Anaemia Clinical Study Group
Anaemia is an extremely common complication associated with chronic kidney disease. It affects approximately two-thirds of patients not yet on dialysis and around 90–95 per cent of patients receiving regular dialysis.
It results in tiredness, fatigue, and reduced energy levels. It can cause significantly reduced quality of life, physical capacity, and an increased need for blood transfusions.
Treatments for anaemia aim to reverse the adverse consequences of this condition.
Who we are
We are a group of leading clinical investigators from all parts of the UK with a specific research interest in the management of anaemia in patients with renal disease and iron deficiency.
The Group is co-chaired by Professor Sunil Bhandari and Dr Ben Oliveira.
Professor Bhandari is a Consultant in Nephrology and Honorary Professor, Hull University Teaching Hospitals NHS Trust.
Dr Oliveira is a senior registrar in Renal Medicine based in the North Thames Deanery. He is currently undertaking a PhD investigating the role of iron in augmenting skeletal muscle mitochondrial function in patients with chronic kidney disease (CKD). He has been part of the team running the recently completed Iron and Muscle trial investigating intravenous iron on skeletal muscle function in CKD. His research has also explored the mechanisms of benefit of iron seen in the PIVOTAL trial performed on haemodialysis patients. His other interests include healthcare inequities; he is a member of the Health Equities Advisory Group which form part of the London Kidney Network. He has also led on delivering training days to renal registrars across London in his previous role as trainee representative.
Our aims:
To further the science of erythropoiesis in chronic kidney disease, particularily in relation to the management of anaemia in these patients.
The current focus is on iron management, but in the near future, this will include HIF prolyl hydroxylase inhibitors, anti-hepcidin strategies, and individualised management from genomic analysis.
Other areas of interest include:
- the HIF stabiliser phase 3 clinical trials to which many UK renal units are contributing
- the potential role of iron in cardiac and skeletal muscle function and
- the possible links between iron and phosphate/FGF-23 metabolism.
Challenges and evidence gaps:
- What is the ideal haemoglobin (Hb) target range for patients receiving dialysis?
- What is the ideal Hb target range in patients with CKD receiving HIF stabilisers for their anaemia (both dialysis and non-dialysis)
- More about the possible use of iron maltol and sucrosomial iron in patients with CKD
- Are changes in phosphate as a result of iron therapy significant?
- A better understanding of the basic science.
Recently completed projects:
- A UK multicentre prospective 2-arm randomised controlled study investigating the optimum amount of IV iron to administer to haemodialysis patients
- Led by Professor Iain Macdougall, Trial Manager - Chante Reid (previously Claire White)
50 sites, 2141 patients - one of the largest renal trials exclusively conducted in the UK - Trial ran from November 2013-July 2018
- Trial oversight: Glasgow Clinical Trials Unit
- Funded by Kidney Research UK through an unrestricted grant from Vifor Fresenius Medical Care Renal Pharma
- Primary results presented at ASN 2018 and published NEJM (N Engl J Med 2019; 380:447-458). Follow-up papers and DNA sub-study planned
- Find out more
Iron & Heart Study
- A multicentre prospective double blind randomised controlled pilot trial examining whether giving intravenous iron to patients with advanced CKD, who are iron deficient but not yet anaemic, could improve symptoms, physical agility, exercise capacity and heart function
- Led by Professor Sunil Bhandari at Hull and East Yorkshire Hospitals NHS Trust
- 54 patients across three UK renal units (Hull, Salford and King's College Hospital)
- Funded by Kidney Research UK through an unrestricted grant from Pharmacosmos A/S
- Complete and currently being analysed.
Comparative pilot study
- Comparative pilot study of Cosmofer vs venofer vs Monofer on oxidative stress and endothelial function
- Led by Professor Sunil Bhandari
- 40 patients
- Completed and analysis pending.
Ongoing projects:
Iron and Muscle - a three year study assessing the impact of IV iron therapy on exercise and physical capacity in patients with chronic kidney disease (CKD) who are not yet on dialysis or anaemic, but who are deficient in iron. Commenced Spring 2019. 70 patients across seven renal units. Led by Drs Sharlene Greenwood, Kate Bramham and Obi Okonko, at King's College Hospital. The research team at Leicester, led by Professor Alice Smith, have and will continue to play a vital role in the development and implementation of this important study. Funding - Kidney Research UK supported through an unrestricted grant from Vifor Fresenius Medical Care Renal Pharma. Find out more.
A retrospective cohort study on the interaction between achieved haemoglobin and EPO dose in HD patients on hard outcomes obtained via the UK Renal Registry. Led by Kate Birnie. Funding - Medical Research Council (MRC).
Pilot study investigating a computerised algorithm to determine the optimum balance between IV iron and EPO in haemodialysis patients. Led by Kings College Hospital. Funding - Vifor Fresenius Medical Care Renal Pharma.
Got a question? Get in touch.
For more information and to find out about getting involved as a patient or researcher, contact: