Laboratory staff examining samples

Research themes

Renal avatar

List of research themes in hexagon shaped boxes: Chronic kidney disease, CKD and cardiovascular disease, CKD and multi-morbidity, renal replacement therapy, specific renal conditions, service improvement research

Chronic kidney disease (CKD)

The department has an extensive history of research in non-dialysis dependent CKD, and integral to this has been curation of the Salford Kidney Study, a data and bio-sample resource that includes > 3850 patients with NDD-CKD and which has recruited patients since 2002. In addition, the team have experience of secondary use of anonymised patient data for epidemiologic studies.

The key areas of research in CKD are:

  • CKD epidemiology, including specific sub-groups of patients such as those with different forms of glomerulonephritis
  • Biomarkers of rapid progression of CKD – proteomic, genomic and RNA microarray studies
  • Development of risk prediction models for key outcomes: delta eGFR, ESKD, CVE and mortality (and study of KFRE)
  • Creation of a pathway for improved diagnosis of patients with ‘unknown CKD’
  • Transition from advanced CKD to renal replacement therapy (dialysis or transplantation)

Researchers: Prof Phil Kalra, Dr Rosie Donne, Prof Smeeta Sinha, Prof Darren Green, Dr Raj Chinnadurai, Dr Ibrahim Ali

CKD and cardiovascular disease

The department is well known for its research into cardiovascular disease in CKD, through cardiovascular sub-studies of the Salford Kidney Study, KRUK grant funded epidemiological analyses of sudden death risk in haemodialysis patients, and as the leading site for cardiac MRI and echo sub-studies of the ASTRAL (renovascular) trial. More recently, the Department has developed an extensive portfolio of research into the management of heart failure in patients with CKD.

Key areas of cardiovascular research include:

  • A study of longitudinal cardiac imaging and associated cardiovascular biomarkers in >220 haemodialysis patients. Data captured included annual assessment of full BSE protocol echo with additional RT3DE, >500hx xml ECG, stored serum, plasma, whole blood and high granularity cardiovascular outcome data.
  • Innovative models of integrated renal and heart failure care through research driven multidisciplinary clinics for the North Sector of Greater Manchester
  • “Big data” analyses of acute care flow models for predicting AKI, readmission risk and critical deterioration in acute cardiovascular presentations and other high risk patient groups. Admissions dataset of >400,000 acute hospitalisation episodes from 2014 – 2022.

Researchers: Prof Darren Green, Prof Phil Kalra, Dr Dimitrios Poulikakos, Dr David New

CKD and multi-morbidity

Chronic kidney disease is commonly associated with multiple conditions such as diabetes mellitus, hypertension, and coronary artery diseases. There is an unmet need to investigate the impact of multi-morbidity in patients with chronic kidney disease as they are usually excluded from major clinical trials. In our department, we are utilising large data sets from the Salford Kidney Study cohort (non-dialysis CKD patients), Salford Integrated Records (Salford Clinical Commissioning Group), and data from our Salford multimorbidity clinic (Metabolic Renal Cardiac (MRC) clinic).

Key areas of research in CKD and multimorbidity are:

  • The impact of obesity on cardiac and renal outcomes in various levels of co-morbidity.
  • The effect of deprivation index on outcomes in patients with CKD and multimorbidity.
  • Redesigning services for patients with CKD by utilising digital monitoring tools at population level as well as providing specialist service for people with multiple long-term conditions in the MRC clinic.

Researchers: Prof Phil Kalra, Prof Darren Green, Dr James Ritchie, Prof Smeeta Sinha, Dr Helen Alderson

Renal replacement therapy (dialysis and transplant)

The department has an excellent portfolio of research involving patients receiving renal replacement therapy (dialysis and transplant) over the years. We have been part of some of the landmark clinical trials including the PIVOTAL trial (comparing high-dose vs low-dose iron regimens on outcomes) and the PEDAL trial (evaluating the effectiveness of an exercise programme on quality of life).

Our strengths include the following well-structured databases that have contributed to several research publications and a potential resource for future opportunities:

  • Salford Kidney Study (SKS- HD): This is a cohort of 220 haemodialysis patients with demographic, cardiovascular (echocardiogram) data, follow-up cardiovascular and mortality outcomes of three years. Serum and DNA samples collected from the recruited patients are stored for any future research.
  • SKS-COVID-19: This includes a cohort of 270 (235 negative + 35 COVID-19 positive) haemodialysis patients with demographic data, COVID-19 antibody status and stored serum samples.
  • SKS-PD: The SKS has also recruited patients on peritoneal dialysis with added data on cognitive assessment.
  • Salford transplant database includes data from > 960 kidney transplant recipients transplanted between 2000-2021. This database incorporates detailed demographics, transplant related details, cardiovascular events, and viral infections.
  • Cognition, mental health and frailty are core themes for ongoing research in our dialysis population.

Researchers: Dr Rachel Middleton, Dr Dimitrios Poulikakos, Dr Raj Chinnadurai, Dr David Lewis, Prof Phil Kalra, Dr Helen Alderson, Dr James Tollitt, Prof Helen Hurst

Specific renal conditions

There has been a focus on researching several specific renal conditions over recent years. These have either utilised large cohort studies with data going back many years, making extensive use of our comprehensive Electronic Patient Record (ESR); or as in the case with calciphylaxis, our research has contributed to international clinical trials.

Key areas of specific renal conditions research include:

  • Glomerulonephritis including IgA nephropathy, membranous nephropathy, focal segmental glomerular sclerosis (FSGS) and ANCA-associated vasculitis. We have developed comprehensive databases of these rare conditions to determine their natural history and key outcomes.
  • Fabry disease: This rare genetic condition commonly affects the heart, kidneys and other organ systems. We have developed one of the largest national cohorts of patients with this condition in collaboration with our metabolic medicine department.
  • Calciphylaxis: a rare condition usually seen in patients with end-stage kidney disease that classically has poor outcomes. A matched cohort from the Salford Kidney Study dialysis cohort and UK Calciphylaxis study has been analysed.
  • Renovascular disease (RVD): a database of > 1000 patients with atherosclerotic disease (ARVD) accumulated over more than 30 years has contributed to countless studies from the department concentrating on risk and epidemiology. A collection of the rare Fibromuscular disease (FMD) is ongoing.
  • Haematological disorders: > 75 patients with myeloma, plasma cell dyscrasia or amyloidosis

Researchers: Prof Philip Kalra, Prof Smeeta Sinha, Prof Darren Green, Dr Raj Chinnadurai, Dr Francesco Rainone, Dr Edmond O’Riordan, Dr Aine de Bhailis, Dr Nina Brown

Service improvement research

The department’s service improvement research aims at improving the quality of health services that are directly providing benefits for patient care. This field of research, which has a strong translational component, uses data intelligence from existing routinely collected data to understand existing gaps and challenges in care and supports and evaluates innovative transformation of our services with the assistance of digital intelligence tools.

Key areas

  • Digitally enabled transformation for early detection and management of CKD in the community and for integration with secondary care.
  • Remote surveillance of vascular access in haemodialysis patients
  • Multiple long-term condition services

Researchers: Dr Dimitris PoulikakosDr James Ritchie, Dr Janet Hegarty, Dr Thilini Abeygunaratne, Prof Ibi Erekosima, Prof Helen Hurst, Dr Rosie Donne, Dr Ibrahim Ali

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