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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Kidney, Urologic and Hematologic Diseases D 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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Toth-Manikowski, Stephanie M; Mullangi, Surekha; Hwang, Seungyoung et al. (2017) Incremental short daily home hemodialysis: a case series. BMC Nephrol 18:216
Chen, Yan; Sang, Yingying; Ballew, Shoshana H et al. (2017) Race, Serum Potassium, and Associations With ESRD and Mortality. Am J Kidney Dis 70:244-251
Grams, Morgan E; Yang, Wei; Rebholz, Casey M et al. (2017) Risks of Adverse Events in Advanced CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 70:337-346
Grams, Morgan E; Tin, Adrienne; Rebholz, Casey M et al. (2017) Metabolomic Alterations Associated with Cause of CKD. Clin J Am Soc Nephrol 12:1787-1794
Rebholz, Casey M; Grams, Morgan E; Steffen, Lyn M et al. (2017) Diet Soda Consumption and Risk of Incident End Stage Renal Disease. Clin J Am Soc Nephrol 12:79-86
Carrero, Juan Jesús; Grams, Morgan E; Sang, Yingying et al. (2017) Albuminuria changes are associated with subsequent risk of end-stage renal disease and mortality. Kidney Int 91:244-251
Toth-Manikowski, Stephanie; Grams, Morgan E (2017) Proton Pump Inhibitors and Kidney Disease - GI Upset for the Nephrologist? Kidney Int Rep 2:297-301
Shafi, Tariq; Mullangi, Surekha; Toth-Manikowski, Stephanie M et al. (2017) Residual Kidney Function: Implications in the Era of Personalized Medicine. Semin Dial 30:241-245
Ballew, Shoshana H; Chen, Yan; Daya, Natalie R et al. (2017) Frailty, Kidney Function, and Polypharmacy: The Atherosclerosis Risk in Communities (ARIC) Study. Am J Kidney Dis 69:228-236
Chang, Alex R; Chen, Yuan; Still, Christopher et al. (2016) Bariatric surgery is associated with improvement in kidney outcomes. Kidney Int 90:164-71

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