Clinical Trials

Inclusion Criteria:

• Diabetes mellitus (on anti-diabetes drug therapy).
• Age 40-80 years old.
• Estimated glomerular filtration rate (eGFR) 25-55 ml/min/1.73m^2 at time of consent with:
  • eGFR decline of 5 ml/min over 18 months or 10 ml/min over 3 years; or 
  • an intermediate or high 5-year risk of progression to end-stage kidney failure (dialysis or transplant) based on the validated Tangri 4-variable (age, sex, eGFR, urinary albumin-creatinine ratio) kidney failure risk equation https://kidneyfailurerisk.com/;
  • Primary cause of kidney disease diabetes without suspicion of concomitant kidney disease beyond hypertension.
• Spot urine albumin:creatinine ≥ 30 mg/g unless on RAAS inhibition therapy.
• Ability to give informed consent.

Exclusion Criteria:

• Hemoglobin A1c ≥ 11%.
• Pregnancy.
• Active malignancy.
• Active Immunosuppression therapy.
• Kidney transplantation history.
• Concomitant glomerulonephritis.
• Nephrotic syndrome.
• Solid organ transplantation history.
• Autosomal dominant or recessive polycystic kidney disease.
• Known renovascular disease.
• Kidney failure (hemodialysis, peritoneal dialysis, or kidney transplantation).
• Body weight >150 kg or BMI > 50.
• Uncontrolled hypertension: Systolic blood pressure (SBP) > 180 mmHg despite antihypertensive therapy.
• Recent cardiovascular event (myocardial infarction, stroke, congestive heart failure within 6 months).
• Known hepatitis B or C, or HIV infection.
• Anticoagulation therapy requiring heparin bridging for procedure.
• Active tobacco use.
• History of methicillin-resistant staphylococcus aureus colonization.
• Recent plastic, chemical or surgical manipulation of adipose tissue for cosmetic purposes within 6 months.
• Inability or unwilling to have magnetic resonance imaging (MRI) studies.
• Inability to give informed consent.
• Potentially unreliable subjects and those judged by the investigator to be unsuitable for the study.