Renal
Overview
The Renal Division at The George Institute focuses on the development and implementation of treatment and prevention strategies for kidney disease. We also work to improve equity in health outcomes and equity in access to health care for patients with kidney disease. Aboriginal renal health is an important focus of the Division's work.
Why Renal?
In Australia, approximately 14% of the adult population have at least one marker of kidney damage, and kidney disease is listed as a cause of death for approximately 1 in 10 Australians. Amongst Indigenous Australians, rates of end-stage kidney disease range from several to more than thirty times the national average. A similar excess burden of kidney disease has been demonstrated among indigenous populations throughout the world, ethnic minorities, and the socioeconomically disadvantaged.
Population ageing and the global diabetes epidemic, along with high rates of hypertension, hypercholesterolemia, obesity, and smoking are leading to significant increases in the number of patients with chronic and end-stage kidney disease globally. The number of persons receiving renal replacement therapy - maintenance dialysis or a kidney transplant - around the world is projected to at least double in the next decade.
The good news is that even small reductions in the rate of progression of chronic kidney disease progression substantially reduce the probability of experiencing end-stage disease, cardiovascular morbidity, or premature death. Treatments of chronic kidney disease in its early stages, addressing cardiovascular risk, and risk factor reduction, have the potential to be highly cost-effective.
New Projects
One of the Renal Division's newest studies is the RENAL study (RCT of Normal vs. Augmented Level of Renal Replacement Therapy). This study, undertaken in collaboration with the Australia and New Zealand Intensive Care Society Clinical Trials Group, is looking at the effect of different doses of dialysis (renal replacement therapy) in patients with severe, acute kidney failure in the intensive care unit (ICU). The study will involve more than 30 ICUs from around Australia and New Zealand and aims to enrol around 1500 patients over a two-year period.
Another new project - The Burden of Chronic Kidney Disease - aims to establish the human and financial burden of chronic kidney disease in Australia and to explore the cost-effectiveness of screening and intervention to prevent progression of disease. With population surveys suggesting that 1 in 7 Australians have at least one marker of kidney damage (protein or blood in the urine or reduced kidney function) the findings from this study will be particularly important.
Ongoing Projects
The SHARP study (Study of Heart and Renal Protection), which began recruiting participants in 2003, aims to determine the effects of cholesterol lowering with a combination of simvastatin and ezetimibe on the risk of major vascular complications in patients with chronic kidney diseases. SHARP is a randomised placebo-controlled trial among 9,000 individuals recruited from more than 200 centres worldwide. The George Institute, in collaboration with the Australia and New Zealand Society of Nephrology, is coordinating and overseeing the recruitment and follow-up of about one-quarter of the study participants from Australia, New Zealand, Malaysia, and Thailand.
IMPAKT (Improving Indigenous Patient Access to Kidney Transplantation) is another of our ongoing studies. IMPAKT comprises five component studies aimed at identifying Indigenous Australians' barriers to accessing renal transplantation, and proposing strategies to reduce disparities in Indigenous Australians' access to renal transplantation.
Future Directions
In collaboration with a network of Chinese nephrologists, we are developing a proposal for a large-scale multi-centre clinical trial in dialysis. We also plan to further develop partnerships with Indigenous researchers, communities, and health services to improve health outcomes for Aboriginal Australians with chronic kidney disease through strategies to reduce systems barriers to necessary care.