Cardio-renal clinical study group
Patients with kidney failure are at a very high risk of heart disease, including heart attacks and stroke, compared to the general population. This risk starts even when kidney function is only slightly abnormal and increases dramatically in patients who need dialysis.
Although some of this risk is explained by well-known risk factors such as high blood pressure and diabetes, this does not account for why patients with kidney disease are at such high risk. Further research to explain this, and develop better treatments is required.
Who we are
We are a national group dedicated to initiating and supporting clinical research in the cardio-renal field.
The group is led by Co-Chairs, Dr Tim Doulton, Consultant Nephrologist at East Kent Hospitals University NHS Foundation Trust Renal Unit, and Dr Matthew Graham-Brown, Honorary Consultant Nephrologist at University Hospitals Leicester.
We are delighted to have new members, and are interested in studies proposed from out with the group.
- Developing a better understanding of and treatments for the cardiovascular complications of chronic kidney disease.
- Addressing why patients with kidney disease are at such a high risk of heart problems (approximately 20 times higher than the general public of the same age).
- Learning more about why patients with primarily cardiovascular disease develop kidney problems and to find better treatments to prevent this or manage this better.
- Undertaking multicentre, collaborative studies and clinical trials in cardio-renal medicine to improve cardiovascular outcomes for patients with kidney disease.
Evidence gaps and challenges:
- Reducing the risk of stroke, myocardial infarction and heart failure in patients with CKD? There are multiple problems at play and no simple answers, although the trials and studies below will address many of these issues.
- Preventing stroke in dialysis patients with atrial fibrillation- this is being addressed with a pan European web survey with the European Renal Association by Charlie Ferro.
- Why do dialysis patients die of sudden cardiac death? Dimitrios Poulikakos is leading a workstream to assess the best investigations to answer this major challenge for us.
- IRON-MAN - a trial looking at the effectiveness of intravenous (IV) iron treatment compared to standard treatment for patients with heart failure and iron deficiency. Led by Dr Paul Kalra (Portsmouth) and funded by the British Heart Foundation.
- Is abnormal bone mineralisation associated with vascular calcification in children and young adults with chronic kidney disease?- Commenced Sept 2017, 90 children and young adults recruited from 9 paediatric and adult centres in the UK. Led by Rukshana Shroff, funded by Kidney Research UK.
- ACHIEVE- a global trial of spironolactone in dialysis patients to improve survival and reduce heart failure. We hope our expertise will attract grant funding to permit UK patients join this trial.
- ECSERT- a pilot study working with the Exercise CSG, looking at home based aerobic and resistance training on cardiometabolic disease in transplant patients. Funded by Kidney Research UK.
Completed studies we helped to deliver:
- ALTERED – examining if allopurinol improves the size and function of the heart in dialysis patients. Led by Professor Allan Struthers (Dundee) and funded by the British Heart Foundation.
- K for Kidneys - examining if vitamin K improves blood vessel calcification in patients with chronic kidney disease. Led by Professor Miles Witham and Paddy Mark (Dundee) and funded by the British Heart Foundation.
- PIVOTAL – using our expertise to help run this clinical trial led by the Anaemia CSG, and assess the ‘end points’.
- 3 H study (HDF, Hearts and Height) looking at the effects of haemodiafiltration (HDF) vs conventional haemodialysis (HD) on growth and cardiovascular markers in children. Led by Rukshana Shroff.
The studies above are helping define the best treatment strategies to prevent cardiovascular problems in patients with chronic kidney disease by using statins or medications used for heart failure or treating high blood pressure. In future studies we will explore different options such as vitamin k therapy or exercise programs to see if they provide additional benefits and help reduce the risk of heart disease risk in patients with kidney failure.
- Ferro, C. J. et al. Lipid management in patients with chronic kidney disease. Nat Rev Nephrol 14, 727-749, (2018).
- Findlay, M. D. et al. Investigating the Relationship between Cerebral Blood Flow and Cognitive Function in Hemodialysis Patients. J Am Soc Nephrol 30, 147-158, (2019).
- Graham-Brown, M. P. et al. Native T1 mapping: inter-study, inter-observer and inter-center reproducibility in hemodialysis patients. J Cardiovasc Magn Reson 19, 21, (2017).
- Haynes, R. et al. Effects of Sacubitril/Valsartan Versus Irbesartan in Patients With Chronic Kidney Disease. Circulation 138, 1505-1514, (2018).
- Macdougall, I. C. et al. Intravenous Iron in Patients Undergoing Maintenance Hemodialysis. N Engl J Med 380, 447-458, (2019).
- Shroff, R. et al. Effects of Hemodiafiltration versus Conventional Hemodialysis in Children with ESKD: The HDF, Heart and Height Study. J Am Soc Nephrol 30, 678-691, (2019).
- Cholesterol Treatment Trialists, C. et al. Impact of renal function on the effects of LDL cholesterol lowering with statin-based regimens: a meta-analysis of individual participant data from 28 randomised trials. Lancet Diabetes Endocrinol 4, 829-839, (16)30156-5 (2016).
For more information and to find out about getting involved as a patient or researcher, contact: