Dr. Malhotra’s research area includes 1) hypertension and chronic kidney disease (CKD), 2) novel serum and urinary biomarkers for kidney health and prognosis, 3) nutritional epidemiology, 4) AKI in critically ill patients, and 5) microvascular function in patients with CKD. He also uses data from retrospective and prospective cohort studies and randomized clinical trials with focus on patient centered outcomes in CKD and dialysis patients. He is funded by the Satellite Coplon and the UCSD Academic Community Grants.
Hypertension and CKD research. Despite the importance of hypertension, the appropriate target for BP in patients with CKD has been unclear. Also, there is concern that treating to a lower BP may increase acute kidney injury (AKI) events in CKD patients. We conducted a meta-analysis of randomized controlled trials (RCTs) to determine if more intensive, compared with a less intensive, BP control is associated with reduced mortality risk in persons with CKD stages 3-5. We showed that more vs. less-intensive BP control resulted in lower risk of all-cause mortality. Subsequently, We evaluate the role of intensive BP lowering on kidney tubule injury in CKD. I demonstrated that reductions in glomerular filtration rate observed with intensive BP lowering reflect hemodynamic changes and not kidney damage.
Biomarkers of Kidney Health and Prognosis. My research has focused on understanding the relationship of novel kidney tubule markers to kidney function decline, cardiovascular disease, and mortality independent of eGFR and albuminuria. Our group has demonstrated that higher kidney tubule biomarkers levels are associated with increased risk of CKD progression.
Nutritional aspect of Kidney Disease. Diabetes and hypertension are established as strong risk factors for CKD and its progression to end stage renal disease (ESRD), however these risk factors do not fully explain the observed racial disparity in incidence of kidney disease. We conducted a nested case-control study within the Southern Community Cohort Study. We demonstrated that among blacks with diabetes, increased dietary protein is associated with increased incidence of ESRD. Whereas, high dietary polyunsaturated fatty acids (PUFA) has protective effect. We performed similar analysis in the Jackson Heart Study. Our results confirmed that, among African Americans with diabetes, higher protein intake was positively associated with greater decline in eGFR in analyses that accounted for risk factors for kidney disease.
Acute Kidney Injury in Critically ill Patients. Acute kidney injury (AKI) is common in critically ill patients and is associated with high morbidity and mortality. Along, with Dr. Mehta who is an expert in the field of AKI, we developed clinical risk prediction tool for AKI in the adult ICU setting to provide clinicians actionable information for prevention, early diagnosis and targeted interventions. In addition, our group showed that urine output is a sensitive and early marker for AKI and is associated with adverse outcomes in intensive care unit patients.
Patient centered outcomes in CKD and Dialysis. We evaluated sleep disorders in HD patients and the potential role of tryptophan and kynurenine dialysis clearance on sleep. In addition, our group have published studies using The MONitoring Dialysis Outcomes (MONDO) database. We are currently evaluating patterns of physical activity in hemodialysis using Fitbit technology.