Nutritional Management of Renal Disease

Nutritional Management of Renal Disease

3rd Edition - December 17, 2012

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  • Editors: Joel Kopple, Shaul Massry, Kamyar Kalantar-Zadeh
  • Hardcover ISBN: 9780123919342
  • eBook ISBN: 9780123919359

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This translational text offers in-depth reviews of the metabolic and nutritional disorders that are prevalent in patients with renal disease. Chapter topics address the growing epidemic of obesity and metabolic syndrome. Each chapter integrates basic and clinical approaches, from cell biology and genetics to diagnosis, patient management and treatment. Chapters in sections 4-7 include new illustrative case reports, and all chapters emphasize key concepts with chapter-ending summaries. New features also include the latest National Kidney Foundation Clinical Practice Guidelines on Nutrition in Chronic Renal Failure, the most recent scientific discoveries and the latest techniques for assessing nutritional status in renal disease, and literature reviews on patients who receive continuous veno-venous hemofiltration with or without dialysis.

Key Features

  • Provides a common language for nephrologists, nutritionists, endocrinologists, and other interested physicians to discuss the underlying research and translation of best practices for the nutritional management and prevention of renal disease
  • Saves clinicians and researchers time in quickly accessing the very latest details on nutritional practice as opposed to searching through thousands of journal articles
  • Correct diagnosis (and therefore correct treatment) of renal, metabolic, and nutritional disorders depends on a strong understanding of the molecular basis for the disease – both nephrologists and nutritionists will benefit
  • Nephrologists and nutritionists will gain insight into which treatments, medications, and diets to use based on the history, progression, and genetic make-up of a patient
  • Case Reports will offer an added resource for fellows, nutritionists, and dieticians who need a refresher course


Practicing nephrologists, nephrology fellows, nutritionists, dieticians, and dialysis nurses; academic and clinical researchers in nephrology and nutrition; and physicians and researchers interested in renal nutrition and related renal diseases (renal cancer, diabetes, glomerulosclerosis, preeclampsia, lupus), such as endocrinologists, geriatricians, bariatric physicians, and diebetologists

Table of Contents

  • Chapter 1. The Influence of Kidney Disease on Protein and Amino Acid Metabolism


    CKD Interrupts the Components of Protein Metabolism

    Defining Muscle Wasting

    Mechanisms of Muscle Wasting

    The Ubiquitin-Proteasome System

    Synergism of Proteolytic Pathways Causes Muscle Wasting in CKD

    Proteolytic Activities Present in Muscles of Patients

    Factors Triggering Muscle Wasting in CKD and Other Catabolic States

    Myostatin and the Regulation of Muscle Protein Wasting

    Myostatin in Muscle Increases in Catabolic Conditions

    Beneficial Responses from Blocking Myostatin in Models of Muscle Catabolism

    Blocking Myostatin can Suppress CKD-Induced Muscle Wasting

    CKD Changes the Concentrations of Certain Amino Acids

    Links Between Amino Acid and Protein Metabolism



    Chapter 2. Carbohydrate Metabolism in Kidney Disease and Kidney Failure


    Insulin Resistance

    Insulin Secretion

    Insulin Clearance


    Carbohydrate Metabolism in Patients with Renal Replacement Therapy

    Treatment of Diabetes Mellitus in Diabetics with CKD

    Drug Management in Diabetics with CKD (Figure 2.1)


    Chapter 3. Altered Lipid Metabolism and Serum Lipids in Kidney Disease and Kidney Failure


    Plasma Lipid and Lipoprotein Profile in CKD/ESRD Patients

    The Nature and Mechanisms of CKD-Induced Lipid Abnormalities

    The Nature and Mechanisms of Adverse Effects of Lipid Disorders in CKD

    Treatment of CKD-Associated Dyslipidemia

    Potential Adverse Effects of Statins


    Chapter 4. Uremic Toxicity


    Uremic Symptoms and Signs

    Toxic Effects of Uremic Plasma or Serum

    Definition of a Uremic Toxin

    Impact of Dialysis Treatment on Uremic Toxicity

    Toxicity of Inorganic Substances in Uremia

    Free Water-Soluble Low-Molecular-Weight Solutes

    Protein-Bound Solutes

    Middle Molecules

    General Conclusions



    Chapter 5. Inflammation in Chronic Kidney Disease

    General Considerations

    Multifactorial Causes of Inflammation in Chronic Kidney Disease

    Inflammation as a Cause of Protein-Energy Wasting

    Inflammation as a Catalyst of Other Risk Factors

    Other Consequences of Inflammation

    Monitoring Inflammation

    Treatment of Inflammation in Chronic Kidney Disease


    Chapter 6. Catalytic (Labile) Iron in Kidney Disease


    Definition of Catalytic (Labile) Iron and its Importance in Tissue Injury

    Role of Catalytic Iron in Acute Kidney Injury

    Gentamicin-Induced Mobilization of Iron From Renal Cortical Mitochondria

    Evidence Suggesting a Role for Iron in Gentamicin-Induced Acute Renal Failure in Rats

    Catalytic Iron in Chronic Kidney Disease (Table 6.3)

    Catalytic Iron in Diabetic Nephropathy

    Catalytic Iron in Chronic Kidney Disease

    Concluding Comments


    Chapter 7. Carbonyl Stress in Uremia


    Increased Age and other Protein Modifications

    Carbonyl Stress

    Clinical Consequences of Carbonyl Stress

    Nutrition and Carbonyl Stress


    Chapter 8. Effect of Acidemia and Alkalemia on Nutrition and Metabolism


    Acute Responses to Acidosis and Alkalosis

    Comparing Effects of Acidemia to those of Starvation

    Endocrine Responses to Acidemia

    Calcium Metabolism

    Protein Malnutrition

    Metabolic Acidemia Stimulates the Ubiquitin/Proteasome Proteolytic Pathway

    Clinical Implications of Acidemia for Protein Nutrition


    Chapter 9. Prevention and Management of Cardiovascular Disease in Kidney Disease and Kidney Failure


    Cardiovascular Risk Factors

    Management of CVD



    Chapter 10. Assessment of Protein and Energy Nutritional Status


    Definition of Protein and Energy Wasting

    Assessment of Protein Mass

    Assessment of Protein and Energy Homeostasis

    Summary and Recommendations


    Chapter 11. Causes of Protein-Energy Wasting in Chronic Kidney Disease


    Causes of Pew in CKD

    Pathophysiology of Pew in CKD

    Endocrine and Hormonal Disorders

    Effect of Volume Overload

    Contribution of Co-Morbidities

    Altered Protein Kinetics in CKD

    Nutrient Loss During Dialysis

    Inflammation: Agent Provocateur of Pew

    Role of Metabolic Acidemia

    Oxidative Stress: Other Key Pathways

    Summary and Conclusion


    Chapter 12. Protein-Energy Wasting as a Risk Factor of Morbidity and Mortality in Chronic Kidney Disease


    Pertinent Outcomes in Patients with CKD

    Association of Measures of Nutrition with Outcomes

    Nutrient Intake and Outcomes

    Body Size, Body Composition and Outcomes

    Laboratory Measures and Outcome

    Nutritional Scoring Systems and Outcomes

    Nutritional Interventions and Outcomes



    Chapter 13. Effect of Nutritional Status and Changes in Protein Intake on Renal Function


    Role of Specific AA

    Factors Mediating the Renal Response to Protein and Amino Acids

    Humoral Mediators

    Local Mediators

    Intrinsic Renal Mechanisms

    Effects of Nutritional Status or Protein Deprivation on Renal Function

    Levels of Plasma Creatinine and Serum Urea Nitrogen in Patients with Protein-Energy Malnutrition

    Concentration and Dilution of the Urine in Patients with Protein-Energy Malnutrition

    Acid Excretion and Acid-Base Balance in Patients with Calorie-Protein Malnutrition

    Effects of Chronic Protein-Energy Malnutrition on Renal Sodium Excretion

    Effects of Maternal Nutrition on Renal Development

    Protein Energy Wasting in Advanced Renal Disease


    Chapter 14. Low Protein, Amino Acid and Ketoacid Diets to Slow the Progression of Chronic Kidney Disease and Improve Metabolic Control of Uremia


    Assessing the Progression of Chronic Renal Insufficiency

    Protein Intake and Chronic Renal Insufficiency: Experimental Data

    Dietary Protein Intake: Clinical Studies

    Clinical Evidence of the Effects of Low Protein Diets



    Chapter 15. Reducing Tryptophan Metabolites to Reduce Progression in Chronic Kidney Failure

    Search for Uremic Toxins

    Metabolism of Indoxyl Sulfate, a Tryptophan Metabolite

    Protein Metabolite Theory as a Mechanism of CKD Progression

    Indoxyl Sulfate Induces Reactive Oxygen Species (ROS) in the Kidney

    Role of Organic Anion Transporters in Nephrotoxicity of Indoxyl Sulfate

    Indoxyl Sulfate Reduces Klotho and Induces Senescence in the Kidney

    Vascular Toxicity of Indoxyl Sulfate

    Clinical Effects of AST-120



    Chapter 16. Altering Serum Lipids to Reduce Progression of Chronic Kidney Disease

    Kidney Disease and Dyslipidemia

    Lipid Lowering and Pleiotropic Effects of Statins

    Statins in Experimental Kidney Disease

    Effects of Dyslipidemia and Statins on the Progression of Kidney Disease in Human Subjects


    Chapter 17. Disorders of Phosphorus Homeostasis: Emerging Targets for Slowing Progression of Chronic Kidney Disease


    Role of Dietary Phosphorus Intake in Disturbances of Mineral Metabolism in CKD

    Disorders of Phosphorus Homeostasis and Kidney Disease Progression

    Dietary Phosphorus Restriction in CKD: Practical Considerations Moving Forward



    Chapter 18. Alkalinization to Retard Progression of Chronic Kidney Failure

    Epidemiology of Metabolic Acidosis in Kidney Disease

    Mechanism of Acidosis in CKD

    Animal Models of Kidney Damage With Acidosis

    Animal Models of Treatment

    Observational Studies in Humans



    Chapter 19. Calcium, Phosphate, PTH, Vitamin D and FGF-23 in Chronic Kidney Disease


    Calcium Metabolism

    Vitamin D

    Phosphate Metabolism

    Parathyroid Hormone

    Fibroblast Growth Factor 23 (FGF-23)

    Alterations in Mineral Metabolism in Ckd

    Phosphate and Cardiovascular Disease (CVD)

    Phosphate and Vascular Calcifications

    Control of Serum Phosphate in CKD

    Dietary Phosphorus Restriction

    Inorganic Phosphorus and Food Additives

    Dietary Phosphorus, Protein Intake and Phosphorus-Protein Ratio

    Phosphorus Removal With Dialysis

    Phosphate Binders

    Therapy With Vitamin D Sterols




    Chapter 20. Phosphate Metabolism and Fibroblast Growth Factor 23 in Chronic Kidney Disease


    Phosphate Metabolism in Health

    Phosphate Metabolism Across the Spectrum of CKD

    The Role of Phosphate and FGF-23 Excess in the Pathophysiology of CKD Outcomes

    Therapeutic Approaches to Lowering Phosphate and FGF-23 Excess

    Impact of Dietary Phosphate on Phosphate/FGF-23 Excess

    Questions and Controversies





    Chapter 21. Vitamin D in Kidney Disease

    Normal Vitamin D Metabolism

    Prevalence and Etiology of Deficiency in The Vitamin D Axis in CKD



    Other Compounds

    Therapeutic Considerations




    Chapter 22. Nutritional Management of Water, Sodium, Potassium, Chloride, and Magnesium in Kidney Disease and Kidney Failure

    Sodium and Chloride





    Chapter 23. Trace Elements, Toxic Metals, and Metalloids in Kidney Disease


    Alterations in Essential Trace Elements in Patients With Kidney Disease

    Alterations in Nonessential Trace Elements, Metals, and Metalloids in Patients With Kidney Disease

    Trace Element Abnormalities in Renal-Specific Syndromes

    Diagnostic and Therapeutic Approaches



    Chapter 24. Vitamin Metabolism and Requirements in Renal Disease and Renal Failure


    Structure and Physiological Role of Vitamins

    Vitamin Intake in Chronic Renal Disease

    Vitamins Status in Chronic Renal Disease

    Vitamins as Therapy for People with Kidney Disease

    Recommendations for Vitamin Supplementation and Vitamin Therapy in Renal Diseases



    Chapter 25. Nutrition and Anemia in End-stage Renal Disease



    Vitamin C

    Vitamin D

    Folic Acid

    Vitamin B6 (Pyridoxine)

    Vitamin B12


    Growth Hormone and Insulin-Like Growth Factor-I (IGF-I)


    Chapter 26. Nutritional and Non-nutritional Management of the Nephrotic Syndrome


    Dietary Protein

    Albumin Homeostasis in the Nephrotic Syndrome

    Dietary Protein and Renal Injury

    Effects of the Nephrotic Syndrome on Solid Tissue Proteins

    Dietary Proteins as Potential Allergens Responsible for Renal Disease

    Dietary Fat

    The Effect of Altered Glomerular Permselectivity on Lipid Metabolism

    Cardiovascular Effects of Hyperlipidemia in the Nephrotic Syndrome

    Thromboembolic Complications

    Effects of Lipids on Renal Disease

    Polyunsaturated Fatty Acids

    Derangements in Divalent Cation Metabolism in the Nephrotic Syndrome

    Derangements in Salt and Water Metabolism in the Nephrotic Syndrome (Volume Homeostasis)

    Recommendations for Nutritional and Non-Nutritional Treatment of the Nephrotic Syndrome



    Chapter 27. Nutrition and Blood Pressure


    Obesity and Energy Intake

    Individual Nutrients, Miscellaneous Substances and Blood Pressure

    Nutritional Management Strategies for The Prevention or Treatment of Hypertension

    Health Enhancing Diets and Lifestyles

    Long-Term Adherence and Blood Pressure Responses to Health Enhancing Lifestyles

    Challenges to Diet and Lifestyle Approaches for Preventing and Treating Hypertension

    Conclusions and Recommendations

    Key Points


    Chapter 28. Effect of Obesity and the Metabolic Syndrome on Incident Kidney Disease and the Progression to Chronic Kidney Failure


    Definitions of Obesity/Metabolic Syndrome

    Obesity and Metabolic Syndrome as Risk Factors for Incident CKD

    Obesity and Metabolic Syndrome as Risk Factors for Progression of CKD

    Pathophysiology of Obesity on the Kidney

    Effect of Weight Loss Interventions on Kidney Disease



    Chapter 29. Nutritional and Metabolic Management of Obesity and the Metabolic Syndrome in the Patient with Chronic Kidney Disease


    Obesity-Related Chronic Kidney Disease (CKD)

    Obesity-Related Glomerulopathy

    Measuring GFR

    Metabolic Syndrome

    Treatment of Obesity and Obesity-Related Kidney Disease

    Bariatric Surgery (see also Chapter 28)

    Metabolic Syndrome


    Chapter 30. Bariatric Surgery and Renal Disease

    Magnitude of Problem

    Pathogenesis of Obesity

    Clinical Manifestations

    Medical Therapy

    Role of Bariatric Surgery in Treatment of Morbid Obesity

    Surgical Techniques of Bariatric Surgery (see Figure 30.1)

    Outcomes of Bariatric Surgery

    Renal Disease and Morbid Obesity

    Pathogenesis of Renal Disease in Obesity

    Role of Bariatric Surgery in Chronic Kidney Disease

    Role of Bariatric Surgery in Transplant Candidates

    Bariatric Surgery and Nephrolithiasis

    Other Renal Effects of Bariatric Surgery

    Future Research


    Chapter 31. Nutritional and Metabolic Management of the Diabetic Patient with Chronic Kidney Disease and Chronic Renal Failure


    Glucose/Insulin Homeostasis

    Value of Glycemic Control, and its Determination in CKD


    Diabetes/Bone and Mineral Metabolism

    Dietary Protein Intake and Diabetic Kidney Disease

    Salt Intake and Diabetic Kidney Disease


    Chapter 32. Nutritional Management of Maintenance Hemodialysis Patients


    Factors Altering Nutrient Intake in Maintenance Hemodialysis Patients

    Loss of Nutrients During Maintenance Hemodialysis Treatment

    Importance of Pew and Diet as Patients Approach Esrd and Commence MHD

    Assessment of Nutritional Status in MHD Patients

    Acidemia and Protein Wasting

    Goals of Nutritional Management of MHD Patients

    Dietary Nutrient Requirements (see Table 32.3)

    Management of Pew in MHD Patients

    Treatment of Acute Catabolic Illness

    Daily or Long Duration Hemodialysis and Nutritional Status


    Chapter 33. Nutritional Management of End-Stage Renal Disease Patients Treated with Peritoneal Dialysis


    Type of Peritoneal Dialysis

    Peritoneal Dialysis Solutions

    Specific Effects of Peritoneal Dialysis on Nutritional Status and Metabolism

    Dietary Recommendations for ESRD Patients Undergoing Peritoneal Dialysis

    Protein-Energy Wasting in Peritoneal Dialysis Patients

    Management of Protein-Energy Wasting in Patients Treated with Peritoneal Dialysis


    Chapter 34. Nutritional Management of Kidney Transplant Recipients



    Bone Disease

    Diabetes Mellitus



    Food Safety




    Protein and Energy Requirements

    Nutritional Management

    Pretransplant Status and Posttransplant Outcome




    Chapter 35. Nutritional Management of the Child with Kidney Disease


    Etiology of Protein-Energy Wasting

    Assessment of Nutritional Status

    Nutritional Requirements

    Bone Mineral Metabolism

    Acid–Base and Electrolytes

    Vitamins and Micronutrients

    Nutrition Management


    Chapter 36. Nutritional Management of Acute Kidney Injury


    Metabolic Environment of the Patient with AKI

    Metabolic Alterations Specifically Attributable to AKI

    Metabolic Interventions of Controlling Catabolism

    Clinical Studies on Protein Catabolism in AKI

    Amino Acid/Protein Requirements in Patients with AKI

    Carbohydrate Metabolism

    Lipid Metabolism

    Micronutrients and the Antioxidant System in AKI


    Metabolic and Nutritional Factors and the Prevention and Therapy of AKI

    Impact of Renal Replacement Therapy (RRT) on Metabolism and Nutrient Balances

    The Effect of Nutrition Status and Nutrient Supply on Prognosis

    Practice of Clinical Nutrition in Patients with AKI

    Oral Nutrition in Patients with AKI

    Nutritional Support in Patients with AKI

    Enteral Nutrition in AKI

    Parenteral Nutrition in AKI

    Complications of Nutritional Support

    Monitoring of Nutrition Support in Patient with AKI


    Chapter 37. Nutritional Management of Patients Treated with Continuous Renal Replacement Therapy


    Modes of CRRT

    Generic Effects of CRRT on Energy Metabolism

    Specific Effects on Nutrient Balance

    Recommendations on Nutritional Therapy




    Chapter 38. Anorexia and Appetite Stimulants in Chronic Kidney Disease

    General Considerations

    Prevalence of Anorexia, Methods of Assessment and Clinical Implications

    Pathogenesis of Anorexia in CKD

    Treatment of Anorexia in CKD


    Chapter 39. Oral and Enteral Supplements in Kidney Disease and Kidney Failure


    Oral and Enteral (Tube Feeding) Nutrition in CKD Patients

    Oral and Enteral Nutrition for Patients with Nephrotic Syndrome

    Oral and Enteral Nutrition in Chronic Dialysis Patients

    Oral and Enteral Nutrition in Acute Kidney Injury



    Chapter 40. Intradialytic Parenteral Nutrition, Intraperitoneal Nutrition and Nutritional Hemodialysis


    Intradialytic Parenteral Nutrition (IDPN)

    Randomized Prospective Controlled Trials of IDPN

    Advantages and Disadvantages of IDPN

    Indications for IDPN

    IDPN in the United States

    Nutritional Hemodialysis and Intraperitoneal Nutrition


    Chapter 41. Therapeutic Use of Growth Factors in Renal Disease


    Treatment of Protein-Energy Wasting (PEW) in ESRD Patients

    Therapeutic Use of Growth Factors in Renal Disease

    Growth Factors in the Management of Wasting in Renal Disease



    Chapter 42. Nutritional Prevention and Treatment of Kidney Stones


    Pathophysiology of Kidney Stone Formation

    General Dietary Effects on Kidney Stones

    Effect of Diet Based on Urinary Findings

    Dietary Recommendations Based on Stone Type

    Obesity and Kidney Stones

    Melamine Stones


    Chapter 43. Herbal Supplements in Patients with Kidney Disease


    Acute Kidney Injury

    Chronic Kidney Disease

    Five Herbals with Some Proven Efficacy


    Clinical Implications


    Chapter 44. Drug–Nutrient Interactions in Renal Failure


    Effect of Food Intake on Drug Absorption

    Effects of Nutrients on Drug Metabolism

    Interactions of Food Supplements with Drugs

    Drug-Induced Nutritional Deficiencies

    Taurine and ACE-Inhibitor Effects

    Nutrient Interactions with Oral Anticoagulants

    Interactions of Calcineurin Inhibitors with Nutrients

    Enteral Tube Feeding and Oral Drug Administration


    Chapter 45. Exercise Training for Individuals with Advanced Chronic Kidney Disease


    Characteristics of Advanced CKD Patients

    Value of Exercise and Physical Activity in Advanced CKD

    Principles of Exercise Training

    Patient Assessment

    Components of the Exercise Training Prescription

    Exercise Training Program Design for Patients with Advanced CKD

    Components of the Exercise Training Session

    Risks of Exercise in the Advanced CKD Patient

    Urgent Need for Development of Renal Rehabilitation Programs



    Chapter 46. Motivating the Kidney Disease Patient to Nutrition Adherence and Other Healthy Lifestyle Activities


    What is Motivational Interviewing?

    What isn’t Motivational Interviewing?


    Handling Resistance

    Empirical Support

    Applications in Kidney Disease Management

    Learning Motivational Interviewing

    Dissemination of Motivational Interviewing

    Future Research Directions in Kidney Disease Management



    Color Plates


Product details

  • No. of pages: 816
  • Language: English
  • Copyright: © Academic Press 2012
  • Published: December 17, 2012
  • Imprint: Academic Press
  • Hardcover ISBN: 9780123919342
  • eBook ISBN: 9780123919359

About the Editors

Joel Kopple

Joel D. Kopple, MD, editor of the book’s first three editions, is Professor Emeritus of Medicine and Public Health at the David Geffen School of Medicine at UCLA and UCLA Fielding School of Public Health, Los Angeles, CA, and is a member of the Division of Nephrology and Hypertension and The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California. Dr. Kopple was Chief of the Division of Nephrology and Hypertension at Harbor-UCLA Medical Center from 1982 to 2007. He has published over 600 scientific papers and book chapters and has edited or coedited 15 seminars and proceedings. Dr. Kopple is a former president of the National Kidney Foundation (NKF), the American Society of Parenteral and Enteral Nutrition, the International Society for Renal Nutrition and Metabolism, and the International Federation of Kidney Foundations and was a founder of World Kidney Day.

Affiliations and Expertise

The Lundquist Institute at Harbor-UCLA Medica Center, David Geffen School of Medicine at UCLA and UCLA Fielding School of Public Health, Torrance and Los Angelese, CA, United States

Shaul Massry

Shaul G. Massry, MD, editor of the book’s first three editions, is Professor Emeritus of Medicine and Physiology and Biophysics at the Keck School of Medicine, University of Southern California, Los Angeles, California. He served as Chief of its Division of Nephrology from 1974 to 2000. He has published over 600 scientific papers and over 80 book chapters, and he is editor or coeditor of 28 books. Dr. Massry has received honorary doctorates from 14 universities across Europe, including the oldest and prestigious Charles University (Prague, Czech Republic), The University of Bologna (Italy), and the University of Padua (Italy). Dr. Massry is a former president of the National Kidney Foundation (NKF).

Affiliations and Expertise

Professor of Medicine, Physiology and Biophysics, University of Southern of California, Los Angeles, CA, United States

Kamyar Kalantar-Zadeh

Kamyar Kalantar-Zadeh, MD, PhD, MPH, editor of the book’s third edition and an Editor-in-Chief of the Journal of Renal Nutrition, is Professor of Medicine, Pediatrics, Public Health and Nursing Sciences, and Chief of Nephrology, University of California Irvine School of Medicine, Irvine, CA; Adjunct Professor of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA; and a staff physician in Veterans Affairs Hospital, Long Beach, CA. Dr. Kalantar is a former president of the International Society for Renal Nutrition and Metabolism and the International Federation of Kidney Foundations, co-chair of the joint steering committee of World Kidney Day, and Chair of the Medical Advisory Committee of the National Forum of the ESRD Networks. He has served as PI of a dozen National Institutes of Health grants and has coauthored over 800 manuscripts in peer-reviewed journals.

Affiliations and Expertise

Harold Simmons Center for Kidney Diseae Research and Epidemiology, Division of Nephrolofy, Hypertension and Kidney Transplantation, Department of Medine, University of California Irvine School of Medicine, Orange, CA, United States; Nephrology Section, Department of Medicine, Tibor Rubin Veterans Affairs Medical Center, Veterans Affairs Long Beach Healthcare System, Long Beach, CA, United States; The Lundquist Institute at Harbor-UCLA Medical center, Torrance, CA, United States; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, United States

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