My clinical activities are focused on caring for patients with chronic kidney disease (CKD) and those with end-stage renal disease undergoing renal replacement therapy. I am the Chief Medicine at Erie County Medical Center (ECMC) as well as the Vice Chair for Clinical Affairs for the UB Department of Medicine..

My current research involves a collaborative project with the School of Pharmacy on the effects of age, gender, race on the handling of immunosuppressive medications used to prevent rejection of kidney transplants.

previous contributions to research include:
1. Regional Vascular reactivity to vasopressors especially angiotensin 11
My initial research when I was a fellow and a junior faculty member was focused on the mechanisms of altered responsiveness to vasopressor agents and their role in systemic and renal hemodynamics. Specifically, I published on decreased vascular reactivity to angiotensin II in a number of disease states including cirrhosis, potassium depletion and high protein intake and also described impaired auto regulation of renal blood flow in animals fed a high protein diet.
2. Cyclosporine nephrotoxicity
During my fellowship at the University of Minnesota, that institution was one of only four in the country permitted to use the calcineurin urine inhibitor cyclosporine to prevent transplant rejection. The potential nephrotoxicity of this drug was soon recognized. We noticed that it had certain parallels to pre-renal azotemia and studied the effect of the drug unreal blood flow. In 1985 we were the first to describe renal vasoconstriction as a potential mechanism of the drugs nephrotoxicity.
3. Studies of cytomegalovirus infection and renal transplantation.
Cytomegalovirus (CMV) is one of several viruses that can cause serious infections in immunosuppressed patients resulting in serious morbidity and mortality. Initially early diagnosis was challenging because of the need for prolonged culture techniques. In the 1990s a semiquantitative test for detection of the virus and circulating blood leukocytes using immunostaining was developed originally in the Netherlands. Through a collaboration with that group Erie County Medical Center where I worked, was one of the first sites in the US to use this technique for early diagnosis of CMV infection. My work further extended that to show that not only was the test useful an early diagnosis but could also be used to monitor the response to therapy and detect early relapse or be used to guide preemptive therapy before the patient became symptomatic. I also was a site investigator for a randomized control trial of prophylactic therapy to prevent cytomegalovirus infection.
4. Vascular access in hemodialysis.
Patients on hemodialysis are critically dependent on a functioning access to their circulation either in the form of an arteriovenous graft or an arteriovenous fistula. The longevity of such an access can be compromised by acquired stenoses and/or thromboses. Working with the company from Ithaca New York (Transonics Inc) I assisted in the development and implementation of a technique to measure vascular access blood flow during hemodialysis treatment treatments and using these measurements