FUNDED RESEARCH PROJECTS FOR 2015
Hawke's Bay Health
"Community Pharmacist - patient education to reduce the risk of acute kidney injury"
$9,750 - One year grant
Dr Patricia Metcalf
University of Auckland
"Prevalence and risk factors for chronic kidney disease in general population"
$15,000 - Two year grant
FUNDED RESEARCH PROJECTS FOR 2014
Hawkes Bay District Health Board
Home Dialysis PhD project - "The Home First Study: Patient Qualitative Interviews"
$8,000 - One year grant
Hawkes Bay District Health Board
"Kidney Outreach Team for High Risk Diabetic Kidney Disease"
$12,800 - Two year grant
FUNDED RESEARCH PROJECT FOR 2011
Strategies for increasing rates of live transplantation in New Zealand
Health Services Research Centre
$14,990 - Three year grant
Research on living donor kidney transplantation
Research is being carried out by a Victoria University PhD student on barriers to live donor kidney transplantation in New Zealand. The research will explore the barriers to transplantation and identify whether there are ways to improve access to transplantation for those patients who want one. The researcher, Paula Martin, is a former kidney donor and is hoping the research will provide useful information that can be used in planning transplant services for patients. As part of the research, a survey will be posted in October 2011 to people on the waiting list for a kidney transplant to find out their views about the barriers to live transplantation. Paula is hoping as many people as possible will complete the questionnaire, which is completely confidential. For any queries about the research, Paula can be contacted on email@example.com.
Research supported by Kidney Health New Zealand sheds light on the motivation and experiences of non-directed living kidney donors.
A paper published recently in the international journal, Clinical Transplantation, reports on interviews with 18 South Island non-directed living kidney donors carried out by Dr Allison Tong from the Centre for Kidney Research at Westmead Hospital in Sydney.
Non-directed living kidney donors (sometimes called altruistic or Good Samaritan donors) have been accepted for assessment in the South Island for the past 14 years. The first such transplant in Australia and New Zealand was carried out at Christchurch Hospital in 1998 and a further 17 have been done since then.
The authors state that “Non-directed living kidney donors were motivated by the desire to offer a chance of normal life without conditions or expectation of reciprocity.” The study found that non-directed donors wanted to remain anonymous and valued well organized co-ordination of their care, comprehensive information and good psychological support.
Other issues of importance were reassurance of adequate post-surgical care and access to reasonable financial reimbursement. The kidney donors reported improved fitness and health and a sense of empowerment, satisfaction and connectedness. Importantly, all donors had no regrets about donation.
The authors conclude that “Reluctance to consider non-directed donation programs solely on concerns of unrealistic or ill-motivations and potential feelings of donor regret appear unwarranted.” The latest report from the ANZDATA Registry records that there were eight non-directed living kidney transplants done in 2009 in New Zealand.
The study was jointly funded by Kidney Health New Zealand and Kidney Health Australia. Dr Tong worked closely with the South Island Transplant Group.
SOLID - An exciting new dialysis study!!!
SOLID is an acronym which stands for "SOdium Lowering In Dialysis".
SOLID is a scientific dialysis study which will begin in late 2011 in New Zealand. Patients on home haemodialysis in Counties Manukau, Auckland, Waitemata, Capital and Coast and Canterbury DHBs will be eligible to participate in the study and we would like to have as many patients as possible participate!
The trial is endorsed by the Health Research Council of New Zealand and the Australasian Kidney Trials Network. The study will be co-ordinated from Counties Manukau and nephrologists from all over the country will also be involved. We will begin approaching patients to invite them to enrol in the study around February next year.
What is the study about?
The study is based upon the knowledge that where salt (sodium) goes in our bodies, water goes too. A lesson which we all know from the dieticians! In dialysis patients this is very important as really the only way for water to leave the body is on dialysis. Therefore, if a dialysis patient has too much salt and hence water in their body, they may not be able to get rid of it. It will cause high blood pressure and damage their heart and blood vessels. We think that if we can reduce the amount of salt in dialysis patients’ bodies, then we can improve the quality and quantity of dialysis patients’ lives.
So how do we reduce salt?
The way that we are going to reduce salt in the body is to reduce the amount of salt in the dialysate which home haemodialysis patients use. The idea is that with less salt in the dialysis fluid, the patient will end up with less salt in their body at the end of dialysis. After a year of having dialysis with less salt in the dialysate we hope to show that the trial patients’ blood pressures, blood vessels and hearts will be in better shape than they were at the start of the trial.
What is involved for the patients?
The study is what we call a controlled trial. Half of the patients in the study will receive the low salt dialysate for a year and the other half will continue on their usual dialysate. Everybody in the study will have an MRI scan of their heart at the beginning of the year and everyone will have an MRI scan of their heart at the end of the year. The scans will be reviewed by a prominent New Zealand’s cardiologist (heart specialist) called Dr Ruvin Gabriel. He will be looking to see if we’ve improved the hearts of the people on the low salt dialysate over the course of the year. We will also be measuring some other things like blood pressure every 3 months during the study to see if they improve with the low salt dialysate. We believe that all the patients in the trial will benefit from the close attention that they will receive during the study and that the information that we get from doing this study will help to improve the health of all dialysis patients in New Zealand. At Counties Manukau, we’ve already performed a smaller pilot version of this study and showed that low salt dialysate is safe and causes no additional symptoms.
How will information from the trial help dialysis patients in the future?
We are really excited about this study, as we think that it has the potential to show that a simple and cost free alteration to the amount of salt in dialysate can ultimately save lives.
Want more information?
The doctors involved are:
- Counties Manukau - Dr Mark Marshall, Dr Chris Hood and Dr Jo Dunlop
- Waitemata - Dr. Janak de Zoysa
- Auckland - Dr. Imad Haloob
- Wellington - Dr. Grant Pigeon
- Christchurch - Dr. David Macgregor
If you are interested in participating in the trial or would like to know more about it then please feel free to email Dr. Jo Dunlop on firstname.lastname@example.org or speak to your dialysis nurse or SMO.
2010/2011 SUMMER STUDENTSHIP PROGRAMME
Urinary Cystatin C and Microalbuminuria as Biomarkers of Sepsis and Acute Kidney Injury
Supervisors: Dr John Pickering, Professor Zoltan Endre, Dr Geoffrey Shaw
Sponsor: Kidney Health New Zealand
Tom won the award for the ‘Best Presentation in the Clinical Category’.
Acute kidney injury (AKI) is a common condition characterized by a rapid decrease in kidney function. In the intensive care unit (ICU), AKI affects about one in three patients and is often fatal. Early diagnosis could lead to better outcomes for patients, yet the current “gold standard” for diagnosis only picks up AKI days after it has occurred. Imagine if the fire service took hours to realise a house fire is in progress! – this is similar to what we're dealing with here. By the time AKI has been diagnosed, it‟s usually too late to do much about it.
Another important condition in the ICU is sepsis. Put simply, sepsis is a nasty infection. Similarly to AKI it is common, often fatal, and hard to diagnose. Many of the signs and symptoms of sepsis are non-specific – that is, they are also present in other, non-infection-related diseases. This is important because different conditions have different treatments: if a patient has sepsis they can be given antibiotics, but this is unnecessary if they don‟t have an infection.
Therefore, the discovery of new diagnostic tests for AKI and sepsis could improve the outcomes of many patients in the ICU. This studentship focused on this idea by investigating whether a new urine test could be used to diagnose these conditions. This test measures the urinary concentration of a protein called cystatin C. We suspected, from earlier studies, that urinary cystatin C concentration would be higher in patients with AKI or sepsis than in patients without either condition. We also investigated if a second protein, called albumin, was present in the urine of patients with AKI or sepsis, as it has been suggested that the amount of albumin in the urine can affect the amount of cystatin C, hence modulating the diagnostic accuracy of cystatin C as a test for AKI or sepsis.
To test the theory that urine cystatin C diagnoses AKI and sepsis, and that the accuracy of this diagnosis can be improved by also measuring albumin, urinary concentrations of cystatin C and albumin in 72 ICU patients were measured. Using all available information, each patient was classified as having AKI or not having AKI, and as having sepsis or not having sepsis.
It was found that the average concentrations of both cystatin C and albumin were higher in the AKI group than in the non-AKI group, and higher in the sepsis group than in the non-sepsis group. Therefore, patients with greater amounts of cystatin C or albumin in the urine are more likely to have AKI or sepsis. This can be used as the basis of a diagnostic test.
Further analysis identified that the best diagnostic test for AKI would use the concentrations of cystatin C and albumin, while the best diagnostic test for sepsis would use cystatin C only. Using this information, the best possible diagnostic tests were developed, and the quality of these evaluated.
All diagnostic tests misclassify a proportion of patients – as having the disease when they don‟t, or viceversa. Hence the diagnostic ability of any test is usually assessed by calculating the proportion of patients it classifies correctly. On this basis it was found that 67% of people who tested positive for AKI (using the combined cystatin C and albumin test) actually had AKI, while only 15% of those who tested negative had AKI. That is, if 100 people test positive for AKI, 67 of them will have AKI, but if all 100 test negative for AKI only 15 of them will have AKI. Similarly, if 100 people test positive for sepsis (using the cystatin C only test), 81 will have sepsis, but if they all test negative only 32 will. Therefore, while not perfect, these tests provide valid information that can assist in diagnosis of both AKI and sepsis. In all cases, a positive test is associated with a significantly higher likelihood of having the condition being tested for.
While a lot more research is still required, this studentship has hence made one small step towards enhancing the diagnosis of AKI and sepsis and thus one small step towards improving the health of ICU patients.
FUNDED RESEARCH PROJECT FOR 2010
A critical bioethics of kidney health: An ethnographic and philosophical investigation
Rhonda Shaw pictured above with a patient on dialysis
Dr Rhonda Shaw
School of Social & Cultural Studies
Victoria University of Wellington
$57,782 - 20 month grant
This study will examine ethical debates about compensation for live kidney donation and assess the impact of dialysis treatment on families. This is a sociological study designed to contribute evidence-based research to health care and policy debates around kidney donation. If you would like more information about participating in the study please contact Dr Rhonda Shaw at Victoria University of Wellington Ph (04) 463 6134 or email email@example.com.