Latino Kidney Clinic, Joslin Diabetes Center
According to the Centers for Disease Control and Prevention (CDC), more than 100 million Americans are living with diabetes (30.3 million) or prediabetes (84.1 million), with the cost of diagnosis and care escalating to $327 billion per year. Globally, the numbers are equally staggering. The number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014.
This global health crisis fuels a dedicated mass of endocrinologists, diabetes scientists and investigators throughout the U.S. and the world to find novel pathways to prevent, treat and cure Type 1 and Type 2 diabetes and their complications.
The Researcher Spotlight: Innovations and Advancements series highlights promising and innovative diabetes research and spotlights those leading the charge.
About the researcher
Dr. Rosas’s primary research focus is on the epidemiology of metabolic and cardiovascular disease complications in the setting of chronic kidney disease, including dialysis and renal transplantation. Her research has been funded by the National Institutes of Health (NHLBI and NIDDK ), and the Veterans Health Administration.
Dr. Rosas is the recruitment site Principal Investigator (PI) for the Kidney Precision Medicine Project sponsored by NIDDK, which, according to Dr. Rosas, plans to ethically obtain kidney biopsies to create a kidney tissue atlas, define disease subgroups, and identify critical cells, pathways and targets for novel therapies. She is a site investigator for the Preventing Early Renal Loss (PERL) multi-center study evaluating the efficacy of the urate-lowering drug allopurinol, as compared to placebo, in reducing kidney function loss among subjects with Type 1 diabetes.
Following internal medicine training at Michael Reese Hospital/University of Illinois in Chicago, Dr. Rosas completed her nephrology and epidemiology training at the University of Pennsylvania.
Meet the diabetes researcher
Associate professor of medicine
Harvard Medical School, Boston, Massachusetts
PD: Please describe your research focus.
Rosas: My research area is the epidemiology of chronic kidney disease (CKD) in particular as it relates to cardiovascular and metabolic disease. Diabetes is the most common cause of individuals going into renal replacement therapy in the U.S. While I participate in trials to test new agents to slow progression of kidney disease in the setting of diabetes, I am interested in learning more about risk factors that stimulate or slow progression of kidney disease.
PD: Why is it important to pursue research in this area, and what are your key research initiatives?
Rosas: Diabetes is the most common cause of end-stage kidney disease- when you need dialysis or transplant to replace your kidney function. One in three people with diabetes will develop kidney disease. Therefore, it is very important to identify the disease early using both a blood test for creatinine and a urine test to find out how much albumin there is in the urine. Our work below shows that the prevalence of diabetes is increasing and so is the prevalence of CKD in individuals with diabetes.
Population of interest: Using a multistage stratified probability sample, a total of 1,834, 1,067, 1,160 and 1,781 noninstitutionalized U.S. adults with diabetes were included in the analyses of National Health and Nutrition Examination Surveys (NHANES) for years 1988–1994, 1999–2002, 2003–2006, and 2007–2010, respectively.
Description of methodology: Using the 1988-2006 NHANES, we examined mortality trends in adults with diabetes. Chronic kidney disease (CKD) phenotypes were defined by the eGFR (≥90, 60–89 and <60 mL/min/1.73 m2) and ACR (<30, 30–300 and >300 mg/g) values.
Conclusions: The prevalence of diabetes in the U.S. population increased during the past three decades from 8.0 percent during years 1988–1994 to 11.8 percent during years 2007–2010 (47.5 percent relative increase). The prevalence of low eGFR without increased urine albumin excretion in the U.S. population with diabetes has been increasing. The proportion of deaths in the U.S. population with diabetes associated with low eGFR and ACR <30 mg/g has increased over time. However, mortality risk generally decreased over time for those with low eGFR and ACR ≥30 mg/g.
Kramer H, Boucher RE, Leehey D, Fried L, Wei G, Greene T, Rosas SE, Cooper R, Cao G, Beddhu S.
Diabetes Care. 2018 04; 41(4):775-781. PMID: 29436384.
PD: Have you received any awards relative to your research?
Rosas: In 2017, I was named physician of the year by the National Kidney Foundation New England chapter. Early in my career, I received the McCabe Award from the McCabe Foundation and the Barra Award from the Barra Foundation.
In addition, I proudly received the 2009 National Hispanic Medical Association Fellow of the Year award for leadership on improving the health of Hispanics and was the chair for the 2011 NIDDK Network of Minority Health Research Investigators.
PD: What are your 2019 research goals? What is in the pipeline?
Rosas: I am participating in two large NIH trials, and they will be recruiting participants this year.
About the trial: The Kidney Precision Medicine Project (KPMP) will find new ways to treat both acute kidney injury (AKI) and chronic kidney disease. We will be obtaining kidney tissues from individuals volunteering to participate in order to link metabolomics and proteomics with kidney structure. While we have learned a lot about kidney disease in the past, new technology has not been applied to better define the different pathways that lead to kidney disease progression in the most common causes, such as diabetes and hypertension. The hope is that in the future we will be able to differentiate kinds of CKD and provide different therapeutic options. For example, we all know that different individuals with the same A1C develop different complications. We do not know why—is it that one has protective factors or the other has factors that lead to deterioration or both?
The APOL1 Long-term Kidney Transplantation Outcomes Network (APOLLO) will determine if APOL1 gene is associated with progression of kidney disease in transplanted patients. In patients without diabetes, the APOL1 gene has been associated with earlier progression to dialysis. This study will determine if donated kidneys from people with the APOL1 gene have the same survival as those without the gene after transplantation.
PD: Have you received any grant awards relative to your research?
APOL1 Long-term Kidney Transplantation Outcomes Network (APOLLO) (APOLLO)
U01DK116102 (ROSAS, SYLVIA E) Sep 25, 2017 – May 31, 2021
Kidney Transplant Outcomes and APOL1
Role: Principal Investigator
Harvard Chronic Kidney Disease Research Biopsy Center
Kidney Precision Medicine Project
UG3DK114915 (WAIKAR, SUSHRUT S./ROSAS, SYLVIA E) Sep 18, 2017 – Jun 30, 2019
Harvard Chronic Kidney Disease Research Biopsy Center
Role: Co-Principal Investigator
Beyond the research
Rosas: I like to garden and travel to different places in the U.S.A. and abroad. I grow a vegetable and herb garden every year. However, given the New England weather, the herbs do a lot better than the vegetables. In the U.S.A., my favorite trip has been to visit the national parks in southern Utah and the Grand Canyon. One of my most recent international trips was to Peru. While Machu Picchu was impressive, I really enjoyed the visit to Lake Titicaca and the floating islands of Uros.
PD: What diabetes technologies are you watching in 2019?
Rosas: Single-cell sequencing is one of the many technologies that will be used for KPMP. It will allow us to determine what types of cells are each part of the kidney and, more importantly, how they differ from each other and in different types of diseases or stages of disease.
Learn more about Sylvia E. Rosas, MD, MSCE, and Joslin Diabetes Center’s Latino Kidney Clinic here.
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