The Kidney in Health and Disease
The scale of the problem of renal disease, frequently called the ‘silent killer’ because of its gradual and insidious onset, is shown starkly by the graph below, which shows the number of new patients each year undergoing renal replacement therapy (RRT), either dialysis or renal transplantation, in New Zealand and Australia, over the twenty years from 1987-2007. The number reaching end stage renal disease has shown an exponential increase over this period. Both American and Australian data suggest that as many as one in seven of their respective populations is at risk of developing chronic kidney disease (CKD). In New Zealand, almost half (203 out of 461) of those treated by RRT in 2007 were Maori and Pacific Islanders.
The number of new patients receiving RRT (dialysis or renal transplantation) in New Zealand (red) and Australia (blue) between 1997 and 2007. Data from ANZDATA report 2008.
Recent evidence from epidemiological studies has identified that 1 in 7 Australians have deteriorating kidney function, primarily the result of the increased incidence of diabetes and hypertension, and which has translated into increasing numbers entering dialysis programs,. Large epidemiological studies have further identified increased risk of kidney failure in those with age greater than 50, those who smoke, are persons of indigenous descent or have a familial history of renal disease and/or diabetes.
In New Zealand, similarly, there is an epidemic of type 2 diabetes mellitus which will have major implications for the limited health resources of this country. Obesity and other life style factors are significant contributing influences. Nearly 50% of patients starting dialysis have kidneys damaged by diabetes. Early diagnosis can substantially affect outcomes, and timely intervention can greatly mitigate renal deterioration or extend the functional life of the kidneys, as well as reducing cardiovascular risk, offering material improvement to the quality of life. There is therefore a premium on understanding mechanisms of insult to the kidney, so as to allow earlier detection and better treatment.. In addition, the kidney and heart are integral in terms of haemodyanmics and regulatory functions. The kidney plays a central role in electrolyte balance, volume and blood pressure regulation, all of which are substantially modified in chronic kidney disease (CKD). Thus, patients with CKD have in addition a 3 to 5 fold higher risk of cardiovascular events and diabetic sufferers with CKD have up to a 20 fold higher risk of early death. The close link with cardiovascular risk factors to morbidity and mortality, places renal disease, diabetes and cardiovascular disease into an interactive spectrum of metabolic disease. This is the overall focus of the research undertaken by this group.
The University of Otago Research Theme is the only group of researchers in New Zealand carrying out studies of renal disease from ‘bench to bedside’ – from molecular studies of renal development, through laboratory studies of renal physiology and pathophysiology, to clinical investigations. Innovative medical research thrives on the cross-fertilisation of ideas between scientists and clinicians from diverse backgrounds but common interests. This is an established aspect of our collaborative programme.
The interests of the group lead outwards into the wider academic community, to those patients and volunteers involved in clinical trials, and to the general public.
All members of the group meet up to four times a year for a half or full day of research seminars.
From the director: ROBERT J WALKER, MBChB, MD, FRACP, FASN, FAHA
This is now the 5th year for the University of Otago Renal Research Theme (The Kidney in Health and Disease). I believe this has been a very successful collaboration of many colleagues; both locally, nationally and internationally, with the focus on very broad aspects of kidney function in health and disease. We have continued to hold 3 research forums each year with excellent presentations from our students as well as senior members. In addition we continue to attract high quality visiting speakers including Professor Hans-Peter Marti (Bern, Switzerland), Professor Paul Goodyear (Montreal, Canada), Professor Peter Matheson (Bristol, UK) and Professor Richard Kitching (Melbourne, Austalia). To add further to our diversity Mr Michael Woodhouse (MP, Dunedin) spoke to the group about enhancing donor awareness and how from a political perspective this can be achieved, and his intentions with a private member’s bill.
It is also very pleasing that the University of Otago continues to recognise the impact that this group is having on raising the profile of research into kidney disease and we have received funding as a research theme for another 3 years. This booklet details the success all participants have had this year with publications and research grants.
We will continue to organise regular meetings including a combined meeting with the Renal Scientists group (Australian and New Zealand Society of Nephrology) in August 2012. We welcome any additional input into the research group. Contact either email@example.com or Jennifer.firstname.lastname@example.org