In recognition of World Kidney Day, read about some of the cutting-edge research by CHÉOS Scientists on the treatment of kidney disease.
March 8 is World Kidney Day, an annual global awareness campaign for the range of disorders that impact these vital organs. Several CHÉOS Scientists are on the cutting edge of research on the treatment, management, and prevention of the diseases affecting the kidneys.
In B.C., one in ten people are affected by kidney disease. B.C. is also a leading province in Canada when it comes to kidney donations. Many people are unaware that they have early stage kidney disease as a result of little to no symptoms. If caught early, kidney function can be maintained with diet and lifestyle changes, but if the disease progresses to end-stage, the kidneys lose function and kidney transplant is often the best treatment option. Transplant can provide better quality of life and improved chances of survival compared to dialysis (where a machine is used to help filter a patient’s blood).
CHÉOS Scientists Drs. John Gill, Caren Rose, and Jagbir Gill have investigated a range of aspects related to the kidney transplant process and associated treatment outcomes. Most recently, they co-authored a paper, published in the American Journal of Kidney Diseases, on how the duration of dialysis prior to receiving a living-donor transplant impacts transplant outcomes. In ideal circumstances, individuals in need of a new kidney undergo pre-emptive transplantation (i.e. taking place before dialysis is ever started), but this isn’t always possible due to increasing demands on donor programs and challenges identifying appropriate donors. By looking at the outcomes of a cohort of donor transplant recipients from the U.S., they found that the longer someone was on a dialysis before receiving a transplant, the more likely it was that the transplant would fail. However, they also found that the length of time someone was on dialysis was associated with sociodemographic characteristics like employment status, race, and education as well as variations in transplant centre practices. These findings make it less clear whether the outcomes were the result of exposure to dialysis or differences in pre-existing health and socioeconomic status. Interestingly, a previous study from this group found that, compared to dialysis, deceased-donor kidney transplantation was associated with better survival in patients who had been on dialysis for more than ten years.
Dr. John Gill has also been involved with research that focuses on the social and ethical implications inherent in and unique to live donor kidney transplantation. He collaborated on a study with researchers from Australia investigating the clinician’s role in evaluating kidney donor-recipient relationships. In most cases, clinicians, including nephrologists, surgeons, coordinators, social workers, psychiatrists, and psychologists, assess the donor-recipient relationship prior to donation in order to prevent coercion and assist donors and recipients in navigating changes to interpersonal dynamics. Transplant clinicians from nine countries were interviewed about their attitudes and approaches towards conducting these assessments. The study revealed the balance that clinicians have to maintain between upholding donor autonomy and protecting against vulnerability and premature decisions, as well as the ambiguity and uncertainty faced while making such assessments. One of the challenges clinicians faced was in teasing apart donors’ altruistic intentions from the pressures of societal and family duty.
Other social considerations related to kidney disease and transplant are sex and gender. Previously, Drs. Gill, Gill, and Rose published a study on how the timing of pregnancy after kidney transplantation affects the risk of transplant failure. Although the mechanisms are not clear, a pregnancy too soon after receiving a kidney can result in transplant failure. The study found that the first pregnancy within two years post-transplant is associated with increased risk of failure, providing valuable information to clinicians. Pregnancy-related complications can also be risk factor for kidney disease. This year, World Kidney Day coincides with International Women’s Day and will promote affordable and equitable access to health education, health care, and prevention for kidney diseases for all women and girls with the theme of “Include, Value, Empower.”