Constituting a major threat to US public health, kidney disease is now an epidemic, with the number of affected persons escalating at a rate that produces an increase of 10-12% dialysis patients annually. The dialysis entitlement program currently consumes 5% of the Medicare budget for only 0.6% of Medicare recipients (approximately 20 billion US dollars annually). Beyond training more clinical nephrologists to shoulder the increasing burden of caring for chronic &end-stage kidney disease populations, the largest impact may only be realized by focusing efforts upstream on early diagnosis, pathogenesis &progression of the disease processes itself, which can only be accomplished through research. Central to meeting this need is to supply highly trained &skilled physician-scientists to conduct the research necessary to address this escalating public health problem. The need for energetic research efforts focused on better diagnostic tools, causes of kidney disease &novel treatment strategies is irrefutable. The purpose of this training grant is to train MD &MD, PhD physicians for independent academic research careers in kidney disease by providing training in basic &clinical sciences. We will integrate instruction across disciplines to ensure that trainees emerge highly skilled at translational research. Specific goals of the training program are to: (i)Provide trainees with skills necessary to become independent &complete academic clinician-scientists in basic, clinical and/or translational kidney-related research;(ii)Foster research efforts between basic &clinical trainees, &across departments and disciplines;(iii)Nurture &facilitate the transition from trainee status to independent academic faculty position. Despite the historical success of this training program (well over 2/3 of graduates in academic positions), we must continue to build on our commitment to train the next generation of physician-scientists in translational kidney-related research. Improving our capacity to bridge the gap between bench &bedside is essential to obtain funding by several agencies (NIH Roadmap) &will improve our ability to translate new knowledge &breakthroughs into clinical benefits for patients with kidney disease. Thus, the Program Director has decided a priori to provide this training upfront in this competitive grant renewal, by aligning and integrating the very successful Division of Nephrology's clinical science training program (not currently funded by T32) with the basic science program (currently funded by T32). This paradigm shift takes advantage of the newly established Kidney Research Institute and the Division of Nephrology's four integrated and cohesive research themes. Together, this provides an ideal environment and opportunity for """"""""360-degree training"""""""": basic scientists can test hypotheses in human studies &clinical researchers can probe mechanisms to explain findings in population-based studies. These interactions will become motivating forces for scientific creativity. In addition, our ongoing efforts to introduce further diverse perspectives into biomedical research by training underrepresented minority physician-scientists (6 recent trainees in basic and clinical science;4 now in academia) will remain a high priority. It is our expectation that continuing our success in developing the next generation of physician-scientists will insure a vigorous pipeline for delivering novel therapeutics to patients with kidney disease.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Institutional National Research Service Award (T32)
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Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Program Officer
Rys-Sikora, Krystyna E
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University of Washington
Internal Medicine/Medicine
Schools of Medicine
United States
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Rivara, Matthew B; Zelnick, Leila R; Hoofnagle, Andrew N et al. (2017) Diurnal and Long-term Variation in Plasma Concentrations and Renal Clearances of Circulating Markers of Kidney Proximal Tubular Secretion. Clin Chem 63:915-923
Adams, Scott V; Rivara, Matthew; Streja, Elani et al. (2017) Sex Differences in Hospitalizations with Maintenance Hemodialysis. J Am Soc Nephrol 28:2721-2728
Peltan, Ithan D; Mitchell, Kristina H; Rudd, Kristina E et al. (2017) Physician Variation in Time to Antimicrobial Treatment for Septic Patients Presenting to the Emergency Department. Crit Care Med 45:1011-1018
Rivara, Matthew B; Chen, Chang Huei; Nair, Anupama et al. (2017) Indication for Dialysis Initiation and Mortality in Patients With Chronic Kidney Failure: A Retrospective Cohort Study. Am J Kidney Dis 69:41-50
Rivara, Matthew B; Yeung, Catherine K; Robinson-Cohen, Cassianne et al. (2017) Effect of Coenzyme Q10 on Biomarkers of Oxidative Stress and Cardiac Function in Hemodialysis Patients: The CoQ10 Biomarker Trial. Am J Kidney Dis 69:389-399
Rivara, Matthew B; Soohoo, Melissa; Streja, Elani et al. (2016) Association of Vascular Access Type with Mortality, Hospitalization, and Transfer to In-Center Hemodialysis in Patients Undergoing Home Hemodialysis. Clin J Am Soc Nephrol 11:298-307
Mehrotra, Rajnish; Soohoo, Melissa; Rivara, Matthew B et al. (2016) Racial and Ethnic Disparities in Use of and Outcomes with Home Dialysis in the United States. J Am Soc Nephrol 27:2123-34
Rivara, Matthew B; Adams, Scott V; Kuttykrishnan, Sooraj et al. (2016) Extended-hours hemodialysis is associated with lower mortality risk in patients with end-stage renal disease. Kidney Int 90:1312-1320
Rangan, Gopala K (2016) C5b-9 does not mediate tubulointerstitial injury in experimental acute glomerular disease characterized by selective proteinuria. World J Nephrol 5:288-99
Gura, Victor; Rivara, Matthew B; Bieber, Scott et al. (2016) A wearable artificial kidney for patients with end-stage renal disease. JCI Insight 1:

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