Dr. Shukla has a multi-prong Kidney Disease Research Program at UFL and VA in the field of advanced CKD and home dialysis. The program is interested in better understanding and developing evidence-based strategies for management of the high morbidity and mortality conditions that surround the patients with advanced kidney disease and end stage renal disease. The projects in this Kidney Disease Research Program transit through nearly the entire spectrum of translational research, from basic science, to early human studies, to clinical trials and involving the patient-centered and health services research arena (T1 through T4 tier of NIH), and focuses on clinical topics of advanced CKD, cardiovascular disease (CVD), and informed decision making, and health system designing. Brief outline of ongoing research is below.
Clinical and Translational Research in CKD
Progressive CKD is associated with worsening cardiovascular morbidity and mortality. Many traditional and non-traditional cardiovascular risk factor participate in worsening this cardiovascular risk, and further limit the response of this disease to the conventional therapeutic regimens. Till date, few if any, therapeutic strategies have been successful in reducing cardiovascular morbidity and mortality in patients with CKD, especially advanced CKD and ESRD. The clinical and translational arm of our Kidney Disease Research Program focuses on establishing a novel therapeutics for these complex problems. Over last 10 years, Dr. Shukla has conducted a series of experiments from bench to bedside, establishing a novel therapy for Cardiovascular Disease in CKD. At present time the program is engaged in a Phase 2B clinical study.
Patient Centered Research
Advanced CKD and ESRD are a huge burden for individual patients, society and healthcare system. Dialysis therapy form the mainstay for renal replacement therapies in patients with kidney failure. Despite providing equivalent medical outcomes and trends for better patient-centered and health services outcomes, home dialysis therapies are grossly underutilized for the management of ESRD in the US; over last 4 decades it has remained at or below 10% of the US ESRD population. We have developed and validated a novel advanced CKD to ESRD transition program and over last 10 years through a series of studies, have shown that this transition model allows patient-centered initiation of home dialysis therapies in over 50-70% of incident ESRD. We have further established that this model can be efficiently disseminated through telemedicine, and are currently working with UFL and VA systems to establish a region-wide dissemination programs for this transition model. The research program surrounding these activities is looking for the value of shared decision making/informed decision making, patient empowerments and systemic limitations to patients’ selection and use of home dialysis therapies.
Health Services and Systems Research
Lack of patient awareness is not the only limiting aspect of the underuse of home dialysis in the US. This arm of Kidney Disease Research Program focuses on developing models for system-based improvement in the delivery of the care, especially for determining the needs for optimal care and dissemination of such care through the use of various telemedicine-based models.
Teresa Lyles, Ph.D.
Popy Shell, MPH
Shobha Subash, MPH
Lina Ly, MS
Zachary Purvis, BS