About

Alfred K. Cheung is a Professor of Internal Medicine and a faculty member in the Division of Nephrology & Hypertension at the University of Utah. He is Board certified in Internal Medicine and Nephrology. His research interests are clinical aspects of chronic kidney disease, hemodialysis, and hypertension. He currently serves as the Vice Chair for Research in the Department of Internal Medicine. His educational background includes a B.A. from State University of New York, an M.D. from Albany Medical College, and postgraduate training in internal medicine and clinical nephrology at Loma Linda University and the University of California - San Diego. His extensive publication record includes studies on vascular abnormalities in chronic kidney disease, the effects of various treatments on kidney outcomes, and disparities in dialysis care, among others.

Research topics

• Medicine
• Internal medicine
• Intensive care medicine
• Radiology
• Pathology
• Cardiology
• Nursing
• Physical therapy
• Endocrinology
• Psychiatry
• Urology
• Nuclear medicine
• Surgery
• Emergency medicine

Selected publications

• Response to the "Letter to the Editor: ''Prebiotic Administration to CKD Patients Modifies Their Microbiome and Metabolism''."

  Journal of Renal Nutrition · 2026-03-01

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  PublisherDOI

• Safety, Tolerability, and Feasibility of Empagliflozin Therapy in Patients Treated with Long-Term Hemodialysis

  Journal of the American Society of Nephrology · 2025-10-01

  articleSenior author

  Background: The safety and tolerability of SGLT2is in dialysis-dependent CKD (DD-CKD) have not been investigated, despite growing evidence that SGLT2is may exert off-target benefits to improve CV outcomes independent of renal SGLT2 inhibition. Methods: We performed a randomized, double-blind, placebo-controlled, three-arm, phase 1 study in 62 hemodialysis patients to evaluate safety and tolerability of empagliflozin and feasibility of conducting a phase 3 clinical trial. Participants were randomized to 10 mg or 25 mg of empagliflozin or placebo at 1:1:1 ratio and treated for 12 weeks. A detailed PK study of empagliflozin was performed in a subset of study participants. The primary safety and tolerability endpoint was the proportion of participants in each intervention group who adhere to the full randomized dose of empagliflozin at the end of the study. The result will be regarded as meeting the minimum benchmarks for proceeding to a phase 3 trial if at least 68% of the participants adhere to the assigned dose at the end of the study. Results: Out of250 screened, a total of 62 (25%) have enrolled in the study (N=20, Group 1; N=22, Group 2; N=20, Group 3). The participants had a mean age±SD of 58±13 years, and 68% were white males. Of the 62 participants, 13 (21%) have prematurely discontinued the study (7 withdrew for personal reasons; 1 was withdrawn by the investigator due to prolonged hospitalization judged unrelated to the study; 1 became lost to follow up due to relocation; 1 received kidney transplantation; 1 had sudden death; 2 (each from Group 1 and 2) withdrew due to serious adverse events of hypoglycemia and abnormal transaminases possibly related to the study drug). The discontinuation rate per study group to date has been 17% for Group 1, 20% for Group 2, and 28% for Group 3. There were 17 hospitalizations in 12 participants and were assessed to be unrelated to the study. No participants required dose reduction. The analyses of the study will be completed following the last study visit on 6/28/2025. Conclusion: Our results, while incomplete and limited by the small size, suggest reasonable safety and tolerance of empagliflozin in DD-CKD, and each study group is on track to meet the minimum benchmarks for proceeding to a phase 3 trial. Funding: NIDDK Support

  PublisherDOI

• Associations of Urine Biomarkers During Ambulatory Acute Kidney Injury With Subsequent Recovery in Kidney Function: Findings From the SPRINT Study

  American Journal of Kidney Diseases · 2025-04-21 · 3 citations

  articleOpen access

  RATIONALE & OBJECTIVE: Serum creatinine elevations in the ambulatory setting frequently occur during antihypertensive treatment and complicate clinical management, but few tools are available to distinguish whether kidney function will recover in this setting. This study evaluated whether urine biomarkers of glomerular and tubular health are associated with subsequent recovery of estimated glomerular filtration rate (eGFR) after acute kidney injury (AKI) has occurred in the ambulatory setting during blood pressure (BP) treatment. STUDY DESIGN: Longitudinal analysis of clinical trial participants. SETTING & PARTICIPANTS: 652 participants in SPRINT (the Systolic Blood Pressure Intervention Trial) in whom AKI developed in the ambulatory setting, defined as an increase in serum creatinine of≥0.3mg/dL from baseline detected at the 1-year or 2-year study visit. EXPOSURE: Eight urine biomarkers indexed to urine creatinine (Cr) measured at baseline and at the study visit when ambulatory AKI was detected. OUTCOME: <50% recovery in eGFR ("nonrecovery") at 12 months. ANALYTICAL APPROACH: Multivariable logistic regression models, stratified by randomization arm, to evaluate biomarker associations with the odds of nonrecovery of eGFR. RESULTS: at the time of ambulatory AKI. Among biomarkers measured at the time ambulatory AKI was detected, higher urine albumin-Cr ratio (OR per 1-standard deviation higher, 1.72; 95% CI, 1.10-2.70) and lower epidermal growth factor/Cr (OR, 0.46; 95% CI, 0.26-0.79) were associated with nonrecovery of eGFR in the standard BP treatment arm; higher urine α-1 microglobulin-Cr ratio (OR, 1.45; 1.09-1.92), lower epidermal growth factor Cr ratio (OR, 0.62; 95% CI, 0.46-0.83), and lower kidney injury molecule-1-Cr ratio (OR, 0.75; 95% CI, 0.59-0.96) were associated with nonrecovery of eGFR in the intensive BP treatment arm. LIMITATIONS: Persons with diabetes and proteinuria>1g/d were excluded. CONCLUSIONS: Among adults enrolled in a BP treatment trial who experienced ambulatory AKI, urine biomarkers reflecting glomerular injury and tubular dysfunction may help to distinguish whether kidney function will subsequently recover. PLAIN-LANGUAGE SUMMARY: Increases in serum creatinine concentration can occur when treating hypertension and complicate clinical management, but there are few tools available to distinguish whether an individual's kidney function will subsequently recover. In this study, we investigated the association of kidney biomarkers measured in the urine with subsequent kidney function among individuals in the outpatient setting in whom an increase in serum creatinine occurs. We found that biomarkers reflecting worse glomerular injury and tubular dysfunction are associated with the risk of an individual's kidney function not recovering. These results suggest that a broader assessment of kidney health when serum creatinine increases in the outpatient setting may help distinguish subsequent trajectories in kidney function.

  PublisherDOI

• Impact of SGLT2 Inhibitors and GLP-1 Receptor Agonists on Kidney Failure Risk Prediction

  Journal of the American Society of Nephrology · 2025-10-01

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  PublisherDOI

• Cuffless, calibration-free hemodynamic monitoring with physics-informed machine learning models.

  PubMed · 2025-12-31

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  Wearable technologies have the potential to transform ambulatory and at-home hemodynamic monitoring by providing continuous assessments of cardiovascular health metrics and guiding clinical management. However, existing cuffless wearable devices for blood pressure (BP) monitoring often rely on methods lacking theoretical foundations, such as pulse wave analysis or pulse arrival time, making them vulnerable to physiological and experimental confounders that undermine their accuracy and clinical utility. Here, we developed a smartwatch device with real-time electrical bioimpedance (BioZ) sensing for cuffless hemodynamic monitoring. We elucidate the biophysical relationship between BioZ and BP via a multiscale analytical and computational modeling framework, and identify physiological, anatomical, and experimental parameters that influence the pulsatile BioZ signal at the wrist. A signal-tagged physics-informed neural network incorporating fluid dynamics principles enables calibration-free estimation of BP and radial and axial blood velocity. We successfully tested our approach with healthy individuals at rest and after physical activity including physical and autonomic challenges, and with patients with hypertension and cardiovascular disease in outpatient and intensive care settings. Our findings demonstrate the feasibility of BioZ technology for cuffless BP and blood velocity monitoring, addressing critical limitations of existing cuffless technologies.

  Publisher

• Initial Testing for Albuminuria and Hematuria in Young Adults with New-Onset CKD

  Journal of the American Society of Nephrology · 2025-10-01

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  PublisherDOI

• Supportive Housing Participation and Risks of ESKD and Death in US Veterans Experiencing or at Risk for Homelessness

  Journal of the American Society of Nephrology · 2025-10-01

  articleSenior author
  PublisherDOI

• Effect of Sodium Bicarbonate on Plasma α-Klotho Levels in CKD

  Journal of the American Society of Nephrology · 2025-10-01

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  PublisherDOI

• Plasma Biomarkers of Kidney Tubule Health during Ambulatory AKI and Kidney Function Recovery in SPRINT

  Clinical Journal of the American Society of Nephrology · 2025-10-27 · 1 citations

  articleOpen access

  KEY POINTS: AKI frequently occurs in the ambulatory setting, but there are no available tools to distinguish whether kidney function will recover. Plasma biomarkers reflecting kidney tubular injury and dysfunction measured at the time of AKI are associated with nonrecovery in kidney function. Measuring plasma biomarkers of kidney tubule health during ambulatory AKI episodes could be helpful in guiding treatment decisions. BACKGROUND: AKI frequently occurs in the ambulatory setting, but few tools are available to distinguish whether an individual's kidney function will subsequently recover. METHODS: We included 652 participants with and without CKD in the Systolic Blood Pressure Intervention Trial who experienced ambulatory AKI, defined as a rise in serum creatinine of ≥0.3 mg/dl from baseline that occurred at the 12- or 24-month study visits. Four plasma biomarkers of kidney tubule health were measured at baseline and when ambulatory AKI was detected: kidney injury molecule-1 (KIM-1), soluble TNF receptor 1 (sTNFR1) and soluble TNF receptor 2, and uromodulin. Multivariable logistic regression models were used to evaluate biomarker associations with subsequent odds of <50% recovery in eGFR (nonrecovery) at 12 months. RESULTS: The mean age was 70±10 years; eGFR at baseline was 62±25 ml/min per 1.73 m 2 , and there was an eGFR decline of 21.7±12.5 ml/min per 1.73 m 2 at the time ambulatory AKI was detected. When measured at the time of ambulatory AKI, higher KIM-1 (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.14 to 1.73) and sTNFR1 (OR, 2.07; 95% CI, 1.49 to 2.88) and lower uromodulin (OR, 0.77; 95% CI, 0.63 to 0.94) were each associated with eGFR nonrecovery in multivariable models that adjusted for eGFR and albuminuria. In models that included all four plasma biomarkers, KIM-1 and sTNFR1 remained jointly associated with eGFR nonrecovery. CONCLUSIONS: Among hypertensive adults with ambulatory AKI, plasma biomarkers reflecting impaired kidney tubule health measured at the time of ambulatory AKI are associated with subsequent nonrecovery in kidney function.

  PublisherDOI

• Hemodynamics are associated with subsequent lumen remodeling and clinical maturation of hemodialysis arteriovenous fistula

  Scientific Reports · 2025-02-19 · 7 citations

  articleOpen access

  Abstract The pathogenesis of arteriovenous fistula (AVF) maturation failure is unclear. We evaluated the associations of wall shear stress (WSS) with subsequent AVF remodeling and clinical maturation using regression models in this prospective cohort study. Participants underwent duplex ultrasound at postoperative Day 1, Week 2, and Week 6 to measure AVF blood flow rate and diameter of the draining vein and proximal artery. The median vein WSS of 602 participants decreased from Day 1 to Week 6 (from 33.4 to 21.6 dyne/cm 2 ) but did not change noticeably for the artery (from 58.4 to 55.1 dyne/cm 2 ). WSS was positively associated with subsequent lumen expansion, with doubling of Day-1 WSS presaging a 9% (95% confidence interval (CI) 5%-14%; P &lt; 0.001) greater Day 1-to-Week 6 increase in vein lumen cross-sectional area and a 5% (95% CI: 1%-10%; P = 0.020) greater increase in artery lumen area. The odds of unassisted clinical maturation increased by 45% (95% CI: 11%-89%; P = 0.006) with each doubling of Day-1 vein WSS, and by 82% (95% CI: 39%-250%; P &lt; 0.001) with each doubling of Day-1 artery WSS. These findings show that WSS was positively associated with subsequent lumen expansion and AVF unassisted clinical maturation.

  PublisherOA PDFDOI

Recent grants

• NIH Grant R01DK088777

  NIH · $2.6M · 2017

• NIH Grant U01DK082222

  NIH · $1.8M · 2016

• NIH Grant U01DK099933

  NIH · $1.5M · 2021

• NIH Grant R01DK045575

  NIH · $478k · 1996

• NIH Grant U01DK049252

  NIH · $1.8M · 2004

Frequent coauthors

• Srinivasan Beddhu

  VA Salt Lake City Healthcare System

  711 shared

• Paul K. Whelton

  Tulane University

  405 shared

• Michael V. Rocco

  Wake Forest University

  389 shared

• Tom Greene

  University of Utah

  386 shared

• Mahboob Rahman

  372 shared

• Paul L. Kimmel

  National Institutes of Health

  279 shared

• Barry I. Freedman

  253 shared

• Anthony A. Killeen

  University of Minnesota

  250 shared