and Asian or Pacific Islander (aOR, 0.46; 95% CI, 0.28-0.74) individuals were less likely to respond compared with non-Hispanic White participants. Participants residing in census tracts with higher Social Vulnerability Index, indicating greater neighborhood-level social vulnerability, were less likely to respond to the SMS survey (fifth vs first quintile aOR, 0.61; 95% CI, 0.37-0.99). Over 80% of a sample of survey respondents and nonrespondents completely agreed or agreed with the Acceptability of Intervention Measure. Qualitative analysis identified 4 drivers of patient preferences for survey administration: (1) convenience (subtopics: efficiency, multitasking, comfort, and synchronicity); (2) privacy; (3) interpersonal interaction; and (4) accessibility (subtopics: vision, language, and fatigue).
LIMITATIONS: Generalizability, length of survey.
CONCLUSIONS: An SMS text message-based survey had moderate reach among patients receiving dialysis and was highly acceptable, but response rates were lower in older (age ≥ 80), non-White individuals and those with greater neighborhood-level social vulnerability. Future research should examine barriers and facilitators to mHealth among patients receiving dialysis to ensure equitable implementation of mHealth-based technologies.
Management of Patients with Multidrug-Resistant Organisms in Outpatient Dialysis Facilities
Mary Dittrich, Jeffrey Silberzweig, Jeffrey L Hymes, Jeff Giullian, Gopa Green, Leslie P Wong, Barry I Freedman, J Ganesh Bhat, Leslie Spry, Robert Taylor, Richard Spech, Raghu Durvasula, Sky R Blue...
Clin J Am Soc Nephrol. 2023 Dec 27;19(5):656-9. doi: 10.2215/CJN.0000000000000419. Online ahead of print.
A Distinct Nasal Microbiota Signature in Peritoneal Dialysis Patients
Iman Khan, Sylvia Wu, Anika Hudson, Clayton Hughes, Gabriel Stryjniak, Lars F Westblade, Michael J Satlin, Nicholas Tedrow, Anne-Catrin Uhlemann, Colleen Kraft, Darshana M Dadhania, Jeffrey Silberzweig, Iwijn De Vlaminck, Carol Li, Vesh Srivatana, John Richard Lee...
Kidney360. 2023 Oct 1;4(10):1419-1429. doi: 10.34067/KID.0000000000000249. Epub 2023 Aug 29.
ABSTRACT
KEY POINTS:
Staphylococcus, Corynebacterium, Streptococcus, and Anaerococcus are the most common genera in the anterior nares.
The nasal abundance of Staphylococcus is inversely correlated with the nasal abundance of Corynebacterium.
Peritoneal dialysis patients have a distinctly diverse representation of Staphylococcus and Streptococcus in their anterior nares.
BACKGROUND: The nasal passages harbor both commensal and pathogenic bacteria that can be associated with infectious complications. The nasal microbiome in peritoneal dialysis (PD) patients, however, has not been well characterized. In this study, we sought to characterize the anterior nasal microbiota in PD patients and assess its association with PD peritonitis.
METHODS: In this study, we recruited 32 PD patients, 37 kidney transplant (KTx) recipients, and 22 living donor/healthy control (HC) participants and collected their anterior nasal swabs at a single point in time. We followed the PD patients for future development of peritonitis. We performed 16S ribosomal RNA (rRNA) gene sequencing of the V4–V5 hypervariable region to determine the nasal microbiota. We compared nasal abundance of common genera among the three groups using Wilcoxon rank-sum test with Benjamini–Hochberg adjustment. DESeq2 was also used to compare the groups at the amplicon sequence variant levels.
RESULTS: In the entire cohort, the most abundant genera in the nasal microbiota included Staphylococcus, Corynebacterium, Streptococcus, and Anaerococcus. Correlational analyses revealed a significant inverse relationship between the nasal abundance of Staphylococcus and that of Corynebacterium. PD patients have a higher nasal abundance of Streptococcus than KTx recipients and HC participants. PD patients have a more diverse representation of Staphylococcus and Streptococcus than KTx recipients and HC participants. PD patients who concurrently have or who developed future Staphylococcus peritonitis had a numerically higher nasal abundance of Staphylococcus than PD patients who did not develop Staphylococcus peritonitis.
CONCLUSIONS: We find a distinct nasal microbiota signature in PD patients compared with KTx recipients and HC participants. Given the potential relationship between the nasal pathogenic bacteria and infectious complications, further studies are needed to define the nasal microbiota associated with these infectious complications and to conduct studies on the manipulation of the nasal microbiota to prevent such complications.
Changes in Bone Quality after Treatment with Etelcalcetide
Pascale Khairallah, Jenna Cherasard, Joshua Sung, Sanchita Agarwal, Maria Alejandra Aponte, Mariana Bucovsky, Maria Fusaro, Jeffrey Silberzweig, Gail N Frumkin, Karim El Hachem, Linda Schulman, Donald McMahon, Matthew R Allen, Corinne E Metzger, Rachel K Surowiec, Joseph Wallace, Thomas L Nickolas...
Clin J Am Soc Nephrol. 2023 Nov 1;18(11):1456-1465. doi: 10.2215/CJN.0000000000000254. Epub 2023 Aug 14.
ABSTRACT
INTRODUCTION: Secondary hyperparathyroidism is associated with osteoporosis and fractures. Etelcalcetide is an intravenous calcimimetic for the control of hyperparathyroidism in patients on hemodialysis. Effects of etelcalcetide on the skeleton are unknown.
METHODS: In a single-arm, open-label, 36-week prospective trial, we hypothesized that etelcalcetide improves bone quality and strength without damaging bone-tissue quality. Participants were 18 years or older, on hemodialysis ≥1 year, without calcimimetic exposure within 12 weeks of enrollment. We measured pretreatment and post-treatment areal bone mineral density by dual-energy X-ray absorptiometry, central skeleton trabecular microarchitecture by trabecular bone score, and peripheral skeleton volumetric bone density, geometry, microarchitecture, and estimated strength by high-resolution peripheral quantitative computed tomography. Bone-tissue quality was assessed using quadruple-label bone biopsy in a subset of patients. Paired t tests were used in our analysis.
RESULTS: Twenty-two participants were enrolled; 13 completed follow-up (mean±SD age 51±14 years, 53% male, and 15% White). Five underwent bone biopsy (mean±SD age 52±16 years and 80% female). Over 36 weeks, parathyroid hormone levels declined 67%±9% ( P < 0.001); areal bone mineral density at the spine, femoral neck, and total hip increased 3%±1%, 7%±2%, and 3%±1%, respectively ( P < 0.05); spine trabecular bone score increased 10%±2% ( P < 0.001); and radius stiffness and failure load trended to a 7%±4% ( P = 0.05) and 6%±4% increase ( P = 0.06), respectively. Bone biopsy demonstrated a decreased bone formation rate (mean difference -25±4 µ m 3 / µ m 2 per year; P < 0.01).
CONCLUSIONS: Treatment with etelcalcetide for 36 weeks was associated with improvements in central skeleton areal bone mineral density and trabecular quality and lowered bone turnover without affecting bone material properties.
CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: The Effect of Etelcalcetide on CKD-MBD (Parsabiv-MBD), NCT03960437.
A Distinct Nasal Microbiota Signature in Peritoneal Dialysis Patients
Iman Khan, Sylvia Wu, Anika Hudson, Clayton Hughes, Gabriel Stryjniak, Lars F Westblade, Michael J Satlin, Nicholas Tedrow, Anne-Catrin Uhlemann, Colleen Kraft, Darshana M Dadhania, Jeffrey Silberzweig, Iwijn De Vlaminck, Carol Li, Vesh Srivatana, John Richard Lee...
medRxiv [Preprint]. 2023 Feb 24:2023.02.23.23286379. doi: 10.1101/2023.02.23.23286379.
ABSTRACT
RATIONALE & OBJECTIVE: The nasal passages harbor both commensal and pathogenic bacteria. In this study, we sought to characterize the anterior nasal microbiota in PD patients using 16S rRNA gene sequencing.
STUDY DESIGN: Cross-sectional.
SETTING & PARTICIPANTS: We recruited 32 PD patients, 37 kidney transplant (KTx) recipients, 22 living donor/healthy control (HC) participants and collected anterior nasal swabs at a single point in time.
PREDICTORS: We performed 16S rRNA gene sequencing of the V4-V5 hypervariable region to determine the nasal microbiota.
OUTCOMES: Nasal microbiota profiles were determined at the genus level as well as the amplicon sequencing variant level.
ANALYTICAL APPROACH: We compared nasal abundance of common genera among the 3 groups using Wilcoxon rank sum testing with Benjamini-Hochberg adjustment. DESeq2 was also utilized to compare the groups at the ASV levels.
RESULTS: In the entire cohort, the most abundant genera in the nasal microbiota included: Staphylococcus, Corynebacterium, Streptococcus , and Anaerococcus . Correlational analyses revealed a significant inverse relationship between the nasal abundance of Staphylococcus and that of Corynebacterium . PD patients have a higher nasal abundance of Streptococcus than KTx recipients and HC participants. PD patients have a more diverse representation of Staphylococcus and Streptococcus than KTx recipients and HC participants. PD patients who concurrently have or who developed future Staphylococcus peritonitis had a numerically higher nasal abundance of Staphylococcus than PD patients who did not develop Staphylococcus peritonitis.
LIMITATIONS: 16S RNA gene sequencing provides taxonomic information to the genus level.
CONCLUSIONS: We find a distinct nasal microbiota signature in PD patients compared to KTx recipients and HC participants. Given the potential relationship between the nasal pathogenic bacteria and infectious complications, further studies are needed to define the nasal microbiota associated with these infectious complications and to conduct studies on the manipulation of the nasal microbiota to prevent such complications.
Response to COVID-19: The Outpatient Dialysis Setting
Jeffrey Silberzweig, Sylvia Wu, Matthew Sinclair, Thomas Watson, Nancy Welder, Danilo Concepcion, Jerry Yee, Felicia Speed, Daniel Cukor, Brigitte Schiller, Daniel Weiner...
Clin J Am Soc Nephrol. 2023 Jul 1;18(7):949-952. doi: 10.2215/CJN.0000000000000091. Epub 2023 Jan 30.
Kidney360. 2023 Mar 1;4(3):405-408. doi: 10.34067/KID.0000000000000071.
ABSTRACT
Access to care for patients with ESKD is frequently disrupted after natural disasters, public health crises, and human conflict. Emergency preparation can mitigate the risk of harm and improve outcomes. Before Hurricane Katrina in 2005, the United States was unprepared to assist patients facing disaster. We evaluate responses to Hurricane Katrina which caused unprecedented damage to health and property in the Gulf Coast. As a result of the multitude of identified problems with the national, local, and kidney-specific responses to Katrina, new systems were created that mitigated loss after Hurricane Sandy in 2012. The improved disaster response system was no match for the coronavirus disease 2019 pandemic; real-time changes worsened the effect on highly vulnerable populations, including patients with ESKD. Similarly, preparation can only mitigate the difficulties faced by patients with ESKD living in a war zone. Government agencies need to provide tools and dialysis centers need to educate patients. Beginning with steps implemented in the aftermath of Hurricane Katrina and augmented after Hurricane Sandy, every patient with ESKD and those who care for them must begin emergency preparations before the need arises. Recognizing that it is not possible to prepare for every possible emergency, our health care systems must be ready to adapt to our ever-changing world. After reviewing the responses to previous events, we suggest steps that should be considered to improve preparations for our uncertain future.
Jeffrey Silberzweig, J Ganesh Bhat, Mary O Dittrich, Raghu Durvasula, Jeff Giullian, Jeffrey L Hymes, Doug Johnson, Brigitte Schiller, Richard Spech, Leslie Spry, Geoffrey Scott Walker, Suzanne Watnick, Jerry Yee, Barry I Freedman...
J Am Soc Nephrol. 2022 Aug;33(8):1440-1444. doi: 10.1681/ASN.2021111475. Epub 2022 Jun 2.
Peritoneal Effluent Cell-Free DNA Sequencing in Peritoneal Dialysis Patients With and Without Peritonitis
Philip Burnham, Fanny Chen, Alexandre P Cheng, Vesh Srivatana, Lisa T Zhang, Emmanuel Edusei, Shady Albakry, Brittany Botticelli, Xunxi Guo, Amanda Renaghan, Jeffrey Silberzweig, Darshana M Dadhania, Joan S Lenz, Michael Heyang, Iliyan D Iliev, Joshua A Hayden, Lars F Westblade, Iwijn De Vlaminck, John R Lee...
Kidney Med. 2021 Oct 28;4(1):100383. doi: 10.1016/j.xkme.2021.08.017. eCollection 2022 Jan.
ABSTRACT
RATIONALE & OBJECTIVE: Conventional culture can be insensitive for the detection of rare infections and for the detection of common infections in the setting of recent antibiotic usage. Patients receiving peritoneal dialysis (PD) with suspected peritonitis have a significant proportion of negative conventional cultures. This study examines the utility of metagenomic sequencing of peritoneal effluent cell-free DNA (cfDNA) for evaluating the peritoneal effluent in PD patients with and without peritonitis.
STUDY DESIGN: Prospective cohort study.
SETTING & PARTICIPANTS: We prospectively characterized cfDNA in 68 peritoneal effluent samples obtained from 33 patients receiving PD at a single center from September 2016 to July 2018.
OUTCOMES: Peritoneal effluent, microbial, and human cfDNA characteristics were evaluated in culture-confirmed peritonitis and culture-negative peritonitis.
ANALYTICAL APPROACH: Descriptive statistics were analyzed and microbial cfDNA was detected in culture-confirmed peritonitis and culture-negative peritonitis.
RESULTS: Metagenomic sequencing of cfDNA was able to detect and identify bacterial, viral, and eukaryotic pathogens in the peritoneal effluent from PD patients with culture-confirmed peritonitis, as well as patients with recent antibiotic usage and in cases of culture-negative peritonitis.
LIMITATIONS: Parallel cultures were not obtained in all the peritoneal effluent specimens.
CONCLUSIONS: Metagenomic cfDNA sequencing of the peritoneal effluent can identify pathogens in PD patients with peritonitis, including culture-negative peritonitis.
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