Research

Over four decades of research has revealed a myriad of health benefits associated with increasing physical activity and participating in exercise training programs across the spectrum of CKD. As such, current clinical guidelines (KDOQI) specify that CKD patients should be participating in exercise on most, if not all, days of the week. Despite the available scientific evidence and the current guidelines, exercise and physical activity are still not implemented as part of routine care in this patient cohort. Whilst there are several barriers as to why exercise is not yet integrated into routine care, it has previously been reported that Nephrology healthcare providers do not have enough time and/or sufficient knowledge on exercise prescription to effectively counsel and implement physical activity and exercise interventions for these patients. In addition, there are no available programs for CKD patients in the Richmond community to attend to participate in regular exercise and receive lifestyle change education that is tailored to their disease.

As a result, we have established a Renal Rehabilitation program at VCU that is free of charge, clinician referred, exercise rehabilitation service to CKD patients in the Richmond community. The program is a collaboration between VCU’s Department of Kinesiology and Health Sciences, the Department of Health Behavior and Policy, and the Department on Internal Medicine, Division of Nephrology. As part of the program, participants routinely undergo assessments of their physiological function and quality of life in order to individually track their progress.

Funding: VCU Health Department of Internal Medicine/ Gupta-Levy Transplant research Initiative

Status: Recruiting Participants

Despite medical and surgical advances, long term survival after a liver transplant is lower compared to the general population, largely due to an increased burden of heart and blood vessel disease. We do not fully understand why this is yet, but we do know that these patients have a narrowing of their arteries due to a buildup of plaque. As a result of this disease in the blood vessels, these patients may be susceptible to developing a type of heart failure, known as heart failure with preserved ejection fraction, where the heart cannot relax efficiently during the cardiac cycle. We urgently need to find out what causes this heart a blood vessel disease and implement targeted interventions to ensure that these patients live a long life after receiving a transplant that is free of disease. We are very interested in the role that a compound called trimethylamine N-oxide (TMAO) might play in heart and blood vessel disease in patients that have had a liver transplant. TMAO is produced by bacteria in the gut in the setting of a diet rich in red meat, eggs, seafood and diary. In the general population, high levels of TMAO are linked with a higher risk of dying from heart disease. Our preliminary studies in patients that have had a liver transplant show that those with higher TMAO levels have worse blood vessel heath. Animal studies have shown that we can reduce TMAO levels and restore blood vessel health with a compound called 3,3-dimethyl-1-butanol (DMB), but this has not yet been studied in humans. Interesting, cold pressed extra-virgin olive oil (EVOO) has very high concentrations of DMB. Therefore, in a group of 12 patients who have received a liver transplant we are proposing a pilot study to investigate if adding EVOO to the diet for 4 weeks can reduce TMAO levels and subsequently improve blood vessel function and the heart’s ability to relax at rest and during exercise. This research is important because we expect to demonstrate the efficacy of a novel, non-pharmacological, low cost approach to improve heart and blood vessel heath.

Funding: Pauley Heart Center/Stravitz-Sanyal Institute for Liver Disease & Metabolic Health

Status: Pre-enrollment

Weight gain often occurs following a liver transplant. This weight gain is problematic as it leads to many other health problems. The reasons of this weight gain are still poorly understood. To better understand weight gain, this study is looking to see how a 6-month low carbohydrate diet can affect the body's ability to use energy in addition to the affects it has on heart and blood vessel health.

This study will help researchers to better understand weight gain after a transplant. This knowledge will help health care providers to prevent weight gain after a liver transplant and therefore improve the health of liver transplant patients.

Status: Recruiting participants

Funding: VCU CCTR Multischool Award

Mitochondrial dysfunction is consistently reported in CKD and heart failure. Mitochondrial dysfunction has been implicated in cardiac, skeletal muscle and vascular dysfunction and is therefore an attractive target for a 'whole systems' therapeutic approach that would encompass exercise intolerance and abnormal blood vessel hemodynamics. A known contributor to and subsequent cyclical result of mitochondrial dysfunction is an abnormally heightened production of mitochondria derived oxidative stress. This study will address the role of mitochondria derived oxidative stress in mitochondrial dysfunction, exercise intolerance and large blood vessel hemodynamics HFpEF patients with and without CKD.

Status: Enrollment Closed

Funding: American Heart Association