Research Opportunities - Queensland

Queensland

• Princess Alexandra Hospital
  
• Royal Brisbane Hospital

Princess Alexandra Hospital

Introduction

The Princess Alexandra Hospital Renal Unit is one of the few medical research groups in Australia to have received NHMRC Centre of Clinical Research Excellence status and funding. As a further endorsement by NHMRC, the Princess Alexandra Hospital Cardiovascular, Metabolic and Kidney Disease Group CCRE funding has now been extended for an additional 5 years (until the end of 2012). In 2004, our unit also received the endorsement of, and funding by, Kidney Health Australia, the Australian and New Zealand Society of Nephrology and the National Health and Medical Research Council to act as the central co-ordinating centre for the Australasian Kidney Trials (AKT) Network (a clinical trials network set up to conceive, co-ordinate and run multicentre clinical research trials in nephrology). The University of Queensland Centre for Kidney Disease Research (CKDR) is also based at the PAH Nephrology Department and conducts a large number of research activities at both the clinical and basic science levels (including renal transplantation, peritoneal dialysis, haemodialysis and general nephrology). Registry data analyses are also possible through our links with the Queensland Renal Collaborative for Healthcare Improvement database, the Queensland Live Donor Registry and the ANZDATA Registry. There are over 80 projects currently underway in the Department, examining such diverse areas as infection control, anaemia management, cardiac risk factor intervention, optimal timing of dialysis commencement, metabolic syndrome and kidney disease, enhancement of dialysis adequacy, novel prevention strategies for acute renal failure, preservation of kidney function, monitoring healthcare delivery quality, optimization of the safety of anti-rejection drug protocols in transplantation, immunosuppressive drug pharmacokinetic studies, and skin cancer and lymphoma prevention in kidney transplant patients. Over the last 5 years, several of our research trials have earned national research awards (including the Australian Kidney Foundation Clinical Research Award and the Australian and New Zealand Society of Nephrology TJ Neale Award for “Outstanding Contributions to Nephrologic Science”) and prompted changes in clinical practice guidelines. Our unit also offers extensive training in basic and clinical research, trial design, epidemiology and biostatistics.

A fully-funded ($110,000 p.a.) Research Fellow position, as well as a number of Practitioner Fellowships and Postgraduate Research Scholarships are available to advanced trainees and nephrologists (see below). In addition, our hospital has 5 advanced nephrology training positions.

Basic Science Research

• Mechanisms and therapeutic manipulation of renal fibrogensis, carcinogenesis, acute renal failure and progression of chronic renal failure.
• Erythropoeitin and darbepoietin alpha as novel renoprotective agents in in vitro and in vivo models of acute renal failure.
• Erythropoeitin as a novel renoprotective agent in in vitro and in vivo models of acute renal failure.
• Protective effect of Angelica sinensis on renal vascular endothelial cell damage induced by oxidative stress.
• Effects of medicinal plant extracts on renal cells in vitro: Potential therapeutic and toxic effects.
• Expression and phosphorylation of P66SHC in young and old rats subjected to oxidative stress.
• Molecular pathways in age-associated chronic renal pathologies.
• The role of protease activated receptors (PARs) in progressive renal scarring, inflammation and failure.
• Strategies for modifying acute renal ischemic injury: increasing the mobilisation and maturation of endothelial progenitor cells.
• Apoptosis of tubulointerstitial chronic inflammatory cells in progressive renal fibrosis after cancer therapies.
• Therapeutic value of orally administered silibinin in renal cell carcinoma: manipulation of IGFBP-3 levels.
• The therapeutic application of adult mesenchymal stem cells in renal regeneration.

Clinical Research

(a) Peritoneal Dialysis

• The balANZ trial - A multicentre randomised controlled trial of BalanceÒ in Australian and New Zealand PD patients
• Predictors of peritonitis in the Australian and New Zealand PD patient populations.
• The effect of dialysis modality on decline of residual renal function.
• The IMPENDIA trial.
• Independent predictors of time to first peritonitis episode and peritonitis rate (and time to permanent catheter loss due to peritonitis) in the Australian and New Zealand PD patient populations.
• Outcomes following catheter removal for peritonitis (including outcomes upon recommencement of PD).
• Predictors of hospitalisation, catheter removal, HD transfer or death in PD patients experiencing peritonitis in the Australian and New Zealand PD patient populations.
• Outcomes of Staphylococcus aureus peritonitis in the Australian and New Zealand PD patient populations.
• Outcomes of Pseudomonas aeruginosa peritonitis in the Australian and New Zealand PD patient populations.
• Outcomes of fungal peritonitis in the Australian and New Zealand PD patient populations.
• The impact of APD versus CAPD on peritonitis in the Australian and New Zealand PD patient populations.
• Predictors of recovery (and time to recovery) of dialysis-independent renal function in scleroderma renal crisis patients commencing PD or HD in Australia and New Zealand
• A systematic review of the effects of biocompatible peritoneal dialysis solutions on patient outcomes.
• The effect of dialysis modality on infectious mortality in the Australian and New Zealand PD patient populations.
• The effect of dialysis modality on the prevalence and incidence of hepatitis infections in the Asia-Pacific region.
• Microbiology and outcomes of peritonitis in Australian peritoneal dialysis patients.
• A randomised, controlled trial of exit site application of MedihoneyTM Wound Gel for the prevention of catheter-associated infections in peritoneal dialysis patients (HONEYPOT trial).
• A randomised controlled trial of oral HEMe iron polypeptide Against Treatment with Oral Controlled Release Iron Tablets for the correction of anaemia in peritoneal dialysis patients (HEMATOCRIT trial).
• Effect of PD modality on clinical outcomes in Australia and New Zealand.
• The impact of peritoneal small solute transport on peritoneal dialysis patient outcomes in Australia and New Zealand.
• The impact of peritoneal transport status on subsequent haemodialysis patient outcomes in Australia and New Zealand.
• Predictors of residual renal function decline in Australian and New Zealand peritoneal dialysis patients.
• A retrospective observational cohort study assessing the clinical outcomes of amputation in dialysis patients.

(b) Haemodialysis

• Nocturnal Home Haemodialysis performed alternate nightly:  assessment of multiple outcomes.
• Temporary vascular access in haemodialysis:  reasons for process failure in incident dialysis patients.
• Ethanol lock therapy for the prevention of tunnelled catheter-related bacteraemia in haemodialysis patients.
• A randomised, placebo-controlled trial of oxpentifylline on haemoglobin levels in patients with erythropoietin-resistant anaemia.
• The impact of nocturnal home haemodialysis on patient outcomes.
• Effects of Alternate Night Nocturnal Hemodialysis on Oxidative Stress and Antioxidant Enzymes.
• Nutritional status and appetite regulation in alternate night nocturnal haemodialysis.
• Bone mineral metabolism and histology in alternate nightly nocturnal haemodialysis.
• Prognostic indices in post-transplantation lymphoproliferative disorders (PTLDs) after renal transplantation.
• Safety of immunosuppression cessation during chemotherapy for Post-Transplantation Lymphoproliferative Disorders (PTLD) in Renal Transplant Patients.
• Contemporaneous outcomes of bacteraemias in haemodialysis patients.
• A prospective trial of intradermal hepatitis B vaccination in dialysis patients who have failed to seroconvert following standard subcutaneous vaccination.
• A pure red cell aplasia surveillance program in haemodialysis patients receiving erythropoietin.
• A randomized, placebo-controlled study to assess the effects of Cholesterol-lowering therapy with a combination of simvastatin and Ezetimebe on the Risk of Major Cardiovascular Complication Among Individuals with Chronic Kidney disease (SHARP trial).
• The initiating dialysis early and late (IDEAL) study.
• Quality of life and alternate nightly home haemodialysis.

(c) Transplantation

• Pharmacokinetic and pharmacodynamic investigation of free mycophenolic acid and its glucuronide metabolite in renal transplant recipients.
• A formula for the prediction of renal allograft function following renal transplantation.
• Outcomes associated with live donor renal transplantation in Queensland.
• Intravenous versus oral iron supplementation for the correction of post-transplant anaemia.
• A randomised controlled trial of sirolimus on skin cancer incidence in renal transplant recipients.
• The role of tumourectomised kidneys as a potential source of allografts for renal transplantation.
• Polycystic kidneys as a potential source of allografts for renal transplantation.
• Post Transplant Antibody Study: Does post-transplant monitoring of anti-HLA antibodies in recipients of solid organ allografts predict rejection?
• Pre-transplant pharmacokinetics as a predictor of dose requirement post renal transplantation.  A multicentre, open, prospective, 2-arm, phaseIV study of Prograf (tacrolimus) in renal transplant patients.
• Defining the metabolic syndrome in renal transplantation.
• Predictors of graft function in recipients of kidneys from live donors.
• Adiponectin in renal transplant recipients.
• Impact of the metabolic syndrome on renal transplant outcomes.
• Impact of Aggressive Intervention in RTR with impaired glucose tolerance on insulin resistance and atheroma burden.
• Assessment of exercise and dietary factors associated with abnormal glucose tolerance in renal transplant recipients.
• Assessment of Everolimus in addition to Calcineurin Inhibitors Reduction in Maintenance Renal Transplant Recipients (ASCERTAIN).
• Valcyte in CMV-disease treatment of solid organ recipients. (VICTOR)
• A Randomized, Open-Label Study to Compare the Rate of New Non-Melanoma Skin Cancer in Maintenance Renal Allograft Recipients Converted to a Sirolimus-based Regimen versus Continuation of a Calcineurin Inhibitor-based Regimen.
• Identification of cardiovascular risk markers in live donors post nephrectomy: longitudinal follow-up.  Focus on endothelial dysfunction, inflammation and oxidative stress.

(d) General Nephrology

• A multicentre, randomized controlled trial of the effect of cholesterol reduction on cardiovascular end-points in patients with chronic renal failure.
• Initiation of Dialysis Early and Late (IDEAL) Trial.
• The impact of eGFR on referral patterns.
• The role of novel of novel biomarkers of cardiovascular disease in chronic kidney disease: focus on adiponectin and leptin.
• Opinions on the effect, content and structure of guidelines on CKD: Results of a national survey of nephrologists.
• Oxidative stress and cardiovascular disease in chronic kidney disease.
• The use of Human Neutrophil Gelatinase-Associated Lipocalin as a predictor of contrast induced nephropathy in critical illness.
• The use of Human Neutrophil Gelatinase-Associated Lipocalin as a predictor of acute kidney injury in renal transplantation.
• Irbesartan Versus Placebo in Combination with Standard Cardiovascular Protection ACE-I Therapy with Ramapril for the treatment of Albuminuria in Subjects at Elevated Cardiovascular Risk.
• The Effect of Sulodexide in Patients with Type 2 Diabetes and Microalbuminuria.
• The Effect of Sulodexide in Overt Type 2 Diabetic Nephropathy.

Renal Research Fellow

The Princess Alexandra Hospital has a Renal Research Fellow Position available for advanced trainees to pursue clinical renal research.

Practitioner Fellowships and Postgraduate Research Scholarships

The Renal Unit forms part of the Princess Alexandra Hospital Cardiovascular and Metabolic Research Group, which has been funded by the NHMRC as a “Centre of Clinical Research Excellence.” A number of Practitioner Fellowships and Postgraduate Research Scholarships are available to advanced trainees and nephrologists.

Practitioner Fellowships and Postgraduate Research Scholarships are also available to advanced trainees or nephrologists who wish to undertake a higher degree in clinical nephrology research through the Australasian Kidney Trials (AKT) Network. These scholarships are funded by the School of Public Health and the University of Queensland.

The Princess Alexandra Hospital also provides a Research Scholarship ($50,000 per annum) to registrars who wish to undertake basic science or clinical research (preferably towards the attainment of a higher degree).

Contact:

Professor David Johnson
Chair of Medicine, Director of Renal Medicine
Ph +61 7 3240 5080
Fax: +61 7 3240 5480
Email: david_johnson@health.qld.gov.au

Updated March 2008

Royal Brisbane Hospital

Clinical Research:

• dyslipidaemia of renal failure: mechanisms and responses to dietary and pharmacological therapies (includes laboratory studies)
• peritoneal dialysis adequacy/technique
• haemodialysis therapeutic management
• erythropoietin

Contact:

Dr David Saltissi
Ph: +61 7 3253 8111
Fax: + 61 7 3253 7148
Email: saltissid@health.qld.gov.au

Basic Research:

Renal Metabolism and Function

• oxygen - and nitrogen - derived free radicals and the nitric oxide-peroxynitrite pathway
• regional blood flow and metabolism
• apoptosis and necrosis
• oxygen delivery, cell pH and pCO2 as markers of renal and GIT ischemia

Clinical Research:

• detection of and recovery from acute renal failure, including tubular enzymuria and the use of invasive PO2/PCO2 monitoring

Contact:

Associate Professor Zoltan Endre
Ph: +61 7 3365 5217
Fax: + 61 7 3365 5581
Email: endre@hippo.herston.uq.edu.au