About our research
Renal transplantation is the largest of the solid organ transplant programmes with around 3,000 performed annually in the UK. It is often the best treatment for patients with end stage kidney disease, with survival, quality of life and health economic advantages.
As one of the biggest kidney transplant centres in the UK, much of our research energy is focused on transplantation but we are also very active in other areas of kidney research.
We have a fast growing clinical research programme in keeping with our aim to be at the forefront of treatment for kidney disease and transplantation.
The Biomedical Research Centre patient and public involvement advisory group (PPIAG) develops methods of engagement with the local population. They also provide a patient/public perspective on a variety of research practices and approaches.
Current research studies
Look through the studies below to find out more about each one. Our research team will only recruit participants currently registered with us. If you are a patient elsewhere, consult with your doctor, who may be able to refer you to us.
Biomedical informatics for post-transplant
This study is part of the National Institute for Health Research Health Informatics Collaborative (NIHR HIC). This brings together five of the country's leading NHS Trusts with large NIHR biomedical research centres to make NHS clinical data more available to researchers, industry and the NHS community. One of the five scientific themes is kidney transplantation.
An important problem for kidney grafts is the reappearance of the same disease that caused the need for transplant. Recurrent disease is seen in 4–20% of patients that receive a kidney transplant.
In this study we will:
- identify the frequency of recurrent disease and the epidemiological and clinical factors that are associated with recurrence
- use previously collected laboratory data (including genetic data) to assess the risk of recurrence and the severity of it.
The four centres involved in the transplant theme are some of the largest kidney transplant centres in the country, performing around one third of all kidney transplants in the UK.
We're focusing on recurrent disease in order to optimise the benefits of the present collaboration. The number of patients that we can incorporate will allow us to answer questions that could not have been answered in a single centre approach.
For more information, please visit the NIHR website.
The National Institute for Health Research (NIHR) BioResource has been establishing a panel of thousands of volunteers with and without health problems from all over the country. This has been expanded to include rare diseases.
All volunteers are asked to donate a small blood sample (or sometimes saliva sample) and give consent to be contacted and invited to participate in future medical research studies, based on analysis of their samples and information they have supplied.
This contact and invitation may or may not be for studies related to the rare disease for which the volunteer has joined the NIHRBR-RD.
Participation in any of these future studies is entirely voluntary: you decide at the time.
By recruiting thousands of volunteers with a rare disease in their family, the NIHRBR-RD aims to help with:
- the development of more affordable DNA-based tests for the diagnosis of rare diseases where the gene is known
- the discovery of genes causing rare diseases; currently only half of the genes for rare diseases are known.
Anonymised information and samples from the BioResource can be made available to researchers and doctors working in biomedical and healthcare research in both the public and private sector, in the UK and overseas.
Dialysis outcomes and practice patterns study (DOPPS)
The DOPPS is a prospective cohort study of haemodialysis practices. It is based on the collection of observational longitudinal data for a random sample of patients from dialysis facilities, in a representative and random sample of units in more than 20 countries.
The samples are designed to provide a reliable picture of practices and outcomes in each facility, and in each geographic area. In view of differences in patient outcomes of mortality and morbidity by country and by dialysis unit, the study helps researchers to:
- describe differences in practice patterns that correlate with differences in outcomes
- understand the factors associated with patient outcomes which will lead to improved patient care and lower mortality and morbidity.
For more information, please visit the DOPPS website.
We will approach eligible patients in specific patient centres to take part in this study.
This trial aims to see whether there is any difference between high-volume haemodiafiltration and high-flux haemodialysis for longer-term survival and hospitalisation from heart disease or infections in people with kidney failure.
The effects on quality of life, admission to hospital, symptoms, infection rates and costs will also be examined.
Iron and muscle study
This study aims to explore the effect of iron on the muscles in the body and how this impacts physical function, levels of fatigue, and the ability to exercise, in non-dialysis patients with chronic kidney disease (CKD) who have low iron levels.
It is not currently standard practice to give injections of intravenous iron to patients who have low levels of iron but are not anaemic.
And it is not known whether iron, with the addition of exercise training, will alter the muscles in the body and the capacity for exercise and improved physical function.
This study aims to generate information that will help kidney doctors to decide whether to prescribe intravenous iron to benefit patients in the future.
National registry of rare kidney diseases (RaDaR)
The national registry of rare kidney diseases (RaDaR) is a Renal Association initiative designed to pull together information from patients with certain rare kidney diseases. This will give a much better understanding of how these illnesses affect people. It will also speed up research.
Over 8,000 patients have been recruited so far from 72 renal units. RaDaR draws information from PatientView, an online system which records renal patient’s results, medications and clinic letters. Recruited patients are provided with a secure log-in to Patient View to access and check their own information online.
Patient benefits of joining RaDaR:
- access to your clinical data online via PatientView
- ability to be contacted about potential research studies or patient information events
- contribute to the increase in knowledge about your condition.
For more information, please visit the Rare Renal website.
We will approach patients to take part in selected outpatient clinics.
Prepare for kidney care
This study looks at the experience of patients and their family members, friends and carers when undergoing preparation for kidney dialysis or preparation for responsive management as part of the 'prepare for kidney care' clinical study.
We are undertaking this study because it is important to know how acceptable these different treatment approaches are to patients and their families and what impact they have on people’s day-to-day lives.
We are also interested in finding out about your experience of the study more generally to help us improve it and future similar studies. One way to help us build an in-depth understanding of these topics is to speak to patients and their family membersm friends and carers and listen to the clinical discussions you have with doctors and nurses about the study.
Atypical Haemolytic Uraemic Syndrome (aHUS) is a rare disease.
When aHUS occurs the cells that line the blood vessels are damaged and are no longer able to stop blood from clotting.
Blood clots form in small vessels, particularly in the kidney, leading to problems with kidney function. Most cases are due to abnormalities in a part of the immune system called the complement system.
These abnormalities lead to excessive activation of the complement system, which is responsible for the cell damage and blood clots.
Current standard treatment for aHUS involves a long-term intravenous injection of a drug called eculizumab every two weeks. Eculizumab blocks the body’s complement system and its ability to damage its own vulnerable cells.
Research has shown that eculizumab is effective in the treatment of aHUS, but the recommendation that eculizumab treatment should be lifelong is not based on strong evidence and may not be necessary for many patients.
This study hopes to provide evidence for an alternative strategy for treatment of aHUS based on monitoring and treatment re introduction rather than continuous eculizumab treatment.
Survival improvement with cholecalciferol in
patients on dialysis (SIMPLIFIED)
Vitamin D deficiency is common in kidney failure patients, and is linked with death from cardiovascular disease, infections and cancer.
Almost all dialysis patients receive pre-activated vitamin D, since it was thought that only the kidneys can activate vitamin D. However, this approach increases blood calcium concentrations which may be harmful and even make vitamin D deficiency worse.
International treatment guidelines therefore now recommend that kidney patients receive inactive vitamin D (known as cholecalciferol), since we now know that every organ activates its own vitamin D as required, even in patients with kidney failure. However this is not currently used in the NHS, as trials have not yet shown whether this actually improves survival in patients.
We will test whether supplementation with cholecalciferol increases survival in UK dialysis patients.
- We will randomly assign adult UK dialysis patients to high dose cholecalciferol or standard care. Instead of seeing patients for extra study visits, we will use existing data sources such as the UK Renal Registry (UKRR), Hospital Episode Statistics (HES) and death records to find out what happens to patients in the study. This makes a very large study possible for a much lower cost than would otherwise be the case.
- We will determine the number of deaths over time in the two groups, to establish whether cholecalciferol improves survival. Whether patients are alive or dead at the end of the study will be determined from the national deaths register, and the date of death identified.
- We will also measure any differences in survival with no cardiovascular events, infections and cancers, the three leading causes of death in those on dialysis.
- We will use questionnaires to compare the quality of life of those in the two groups.
- We will measure whether cholecalciferol use is cost-effective from the point of view of the NHS.
For more information, please visit the University of Cambridge primary care website.
We will be approaching eligible patients to take part in this study.
Read about ongoing studies. Please note we are no longer recruiting volunteers for these trials. Links to any overall study findings will be published here as soon as they are made available.
Ex-vivo normothermic perfusion in DCD kidney transplantation
To make more kidneys available for transplantation, it is necessary to use organs from less optimal donors. These include kidneys that are retrieved after the heart has stopped, known as donation after circulatory death (DCD) donors.
DCD donor kidneys suffer a period of damage that cause a high percentage of them to not function immediately after transplantation. This doesn’t appear to reduce the long-term survival of the kidney, but it can lead to prolonged hospital stays, additional requirement for dialysis therapy and complications shortly after transplantation.
Under normal circumstances a kidney is preserved by flushing and cooling with preservation solution, and is then stored on ice until ready for transplantation. This conditioning can increase the risk of early graft dysfunction, particularly in DCD donor kidneys.
We have developed a new technique of kidney preservation that involves warming the kidney with a blood-based solution for a short period just prior to transplantation. This is called ex-vivo normothermic perfusion (EVNP).
Restoring circulation and providing the kidney with oxygen in a protective environment can improve the condition of the kidney, enabling it to function better after transplantation.
Approximately 400 patients who are waiting for a kidney transplant have been recruited into the study. Only kidneys from DCD donors have beeb included in the trial. They have been randomly allocated to one of two groups: the kidney will either undergo the standard cold storage or EVNP.
Three centres in the UK are involved in the study (Cambridge, Guy's and St Thomas' and Newcastle).
Black people with HIV infection are at increased risk of kidney disease, with 1-2 per cent developing kidney failure requiring dialysis. The reasons for this are not well understood.
The purpose of the GEN-AFRICA study is to examine the risk factors for severe kidney disease, especially the contribution of a person’s genetic makeup, in people with HIV.
To do this, we are working with doctors and scientists at King’s College Hospital, University College London, Imperial College London, and the National Institute of Health (USA) to improve our understanding of HIV infection and its effects on the kidney.
This study compared a widely used plastic graft (ePTFE graft) with a new experimental graft developed by Humacyte called the human acellular vessel (HAV).
The HAV is a 6mm diameter tissue-engineered tube that is surgically implanted in the forearm or upper arm. It can be used for haemodialysis access in patients with end-stage renal disease.
The HAV is grown from aortic vascular smooth muscle cells (special cells that partially make up normal blood vessels) obtained from an organ donor.
As the cells grow, they produce proteins, such as collagen, which is a normal component of human blood vessels. When the HAV is fully formed, the cells are removed so the HAV itself does not contain any living cells.
Early studies suggest that patients’ own cells may move into the HAV so that it becomes more like a natural blood vessel. If that happens the HAV may more closely act like a human blood vessel and possibly reduce complications such as clots and infections which, in turn, may mean that the HAV will continue to work for a longer period of time compared with an ePTFE graft.
Study subjects were randomised to receive either a HAV or a commercially available ePTFE graft and will be followed up for up to five years post-implantation at routine study visits.
Treatment of kidney disease accounts for a significant proportion of NHS spending. Although transplantation is the best treatment for kidney failure, most transplants do not survive for the recipient's natural lifespan, but instead fail after 10-12 years.
Damage by the immune system, called 'chronic rejection' accounts for 50% of failing transplants. It is now possible to identify patients at risk by screening for 'HLA antibodies' in the blood.
This study tested a screening and treatment protocol for antibodies in a randomised controlled trial. Those with antibodies were randomised into biomarker-led care (BLC) or standard care (SC) groups.
In BLC groups, test results were revealed. Recruits had their anti-rejection drugs changed to a regime of prednisone, tacrolimus and MMF, each already licensed for use in transplant recipients. We have evidence that this regime is effective at preventing graft dysfunction and expect this to feed through to improvements in survival.
Testing will continue every eight months. The primary outcome is kidney failure rates within three years of randomisation in HLA antibody recruits, predicted to be approximately 20% in the SC groups but less than 10% in the BLC groups.
Secondary outcomes include:
- rates of deterioration
- incidences of infection
- cancers and diabetes
- an analysis of the role of non-adherence with medication
- a scientific study to identify new biomarkers associated with outcomes.
A cost analysis will confirm whether the screening programme and treatment protocol can save money by keeping kidney transplants functioning for longer.
For more information, please visit the international standard randomised controlled trials number (ISRCTN) registry website.
Haemodialysis is a treatment used when kidneys are no longer able to function properly.
Doctors need access to the patient’s blood vessels for the treatment. The best method is with an arteriovenous fistula (AVF), made by surgically joining an artery and a vein.
The fistulae commonly develop narrowed segments which can lead to hospital admission for fistuloplasty. The narrowed segments are treated in the x-ray department with a special balloon which is inflated to stretch the narrowed segment. However, the narrowing can return and around 60% of patients need a repeat procedure during the first year.
There is evidence that using a balloon coated with certain drugs (such as paclitaxel) can stop the biological processes that cause narrowing after balloon treatment. In this project we have used drug-coated balloons in AVF used for haemodialysis.
- The research included haemodialysis patients with a narrowed fistula. Patients received the drug coated balloon treatment after a narrowed fistula was dilated with a normal balloon.
- We compared the outcomes in patients that were treated with the paclitaxel coated balloon and the control group who were treated with an uncoated balloon. The main assessment of outcome will be the time taken for the narrowing to recur, preventing the fistula from being used or necessitating another procedure.
- We collected blood samples for future studies that may help to develop tests that predict the response to treatment and suggest the best therapeutic option for a specific patient.
This study is no longer recruiting patients and results will be available in due course.
Shared haemodialysis (SHAREHD)
SHAREHD is a Health Foundation-funded programme that aims to support patients receiving haemodialysis treatment in hospital so that they can be more independent and confident in participating in aspects of their own haemodialysis care.
There is considerable evidence that greater patient engagement and helping people to manage their own health is associated with better outcomes across a range of medical conditions.
Across England, 12 dialysis centres plan to extend the learning from local initiatives and the Yorkshire and Humber Shared Haemodialysis Care programme to build a body of evidence that can support a nationwide change towards better patient choice.
This study is based on the hypothesis that people who undertake haemodialysis at dialysis centres benefit from the opportunity to take a greater role in their own care.
The study will collect information using questionnaires at regular intervals. These will measure factors including:
- the number of dialysis related tasks that patients perform for themselves
- patient activation
- quality of life
- symptom scores
- cognitive function
- health literacy perception around self-needling
- health economic indicators.
For more information, please visit the SHAREHD website.
Some fistulas fail within a year despite successful surgery. The reason why this happens and how we can prevent it are largely unknown.
The aim of this study is to see how useful Doppler ultrasound is at checking the growth of your fistula after it has been created.
In the future, this may enable us to identify and correct problems with fistulas at an early stage.
Surveying people experiencing young adult kidney failure (SPEAK)
The surveying people experiencing young adult kidney failure (SPEAK) study is the first national survey of young adults on kidney replacement therapies. It is to investigate the impact of permanent kidney failure of the lives of young people in the UK.
This study is needed because the outcomes for these young adults are not well known. Young adulthood is an important time. It involves becoming independent in life, completing education, establishing careers and families and taking responsibility for your own healthcare.
We know that being aged 17-23 dramatically increases the risk of losing a transplant. Even though most kidney patients move to adult services at 18, brain growth and development continues until your mid-20s.
Healthcare services for young adult kidney patients vary across the UK. The SPEAK study is needed to tell us how we need to change services to completely address all the needs of a young adult kidney patient. It will also give future patients a much clearer idea about the different ways in which having kidney failure affects your life.
For more information, please visit the UK Renal Registry website.
Understanding barriers and outcomes of unspecified kidney donation
The waiting list for a kidney transplant in the UK includes over 7,000 people and is increasing.
The best available treatment for kidney failure is a kidney transplant from a living donor. The donor is usually a friend or relative.
In 2006 donation to a stranger (known as unspecified altruistic donation) was introduced in the UK. Since then the number of unspecified altruistic donations has increased year on year. In 2012, 60 transplants used kidneys from unspecified altruistic donors, accounting for around 1 in 20 of all kidney transplants from living donors.
These donations provide a high quality kidney to patients on the national transplant list and to someone in the paired/pooled scheme who would not otherwise obtain a transplant due to incompatibility with their donor.
The number of unspecified altruistic donations varies widely across transplant centres. In 2012, three (out of a total of 23) centres accounted for 45% of all unspecified altruistic donations.
There is considerable variation between centres in the proportion of people making contact who then actually proceed to donate a kidney. Reasons for this variation are unknown but may include resource issues, concerns regarding an individual's motivations, or that the individual may develop physical or psychological issues after donation.
The aim of this project is to perform a comprehensive assessment of the unspecified altruistic donor programme in the UK:
- to explore variation between centres
- to identify barriers and facilitators to donation for those that have expressed a willingness to do so.
These questions will be addressed by interviews and questionnaires sent to potential or actual unspecified donors in the UK.
For more information, please visit the international standard randomised controlled trials number (ISRCTN) registry website.