Queensland
The Princess Alexandra Hospital Nephrology Department enjoys the best patient survival rates of any dialysis and kidney transplant centre in Australia and New Zealand. The Department is one of the few medical research groups in Australia to receive NHMRC Centre of Clinical Research Excellence status and funding. Since 2005, our unit has 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 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 in Australasia). In 2009, the AKT Network merged with the Princess Alexandra Hospital Renal Research Laboratory (a basic science research facility) to form the University of Queensland Centre for Kidney Disease Research (CKDR). The centre conducts a large range of bench-to-bedside translational 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 Clinical Practice Improvement Centre database, the Queensland Live Donor Registry and the ANZDATA Registry. Our research has earned national research awards (including the Kidney Health Australia Clinical Research Award and the Australian and New Zealand Society of Nephrology TJ Neale Award for “Outstanding Contributions to Nephrological Science”) and prompted numerous changes in clinical practice guidelines. The Department generates over 60 peer-reviewed publications per year. Our unit also offers extensive training in basic and clinical research, trial design, epidemiology and biostatistics.
There are over 80 projects currently underway in the Department, examining such diverse areas as:
a) Multi-centre randomised controlled trials (HONEYPOT, HERO, FAVORED, PEXIVAS, BLOCADE, IMPROVE-CKD, ACTIVE Dialysis, IDEAL, SHARP, CORAL, balANZ)
b) Prevention and treatment of peritoneal dialysis-associated peritonitis
c) Prevention and treatment of haemodialysis catheter-associated bacteraemia
d) ANZDATA Registry peritoneal dialysis research
e) Nocturnal home haemodialysis
f) Anaemia management and iron supplementation
g) Cardiac risk factor intervention
h) Cochrane reviews (peritoneal dialysis, anaemia treatment, erectile dysfunction)
i) Vitamin D research
j) Optimal timing of dialysis commencement
k) Metabolic syndrome and kidney disease
l) Enhancement of dialysis adequacy
m) Preservation of residual kidney function
n) Monitoring healthcare delivery quality
o) Optimization of the safety of anti-rejection drug protocols in kidney transplantation
p) Immunosuppressive drug pharmacokinetic studies
q) Skin cancer and lymphoma prevention in kidney transplant patients
r) BK virus nephropathy
s) Tumourectomised kidney transplants
a) Eythropoietin as a novel cytoprotective agent in acute kidney, brain and heart injury
b) Molecular pathways in age-associated chronic renal pathologies
c) The role of protease activated receptors (PARs) in progressive renal scarring, inflammation and failure using primary human kidney cell culture
d) Therapeutic application of adult mesenchymal stem cells in renal regeneration.
e) Mechanisms and therapeutic manipulation of renal cell carcinoma.
f) Targeting apoptotic pathways for treatment of renal cell carcinoma
g) Mitochondrial dynamics in the senescing kidney
1. Advanced Nephrology Training Positions: The Department has 6 advanced training and 3 basic physician training positions. These are 12 month clinical appointments,which commence in the 2nd or 3rd week of January each year. Online applications (http://www.health.qld.gov.au/medical/rmoinfo.asp) are invited in late June and usually close late July. Interviews are usually held on the 2nd Thursday of August. We hold weekly Renal educational meetings, registrar education meetings, Medical Grand Rounds, Renal Journal clubs and biostatistics and epidemiology training courses. Renal biopsy meetings are held fortnightly. We expect advanced nephrology trainees to complete at least 1 research project (and preferably more) per year. Trainees rotate through 2 month terms of Renal Transplant Inpatients, Renal Transplant Outpatients, General Dialysis Ward, Peritoneal Dialysis, Haemodialysis, General Nephrology Ward and a Satellite Dialysis Unit (Logan, Ipswich or Redlands). The Ipswich rotation is linked with an attachment to the Hypertension Unit.
2. Australasian Kidney Trials Network Fellowship: AKT Network Scholarships, paid at NHMRC equivalent, are 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 University of Queensland, School of Medicine.
3. Centre of Clinical Research Excellence (CCRE) Trainee Fellowship: Our unit is part of the Cardiovascular/Metabolic CCRE and offers training scholarships looking at cardiovascular risk assessment, stratification and modification in chronic kidney disease (CKD). The fellowships are paid at NHRMC-equivalent and enrolment in a higher degree (M Phil or PhD) is expected.
4. Princess Alexandra Clinical Research Fellowship: The Princess Alexandra Hospital provides 3 Clinical Research Fellowships each year for a 12-month period, to registrars who wish to undertake basic science or clinical research (preferably towards the attainment of a higher degree).
Professor David Johnson
Director of Nephrology
C0-Director of Centre of Kidney Research
Ph +61 7 3240 5080
Fax: +61 7 3240 5480
Email: david_johnson@health.qld.gov.au
Updated February 2010
The Department of Renal Medicine is part of the Royal Brisbane and Women’s Hospital, which is the largest public teaching hospital in Australia. The hospital and co-located institutes have excellent teaching and research facilities and opportunities. The Renal Medicine Department provides renal services to the north side of Brisbane with an approximate population of 0.8-1.2 million. Services are delivered in a range of settings including innovative models of chronic care in community centres at Nundah and Northwest, hospital based services at the Royal Brisbane and Women’s and The Prince Charles Hospitals and independent services within both a community centre and at Caboolture Hospital. The services will expand with more chronic care and satellite haemodialysis at North Lakes.
The Royal Brisbane and Women’s Hospital has committed to developing research in the department with the appointment of a half time senior staff specialist in research. The Department has seven full time staff specialists, 2 advanced trainees, 3 general registrars and 3 resident medical officers. The research infrastructure is available for advanced renal trainees who are expected to undertake and complete a research project.
Research Faculty:
Professor Robert Fassett has recently moved from Tasmania where many research projects from Renal Research Tasmania will be completed and expanded in Brisbane.
Professor Wendy Hoy who is an NHMRC research fellow, is based at the Medical School at the University of Queensland. Professor Hoy is an International leader in research with a focus on indigenous kidney disease.
The University of Queensland and the Queensland Government have recently built a new University of Queensland Centre for Clinical Research (UQCCR) on the Royal Brisbane and Women’s Hospital campus. There are opportunities for both laboratory and clinical research within this facility.
The Royal Brisbane and Women’s Hospital Foundation offers funding grants for research and post-doctoral studies at the RBWH.
A research fellowship position may be available for an appropriate applicant and PhD scholarships will be available for a range of disciplines including, medicine, nursing and exercise science through UQ postgraduate scholarships.
There are currently seven PhD students involved with renal research across disciplines and campuses.
Dr Helen Healy leads a research program in the biology of renal tubular cell behaviour in progressive kidney disease. The work is conducted in a wet bench laboratory in the Bancroft Institute, Queensland Institute of Medical Research.
Associate Professor Glenda Gobe heads a research program in the mechanisms of kidney injury. The work is wet bench and located in the University of Queensland Centre for Clinical Research (UQCCR). The program includes collaborations between Dr Jonathan Peake in Associate Professor Glenda Gobe’s laboratory, Associate Professor Jeff Coombes and Professor Robert Fassett.
Associate Professor Jeff Coombes leads an oxidative stress and inflammation research group based at the School of Human Movement Studies at the University of Queensland. Associate Professor Coombes has recently acquired a mass spectrometer that extends the group’s capability to assessing oxidative stress by measuring plasma F2 isoprostanes.
Associate Professor Dominic Geraghty’s group at the School of Human Life Science, University of Tasmania are investigating immune cells in the sick environment in a study funded by the Clifford Craig Medical Research Trust.
Dr Cecilia Shing, University of Tasmania, is extending her collaborations with Renal Research to Brisbane renal researchers in several projects.
Basic Science Projects
A study is underway assessing the effects of antioxidants and exercise on vascular function and measures of oxidative stress and inflammation in the Apo E -/- knock out mice after 5/6 nephrectomy.
The Four immuno-study is assessing the effects of anti-rejection medication on vascular function in a rat model.
Antioxidant genotyping of superoxide dismutase, glutathione peroxidase and catalase is being studied in patients with CKD along with antioxidant enzyme activity over a twelve-month period.
Investigating the effects of exercise on the RhoA gene in endothelial cells in a renal cardiovascular model (ApoE knockout mouse with 5/6 nephrectomy)
Developing an assay to simultaneously measure markers of oxidative stress and antioxidant status in biological samples
A study is starting in 2009 assessing premature cell aging and its role in CKD and associated cardiovascular disease.
A study is underway assessing the influence of nutritional supplements on the secretion of inflammatory markers by peripheral blood mononuclear cells in patients with CKD.
Transient receptor potential vanilloid (TRPV) 1 and TRPV2 are being assessed in a study in hemodialysis patients.
Gene expression profiles of proximal epithelial cells in human chronic kidney disease
The role of human proximal epithelial cells as immune response cells
Acute Kidney Injury
A study of vascular function in patients with acute kidney injury is underway assessing arterial stiffness in patients with acute kidney injury. This will be conducted in collaboration with Dr Vince D’Intini and Dr John Gowardman from the Intensive Care Unit at the RBWH.
Dr Vincent D’Intini will be developing collaborations with Professor Jeff Lipman studying pharmacokinetics and pharmacodynamics of drugs in ICU patients with acute kidney injury on hemofiltration.
Chronic Kidney Disease
The LORD (Lipid Lowering and Onset of Renal Disease) Trial has just been completed in Northern Tasmania with additional data analysis to be conducted over the next year.
Antioxidant Genotyping of superoxide dismutase, glutathione peroxidase and catalase is being studied in patients with CKD along with antioxidant enzyme activity over twelve months.
Palliative care is being studied in CKD patients in an NHMRC funded project, in which Professor Fassett is a Co-Chief investigator with Associate Professor Ros Bull in Northern Tasmania.
A study has been completed assessing the prevalence of renal artery stenosis in Northern Tasmania.
Peritoneal Dialysis
COMIVID this study is assessing measures of oxidative stress and inflammation along with vascular function in incident dialysis patients with the aim of comparing patients selecting peritoneal dialysis with those selecting hemodialysis.
The time of starting PD catheter use is being studied in a Trial led by Dr Dwaraka Ranganathan called the Timely PD study: A randomised controlled trial to determine the delay before dialysing through a PD catheter (1, 2 or 4 weeks) after its insertion
He is also studying the pharmacokinetics of intraperitoneal gentamicin in peritoneal dialysis patients with peritonitis in collaboration with Burns and Critical Care Research unit at the University of Queensland. A study of daily exit site mupiracin use in peritoneal dialysis is also underway.
Hemodialysis
COMIVID this study is assessing measures of oxidative stress and inflammation along with vascular function in incident dialysis patients with the aim of comparing patients selecting peritoneal dialysis with those selecting hemodialysis.
The ARTIST study is assessing arterial stiffness in incident hemodialysis patients in conjunction with Dr James Sharman at the School of Medicine at the University of Queensland at the Princess Alexandra Hospital.
The PEDAL study has recently been completed assessing exercise interventions in hemodialysis patients.
Mr Stuart Walker is leading the U-clip study and this is assessing U-clips compared with traditional suturing in arteriovenous fistula creation.
Differing vascular access catheter removal techniques are being assessed in a study being led by Dr Dwaraka Ranganathan.
Kidney Transplantation
The Xanthin study is randomised double blind placebo controlled trial assessing the effects of astaxanthin on measures of oxidative stress, inflammation and vascular function in kidney transplant patients.
Laparoscopic adjustable banding is being reviewed in obese kidney transplant patients and obese living donors for transplantation.
A report of congenital malformations associated with the administration of mycophenolate mofetil is being submitted for publication.
Proposed studies.
Epidemiology
The Centre for Chronic Disease at the University of Queensland studies chronic disease and its risk factors in high-risk populations.
Current initiatives include
1. A longitudinal (10-14 yr) study of the natural history of chronic disease in the Tiwi community in the NorthernTerritory.
2. Predictors of cardiovascular disease.
3. Studies of the influence of birthweight on chronic disease susceptibility
4. A genome scan of the Tiwi community and correlations with chronic disease profiles.
5. A randomised controlled trial of medical prevention of hypertension, albuminuria and renal disease in one remote Aboriginal community.
6. Programs to help improve chronic disease awareness in two remote Central Australian Aboriginal communities.
7. Participation in practice improvement projects in chronic disease in Queensland.
8. Collaboration with the Centre for Clinical Research Excellence in circulatory disease with a coalition of Aboriginal Medical Services in Queensland
9. Studies on patterns and trends of chronic disease deaths in Aboriginal people nationwide.
10. Proposed linkage studies to define patterns and trends of hospitalizations for chronic disease in Indigenous people in Queensland.
11. A study of the uptake and utilization of chronic disease medications in Queensland.
12. A review of Indigenous renal biopsies nationwide in Australia.
13. A multinational study of kidney ultrastructure in coronial (forensic) autopsies.
Australasian Kidney Trial Network (AKTN)
Professor Fassett is a member of the Trial Management Committee for the HERO study. The Renal department at the RBWH will be participating in this study.
Pharmaceutical Company Trials
The Department of Renal Medicine is participating in the following National and International Clinical Trials And Observational Studies
General Studies
Contacts:
Professor Robert Fassett
Director of Renal Research
Renal Medicine
Royal Brisbane and Women’s Hospital
Brisbane, Queensland, 4029
+61419399571
rfassett@mac.com
Dr Helen Healy
Director of Renal Medicine
Royal Brisbane and Women’s Hospital
Brisbane, Queensland, 4029
Helen_Healy@health.qld.gov.au
Dr Jeff Coombes
Associate Professor in Exercise Science
The University of Queensland
Brisbane,
Queensland, 4032
jcoombes@uq.edu.au
Updated December 2008
