Morgan E. Grams, MD, MHS, is an Assistant Professor in the Division of Nephrology at Johns Hopkins University. She seeks a Mentored Patient-Oriented Research Career Development Award in order to obtain essential skills and mentored research experience for an independent career as a physician scientist in the field of chronic kidney disease. The research proposal details a five-year plan consisting of doctoral-level coursework in Clinical Epidemiology, mentorship by Dr. Josef Coresh, MD, PhD, and Dr. Dorry L. Segev, MD, PhD, and epidemiologic research in the cardiovascular and mortality risks associated with chronic kidney disease.
The specific aims of the research agenda are to: 1) Characterize cardiovascular and mortality risk among individuals with advanced chronic kidney disease;2) Identify risk factors for death and cardiovascular endpoints in preemptively listed transplant candidates before and after the initiation of renal replacement therapy;and 3) Estimate the optimal level of native kidney function at which a viable transplant candidate should be transplanted. Immediate career goals include the mastery of advanced meta-analysis techniques, methods of causal inference, and Markov decision process models through an academic curriculum integrated with the research plan. Long-term, Dr.
Grams aims to lead independent research programs investigating optimal treatment and decision-making in advanced chronic kidney disease. Completion of the proposed aims will provide vital information relevant to the one million U.S. patients with pre-dialysis stage 4-5 chronic kidney disease. Chronic kidney disease is associated with exceedingly high rates of cardiovascular morbidity and mortality, but the optimal treatment of this population remains unknown. Preemptive kidney transplantation, or transplantation prior to the initiation of maintenance dialysis, is an increasingly common therapy. Similar to trends in dialysis initiation, it is being performed earlie in the course of chronic kidney disease progression. A better understanding of the optimal timing of kidney transplantation may inform national policies governing deceased donor kidney listing and allocation, and also improve clinical decision-making for pre-dialysis transplant patients with living donors. Furthermore, identification of characteristics associated with high cardiovascular and mortality risk may be used to guide therapy and future trials in the advanced chronic kidney disease population.

Public Health Relevance

The results of this project will provide evidence-based guidelines for when and in which patients preemptive kidney transplantation should be performed. Moreover, the detailed analysis of outcomes in patients with advanced chronic kidney disease will help inform counseling, treatment and referral practices among this growing population.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Clinical Investigator Award (CIA) (K08)
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Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
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Rankin, Tracy L
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Johns Hopkins University
Internal Medicine/Medicine
Schools of Medicine
United States
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Grams, Morgan E; Li, Liang; Greene, Tom H et al. (2015) Estimating time to ESRD using kidney failure risk equations: results from the African American Study of Kidney Disease and Hypertension (AASK). Am J Kidney Dis 65:394-402
Grams, Morgan E; Waikar, Sushrut S; MacMahon, Blaithin et al. (2014) Performance and limitations of administrative data in the identification of AKI. Clin J Am Soc Nephrol 9:682-9
Grams, Morgan E; Rebholz, Casey M; McMahon, Blaithin et al. (2014) Identification of incident CKD stage 3 in research studies. Am J Kidney Dis 64:214-21
Foster, Meredith C; Rawlings, Andreea M; Marrett, Elizabeth et al. (2014) Potential effects of reclassifying CKD as a coronary heart disease risk equivalent in the US population. Am J Kidney Dis 63:753-60
Tsai, Ching-Wei; Grams, Morgan E; Inker, Lesley A et al. (2014) Cystatin C- and creatinine-based estimated glomerular filtration rate, vascular disease, and mortality in persons with diabetes in the U.S. Diabetes Care 37:1002-8
Grams, Morgan E; Chow, Eric K H; Segev, Dorry L et al. (2013) Lifetime incidence of CKD stages 3-5 in the United States. Am J Kidney Dis 62:245-52
Grams, Morgan E; Chen, B Po-Han; Coresh, Josef et al. (2013) Preemptive deceased donor kidney transplantation: considerations of equity and utility. Clin J Am Soc Nephrol 8:575-82
Grams, M E; Massie, A B; Schold, J D et al. (2013) Trends in the inactive kidney transplant waitlist and implications for candidate survival. Am J Transplant 13:1012-8
Grams, Morgan E; Juraschek, Stephen P; Selvin, Elizabeth et al. (2013) Trends in the prevalence of reduced GFR in the United States: a comparison of creatinine- and cystatin C-based estimates. Am J Kidney Dis 62:253-60