The Trust’s renal research team is involved actively in studies dedicated to improve outcomes in patients with kidney disease. We have completed several studies that contributed to the improvement of service delivery in this area, a couple of which are as follows:
SELF-MADE(Self-Management and Dialysis Evaluation)
This study resulted in the development of Shared Care space in haemodialysis. Some patients were trained to set up their own dialysis machines in the renal unit, self-needle, put themselves on the machine and take themselves off. This promoted patients’ autonomy and has given them more control with their dialysis treatment. This study also resulted in the promotion of exercise on dialysis, as well as peer-support for patients undergoing this treatment.
Disease-specific predictive formulas for energy expenditure in dialysis population
Through this study, we arrived at a predictive equation for resting energy expenditure in dialysis patients. This equation can assist in prescribing dialysis dose according to patients’ metabolic rate as well as in calculating metabolic rate for patient’s individual calorie requirement.
The team is currently involved in several studies, a few of which are described below:
We are participating in a nationwide study to investigate the optimum dose of intravenous iron used to treat haemodialysis patients. Anaemia is common in kidney failure and patients treated with haemodialysis who suffer from anaemia are treated with intravenous iron. Currently, iron dosing is not standardised and practice varies in different renal units and different countries. This study will help to determine the optimum dose of iron to administer to haemodialysis patients for the treatment of anaemia.
There is no known treatment for autosomal dominant polycystic kidney disease. Recently, Tolvaptan – a selective vasopressin receptor antagonist has been shown to reduce the rate of cyst growth in patients affected by the disease. We are currently participating in an international study to investigate whether tolvaptan is effective at protecting decline of kidney function in patients suffering from autosomal polycystic kidney disease.
Anaemia is common in kidney failure and patients treated with haemodialysis who suffer from anaemia are treated with intravenous iron and erythropoieitin. However, a proportion of patients do not respond to iron and EPO treatment. Hepcidin – a peptide hormone may be implicated in patients who are persistently anaemic despite iron and EPO treatment. We are currently participating in a study to investigate the safety and effectiveness of hepcidin antagonists to treat anaemia in patients on haemodialysis.
1. Endotoxin studies
Inflammation is commonly seen in haemodialysis patients but the cause is not understood. Endotoxins – fragments of bacteria may be involved. Endotoxin research has been difficult due to the technical difficulties with measuring endotoxin in blood. We have recently validated a laboratory method to measure endotoxin in haemodialysis patients accurately. We will be using this accurate method of endotoxin detection to understand the relationship between inflammation and blood endotoxins in patients treated with haemodialysis.
Higher levels of physical activity are associated with many physical and mental health benefits in individuals with kidney disease. However, availability of reliable tools to estimate physical activity in clinical practice are lacking. We are conducting a study to develop and validate a physical activity questionnaire specifically for use in individuals with kidney disease. This tool will facilitate measurement of physical activity routinely in clinical practice and will also help with nutritional management of those with kidney disease.