John Paul Middleton

I. More than 20 million people in the United States have chronic kidney disease (CKD), and these people carry an enormous medical burden.  Patients with CKD suffer from the metabolic sequelae of poor kidney function, hypertension, progressive worsening of glomerular filtration rate (GFR), and from disproportionate cardiovascular diseases. Therefore, a large number of people can benefit from early recognition of CKD, improved understanding of the metabolic and cardiovascular responses to CKD, and by limiting progressive decline of GFR.

II. Current research efforts aim to improve understanding of the association among traditional and novel cardiovascular risks and kidney disease. Ultimately the goal of the ongoing research will be to improve the management of the unique cardiovascular complications that occur in the patients with chronic kidney disease and to reduce the risk of developing advanced CKD.

III. Clinical trials underway at Duke include prospective trials in diabetic nephropathy, end-stage kidney disease, and in focal segmental glomerulosclerosis (FSGS.  In addition, Dr. Middleton serves on the Steering Committee for the NIH Clinical Trial in Focal Segmental Glomerulosclerosis (FSGS). Dr. Middleton and his group is also performing retrospective trials with large clinical databases to determine etiology of and outcomes from sudden cardiac arrest in patients with advanced CKD.

IV. Recent studies have helped identify interventions to reduce progression of hypertensive nephrosclerosis and diabetic nephropathy. The research group has also determined exposures that augment the cardiovascular risk of chronic kidney disease, including CKD that is maintained on hemodialysis.

V. Key words: chronic kidney disease CKD), hypertension, glomerular disease, progression of chronic kidney disease (CKD), cardiovascular complications of chronic kidney disease (CKD), hemodialysis, cardiovascular risk