Ph.D. student researches treatment decision-making in kidney failure cases

A two-year grant funds the research, which focuses on 50 patients at Temple University Hospital.

Megan Urbanski will recruit 50 patients from Temple University Hospital for her research on end-stage renal disease, also known as kidney failure. | SYDNEY SCHAEFER / THE TEMPLE NEWS

Megan Urbanski feels privileged for the opportunity to translate her experience as a nephrology social worker at Temple University Hospital into her research on end-stage renal disease.

“I was of course thrilled when I received news of the grant, but also grateful that the reviewers recognized the need to invest in research for this understudied and disadvantaged population,” Urbanski said.

Nephrology social workers support and advise patients experiencing ESRD, also known as kidney failure, who need a transplant due to chronic kidney disease.

The disease progresses through five stages of kidney damage and stage five is the most advanced, often resulting in kidney failure, according to the American Kidney Fund, a nonprofit that helps people fight kidney disease.

Urbanski, a social and behavioral sciences Ph.D. student in the College of Public Health, received a two-year grant worth $83,693 to research the different ways doctors treat people with chronic kidney disease based on how they were diagnosed.

Urbanski received the Ruth L. Kirschstein National Research Service Awards for Individual Predoctoral Fellows grant in June 2018 from the National Institute of Diabetes and Digestive and Kidney Diseases, a biomedical research institute in the National Institutes of Health.

Urbanski and other Ph.D. students applied for the F31 grant through NIH, the nation’s medical research agency, as part of the Ph.D. program’s requirement to complete a dissertation.

Urbanski’s research will study patients from TUH, which she expects to recruit in November. She will conduct interviews with 25 people who were aware of their diagnosis before reaching ESRD and another 25 people who were told they had chronic kidney disease after reaching ESRD.

About 22 percent of people with ESRD don’t receive medical care until they reach that stage of chronic kidney disease, according to a 2017 report from the United States Renal Data System. ESRD often causes symptoms like nausea, vomiting, chest pain, shortness of breath, which ultimately requires dialysis to improve kidney function or a transplant, according to Mayo Clinic.

Heather Gardiner, the director of the Health Disparities Research Lab in the College of Public Health, sponsors Urbanski’s ESRD research.

According to National Institute of Diabetes and Digestive and Kidney Diseases, the grant requires predoctoral students to receive mentored training on their dissertation research from faculty sponsors in their schools.

“I think Megan is an incredible and very talented researcher,” said Gardiner, who is also an associate professor of social and behavioral sciences. “She’s a beginning researcher, but she’s got a lot of potential and I am interested in helping to foster that.”

With her research, Urbanski said the goal is to compare the experiences of both groups of patients to evaluate the information, support and treatment they received and the emotions uninformed patients went through after learning about their diagnosis.

She will also speak to nephrologists, or kidney specialists, who diagnosed the patients in the study, to gain a better understanding of how that information was conveyed. Nephrology is a subspecialty of medicine that focuses on diagnosing and treating kidney diseases, according to the American College of Physicians, a national organization of internal medicine physicians.

Gardiner said the study could change the educational and decision-making process of ESRD, which could ultimately lead to improved health outcomes and better satisfaction from patients.

“I feel like the impact could be really profound for these patients, who hopefully will then be provided better-timed education around what their treatment options are,” she said.

Urbanski’s time at TUH influences the patients she intends to highlight in her research. A majority of patients diagnosed with ESRD are African American and Hispanic, and Urbanski said she hopes to redress some of the health disparities those communities face.

To complete her research, Urbanski will also work with Laura Siminoff, the dean of the College of Public Health and a co-sponsor of the research. Urbanski met Siminoff while she was a nephrology social worker in the transplant program at TUH.

“I’m very excited for our students because [a grant] makes a big difference for them in terms of being able to do their research,” Siminoff said. “But it also makes a big difference for their career as they move forward.”

Other members of the research team include Dr. Crystal Gadegbeku, the chief of the section of nephrology, hypertension and kidney transplantation at TUH and Amy Waterman, a nephrology professor and senior quality officer in the Kidney Transplant Program at UCLA.

Throughout the team’s interview process, Urbanski said she will ask patients what educational intervention methods would have been helpful at the time of their diagnosis in order to improve current practices.

“Not all kidney disease treatments are created equal,” Urbanski said. “People need to be armed with all the information as soon as possible, and we just don’t know what kind of information they’re getting yet, or when they’re getting it, or if they’re getting it.”

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