Dana Fuhrman, DO, MS Awarded K23 Grant to Study Renal Fitness in CHD Young Adults

Dana Fuhrman, DO, MS was awarded a K23 grant for an innovative study of renal fitness in young adults with congenital heart disease (CHD). She will lead a group of investigators from critical care, nephrology and cardiac surgery to unravel the mysteries of kidney ‘fitness’ and how it can be augmented in patients undergoing complex heart surgery. The project is funded by the National Institute of Diabetes and Digestive and Kidney Diseases.

“Patients’ kidneys can take a beating from disease and treatment. Understanding how some patients can endure kidney insults while others become injured is a key unmet need,” explained John Kellum, MD, Director of the Center for Critical Care Nephrology in the Department of Critical Care Medicine, an internationally recognized acute kidney injury researcher, who is Dr. Fuhrman’s primary mentor. “The implications of her work will eventually stretch as wide as all acute kidney injury which affects the lives of 4 million Americans each year.”

Children’s hospitals across the country face an exponential increase in the numbers of young adults with CHD requiring corrective surgeries since more and more children with CHD are surviving into adulthood. Many of these patients have poor renal outcomes, including acute kidney injury (AKI), that require intensive intervention by nephrologists and intensivists.

“Unfortunately, we have had limited means to predict which patients will do poorly,” said Dr. Carlton Bates, MD, Chief of the Division of Pediatric Nephrology at UPMC Children’s Hospital of Pittsburgh. “Dr. Fuhrman’s research has the promise of identifying new and innovative biomarkers to indicate those patients at high risk of poor outcomes, allowing clinicians to gauge their level of scrutiny and care following cardiac procedures.”

There are no readily available means to quantify renal fitness clinically, and there are no prior studies that examined the long-term effects of glomerular reserve or preoperative tubular biomarker values in any patient group. Given this paucity of data, the goal of Dr. Fuhrman’s research is to establish an objective method to quantify renal fitness in young CHD patients ages 18-28. She plans to quantify glomerular reserve by measuring estimated glomerular filtrate rate (eGFR) values using cystatin C before and after a protein load. She piloted this easily replicated method during her nephrology fellowship years as a T32 NIH scholar.

On admission to the hospital for coronary bypass (CBP) exposure, these young CHD patients will be assessed for AKI risk in order to determine:

  • The association of glomerular reserve and AKI risk;
  • The expression of tubular biomarkers that have been shown to be early markers of kidney damage;
  • The association of these biomarkers with AKI.

Patients will be followed for 1 and 2 years in order to determine if preoperative glomerular reserve and tubular biomarkers estimate the risk of chronic kidney disease.