Kidney Care Appeal

Research in the Community

Kidney Disease in the South Asian Population

In people of South Asian background in the United Kingdom, the prevalence of established kidney failure is approximately three times higher than in the Anglo Saxon population. This disparity is particularly severe in South Asians who develop kidney failure as a consequence of diabetes.

The research staff of the John Walls Renal Unit have been actively involved in the ABLE project (A Better Life Through Education and Empowerment) which was launched in 2001 by Kidney Research UK with the aim of publicising and ultimately reducing the high incidence of established renal failure in ethnic minorities.

Kidney Research UK Logo

More information on this work can be found at the ABLE website (A Better Life Through Education and Empowerment - Kidney Research UK)


Quality Improvement in the Care of People with Chronic Kidney Disease

The early detection of Chronic Kidney Disease (CKD) and application of best practice was identified as a key priority in the Renal National Services Framework and has recently been highlighted as a national health priority as part of the cardiovascular screening program. However, audit data from around the country has typically demonstrated wide variation in the standards of care offered to patients with CKD.

Kidney Research UK Logo

To tackle this problem, the John Walls Renal Unit is a co-investigator with Kidney Research UK and St George's-University of London in a major three-year programme of research to improve the care of all patients with early Chronic Kidney Disease. This is jointly funded by the Health Foundation and Edith Murphy Foundation.

The aim of the project is to develop, implement and evaluate a range of quality improvement interventions in CKD in primary care. There are two parts to the project:

1.  Usual practice is being compared with two quality improvement interventions in a cluster-randomised trial. The interventions are:

a.   The dissemination of evidence based Clinical Practice Guidelines                      

b.   The provision of Audit-based education to primary care teams

The ability of these interventions to affect the progression of CKD in the population over time is being examined and the cost-effectiveness will be evaluated.

At the same time 'process evaluation', (a way of understanding the experiences of practices undertaking the different interventions) will be undertaken.

2. The project has also developed two new interventions, namely:

a. The implementation of a "care bundle" for use in patients with CKD in primary care

b.  A patient empowerment programme

These new interventions were developed by expert groups and are now being piloted in a small number of GP practices.

Further information is available on the Kidney Research UK website.



Helping Kidney Patients to Control Their Own Blood Pressure More Effectively (The CHEERS Study)

A photograph of a patient having their blood pressure taken

High blood pressure is a common problem in patients with chronic kidney disease and has to be controlled carefully because it can lead to further significant damage to the kidneys.

A project known as the Controlling Hypertension: Education and Empowerment Renal Study (CHEERS) has been set up on the John Walls Renal Unit. The aim of this study is to supplement standard clinical care for these patients by giving them a structured educational programme to help them to manage their own blood pressure. The effectiveness of this educational programme is being tested by comparing these patients with a group of patients who have received standard clinical care only.

This study is supported by the Edith Murphy Foundation.


Patient-Centred Research on When to Start Dialysis Therapy

In many patients with failing kidneys, dialysis therapy must eventually be started to assist the failing kidneys in removing toxins from the body. This is a difficult time both for the patients and for the clinicians treating them, and has been the subject of two recent research studies on the John Walls Kidney Unit.

1) Barriers to the Elective Start of Renal Replacement Therapy (The BERRT Study)

It is widely accepted that it is better for kidney patients to start dialysis as part of a carefully planned programme of preparation for the patient, rather than as emergency therapy following an unplanned admission to hospital caused by a sudden worsening of the patient’s condition.

The aim of this recently completed 4 year study was to find out why some patients who had been treated by kidney specialists for many years still required urgent admissions to start dialysis. The study included interviews with patients, doctors and nurses to try to understand the problems involved in the run-up to dialysis. Analysis of these interviews showed that patient education was often poor, acceptance of the need for dialysis varied among patients, and that significant organisational factors needed to be improved. The study also identified the need to individualise the preparation of patients for dialysis and involve them in decisions about care. This information is now being used to help to improve the care pathway for patients with advanced kidney diseases.

This study and planned dialysis fellowships are supported by the Edith Murphy Foundation.

2) Comparison of Patients Who Had a Planned Start to Dialysis with Those Who Had to Start Dialysis as an Emergency Treatment

The purpose of this research is to collect information about how well people feel on dialysis over the first year that they are doing it, and compare those who have received preparation for dialysis, and those who have not.

Information is collected on how much time patients have spent in hospital, how many times they have been treated as an outpatient, and what treatments they have received. They are also asked how much being on dialysis has cost them from loss of earnings, out-of-pocket expenses, and from the cost of any personal care they have needed.

This information is important in helping to decide how much extra effort and resources should be allocated to early identification of people with kidney disease.

Gathering Information on Side-effects of Treating Anaemia in Kidney Patients

A photograph of red blood cells

The production of red blood cells in the human body depends on a hormone called Erythropoietin which is released from the kidneys. Release of this hormone fails when the kidneys become diseased. Consequently patients with advanced kidney disease do not produce enough red blood cells and become anaemic. One of the great break-throughs in the treatment of kidney patients over the past 20 years has been the availability of manufactured Erythropoietin in a form that can be injected into kidney patients to treat their anaemia.

Unfortunately the immune system in some of these patients produces protein molecules called antibodies which bind to the injected Erythropoietin, especially when it is injected under the skin, and this prevents the hormone from being able to stimulate red blood cell production.

The aim of this project is to set up a registry to record how common this problem is in the kidney patient population. Obtaining this information is an important first step in finding a way to minimise or overcome this problem.

UPDATED: 2nd June 2009
This document has been approved by the head of department or section.