Alex Chang, MD, MS is a Clinical Investigator in the Department of Nephrology at Geisinger Health System. He is applying for a Mentored Patient-Oriented Research Career Development Award in order to develop the requisite skills and mentored research experience to become an independent physician scientist with a focus on prevention/slowing the progression of chronic kidney disease through control of obesity and improvements in diet. This research proposal includes a 5-year plan that includes mentorship by Dr. Lawrence Appel, MD, MPH, Dr. David Carey, PhD, and Dr. Morgan Grams, MD, PhD; completion of courses in epidemiology, biostatistics, and clinical trials; and retrospective and prospective studies examining the effect of bariatric surgery on kidney function.
The specific aims of the research agenda are to: 1) compare long-term kidney function trajectories between bariatric surgery patients and morbidly obese controls using the current clinical standard, eGFR based on serum creatinine (N=6200); 2) Assess associations between filtration markers (creatinine, cystatin C, BTP, and B2M) and directly measured GFR in a prospective cohort of patients undergoing bariatric surgery (n=40); 3) estimate long-term kidney function trajectories by multiple markers and compare trajectories between bariatric surgery patients and morbidly obese controls in a subsample with repeat biobanked specimens (N=400). Successful completion of this research will fill critical knowledge gaps in understanding the long-term effect of weight loss on kidney function while examining whether alternative filtration markers can improve estimation of kidney function in patients with morbid obesity. Further, completion of this research will fulfill the candidate's short-term career goals of developing a strong knowledge base in study design, longitudinal data analysis, multilevel modeling, and recruitment/retention of participants in long-term studies. This K award will also accelerate the candidate's long term objectives of conducting independent investigations on the effects of lifestyle modification and obesity prevention/control on progression of kidney disease, leveraging opportunities for comparative effectiveness research in a large, integrated, rural healthcare system.

Public Health Relevance

The results of this project will provide evidence for whether surgical weight loss can prevent or slow kidney disease, and whether multiple filtration markers may be used to better estimate kidney function trajectories in patients with morbid obesity. Results will have important implications for the management of obesity and chronic kidney disease.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Mentored Patient-Oriented Research Career Development Award (K23)
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Kidney, Urologic and Hematologic Diseases D Subcommittee (DDK)
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Rankin, Tracy L
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Geisinger Clinic
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Chang, Alex R; Zafar, Waleed; Grams, Morgan E (2018) Kidney Function in Obesity-Challenges in Indexing and Estimation. Adv Chronic Kidney Dis 25:31-40
George, Jason C; Zafar, Waleed; Bucaloiu, Ion Dan et al. (2018) Risk Factors and Outcomes of Rapid Correction of Severe Hyponatremia. Clin J Am Soc Nephrol 13:984-992
Chang, Alex R; Surapaneni, Aditya; Kirchner, H Lester et al. (2018) Metabolically Healthy Obesity and Risk of Kidney Function Decline. Obesity (Silver Spring) 26:762-768
Shin, Jung-Im; Luo, Shengyuan; Alexander, G Caleb et al. (2018) Direct Oral Anticoagulants and Risk of Acute Kidney Injury in Patients With Atrial Fibrillation. J Am Coll Cardiol 71:251-252
Chang, Alex R; Appel, Lawrence J (2018) Target Blood Pressure for Cardiovascular Disease Prevention in Patients with CKD. Clin J Am Soc Nephrol 13:1572-1574
Nadkarni, Girish N; Ferrandino, Rocco; Chang, Alexander et al. (2017) Acute Kidney Injury in Patients on SGLT2 Inhibitors: A Propensity-Matched Analysis. Diabetes Care 40:1479-1485
Chang, Alex R; Grams, Morgan E; Navaneethan, Sankar D (2017) Bariatric Surgery and Kidney-Related Outcomes. Kidney Int Rep 2:261-270
Ishigami, Junichi; Grams, Morgan E; Chang, Alexander R et al. (2017) CKD and Risk for Hospitalization With Infection: The Atherosclerosis Risk in Communities (ARIC) Study. Am J Kidney Dis 69:752-761
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
Chang, Alex R; Anderson, Cheryl (2017) Dietary Phosphorus Intake and the Kidney. Annu Rev Nutr 37:321-346

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